Progress, Possibilities of Personalized Medicine

Vol. 18 • Issue 3 • Page 56

Conversations among some industry insiders have been taking place over the past couple of years about the possibility of a blending of clinical molecular diagnostics and molecular imaging departments, creating a so-called “department of diagnostics.” While any major impact resulting from widespread implementation of this concept is still some way off, the possibilities it presents are intriguing and the implications for patient care are powerful. The Molecular Summit, part of The Dark Intelligence Group Inc., took place for the second consecutive year in February as a forum for experts in pathology, radiology and information technology (IT) to discuss ideas and how this possible molecular integration may take shape.

The combining of in vivo and in vitro diagnostics could be an integral step forward in finally allowing healthcare to realize the benefits long promised by the popularly sought concept of personalized medicine, some experts conclude.

Natural Evolution

Exploring some of the ideas behind the thought process of the integration of pathology and radiology reveals at its root many important trends. This meeting covered not just the convergence of molecular diagnostics, imaging and IT, but also the elimination of “one size fits all” therapeutics, silos of knowledge and fragmented healthcare and the adoption of personalized medicine. It included preventative medicine, the promotion of wellness, consumer-directed healthcare and the evolution of pathologic diagnoses from qualitative to quantitative. The integration of pathology and radiology is one paradigm through which to view the natural evolutions and trends that seem to be driving healthcare today-the push to improve overall efficiency and patient care.

On one hand, we are still a long way from true personalized medicine, in its complete form. A plethora of definitions of personalized medicine are used, and while examples can be found, we are only in the opening era today in our use of what George Poste, DVM, PhD, chief scientist and director at The Biodesign Institute of Arizon State University, called “stratified care” in his talk, “On the Road to Personalized Medicine: Likely Adoption Paths for Molecular Imaging.” Stratified care refers to the ability to target some therapies for a handful of diseases toward a certain population of patients.

On the other hand, says Tom Miller, CEO, Workflow and Solutions Division, Siemens Healthcare, “Personalized medicine is not in the future-it is today. What woman with breast cancer does not know if she’s Her2 positive or negative?”

“Many pathologists do not understand how much of what we do every day has already changed,” adds Richard Friedberg, MD, PhD, chairman of the Department of Pathology at Baystate Health, Springfield, MA, who presented on the changes genetic knowledge is bringing to molecular diagnostics and surgical pathology. For years, pathology was chiefly qualitative, but a great deal of the valuable information now is quantitative. IT remains important as it is critical to develop the ability to integrate disparate bits of information and best practices for data mining. Data, he says, becomes information, and information becomes knowledge.

Case Study

Pathology and radiology teams already are collaborating closely in some situations, such as in breast cancer diagnoses. Mark L. Redick, MD, PhD, assistant professor of Radiology, and Ossama Tawfik, MD, PhD, director of Anatomic and Surgical Pathology, both at the University of Kansas Medical Center, reveal how they have implemented videoconferencing to ensure both specialties are best utilized to come up with the most accurate diagnosis.

Previously, there had been discordance between the histologic diagnosis and imaging findings, the doctors explained. And with their departments being at locations on opposite sides of the city, they faced communication challenges when there were discrepancies in their respective findings. They needed simultaneous access to images in a high-resolution, interactive format. Now, videoconferencing allows them to easily communicate face to face and discuss and examine images together to provide physicians with precise information.

One can easily see the link between this convergence of molecular imaging and diagnostics and IT, and the forces driving healthcare often discussed in ADVANCE-improving the quality of care, streamlining workflow efficiencies, preventative and personalized care, and improved connectivity and communication.

Toward Better Healthcare

Some experts insist that this molecular integration will happen; what remains to be seen is exactly how-and when-it will occur on a wide scale. Many components must come together-true integration will require a parallel evolution of business, financial and organizational models, says Dr. Poste. “It’s not merely innovation in technology, as fascinating as the science is,” he points out. This evolution, he claims, will be slower than many people might think, but is quick to add that it is valuable to be prepared by assessing potential scenarios and remaining familiar with advancing technologies.

Kelly J. Graham is assistant editor.