Preparing to launch personalized medicine

Air Force longitudinal study aims to prepare healthcare providers for a world rife with personal genomic information

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TRAVIS AIR FORCE BASE, Calif.—TheUnited States Air Force has brought aboard the Coriell Institute forMedical Research to enroll 2,000 active-duty healthcare providers aspart of a broad-based program designed to prepare for and enable theuse of personal genomic information in clinical practice.
The partnership with the CoriellInstitute is part of the Air Force's PC2-Z longitudinal study,which aims to advance and eventually implement genome-informedpersonalized medicine.

Better technology and less expensivescreening methods provide the impetus for the Air Force MedicalService (AFMS), as well as other medical providers, to begin tounderstand the ramifications of personalized genomic informationbecoming readily available.

"Having your own personal genomeanalyzed is becoming cheaper than an MRI—we're approaching a costof around $1,000 to interpret a person's genome," says MichaelChristman, president and CEO of the Coriell Institute. "Soon itwill be $100. As the technology becomes cheaper than many medicalprocedures commonly employed today, we'll begin to see a flood ofthem in clinical practice."

The Coriell Institute is a nonprofitorganization based in Camden, N.J., dedicated to the pursuit ofgenome-informed medicine. Its Coriell Personalized MedicineCollaborative (CPMC) is a research study that employs anevidence-based approach to determine the efficacy of using personalgenome information in health management and clinical decision-making.

The Air Force's PC2-Z study willexamine the real-world implications of using personal geneticinformation in clinical decisions. Participating Air Force MedicalService personnel will screen patients for genetic markers of riskfactors for diseases such as obesity, cancer and other complexillnesses. This information will be shared and discussed withpatients in an effort to determine whether lifestyle modification orbehavior changes—such as eating healthier foods, maintaining lowerbody weight or increasing physical activity—correlate withreceiving news of increased risks.

The study's participants must alsograpple with the myriad social, ethical, legal and scientific issuesrelated to personalized genetic screening. The widespreadavailability of personalized genomic information is likely to becomplicated by misperceptions and perceived risks of receivingpersonal genetics. In a past study that Coriell conducted inconjunction with the University of Pennsylvania, patients fearedlearning something they didn't want to know, such as predispositionfor Alzheimer's disease or other incurable illnesses. To combatthis, researchers put results up securely online and allowed patientsto then choose to look at some or all of the results. Somepatients—roughly 11 percent in Coriell's previous study—believedthat identified risk factors could be "cured" using gene therapy,which is not the case. Medical providers must be prepared toencounter these kinds of challenges and others.

"We're teaching the teachers whocan make decisions that affect the more than 2 million people coveredby the Air Force Medical Service," says Christman.

"Application of personal genetic datais finally coming out of the realm of textbooks and PowerPoints andinto reality," says Maj. Carlos Maldonado. "This study is notjust about having it, but making sense of it in an intelligent,factual way."

"The study also provides anexperiential learning opportunity for our medical personnel so thatthey have first-hand experience with genetic research," says Lt.Col. Cecili Sessions, chief of AFMS Personalized Medicine.

Having launched in 2007, the CPMC hadalready enrolled 6,000 people in its own personal genetic informationstudy by the time the Air Force called for applicants for apartnership to help it execute the PC2-Z study. The Coriell institutehad become a leader in the field of personalized medicine, and itapplied to the PC2-Z partnership because its team recognized that theorganization's interests aligned closely with those of the AirForce on this project. The Air Force selected Coriell from among theapplicants because of its impeccable reputation and long history ofhelping to provide scientific advances in the field, alongside atrack record of maintaining strict confidentiality of personal data,according to Sessions.

"When we looked to academia andindustry for advances in the evidence base directing personalizedcare, we recognized Coriell as possessing the expertise,infrastructure and leadership to execute the clinical arm of thePC2-Z study," said Surgeon General of the Air Force Lt. Gen.Charles B. Green in a September press release announcing thecollaboration.

The CPMC was named one of the top 10research projects to watch by MIT Technology Review in 2010.

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