It is a rare opportunity for an aspiring young physician to meet someone who has altered the course of medical history. Recently, 20 Duke undergraduates in Dr. Madan Kwatra’s course Pharmacogenomics had the opportunity to do just that. Kwatra, an associate professor of pharmacology and cancer biology, directs the Glioblastoma Drug Discovery Group at Duke.
In his course, he introduces students, many of whom intend to apply to medical school, to the emerging field of pharmacogenomics through case studies from his research on targeted therapies and guest presentations offered by esteemed physicians and researchers in the field.
An Introduction to Medical History
In his recent lecture, Dr. Ralph Snyderman, director of the Duke Center for Personalized Medicine, provided the students with crucial insight about how the study of pharmacogenomics, or how a person’s specific genome affects their response to drugs, is being leveraged to change the future of healthcare through the application of personalized medicine. He started by contextualizing recent discoveries within a brief overview of medical history, beginning with the prevailing pre-1900s “humoral hypothesis.” He commented on the early work of Ignaz Semmelweis who observed an outbreak of “childbirth fever” at his maternity clinic in Austria and noticed a higher rate of mortality among women who delivered in the hospital as compared to those who delivered at home. Microbiologists would later confirm that the disease was associated with microbial agents spread by the hands of physicians who had autopsied patients with the condition. Later, Koch offered key criteria for determining the causative agent of a disease and the field of germ theory, along with chemistry, physiology, pathology and physics, flourished, allowing for the identification of novel therapeutic approaches to many communicable conditions.
Dr. Snyderman described this as the first major transformation in healthcare – a scientific revolution that paved the way for the practice of modern evidence-based medicine. Snyderman commented that most physicians are trained in what he calls a reductionist approach to care, in which the role of the provider is to identify the underlying cause of an existing disease and to fix it.
“Predict it, Personalize it, Understand it”
However, Dr. Snyderman believes that we are in the early stages of the second great transformation in healthcare. Rather than reacting to the presence of disease, using new pharmacogenomic technologies, health care professionals are, as he said, aiming to: “predict [health], personalize it, and understand it.” Physicians working within the fields of pharmacogenomics and personalized medicine conceptualize disease as a dynamic process that could be detected and treated at any time point during its course of development.
Genomics, the study of the genome through next generation DNA sequencing techniques, as well as multi-omics, the study of the transcriptome, epigenome, and microbiome, give physicians important clues about an individual’s disease risk as compared to a pre- determined baseline risk. Dr. Snyderman imagines a future where individuals are empowered to make decisions about their heath alongside their provider using a variety of personal data sources. The students who eagerly listened to his lecture imagined the possibility of their own roles within this rapidly evolving field.
Ralph Snyderman is Chancellor Emeritus at Duke University, James B. Duke Professor of Medicine, and director of the Duke Center for Personalized Health Care. He served as Chancellor for Health Affairs and Dean of the School of Medicine from 1989 to July 2004.