When the Doctor Becomes the Patient

Church: We’ve been using sequencing to help us discover some of the blockbuster new drugs, protein drugs, antibiotic drugs and so forth.  But it’s transitioning to a time where it becomes an important component of personalization and preventative medicine. 

I’m George Church, Professor of Genetics at Harvard Medical School.

Question: How will DNA sequencing change healthcare?

Church: The test, it’s kind of like insurance against floods or fires or something, you don’t say, 'I don’t need any insurance,' you just buy it and you hope you never need it.

Question: Why are electronic medical records important?

Church:    Electronic medical records are incredibly important. We have a very mobile population and so they need to be able to easily get all new physicians in their life up to speed, that’s one utility.  They might actually help with research in the sense that if people, the small set of the population that wants to participate in that, they can easily share their electronic medical records, that could help inform research of all types, noninvasive as well as drug-related.  Electronic medical records could reduce errors in principal, you have to have great software and you have to have good training but if it’s coupled with devices and good practices, it can allow a very strong accountability and strong quality assurance procedures. 

Question: How have electronic medical records helped you personally?

Church:   Around 1999, very early on, they gave me full access to my medical records and I put all my medical records up on the internet and interestingly a hematologist contacted me and noticed from my medical records that I was overdue for a cholesterol test, having picked up a cholesterol drug, Lovastatin.  And sure enough, I tested it out and it was having no effect; it was an inadequate dose and so that resulted in getting the right dose and the right diet and may have added many quality years of life in my case.

Question: How else is technology helping reinvent the healthcare industry?

Church:    A huge one is really bringing the knowledge to the individual via the internet.  It allows people to do social networking and so if they have a fairly specialized form of a disease, it could be a very common disease but if they have something that’s idiosyncratic, they’re no longer limited to their family, they can find other families that are similar to them.  So that’s a potential use of technology, it’s actually quite simple and quite accessible. 

Question: How can we improve access to healthcare?

Church:    Access is a huge problem, not just to insurance, the 45 million that aren’t covered well, it has to do with long waits, it has to do with the inconvenience of traveling, and you can see the beginnings of revolutions around the edges, you can see more home test kits, more information available on the internet, more reliable information, ways of determining what’s reliable or not and so patients are coming in, when they come in, much more well-informed.  Again, there are issues about false positives that you might get or false alarms by becoming, maybe, what people might think that’s too well-informed.  But I think as a whole, as a population becomes more well-informed, has greater access to self-testing, we might consider that better access and it will lead to possibly reduced hospital visits, possibly reduced clinic visits.

Question:    How can we improve integrative medicine?

Church:    So, to make the transition to patient care of highly integrative technologies requires, along with the technologies, requires a lot of computer software and it requires computer interfaces so that to some extent, people can be directly educated and to some extent physicians can be educated because for example, genetics is new to almost all physicians, even in very sophisticated countries and so a huge component is software that does the integration. It used to be that a family doctor could do all these integrations, they could keep everything that they needed to know except for various specialized operations in their head and they could deliver the advice directly there during a house call.  But now that the opportunity has been for years and is now becoming more realistic, is that far more information than a single individual or even a team could integrate requires prior development of software and constant vetting and updating of that software in collaboration with patient groups and physicians.

Question: What is the future of genomic medicine?

Church:    The generic human genome is complete but we need to have this information for each individual because it’s very clear that we don’t all share the same genome. What’s very important is the differences from person to person, both genomic and their environmental differences and the integration of those.  So some of the next big breakthroughs are going to have to do with how we obtain this information for each of the individuals at low cost and high quality and how they share it. 

Genomics pioneer George Church found that cutting-edge medical technology added years to his own life.

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