[tt] Predicting health/illness from biomarkers project at Emory

[Hughes, James J.]

http://www.ajc.com/metro/content/metro/stories/2007/09/13/predictive_091
4.html

How will you die? Your body may know, Emory doctors say

By Ken Foskett
The Atlanta Journal-Constitution

Published on: 09/14/07

Can our bodies, healthy and disease-free, tell us how we will die? Emory
doctors believe they can.

The university has launched a $50 million research initiative in
"predictive" medicine that it hopes will fundamentally change the
nation's struggling health care system.

At a Midtown clinic, Emory researchers plan to screen healthy patients
for biological and genetic clues to future illness.

Researchers believe so-called biomarkers can foreshadow diseases years
before they occur, pointing patients to drugs and lifestyle changes that
could help them stay healthy. And, by studying fit patients, rather than
sick ones, researchers think they can learn more about the internal
mechanisms that ward off disease.

"We don't do much health care," says Dr. Kenneth L. Brigham, who is
leading the initiative. "We do disease care. The research is focused on
what went wrong, not what went right."

Emory doctors believe the strategy can cut health care spending
dramatically, allowing patients to be treated long before they need
costly, crisis intervention.

But the approach also presents new ethical dilemmas, from what
information doctors should disclose to patients, to how medical data
could be used against them.

How, for example, will the information be kept from insurers and
employers? Will greater risk of disease mean less insurance coverage or
fewer job opportunities?

"It's not only about health and health insurance," says Eric Meslin,
director of the Center for Bioethics at Indiana University, who is
studying the ethical questions. "It's about life insurance. It's about
employment. ... It's pick anything where society is making judgments
about who is fit to ... get entitlements."

'A huge relief'

Think of Chesley Lewis as a personal assistant for health care. The
25-year-old Carrollton native is a "health partner" at the Center for
Health Discovery and Well Being, Emory's new predictive health clinic at
Crawford Long Hospital.

Greeting visitors to the 18th floor, Lewis guides them through a battery
of tests and helps them formulate their own "personal health plan,"
which might include losing weight or changing diets.

With muted greens and grays, the clinic resembles a day spa more than a
doctor's office. Those who come to the clinic, open only to Emory's
13,000 employees, are healthy, not sick.

Participants provide researchers hundreds of bits of information, from
diet and religion, to when they sleep or if they are depressed.

Blood samples are broken down for 50 distinct substances. Scanners
calculate body fat and bone density. More sophisticated equipment
measures the thickness of blood vessels.

The data is encrypted, stripped of personal identifying information and
fed into a sophisticated processing warehouse managed by Georgia Tech, a
partner in the project.

Lewis had her bone density measured because an earlier test at another
clinic revealed she was showing signs of osteoporosis.

The newer test showed her bone density was good. "It was a huge relief,"
she said.

Curing what ails you

For years, doctors have had rudimentary methods of determining disease
risk, beginning with a patient's waistline. Simple blood tests for
cholesterol, combined with blood pressure readings and body weight, can
show a person's risk for heart disease and heart attack.

But advances in genetics and biology have suddenly allowed doctors to
look inside the human body with a degree of precision never imagined.
Tests can pinpoint mutated genes, or even those that are missing.

Biologists now understand how genes regulate the body's chemistry. And
they can also spot when the body's chemistry begins to break down.

Researchers studying rheumatoid arthritis, a painful joint disease, have
learned that many sufferers begin producing a distinct antibody years
before they ever get sick.

Diabetics can begin developing diabetes 10 years before it strikes, at
which point their kidneys are already damaged and they need costly
drugs.

Dr. Lawrence Phillips, who will mine patient data at the center, is
developing a new test that can recognize pre-diabetics in an hour. Those
testing positive could arrest the disease through diet changes and
exercise.

"If you find pre-diabetes, you can stay healthy," says Phillips, who
estimates 30 million to 50 million Americans are already in this phase
of the disease but don't know it.

Dr. Roberd Bostick, a cancer epidemiologist at Emory, has isolated
chemical biomarkers for colon and prostate cancer and is studying how
common vitamins might delay or even prevent tumors from growing.

Dr. Kimberly Rask, an internist in public health, will be sifting
through the data for clues about how lifestyle and economic well-being
influence health.

"What is it that improves your likelihood of staying healthy?" she asks.
"How do those pieces fit together to tell you how long you will live?"

Questions arise

Brigham, tapped by Emory to lead the predictive health initiative,
already talks about the U.S. health care system in the past tense.
Geared toward curing the sickest, the system has become too costly,
covers fewer and fewer people and, by some yardsticks, is failing
patients, he says.

Brigham notes that obesity rates have skyrocketed in the United States,
leading to more disease.

Detecting diseases before they do harm could dramatically cut health
care costs, while alleviating pain and suffering for millions of
Americans, he argues.

But predicting health also opens new challenges. The $5,000 to $7,000
per person cost of testing, covered by research funding for Emory
participants, still isn't economical for most. Brigham thinks costs will
drop as researchers cut tests that aren't meaningful.

Trickier, perhaps, are the ethical dilemmas.

Will insurance companies turn to genetic testing for determining a
person's insurability?

"That's a huge risk," says Brigham. "I believe society is going to have
to come to a consensus agreement that you can't hold a person's biology
against them."

Meslin, the ethicist, believes Americans will reject obvious genetic
discrimination. But he notes the gray areas.

What if a person has a risk for seizures? he asks. Should that person
fly a 747 jet?

There are implications for the doctor-patient relationship as well. What
obligation does the doctor have to tell a patient he or she has a risk
for an incurable disease? What if the doctor isn't sure about the degree
of risk?

Will the patient even want to know? Meslin asks.

"The better we get at predictive health," he says, "the more profound
these ethical dilemmas will be."
 
 
 
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