What once was called “personalized medicine” at Penn used to be practiced primarily by individuals or small groups of researchers and clinicians drawn to its possibilities. But as the cover story in the Summer 2016 issue of Penn Medicine demonstrates, the ability to harness vast amounts of information and apply it to the care of the patients has changed the field dramatically. Today, the presence of what is now almost universally called “precision medicine” is much more apparent at Penn Medicine. The institution has made a major commitment, following through on what the faculty clamored for during a strategic planning process begun a few years ago.
The results are clear: in the new issue, “One Size Does Not Fit All” focuses on the Penn Center for Precision Medicine, the Center for Personalized Diagnostics, and the Center for Precision Surgery, all of them recently estabished. One of the goals of the Center for Precision Medicine is to foster connections and collaborations. As David B. Roth, MD PhD, the center’s director puts it, “All the ingredients are at hand, but the scientists and clinicians are too busy doing their day jobs to really be able to make this happen.” The center, he adds, will “add a little bit of extra power” to help realize the potential advances.
Also part of the story is what has been described as the engine behind Penn’s precision medicine efforts -- the Institute for Biomedical Informatics. It, too, was established after the recent strategic planning. According to the institute’s director, Jason H. Moore, PhD, “Every aspect of precision medicine benefits from informatics, from the clinical informatics side, the clinical databases, the patient resources that we can tap into to identify patients at high risk, and computational methodologies to extract the data, work with the data, and find the patterns.” Precision medicine requires mountains of information -- as well as expensive equipment that can process that information swiftly and effectively.
Cost has been a major factor in the development of precision medicine. In 2001, the National Human Genome Research Institute estimated the cost to sequence a single human genome was $95 million. By January 2011, the estimated cost had dropped to $21,000. For early 2015, the institute estimated the cost to generate a high-quality “draft” whole human genome sequence was just above $4,000; remarkably, by later the same year, the estimate was generally below $1,000. Precision medicine is becoming much more widely available.
From the genome to something much less corporeal: spirituality. The next article, “Learning from Chaplains,” relates the experiences of first-year medical students at Penn who shadow chaplains in the trauma department. The students witness the impact of spirituality on patients in crisis situations and learn how important listening and establishing a rapport with them can be.
And from spirituality to . . . poetry? Perhaps not so giant a step, at least in the eyes of Jack Coulehan, MD, who did his internship in internal medicine at HUP. Now one of the most prominent advocates of medical humanities and a published poet, Coulehan believes poetry can offer glimpses of the deeper meanings of a physician’s work. He has also written about a quality he believes is sometimes lacking in doctors today: humility.
Rob Press is a staff member of Penn Medicine’s Communications department. In addition to serving as the digital communications editor and managing our department’s online presence, he writes regularly for our News Blog. When Rob brought his keen eye and sense of humor to describe his experiences as an orthopaedic patient within our own health system, I found it hard to resist. As a bonus, he illustrated the article as well.
“When Majors Act Like Minors” takes a look at the Family Formicidae -- or, to be less formal about it, ants. Shelley Berger, PhD, the Daniel S. Och University Professor, has an appointment in the department of Cell and Developmental Biology. Even before joining Penn, Berger became interested in ants as social creatures and realized they would be an ideal group for studying epigenetics. In the case of ants, each colony comprises thousands of individual sisters with nearly identical makeup, yet they are also clearly divided into different castes with distinct physical traits and behaviors. What make the differences are the molecular “tags” that turn the genes on or off. Earlier this year, Berger was senior author in a paper published in Science about carpenter ants in Florida. The research team reported that very young brawny “major” ants in Florida could be made to behave like the brainy “minors” and go foraging and scouting for food. According to Berger, ants provide an opportunity “to explore and understand the epigenetic processes that come into play to establish behavioral patterns at a young age.”
The shortest feature in the Summer 2016 issue is also the one that looks back the farthest. “Maintaining a Masterpiece” takes a look at one of Pennsylvania Hospital’s most prominent reminders of its distinguished history. Benjamin West, born in nearby Springfield, Pa., had become a widely respected painter in England when he planned to donate and ship one of his paintings to the hospital back in Philadelphia. As it turned out, English royalty took a liking to it and bought it, and West then decided to paint another version of Christ Healing the Sick in the Temple for Pennsylvania Hospital. It arrived in Philadelphia in 1817 and became an immediate attraction and fund-raiser. Today, we learn, the painting is again in need of some conservation efforts -- after 199 years on display.