FORGING NEW TERRITORY IN GENETICS BASED HEALTHCARE
Since the completion of the Human Genome Project in 2003, geneticists around the world have envisioned advances in biotechnology as well as new medical applications as a result of the identification of 20,000 plus genes that make up human DNA.
Here at the Cleveland Clinic, Dr. Elias Traboulsi, Director of Graduate Medical Education and board-certified medical geneticist, has his own vision. “Genetics is where medicine is heading,” says Dr. Traboulsi, who sees the Cleveland Clinic at the forefront of genetics based healthcare.
EDUCATION IS KEY
The first step towards that goal involves educating physicians, nurses, allied health personnel and patients as to the role genetics play in disease. Traboulsi and the Clinic’s own Genomic Medicine Institute have partnered with the non-profit organization, National Coalition for Health Professional Education in Genetics, to launch a Cleveland Clinic wide genetics educational campaign.
The three hour symposium, open to everyone at the Clinic, is scheduled from 7:30 a.m. to 11:00 am on August 1, in the Bunts auditorium. Cleveland Clinic CEO, Dr.Toby Cosgrove and President of the American Society of Human Genetics, Dr. Aravinda Chakravarti will be joined by Director of the Genomic Medicine Institute, Dr. Charis Eng, pediatric ophthalmologist, Dr. Elias Traboulsi, and certified genetic counselor, Cheryl Scacheri, along with seven other physicians, to discuss the Clinic’s plans for expanding professional and public knowledge of the role genetics play in health and the onset, as well as possible treatments, of disease. The program will also cover recent advances within the Clinic’s Genomic Medicine Institute.
THE GENOMIC MEDICINE INSTITUTE
Developed in 2005, the Genomic Medicine Institute (GMI) was designed as a hybrid institute to encompass patient care, research and education, says Dr. Eng. “Research labs, physicians, genetic counselors and the clinic are in close proximity to one another, allowing for bench to bedside patient care.”
Building on the strength of the Cleveland Clinic, the GMI has helped advance patient care. As a cancer geneticist, Dr. Eng refers to herself as a physician scientist, as the research work she does in the lab transfers to her patient care settings. For example, advances in genetic and genomic medicine have lead to gene tests that can identify altered genes linked to the development of breast cancer. With seven genes that can predispose a patient to breast cancer, Dr. Eng warns that it’s important to screen a patient for the right disease, as those same genes are also indicators of other possible forms of cancer, like ovary or colon.
“We can make a difference in the life of patients by catching diseases [or the potential for disease] early on,” says Dr. Eng. A woman with a gene mutation for breast cancer runs the risk of passing that gene on to her daughters and granddaughters. Identifying those segments of the population that could benefit from early detection could slow the onset of disease, if not prevent development of cancer in the first place.
PERSONALIZED GENETIC HEALTHCARE
Located in the Center for Genomics Research Building, the Center for Personalized Genetic Healthcare (CPGH) is the clinical branch of the GMI. Staffed by genetic counselors, their focus is to help patients determine risk of developing familial diseases. Cheryl Scacheri, Director of Genomics Education and Policy, hopes raising awareness about genetics will make people more proactive in averting family related diseases.
Previously, the CPGH focused on rare diseases like downs syndrome. With advances in genetic research, it’s now possible to draw genetic profiles of individuals prone to conditions ranging from high cholesterol to cardiovascular disease, says Scacheri. Genetic profiling can also determine what age treatment should begin for certain diseases, as well as what types of medication a patient’s condition might best respond to based on their genetic make-up.
“The Center for Personalized Genetic Healthcare has elevated how medicine is practiced at the Cleveland Clinic,” says Scacheri. The GMI and the CPGH offer physicians a unique setting where they can interact with genetic researchers as well as have access to the services genetic counselors provide.
As a genetics counselor who specializes in ophthalmology, Scacheri also works alongside Dr. Traboulsi in treating retinal diseases. Scacheri believes adding the genetic component to patient care is key when treating inherited conditions like retinal diseases, blindness and diabetes, which can lead to blindness. Controlling environmental components, like diet and exercise in the case of diabetes, can also help manage disease.
Understanding a patient’s genetic background can make the difference between managing health and managing disease. Verbal family histories can only reveal so much and are frequently incomplete, particularly among individuals that were adopted or conceived through donor banks. The more we know about a patient’s genetic heritage, the more options we’ll have for maintaining good health, says Scacheri. Working with those she calls “genetic champions ” within five of the Clinic’s institutes, Scacheri, along with Dr. Eng and Dr. Traboulsi, are designing a system to make genetic based healthcare the new medical industry standard.
FOCUS GROUPS AND TEAM WORK
Having selected five institutes – Taussig Cancer, Cardiovascular, Cole Eye, Neurological and Glickman Urological – Eng and Scacheri plan to conduct focus groups to determine the needs of each institute. Working as a team with each institute we can help determine which diseases are most relevant to them and how genetic information can in turn help their patients, says Scacheri.
With the help of the Consumer Health Info Center, they plan to tailor their genetics education program by creating patient literature specific to each institute. This literature will eventually be available on the Cleveland Clinic web site. Articles co-authored by a health care provider from each of the institutes, for publication in the Cleveland Clinic Journal of Medicine, are also planned.
In addition to creating materials highlighting the resources at the Clinic for providers and patients alike, Eng and Scacheri hope to spread the word about external resources, including web sites funded by the government, the NIH and John Hopkins. “Not many health care providers are aware of these sites and they’re fabulous sources of genetic information,” says Scacheri.
PROTECTING PATIENT’S RIGHTS
The Clinic’s genetic education campaign follows in the wake of the latest piece of health care legislation signed into law by President Bush. The Genetic Information Nondiscrimination Act (GINA) prohibits use of an individual’s genetic information by employers in hiring, firing and promotional practices. GINA also prohibits health insurers from requiring individuals to take a genetic test before granting them medical insurance.
Eng and Scacheri agree that legislation is necessary for breaking down the barrier of possible future genetic discrimination. In the long run, knowledge of predisposition to a certain disease could actually save health insurers money. On the average, we are each genetically prone to six possible medical conditions, says Eng. She believes in some cases it’s possible to use that genetic knowledge as preventative medicine, by managing a patient’s health risks early on, thus avoiding costly medical treatments later in life.
MOVING WITH THE TIMES
As the Cleveland Clinic expands its reputation as a leader in genetics based healthcare, the fundamental tools of genetics are changing daily. Through research and education, the Genomic Medicine Institute’s staff continues to make medicine more cutting edge. “Genetics is the basis of wellness and wellness is the way to go,” says Dr. Eng. “We need to keep healthy people healthy – it’s what the American health care system needs.”