Apr 12, 2012
Effort to Credential Docs in Genomic Medicine Aims for 2012 Rollout Despite Some ‘Missing Links’
April 04, 2012
By Bernadette Toner
Eric Topol, chief academic officer with Scripps Health and director of the STSI, told PGx Reporter recently that the organizers of the program, called the College of Genomic Medicine, have developed a curriculum and identified instructors for the video segments. The curriculum would encompass three primary modules: genomic biology, disease susceptibility, and pharmacogenomics, he said.
The aim is to create a free online program that will not only educate physicians about the underlying principles of genomic medicine, but will also offer credentialing. The model for the program is the nonprofit Khan Academy, which provides free educational videos on a broad range of subjects.
However, there are two “missing links” that have posed some speed bumps for the initiative, Topol said. One is identifying an appropriate online platform that would have a broad reach across a range of physician communities. The other is funding.
The College of Genomic Medicine was founded in 2010 as the Association for Genomic Medicine with a $600,000 grant from Life Technologies (PGx Reporter 3/10/12). It pulled together an interdisciplinary board of genomic scientists and physicians and set out to establish a curriculum with the initial aim of launching by early 2011.
However, Topol said that the initial funding from Life Tech was “not enough to roll this thing out. To do the credentialing and authentication and all that sort of thing on the web, it does take some significant costs.”
He said that the group has been in discussions with healthcare philanthropies such as the Robert Wood Johnson Foundation but has not yet secured a sponsor. And while other stakeholders in the personalized medicine space — such as the American College of Medical Genetics and the pharmacy benefits manager Medco — have expressed an interest in partnering, these groups cannot provide the funding required to support the effort’s goals.
While Topol is confident that the funding issue will be resolved, the platform question may be a bigger challenge.
“There is no one entity that has the reach to all physicians,” he said. Physician-oriented websites are one option, but the largest one, Medscape, counts just over half the estimated 700,000 physicians in the US among its audience. The next-largest such site, Epocrates, has an audience of about 200,000, Topol said.
Even the American Medical Association, with a membership of around 200,000, does not reach all US physicians, he noted. “And we can’t really work with any particular professional society because each one of them only has a relatively small segment of physicians. So we’d have to aggregate things like the American College of Physicians and the American College of Surgeons and the American College of Cardiology, et cetera.”
Topol noted that the CGM organizers are well aware that “if we just put this up on YouTube, it’s not going to work. It’s not going to go viral … We need to have the ability to get to the physicians, and there isn’t any one entity on the web that does that. “
‘We Can’t Wait’
The medical community is generally slow to adopt new technologies Topol said, but he argued that doctors cannot take the same conservative approach to genomic medicine.
“The stethoscope took 20 years before it was accepted, which is amazing,” Topol said. “We can’t wait 20 years from this point to get genomic medicine accepted by the broad medical community. We can’t even wait 20 months.”
There are “patients who are not getting the optimal attention today, just because the knowledge base has not been transferred broadly,” he said.
In addition, more and more physicians are now encountering the “savvy consumer who has had a genome-wide scan, who is keeping up with a lot of things going on in cancer and genomically guided treatments ... [Doctors] are getting hit more with the questions but they don’t have the ability, for the most part, to respond.”
The extent of physician uncertainty with regard to genomic knowledge was highlighted in a study by Medco and the AMA published in January in Clinical Pharmacology & Therapeutics that surveyed more than 10,000 US physicians and found that only 10 percent felt “adequately informed” about pharmacogenomic testing.
The survey found that only 15 percent of physicians received any genomic education during their medical school training, though 23 percent reported some training during postgraduate medical training. Respondents reported that they obtained information on pharmacogenomic testing primarily from professional colleagues (42 percent of responses), drug labels (39 percent), and the Internet (34 percent).
“The knowledge gap faced by physicians is not primarily in the basic principles of pharmacogenomics; almost all the respondents understood and accepted that genetic variations affect drug response,” the authors wrote. “The gap is more pragmatic and clinical — what tests are available, how to procure them, when to use them, how to interpret the results, and how to apply them in an individual patient.”
They added that this knowledge gap “needs to be addressed through a variety of channels so that physicians can acquire the information they need to make effective use of pharmacogenomic testing.”
Apparently there is no lack of interest among physicians to learn about the subject. Topol and colleagues noted in a commentary published in January in the American Journal of Medicine that in a poll of physicians they conducted, 95 percent “are interested in accessing a genomic medicine curriculum over the Web that is available for free and without commercial influence.” Respondents said they’d be willing to commit an average of five hours to such a program.
Furthermore, Topol, who is editor-in-chief of the Genomic Medicine site on Medscape, said that the most comments he’s seen on the site have been in response to a post that asked whether readers would be interested in an educational video curriculum.
“I’ve never seen so many responses, and it was overwhelmingly, ‘Yes, when can we start?’ The enthusiasm was coming out of the screen. It was palpable.”
Topol said there’s “no question that if we can make these short, attractive, and really high-quality educational videos that we would have a receptive physician audience.”
In terms of specific physician communities who are most enthusiastic about the concept, Topol said he’s been “surprised” to see the degree of interest from the diabetes community.
“They are clamoring for this,” he said.
Diabetes offers a large opportunity for genomic medicine, he said, since there are 13 different drug classes for the disease, but none of them are currently genomically guided.
“It’s quite chaotic,” Topol said. “We know that for the most common drug, metformin, 25 percent of people don’t respond to it, but it’s the go-to drug for type 2 diabetes. No one checks to see whether the person responds, and they just add more drugs on top of it when it doesn’t seem to be working.”
Other disciplines that are already immersed in molecular therapies, such as oncology, can also use a bit of education, Topol said. In particular, he noted that the oncology community needs to move from fixing tissue in formalin to freezing it in order to optimize whole-genome and exome sequencing.
“We have to change that practice,” he said. “Even though oncologists are treating a genomic disease, we haven’t gotten them to recognize that sequencing has to be done on frozen tissue. It cannot be done suitably to any significant extent on [formalin-fixed, paraffin-embedded] specimens.”
In this case, “it’s not even about educating them about the molecular pathways. It’s practice.”
While Topol has seen substantial interest in a genomic medicine educational program from physicians, he acknowledged that such enthusiasm is not universal.
“There are naysayers,” he said. “There are plenty of people who hide under the guise that this is far off and we don’t need to worry about this right now and there’s nothing that’s been proven to change the outcomes of patients – that kind of story line.”
However, he said, “I think every week it’s getting more overwhelming that that kind of thinking is not going to hold.”
A pdf of the article may be downloaded here.