Message from the Director
Genome Sciences & Personalized Medicine
Huntington F. Willard, PhD
Call it what you will. Genomics. Genome Sciences. Integrative Biology. The future. Whatever you call it, it's getting crowded and the pace is quickening. In a recent issue of Genome Technology, no fewer than seven US academic centers—including Duke—were cited for making major commitments to what the cover called Systems Biology. In September, Harvard Medical School joined the fray by creating its first new department in more than twenty years, the Department of—you guessed it—Systems Biology. Clearly, this phrase is as au courant as it gets, because as near as I can tell, no one quite knows exactly what it means. It may be that Systems Biology is something that, to paraphrase Justice Potter Stewart, we know when we see it.
"The key will be to design carefully controlled clinical trials in an environment where the interests of all stakeholders — patients, physicians, scientists and ethicists — are satisfied."I bring this up because a little bit of paranoia about competition can be a healthy thing. It is important for us to be aware that we are not the only ones staking out territory—even still somewhat vaguely-outlined territory—in a reconfigured world, one that, in the space of a few short years, has seen a seismic shift from the micro view of molecular biology to a more comprehensive and integrative approach seeking to understand whole genomes, whole organisms and whole populations. This awareness serves as a constant reminder that we need to carefully define our own niche in this altered landscape, to outline and seize the opportunity to exert "real leadership," as James B. Duke would have called it.
As I've said frequently, the clinical imperatives behind what many of us do cannot be minimized. However, until recently, the opportunities to use genomic information to actually change clinical outcomes for the better have been extremely limited. The work of Joe Nevins, Mike West, and their colleagues here at Duke and in Taiwan suggests that this is changing. As described in this issue of GenomeLIFE, what Nevins and West (or is it West and Nevins?) are doing is notable for several reasons. First, they are developing tools to use data from the entire genome — not just from one or a few genes — to assess risk. Second, the data they gather will have direct implications for individual patients, with an immediate bearing on treatment decisions for individuals. I emphasize that word because it is one of the ways in which we will distinguish ourselves here: by using genome science to personalize medical care.
This work also stands out for another reason. Thanks to the involvement of Bob Cook-Deegan and the National Breast Cancer Coalition, the potential relevance of gene profiling to breast cancer patients will be made clear at the outset, in a true partnership involving not only genome scientists and policy-makers, but also consumers. Importantly, and as a distinctive outcome of Duke's holistic approach to the genome revolution, this partnership will help shape the norms of treatment, not simply respond to them long after they've been established.
So, if gene profiling of breast cancer represents one of the first chances to put genomic medicine into practice, what comes next? The key will be to design carefully controlled clinical trials in an environment where the interests of all of the stakeholders—patients, physicians, scientists and ethicists—are satisfied. Given what’s at stake, one cannot overstate the importance of considering ethical and policy issues in parallel with the science, particularly when the toll of a disease like breast cancer remains so high. My own biased opinion, of course, is that there is no better place in the world for such a trial to take place than here at Duke. The Center for Genome Ethics, Law and Policy has already sought out a place at the table for patients and patient advocates. And on the clinical end, we have the Duke Comprehensive Cancer Center and the Duke Clinical Research Institute, whose expertise, facilities, personnel and very mission—the improvement of patient care through innovative clinical research—all appear to be tailor-made to carry out exactly this next step.
What Joe Nevins, Mike West, Andrew Huang and their team of clinicians, biologists and statisticians are doing is yet another testament to intellectual complementation and what it can produce. And, while Nevins and West may be today's poster-boys for the benefits of reaching across campus, they won't be the last. This issue of GenomeLIFE also describes the beginnings of a new fellowship program, designed to build bridges between the laboratory and society and to train a cohort of new scholars who will thrive at the intersection of genome sciences and genome policy. The first two so-called "GELP Fellows" are just beginning their work here; they, and others to follow, will be among those who will ultimately bring the genome to life.
Huntington F. Willard
Director