Saturday, January 12, 2013

Do you believe in Omics? (Musings on genomics as the savior of pathology)

Updated 16 Jan. 2013

This blog was stimulated by this article in The Scientist:
In it the authors jump on the OMICS bandwagon, specifically genomics and urge pathologists to seize the day to establish the future of pathology in personalized medicine, a field that emerges from applying genomics to clinical decisions.
They* write that pathology is the backbone of modern medicine and its impact has relied on technological advances, e,g, light and electron microscope, digital imaging, polymerized chain reaction, and now genomic sequencing. 
*Authors are from Harvard Medical SchoolDennis Wall is Director of Computational Biology. Peter Tonellato is Director of the Laboratory for Personalized Medicine and heavily involved with promoting pathology in personalized medicine
Not sure that pathologists feel the love supporting the 'backbone of modern medicine'. Girdles were never very sexy. Several have told me that they occasionally feel they are at the bottom of the physician totem pole, more like a jockstrap. 

It's analogous to how medical laboratory technologists / scientists (lab boy, lab girl in the recent past) feel compared to higher salaried and more respected docs and nurses. 

Before musing about transforming pathology education, let's briefly review OMICS, a term with many types and a plethora of definitions. I like this site as it's not replete with bafflegab:
Back to revolutionizing pathology education. The bit in the article that most got me was the need for core competencies in genomics and personalized medicine, and it is likely that "within 2 years it will be required that all residents in pathology demonstrate proficiency in these areas." 

Wow! Competencies and proficiency impose heavy duty training needs. Quite different from the meaningless learning objectives (educators, bear with me) that too often accompany physician presentations:
  • Become familiar with the complications of blood transfusions
  • Learn about blood components and products
  • Understand how to select the best blood product
Describing the characteristics of good learning objectives, the kind needed to measure competency and proficiency, is not my goal. Mentioning them is just to emphasize that educating and training to achieve competency and proficiency are rigorous.

I'd prefer that educational institutions first focus on giving all medical and nursing students, and practitioners whose initial education training was lacking, a few key competencies in transfusion medicine. 
Fact is that undergraduate medical education everywhere devotes little time to transfusion medicine. Several reasons, but they include lack of time in an already jam-packed curriculum and perceived low priority compared to other education needs. Nursing education is similar.

The result is that errors in prescribing and administering transfusions occur all too frequently. 

Soooo... Before revolutionizing medical education by training pathologists to be proficient in genomics and personalized medicine, perhaps medical and nursing education should deal with existing deficiencies as documented in 
Sure, let all pathologists, indeed all health professionals, know about, be aware of and understand genomics and its relevance. Perhaps even develop specialty training.

It's not like pathologist education isn't rigorous enough already. For example, residency programs in :
Spending scarce educational resources transforming pathologist education to make genomics a priority seems ridiculous. Those who advocate it have personal agendas to promote their specialty. They are true believers, as it were. No doubt OMICs will evolve and become increasingly important. Exactly how is impossible to predict. 

Will genomics and personalized medicine be ~ blood substitutes (aka hemoglobin-based oxygen carriers and similar), over-hyped and a long time coming? My guess is yes, mainly because disease is complex and determined by genes, environment, lifestyle, and more. As well, there are many other competing medical advances and health initiatives that can improve health more effectively, better diet and more exercise, to name but two.

As hematopathologists, transfusion nurses, and medical laboratory technologists and scientists who work as specialists in transfusion services are well aware, the competency of many, perhaps most, physicians who order blood, and nurses who administer it, ranges from dismal to needs improvement

And since blood transfusion is common, you'd think being competent would be basic to all docs and nurses who prescribe and administer transfusions, an educational PRIORITY. 

Apparently not. More hip to promote genomics and be seen as visionaries. 

Oh, did I mention that industry is very keen on genomics and personalized medicine? See 2010 blog:
Seems that OMICS is the new religion with many true believers, which reminds me of another true believer, Kathy Bates in Primary Colors, one of the best political films ever. 

The music below was selected to contrast techie innovation with an instrument that has been around for hundreds of years. 

First, this 1998 'techno' song by Cher, one of the best selling singles of all time. If you dislike this music, you may sympathize with those pathologists who hate techie innovations, because it threatens their comfortable ways.
But if you love pure simplicity, nothing beats the Spanish guitar played by the most complex of tools, evolved over 200,000+ years. (grin)

OMICS in personalized medicine (2010 European Commission workshop)

Personalized medicine: caught between hope, hype and the real world. Clinics (Sao Paulo). 2012;67 Suppl 1:91-7.

Platelet proteomics in transfusion medicine: a reality with a challenging but promising future. Blood Transfus. 2012 May;10 Suppl 2:s113-4. 

Shaking hands with the future through omics application in transfusion medicine and clinical biochemistry. Blood Transfus. 2012 May; 10(Suppl 2): s1-s3.