‘Unlike Any Other’
White House PMI Summit Outlines ‘Bold Initiative’
President Obama’s Precision Medicine Initiative (PMI), first unveiled at his January 2015 State of the Union address, took another major step forward on Feb. 25 at the White House PMI Summit. Held in the White House’s south court auditorium and webcast live, the event included the announcement of initial steps based on recommendations offered just 5 months ago by a PMI working group.
“This will be a bold initiative unlike any other,” said NIH director Dr. Francis Collins, adding that, in his 25 years at NIH, no initiative has ever been faster to take shape. “We’re all different…the one-size-fits-all approach [to health care] is far from optimal.” PMI will take into account the contributions of genes, environment and lifestyle in an “unprecedented effort,” he said.
Collins said it would take 3-4 years to assemble a study cohort of more than 1 million individuals, who scientists hope to follow for years. The effort is not focused on any specific disease, he said, nor is PMI “just about illness—it’s also about health.” Important clues to disease prevention are expected to emerge from the data.
Three factors distinguish PMI from other large-cohort studies of the past, Collins said. Participants will be “true partners,” not patients; the cohort will be broadly representative of the nation’s population; and data-sharing is to be swift to both participants and scientists.
Collins said a central institutional review board has been established and that both a coordinating center and biobank, to accept tissue specimens, will be in place by this summer.
“It will truly take a coalition of partners,” said Collins, noting that the White House event drew at least 40 partners from academia, industry and the nonprofit sector. “[PMI] has the potential to transform medicine and health.”
“This is an incredibly exciting time in medicine generally, and the biological sciences,” said Obama, who participated in one of the event’s panels. “A lot of this traces back to work that was done mapping out the human genome.”
The President said that PMI “offers the promise to reduce costs, provide much better care [and] make our entire health care system much more effective…We may be able to accelerate the process of discovering cures in ways that we’ve never seen before.”
Obama said he hopes we can look back in 10 years “and say we’ve revolutionized medicine.”
On a panel with the President was Dr. W. Marston Linehan, chief of NCI’s Urologic Oncology Branch. He described the tortuous process of searching for a single-gene cause of kidney cancer in the era preceding the Human Genome Project. “We now know that it’s a number of different types of cancer that just happen to occur in that organ,” he said.
Not only that, but there are at least 16 genes involved in the development of kidney cancer, with more to be identified, Linehan said.
The rationale for PMI could be traced in his recitation of two kidney cancer cases. It took 18 years for Linehan and his colleagues to find out what kind of cancer killed a patient they first saw in 1989. But in a kidney cancer patient he had seen just the day before the summit, Linehan said no obvious evidence of cancer could be found on the x-ray of this person who was treated with a more appropriate drug—tailored to her disease—than could ever have been imagined for the initial patient.
“I’m not saying we don’t have miles to go before we sleep,” said Linehan, “but we are very encouraged by the progress that has been made. We know that we have a lot of work to do…We couldn’t practice medicine without what we now call precision medicine. We really couldn’t do it. It helps us decide whether to recommend an operation or not; what operation to recommend; what drugs to give. Our most important long-term goal is prevention. It is incalculable to us what this has meant to us and how it directs how we manage these patients.”
To learn more about PMI, visit www.nih.gov/precision-medicine-initiative-cohort-program.—Rich McManus