Keith Yamamoto, left, vice chancellor for research at UCSF, talks with team members, including UCSF's Michael Fischbach, a scientist who uses a combination of genomics and chemistry to study microbes.
One of the major themes to emerge in the campuswide planning initiative known as UCSF 2.0 is advancing the emerging field of precision medicine, which promises to transform health care for everyone everywhere.
Precision medicine aims to harness the power of basic research, computation and technology, human genetics, imaging, patient health records, environmental data and more to define the mechanisms of disease and to develop targeted treatments and therapies.
Ultimately, precision medicine would provide personal, preventive, and predictive care appropriate to each individual patient by integrating knowledge across the spectrum of research, health and health care.
The concept of precision medicine emerged from a 2011 National Academy of Sciences report from a committee co-chaired by then UCSF Chancellor Susan Desmond-Hellmann, MD, MPH, and Charles Sawyers, MD, of Memorial Sloan-Kettering Cancer Center. It has since become a driving vision for UCSF, which convened the OME Precision Medicine summit in May 2013 that drew more than 170 national leaders to discuss how to move the field forward.
Francis Collins, MD, PhD, director of the National Institutes of Health (NIH) who attended the UCSF summit, has since announced that precision medicine is a priority for the NIH in FY 2015.
“Everyone has a part in the solution to the problem of bringing precision medicine more quickly into practice,” said Harvey Fineberg, MD, PhD, president of the Institute of Medicine, who will come o UCSF for a yearlong appointment as a Presidential Chair beginning in September. “Part of the goal is not only to mobilize the profession and government payers, but also to mobilize the public in understanding the opportunity that precision medicine represents, and to have the expectation and demand for the kind of information about yourself and your family that you’re entitled to have.”
The Remarkable Breadth of Precision Medicine
Precision medicine is an all-encompassing effort spanning every discipline from basic science to patient care. At UCSF the endeavor has been organizationally mounted on a Precision Medicine Platform bearing six broad, overlapping components: Basic Discovery, Clinical Discovery, Omic Medicine, Center for Digital Health Innovation, Institute for Computational Health Sciences and a computational Knowledge Network.
Keith Yamamoto, PhD
Keith Yamamoto, PhD, vice chancellor for research, heads the Precision Medicine Platform Committee, which comprises leaders in each platform component and includes many efforts such as the UCSF-developed Health eHeart study to the MSBioscreen. In fact, one challenge for the committee is to get the word out about the full scope of UCSF’s Precision Medicine enterprise, both inside and outside the University.
“We want everyone to understand the remarkable breadth of precision medicine, how they are a part of it, and how they can contribute to and benefit from it,” Yamamoto said. “This includes members of the community, who need to be convinced, indeed become excited about, the value of providing data of all kinds — in UCSF clinics as well as digitally in the normal course of their lives — to improved health.”
Making the case to the public that sharing their personal and private health data will ultimately improve health for them and the entire population is a challenge.
Robert Wachter, MD, chief of the medical service and chief of the Division of Hospital Medicine at UCSF Medical Center who joined the UCSF faculty in 1990, says health care is in the early stages of data sharing. The “open notes movement, which says that patients have a right to their health data, such as doctor's notes, wherever they are, including whether they’re at home or in the hospital,” may empower patients who can then get involved in managing their health.
Robert Wachter, MD
“We now have a technology backbone that is world-class,” Wachter said, speaking about the electronic medical records system at UCSF. “It creates an opportunity for us to link with many other providers and institutions that have it, all of the UCs, the Kaisers and elsewhere.
And patients can now be much more active partners in their care by using telemedicine, social media and in other ways that we don’t even know about yet. The trick is how do we build their trust and how do we make the connections for data analysis using modern technology and involving new partners in the community that allow us to do things we can’t do today. At the same time, we need to pay attention to the enduring value of real person-to-person contact with patients.”
Yamamoto acknowledges the enormous challenge of developing and harnessing computational tools that don’t yet exist to build a knowledge network that integrates massive and diverse types of research and patient health data across multiple approaches, biological systems, programs, projects, sites groups and individuals.
He is looking for private sector partners in Silicon Valley and is already leveraging an extensive partnership with Lawrence Berkeley National Laboratory, and establishing strong links with engineers and computer scientists at UC Berkeley.
UCSF is launching its knowledge network, which will expand and radiate to become institutionwide, from two initial major areas, Oncology and Cancer, and Neuroscience and Neurological Disease.
In other developments to advance precision medicine, UCSF: