When Gianrico Farrugia, M.D., vice president at Mayo Clinic and CEO of Mayo Clinic in Florida, took the stage Monday morning to deliver the opening keynote address to over 800 attendees to the Individualizing Medicine Conference 2015: From Promise to Practice, he was revisiting old haunts and old friends. After a short recap of what he had seen during his four-year involvement in genomics as the former director of the Mayo Clinic Center for Individualized Medicine, Dr. Farrugia offered his short list of the value that genomics brings to the practice of medicine right now.

Dr. Gianrico Farrugia

There are many more, he noted, but these are the ones that can have the greatest impact on medicine today:

1. Pharmacogenomics: Preventing drug-related adverse effects
2. Microbiome markers to predict disease susceptibility and outcomes
3. Whole exome sequencing for undiagnosed diseases
4. “Liquid biopsies”: Cancer mutation/biomarker testing for diagnosis and prognosis
5. Noninvasive prenatal testing

“Our vision at the Center for Individualized Medicine,” he added, "is to provide the right diagnosis, treatment, or prevention at the right time, based on an individual’s unique genomic identity as an integral part of the modern medical practice.”

His personal vision of individualized medicine, however, is slightly different. “It’s to use all available information about an individual and family to inform life choices and deliver the precise care needed and no more — in order to revolutionize global health and medicine,” Dr. Farrugia said.

“There are limits to everything,” he said, when discussing the boundaries of individualized medicine. “Our job is to ignore them.”

Moderator Cathy Wurzer and Center for Individualized Medicine Director Dr. Keith Stewart

Dr. Farrugia followed his successor as the center’s director to the conference stage. Keith Stewart, M.B., Ch.B, the Carlson and Nelson Endowed Director of the Center for Individualized Medicine, joined moderator Cathy Wurzer, the host of Morning Edition for Minnesota Public Radio News, in establishing a vision for the conference and for the future of individualized medicine.

“This is the year of precision medicine,” Dr. Stewart said. “President Obama announced in January the Precision Medicine Initiative; NIH announced last week the framework of the initiative. Now our job is to help deliver individualized medicine to the bedside of all our patients.”

And he believes that the 800 attendees from 31 states and 10 countries who traveled to Rochester for the conference would have the knowledge, create the technology, and provide the solutions to deliver on the president’s promise of precision medicine.

“There is no doubt in my mind that in 20 years everyone will have opportunity to have their genome sequence,” Dr. Stewart said.

Patricia LoRusso, D.O., a leading expert on drug development through clinical trials, brought over 25 years of expertise in medical oncology, drug development, and early phase clinical trial to her talk on the changing landscape of drug development in oncology.

Dr. Patricia LoRusso

 When President Richard Nixon signed the War on Cancer bill on December 23, 1971, Dr. LoRusso noted, we thought cancers were all the same, we didn’t have the right tools to fight the disease, and we didn’t have the prepared minds to even understand what we needed.

“In 44 years,” she added, “We have developed phenomenal tools. But they’re still in their infancy. Only 3 to 5 percent of profiled cancer patients get a matched drug. Fewer than 2 percent were enrolled in clinical trials in 2012. We have to do better for our patients.”

Dr. LoRussa also noted that with over 1500 medicines and vaccines in development today, and the extreme expense of developing phase 3 clinical trial, “We need to look at small studies aiming for big gains. We have to work smarter and be more effective.”

And part of working smarter is to get better at early detection of cancer. “We’re just now starting to win the war on cancer. It’s not about curing advanced cancers: Prevention and early detection are a large part of winning that war.”

The European perspective on precision medicine was brought across the pond and to the cornfields of the Midwest by Vincenzo Costigliola, M.D., and Olga Golubnitschaja, M.D.

“We are developing a new model of patient care in Europe,” said Dr. Golubnitschaja. “We call it the PPPM model: predictive, preventative and personalized medicine.”

Citing the pandemic of diabetes, she noted that 30 to 50 percent of all cases remain undiagnosed, and that they’re happening at earlier and earlier ages. “This gives the individual more years to develop more complications. Who’s going to bear the cost of this additional burden? Who’s going to pay for it? We must get better at predicting and then preventing these diseases.”

Dr. Costigliola challenged the audience — and the United States — to rethink their model of health care delivery. “We must move from treating the population, to treating the patient. In Europe, patients are at the center of what we do. This new philosophy of predictive medicine with targeted prevention and treatments are tailored to the person.”

Whether rightly or wrongly, Dr. Costigliola noted, the perception is that American health care is controlled by government and big dollars, not the needs of the patient.

Wrapping up the morning session of the first day, Stephen Friend, M.D., Ph.D., encouraged the audience to establish a new paradigm for genomic research. From his Seattle-based Sage Bionetwork, he is reimagining the roles of individuals, researchers and technology in the research process.

“We encourage and support open sharing and collaboration of research data, information and knowledge,” Dr. Friend said. “This requires risk takers who aren’t satisfied with the old paradigms.”

Noting his use of mobile apps to get information directly from the patients, he said, “There is a disconnect between technologies and health care institutions. Can we share data and have an open ecosystem through mobile technology? This will allow us to speed up research and discoveries.”

He also encourage everyone in the room to rethink the standard model of how we communicate medical information.

“Right now, it’s a stunted one-way dialog going on from the clinicians to patients. Patients know much more about their medical conditions than we give them credit for. We need to think about a trialogue: A three way conversation between patient, doctor, and researcher—someone who can interpret all this data.”

The afternoon sessions at the conference were a time and place to get heavy into the science and research of genomics. Ten breakout sessions covered a range of issues, from pharmacogenomics to bioethics, from individualizing cancer therapy to the industry’s perspective on individualizing medicine.

A poster session and an exhibitor’s hall occupied attendees when they weren’t listening to one of the 122 expert speakers. Dr. Yewon Choi was selected for the Featured Poster of the Day for the presentation of her research in pharmacogenomics related to diabetes.

The Individualized Medicine Conference 2015 continues tomorrow, September 22, and promises to be an informative and exciting look at the present and future of genomic medicine. If you’re unable to attend, follow along on Twitter at #CIMcon15, or catch the day’s recap on Facebook or the CIM blog.

Tags: #CIMCon2015, Cathy Wurzer, center for individualized medicine, Dr. Gianrico Farrugia, Dr. Keith Stewart, Dr. Olga Golubnitschaja, Dr. Patricia LoRusso, Dr. Stephen Friend, Dr. Vincenzo Costigliola, Dr. Yewon Choi, individualized medicine, Individualizing Medicine Conference 2015, microbiome, pharmacogenomics, Precision Medicine, Uncategorized