Monday, September 10, 2007

Predicitive Health & Medical Education: Lost in Translation

When reflecting upon the greatest medical advancements in the last fifty years of medicine, certain broad and worthy categories come to mind. Imaging technology, drug design, and minimally invasive surgery have made great changes in how patients are treated. As a fourth year medical student, I routinely request a CT, suggest a regimen of Gleevac, or recommend a laproscopic procedure. All of these advances have made waves in the practice of medicine, public expectations, and medical education. Predictive health research, however, has not yet fully entered the medical school curriculum.

I doubt whether there is a single undergraduate who gains acceptance to medical school who cannot identify the names Watson or Crick or explain the basic function of DNA. By now, most students are also aware of the recent completion and publication of
J. Craig Venter’s genome. Nevertheless, discussions with my peers suggest that medical students may not be fully prepared for the medical and ethical implications of recent genetic research. Predictive health research discoveries are taught, but the potential clinical applications are lost in translation--stuck somewhere on the path from the bench to the bedside . . . or, in my case, from the pages of the textbook to the patient.

For my generation of medical students, predictive health research has the potential to significantly change the practice of medicine. While programs like the
Personal Genetics Education Project at Harvard are building interest in predictive health, and while the public is flooded by a confusing array of genetics news reports, what are medical schools doing to prepare future physicians for the predictive health revolution?

Medical students and educators should step up their efforts to join the conversation about the clinical promise and ethical issues of predictive health. We need to start thinking and talking about how we make use of the predictive tools we already have and how we will prepare for future tools. For example, how many of us are ready to explain to new parents the meaning of normal newborn screening results? Are we fully prepared to share the non-watered-down reasons for why we may want a fifty-year old man to get a colonoscopy? Are we ready to address the anxieties of a patient considering a genetic test to better determine her risk of breast cancer? Clearly, students and bloggers like Bertalan Meskó at
ScienceRoll are doing their share to spread the word, but we should encourage our mentors and professors to join the discussion. What is the current state of predictive health, and where can we expect it to advance?

[Note: To encourage a public discussion of the ethical, legal and social implications of predictive health research, PredictER Blog will be inviting guest contributions from students, professionals, and interested members of the public. This post from Pat Barrett, a fourth year medical student at the Indiana University School of Medicine and a graduate student of the Indiana University School of Philosophy, is a fitting introduction to this new feature of PredictER Blog. -- J.O.]


Berci Meskó said...

Thank you, Pat, for mentioning me and my blog! Anyway, you're absolutely right! We should encourage (persuade) our professors and mentors to share their views and thoughts with the public. And it's going to be a hard job. :)

max_powers said...

How far is medicine going to go when it comes to making tough life decisions "easier." Each day should be lived like next day is the last. I should not be pressured by modern medicine to live in fear that my offspring have a 1:4 chance of Down's Sydrome or I have a 33% of developing colon cancer. I guess Darwin and Mendel win again...they always do. If everyone else is getting thier prostate and gallbladder removed, I might as well too.

Anonymous said...

Being that every single person on this planet (including this country!!) is in need of or will be in need of medical services, it would certainly be to everyone's benefit for our future doctors to receive formal education in this area. Having not attended medical school (or much knowledge of the medical area in general), it comes as some surprise to me that medical schools around the country have not yet fully incorporated predictive medicine into their curriculum. Great to see people are raising awareness on this issue!

Unknown said...

Pat - thanks for mentioning the pgEd! I picture people going in to see their family doctor, having had their genome sequenced, and needing a lot of help with interpretation and also deciding what, if anything, to *do* with this information? More tests? A pre-emptive mastectomy? Eat better and exercise more? Nothing? A lot of work to be done, indeed!

Unknown said...

As a non-medical professional, I would suggest we broaden the scope of your argument. Why is it, for instance, that most college students will graduate without any formal education in the sciences or any venue to debate the ethics of medicine in contemporary issues? Given that each of us will experience tense situations in the future with our own health and that of our friends and family members, ethical issues should be a focus not only for medical professionals, but also for those of us outside the profession.