See One, Do One, Teach One

Scripps' Eric Topol argues for the inclusion of whole-genome sequencing in medical education.

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Worthy objective, unworthy

Worthy objective, unworthy object.

While you are at it, why not

While you are at it, why not require full neuropsychological profiling of each student? These assessments have been around a much longer time, and have demonstrated clinical validity and utility well beyond anything yet shown for WGS. I agree with Dr. Topol in the "potential" of WGS, but too little research yet on implications - benefits, risks, and economics - for medical schools to be promotional arms of the many emerging companies in this space.

"we must achieve an advanced

"we must achieve an advanced level of correct and in-depth understanding of cell physiology to fight against the suffering, the deaths, and the uncertain future of our species. Since living cells are the fundamental units of all life, the basic science underlying human health and disease is the science explaining how living cells function. This basic science is cell physiology."Gilbert N. Ling, Ph.D. " I cannot understand why there is no cell physiology to guide our War on Caner and AIDS. I am sure that researchers learn cell physiology in their student days.". Yes, cell physiology is taught in a standard medical curriculum. But that cell physiology taught is not a science, it is only a theory, called the membrane-pump theory. A theory, of course, is just an idea which may explain a natural phenomenon and it may not. To achieve the status of science, the theory must be extensively tested and proven valid. It is here that the problem lies. The membrane-pump theory has not passed those tests.

The idea of undergraduate

The idea of undergraduate medical students taking the time during their busy training to annotate and decipher their own genomes after its been conveniently sequenced for them at a substantial cost is just ridiculous. We are not taking about the students simply interpreting an x-ray of their chest area, but instead attempting an exceedingly complex analysis that is in fact extremely difficult even for experts in the field. Most medical students receive the equivalent of only a 3rd year undergraduate biochemistry course in their formal training, and ultimately have only the most basic understanding of genomics. As general practitioners, it is hard to envision how they would be capable of deciding the appropriate medications for their patients based on genetic profiling without the aid of someone well trained in pharmacogenomics with access to specialized databases.

Examples of where genome-wide-sequencing has made a decisive difference in the diagnosis of disease and has resulted in a more effective therapeutic response are actually rare. Presently, companies like Knome and 23andMe offer SNP chip analyses that are of very dubious value to their clients. With multi-genetic and environment factors at the root of the most common diseases, our knowledge is just too rudimentary to make meaningful predictions. When one critically evaluates just how much more we have learned about the roughly 21,000 proteins encoded by less than 3% of the human genome in the last decade after its initial sequencing, it is obvious at this rate it will be at least another decade or two before any real comprehensive understanding is achieved that will be effectively translated into the delivery of personalized medicine for most diseases.

There is a common tendency for medical students to be mild hypochondriacs where they can feel that they share the symptoms of many of the various diseases they learn about. This condition, known as "Medical students' disease," also goes by the labels "hypochondriasis of medical students," and "Medical student syndrome" amongst others. Some studies have suggested that as much as 70% to 80% of medical students have groundless medical fears during their training. I see no compelling reason to unnecessarily add to medical student anxieties with relatively meaningless predictions of even more diseases from their genome-wide-sequence analysis.

Why not focus on teaching

Why not focus on teaching them basics like ecology and evolution? Given the role of our microbes and commensals, it would make sense that they would be better served by understanding that we're just walking ecosystems.

A fundamental understanding

A fundamental understanding of how sequence data relates to personalized medicine is needed. Two former students of mine have entered med school after finishing our MS in Bioinformatic program at the Polytechnic School of Engineering at NYU. They definitely have an advantage over their classmates.