Physicians or medical school students concerned that they will be ill-equipped to take advantage of pharmacogenomics may soon get one step closer to enlightenment.
GenoMed and the Health Communication Research Institute, a prominent continuing medical education firm, have partnered to offer a novel online course that aims to introduce MDs to the world of personalized medicine and genomics.
But the brand of education they’re selling may not sit well with the Eric Landers and Francis Collinses of the world.
“We’re providing a contrarian view to the current teaching of genomics,” said David Moskowitz, chairman and CEO of GenoMed.
The partners hope the course, called Genomics for Clinicians, will go live sometime next month. Initially, the series will cost $1,000 for two semesters that together will count for 100 CME hours, Moskowitz said. (Physicians in the United States are required to earn 25 hours of CME credit each year in order to keep their medical licenses intact.)
“This course will fill a huge need in post-graduate medical education. There are over 600,000 physicians in practice in the US, and virtually none has ever had a course in medical genomics,” said Moskowitz, whose firm will share the profits from the CME course with the HCRI. “Yet it’s widely agreed that practitioners will need to know medical genomics in order to bring genome-based advances to their patients.”
This movement is somewhat underway at medical schools. Aware that pharmacogenomics is caught in limbo between its potential real-world application and hype, these schools are encouraging students to probe the new discipline delicately. But that isn’t enough for some in industry who are anxious about dealing with a generation of genomics-illiterate physicians. [See SNPtech Reporter, May 9, 2003]
“My concern is that there is a significant lack of knowledge in the physician community in this area,” said Gary Peltz, head of genetics and genomics at Roche Bioscience, one of the largest supporters of pharmacogenomics. The resulting ignorance, some say, will shortchange patients and hamper new technology development.
Some believe medical schools are not the only ones that have a responsibility to keep physicians up to date on new technologies. In fact, most agree that the responsibility falls heavily on the medical societies. These groups, like the American Medical Association and the American Academy of Family Physicians, are in a unique position to educate a broad swath of practicing physicians — there are slightly more than 836,000 medical doctors in the US, according to the AMA.
The AAFP, for its part, believes that pharmacogenomics will play a big role in primary care and family practice and plans to direct an annual “clinical focus” on genomics in 2004, according to Norman Kahn, vice president of science and education at the AAFP. (An AAFP clinical focus hones in on one particular topic that is taught through a variety of media and applications.)
Educators, on the defensive, contend the picture is not that bleak. “We’re not too far behind the curve,” Stephen Huot, associate professor of medicine at Yale, told SNPtech Reporter in a recent interview.
Moskowitz counters that virtually no US physicians have ever had a medical genomics course, not least because these courses seldom exist in med school curricula. He said he expects his CME course to be a suitable surrogate.
While he would not detail the information to be included in the course — he wrote it last year and based it on a popular genomics text — he said a typical pharmacogenomics question would be to “compare and contrast linkage analysis methods to find genes with other techniques. Something broad like that,” he said.
“I want people to feel confident; to critique the stuff that’s coming out,” he said. “I want them to feel that they know a little bit more than their patients do — about a field that nobody knows enough about, not even the experts.”
To be sure, Moskowitz has a sequencer-sized chip on his shoulder about genomics experts. He said an underlying issue that discourages physicians from becoming genomics-literate “is that clinicians are being made to feel like they’re the dumbest of the dumb, and the experts are showcased as the smartest of the smart.”
In fact, Moskowitz said, there’s disequilibrium in the superlatives: “What passes for common sense among physicians is actually a lot more useful in terms of getting an understanding of the clinical uses of genomics than what the experts are telling you, because the experts are invariably PhDs who haven’t seen patients in their life, or they’re MD/PhDs who haven’t seen patients for several decades.”
Specifically, he said “all the experts” are concentrating on the linkage-analysis tree, and they have been since cystic fibrosis was solved,” Moskowitz said. They haven’t solved a single polygenic disease that way.” And who are these experts? “Well, you know who they are: Eric Lander, Francis Collins — the people who decide who get[s] the NIH grants.”
Instead, his course will pursue a “genomic-epidemiology approach” that focuses on odds ratios instead of Lod scores. “We don’t use neutral markers because you have to hit the nail on the head when it comes to polymorphism because there’s essentially no linkage disequilibrium when it comes to diseases,” Moskowitz said.
Lander, who heads the Whitehead/MIT Genome Center in Cambridge, Mass., disagreed with this assessment and called it “gobbledygook.” He added that odds ratios and Lod scores are one and the same. Collins, director of the National Human Genome Research Institute in Bethesda, Md., did not return a phone call and an e-mail message seeking comment.
“The recognition that a genomic epidemiology approach is actually the way to get diseases is, I would say, underappreciated now,” he said. “There’s been a lot of news about genetics every day, but ... I don’t see that memorizing the 3 billion letters of the human genome has any utility whatsoever clinically.”