Skip to main content
Premium Trial:

Request an Annual Quote

In Estonia, The Broad's Lander Sees Country as Potential Model for Implementing Genomic Medicine


TARTU, Estonia (GenomeWeb) ― With its information technology infrastructure and biological resources, Estonia could serve as an example for how the rest of the world integrates genomic medicine into public health and prevention efforts, according to Eric Lander, president of the Broad Institute of MIT and Harvard.

"In many ways, Estonia is at the cutting edge of what is possible," Lander, who is also a professor of biology at the Massachusetts Institute of Technology, said during a talk on Friday at the University of Tartu. "The US is nowhere close to being capable of what you can do."

Though Lander devoted most of his talk, which was also webcast, to an overview of the history and potential future of genomic medicine, he told attendees that he and other professors from the Broad decided specifically to visit the northern European country to learn what is going on there. "I think Estonia could be a model system for how the world should do things," said Lander during his talk.

Perched on the Baltic Sea at the northeasternmost corner of the EU, Estonia, population 1.3 million, has developed a reputation for tech savviness, which it is keen to promote. The Internet phone service Skype, now owned by Microsoft, was developed in the country, and Estonia still hosts nearly half Skype's personnel worldwide. Playtech, the online gaming business, similarly employs more than 600 specialists at offices in the capital of Tallinn and in Tartu, Estonia's second largest city.

But it is the use of IT in Estonia's public sphere, and especially its online medical data management systems, combined with the existence of a biorepository called the Estonian Biobank, that Lander sees as an avenue to not only carry out studies, but to make the information obtained from those studies available to clinicians, ultimately delivering benefits to the general population.

The Estonian Biobank is the result of the Estonian Genome Project, which commenced in 2000. There are currently 52,000 DNA samples in the biobank, which is managed through the University of Tartu's Estonian Genome Center. Andres Metspalu, director of the center, told GenomeWeb that  the center is currently mulling the genotyping of all of those samples on the Affymetrix Axiom array platform, generating information that could eventually aid in the prevention and management of common conditions affecting the Estonian population.

"Think of the amazing opportunities that come from combining the IT infrastructure and the public trust in it with the information that can be learned from the genome," Lander told attendees. "There is so much opportunity to turn medicine into a learning system."

Lander told GenomeWeb after his talk that he decided to visit Estonia because the country "has been a world leader in information and communication technology, [and] because of that they have the opportunity to do the types of medical studies that are very hard to do in the US."

"The idea that a whole country got itself this organized is very impressive," said Lander. While he acknowledged that health systems and organizations in the US, such as Geisinger Health System and Kaiser Permanente, are working to integrate genomic information with personal health data, "There are unique things that can happen when there is a country doing something compared to when there is a hospital or a health system doing something."

For instance, he noted that Estonian clinicians, provided with new genomic information, have the ability to go back to a patient to advise them of, say, an enhanced risk of developing glaucoma, which could result in various preventative healthcare steps. And given the centralization and accessibility of such information, it is possible to share the information between doctors, no matter where they are located.

In the US, in comparison, "there are individual health systems, people come in and out of health systems, so you don't have people who stay in the same health system for their whole lives," Lander said.  "We in the US are all working hard, but we don't have interoperable health records," he added. Even within the Partners Healthcare system in Boston, two hospitals sometimes cannot exchange data because there are different systems," he said. "All of the hard work to make things interoperable has been done here."

One reason for that is that when Estonia regained its independence from the Soviet Union in 1991, Lander noted, the country had no legacy data management systems in place. That gave Estonia the opportunity to "start from scratch" and build new public data management systems, while the US continued to use varieties of older systems and approaches to manage health data.

"In the US, we have always had good enough legacy systems so we don't start from scratch," commented Lander, "but then you pile up legacy."