‘Personalized Medicine' Comes to Mt. Sinai

As part of a new program aimed at diagnosing and treating patients based on their genetic makeup, doctors at Mount Sinai Medical Center today will begin collecting tissue samples.

The hospital plans to offer a $20 incentive to any patient who donates an eight-milliliter vial of blood to a new Biobank, a warehouse of DNA and plasma that is a central component of the hospital's Institute for Personalized Medicine. "Personalized medicine," an approach that incorporates molecular analysis into managing a patient's health, has been touted as the future of medicine ever since scientists completed the map of the human genome in 2003.

At Mount Sinai, doctors began personalized medical research about three years ago. In April, the Andrea and Charles Bronfman Philanthropies donated $12.5 million to establish the institute, and administrators of the Biobank said they hope to enroll 100,000 participants over the next five years.

Initially, the blood samples — which will be stored without information that discloses the patients' identifies — will enable researchers to study diseases such as asthma and diabetes. Ultimately, the data will be linked to patient records to predict such conditions, or to treat illnesses.

"The model is, our history is your future. The medical and genetic history of a patient will translate into improvements in health care," the director of the institute, Dr. Erwin Böttinger, said.

To date, only a handful of hospitals around the country have established centralized programs focused on personalized medicine. For the most part, oncologists seeking to tailor cancer treatments have been pioneers in the nascent field.

"It's not very elegant to say, ‘I have a drug that works very well for 15% of people,'" a gastrointestinal oncologist at Memorial Sloan-Kettering Cancer, Dr. Leonard Saltz, said. By contrast, testing a patient's genetic makeup to determine the risk of side effects, as well as the effectiveness of the medication, could lead to better, more cost effective, and less toxic treatments.

At Memorial Sloan-Kettering, Dr. Saltz said, it is now standard practice to test lung cancer patients for a genetic mutation that can predict a drug's effectiveness. "Of course, it's got to be a very reliable test to make that kind of decision," Dr. Saltz said.

Some expressed concern that there is only patchwork of regulation concerning such tests in what is still an emerging field. Other concerns include the use of genetic information by insurers and employers.

"When you give a sample as a patient, what protections are you going to get? How will your information be protected, and who will have access to it?" the law and policy director of the Genetics and Public Policy Center at Johns Hopkins University, Gail Javitt, said.

Even those who described themselves as supportive of preventative medicine said there is a question of cost.

"No one really knows where this is going," the president of the American Council on Science and Health, Elizabeth Whelan, said. "It really is going to take a new commitment to spending on prevention."