Clinical OMICS

JUL-AUG 2019

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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www.clinicalomics.com July/August 2019 Clinical OMICs 41 five years ago," said Jennifer Cozzone, global personalized health lead with Roche. "We're just at the starting point here of actually figuring out what data is meaningful in many diseases." Companies that successfully man- age and analyze the torrent of health- care data, Cozzone added, have generated interest from investors—in the form of significant valuations— by tapping into the vast potential for insights created by the 96% of data that is generated through real-world practice; the remaining 4% comes from clinical trials. "That's really where we can con- tinue to see ways to deliver value, because that real-world data is actionable in so many different ways—be it to inform, to track investment, to track how patients are actually doing in the real world, or to follow what happens once you do launch innovations," Cozzone said. Also generating insights from data, she added, is growing use of artificial intelligence (AI). In imaging, not only are algorithms in some cases able to do as well as a trained clini- cian in detecting conditions such as fractures, lung tumors, or diabetic eye disease, but in many cases, can see things missed by the naked eye. However, Deleforge cautioned that AI acceptance in healthcare has been slowed by concerns similar to those that have emerged following accidents involving self-driving cars. "We have seen that people are already concerned about using AI-powered diagnostic tools on patients in clinical practice because they're afraid of that one patient that is going to be misdiagnosed," she said. "That's unfortunate, but that's one of the barriers that AI will have to overcome in healthcare." Continued progress in managing and analyzing data, Cozzone added, will be needed for a sustainable overall business model for precision medicine to emerge. Seeking sustainable, shared value "Once we are in a space that's a little bit more mature, where you have a constellation of diagnostic tools, whatever it is that can drive decisions, and then an outcome that is avail- able, hopefully there will be a more sustainable source of value that is more shared, because other stakeholders can actually benefit from that treatment decision or care deci- sion," Cozzone added. Among those stakeholders are physicians, whose accep- tance of new tests will be crucial for precision medicine to expand beyond oncology. "We need to reach those physicians, but they are very much generalists," Donley said. "For them to go deep and think about metabolomics and get a report that tells them that something is different about their child patient's metab- olism, and then conclude about what to do, is something that we spend a lot of time thinking about." In ASD, that challenge has compelled physicians to turn to specialized medical professionals, such as those who focus on metabolism and genetics for autism and neuro- development, and pediatric nutritional specialists who can help to interpret reports. Neurodevelopment specialists, Donley noted, mostly focus on behaviors and do not run genetic or metabo- lomic tests on children absent features such as dysmor- phism, low muscle tone, or a metabolism issue, as such tests have not been traditionally recommended for reim- bursement by payers. "For those physicians who actually do the behavioral diagnosis, getting them to think beyond the dysmorphic patient to look for new things in the literature, and to order the tests, so that they can see if there's something different about their metabolism, is what we're working on," Donley said. As precision medicine spreads from cancer care into other disease areas, mass spectrometry could become a more common diagnostic tool as clinicians will look for clues about their patients' condi- tions in the microbiome and metabolome.

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