PRESCRIPTION FOR THE FUTURE
ASU is on the vanguard of a changing medical scene
By Christopher Vaughan

Medicine is on a collision course with the future.

Experts across the United States are predicting dramatic changes in medical research that will shape the future of health care. Increasingly, many of the changes will be forged at research universities like ASU or in dynamic partnerships between universities and medical schools.

George Poste, director of ASU's Biodesign Institute, has thought deeply and written extensively in research years about the coming changes in health care. Poste sees revolutionary change as inevitable because the current medical system cannot afford to provide the demanding and aging cohort of baby boomers the care they expect. "If I were a politician, I wouldn't want to deal with this problem," Poste says. Luckily, the solution seems to be arriving at the same time. "A convergence of advances in the life sciences, miniaturization, ubiquitous computing, information technology and various fields of engineering will transform the practice of medicine beyond recognition in the next two decades," Poste says. ASU has the opportunity to be in the vanguard of this change, he says.

GENE GENIUS
Experts agree that health care may become more effective and more economical with the rise of "personalized medicine," involving medical management that is tailored to an individual's unique genetic makeup and lifestyle. Scientific institutes with extensive collaborative ties to ASU, such as the Translational Genomics Research Institute (known as TGEN), are already working to make that a reality by conducting massive screenings of the whole genome, looking for the genes that cause disease in individuals and families.

TGEN recently made headlines when it announced that researchers there had screened the complete genome of over 3,000 people and found 50 key genes that are involved in sporadic amyotrophic lateral sclerosis (known as ALS or Lou Gehrig's disease). The researchers discovered several new genes that had not previously been known to be associated with the neurodegenerative disease, including one that seems to be involved in making the cellular "glue" that keeps nerve cells attached to muscle cells. It appears that a defective gene lets the nerve peel away from the muscle and die, according to Dietrich Stephan, director of neurogenomics at the institute and the study's principal investigator.

TGEN is also involved in finding therapeutic agents that are tailored specifically for individuals or groups who have specific genetic profiles. TGEN researchers have created a number of successful anti-cancer agents that may not look very effective in large studies of the general population, but are extremely effective in a people they are designed to help. The researchers also are trying to create cancer therapies that are highly selective in attacking only cancer cells, while leaving healthy cells unscathed.

INFORMATION PLEASE
One of the challenges of personalize medicine and future medical research is that they will require the storage and manipulation of vast amounts of data. Doing so efficiently and effectively is the focus of ASU's new Department of Biomedical Informatics.

"When we are talking about gene data or the new imaging systems you are really dealing with a different level of computing" than has been used in traditional medicine, says Biomedical informatics interim director Sethuraman "Panch" Panchanathan. "We require supercomputer with terabytes of storage and teraflops of computing speed"

One of the other great challenges for researchers in biomedical informatics is working with physicians and other health workers to make sure vast amounts of information both useful and easy to use, Panchanathan says. "If I'm a physician treating a patient for disease X, and if I'm going to find a cure that is already out there, I have to be able to use informatics systems," he says. "We have to look at how we train the next generation of physicians sot that they feel comfortable with informatics concepts."

UP CLOSE AND PERSONAL
Training the next generation of physicians is also a prime concern of George Poste. "The medical school classes of 2006 are largely ignorant of molecular medicine," Poste says. He calls for a radically new curriculum to give physicians the skills they need to operate in the new medical environment.

Physicians are not the only ones who will need to adapt. In fact, Poste and others believe that health care will shift from a "doctor-centric" model to a "patient-centric" one, a model in which people will take increased responsibility for maintaining their own health, and health care will often be delivered by non-physicians like nurses, pharmacists, physical therapists and others.

"Personalize medicine can often mean having someone sit down with a patient for 30 minutes or so and really understand their life and their health," says Kathleen Matt, director of the Office of Clinical Partnerships at ASU And the university's assistant vice president for research. Time spent with a patient can mean the difference between and effective therapy and an ineffective one, Matt says. "If you have a diabetic patient and just give them insulin without counseling them about exercise and changing their diet, they're not going to get better."

Yet, Matt observes, lowered physician reimbursements are pushing physicians to spend less time with patients rather than more. "So nurse practitioners, patient advocates and counselors will have an increasingly important role," she says.

EVIDENCE OF CHANGE
Training nurses to fulfill an expanded role is one of many issues being energetically addressed by Bernadette Melynk, dean of ASU's School of Nursing. "We need to have multidisciplinary education sot hat we have nursing students learning from medical students and vice versa," Melynk says. "Students need to have exposure to translational research methods to close the gap between research and practice."

For Melynk, an important part of closing that gap is a campaign to promote the use of "evidence-based medicine," in which the choice of medical therapy is based on a careful assessment of the best available information. Although it may come as a shock to lay people, that is often not how medicine is currently practiced. The American Academy of Nursing recently conducted a survey and found that only about a quarter of nurses were taught to search for best nursing practices in informational databases, and even those rarely did so, melynk says. "Most simply got information from colleagues."

For Matt, increasing the interaction between medical professional schools and the many ASU-affiliated research institutes doesn't only benefit medical and nursing students; it is also a boon to basic researchers.

"We need to be thinking about the next generation of graduate students as well as the next generation of physicians," she says. "We want to have graduate students and post-docs whose work is affected by exposure to the clinical picture."

COLLABORATION AND COOPERATION
If the future of medical research is based on extensive multidisciplinary cooperation, ASU has jumped into it with both feet. One of the biggest examples of this is perhaps the creation of the Phoenix Biomedical Campus, which will be home to TGEN, ASU's Department of Biomedical Informatics and the University of Arizona College of Medicine's Phoenix campus.

Known officially as the "University of Arizona College of Medicine Phoenix, in partnership with Arizona State University," the new medical school will feature ASU strengths in many areas. The new campus is designed to foster a fertile interaction between medical faculty and ASU researchers. A dozen ASU faculty members hold joint appointments in the medical school and will teach medical coursework. Some medical students will also do research in ASU research laboratories. Joint graduate school programs are being discussed, and a memo of understanding between the University of Arizona and ASU includes provisions for developing joint medical research projects.

When the first medical students come to the campus in August, they will step into a radically redesigned medical curriculum, designed with input from ASU researchers and administrators. David Young, senior vice president for academic affairs and ASU's point person for the new biomedical campus, served on a curriculum design task force organized by the ARizona Commission for Medical Education and Research, which was established in 2004 by Gov. Janet Napolitano. Phoenix program faculty developed the innovative curriculum based on the commission's design recommendations.

Integral to the design of the new medical school is the principle that it must address the social and economic needs of the people of Arizona by addressing the health care challenges of the 21st century.

One nontraditional element of the Phoenix campus medical school is that students will be expected to complete a scholarly project, a sort of honors thesis in medicine. They will conduct the project in one of four areas of concentration: biomedical informatics, molecular medicine, medical ethics/humanities or public health/population-based medicine. All of the students will be exposed to central concepts in each of these fields throughout their coursework in order to give them the grounding they will need to practice medicine in the future.

"The most conservative of professions has to embrace radical change," says the Biodesign Institute's Poste. "We in the metro Phoenix area have the chance to reshape the medical curriculum and start the dramatic changes that medical schools have to undergo."

ASU president Michael Crow said the unique agreement created a win-win for both institutions, as well as the state.

"The partnership between ASU and the University of ARizona on a medical campus leverages the strengths of both institutions," Crow said. "ASU's strengths in the sciences and innovative, healthcare-related academic and research programs are helping transform the way medicine is taught and practiced.

"Those strengths, combined with the University of Arizona's established excellence in medical education, have produced a biomedical campus that teaches tomorrow's doctors in an entirely new way — one appropriate for the challenges and opportunities of the 21st Century."

PARTNERSHIPS PACK THE BENCH
The Phoenix Biomedical Campus will further ASU's already highly productive collaborative agreements between research institutes on campus and medical institutions throughout the valley, such as the Barrow Neurological Institute and the Mayo Clinic Scottsdale. ASU researchers benefit from exposure to a clinical setting and a patient base, while these medical institutions benefit from a "deep bench" of knowledgeable researchers in a variety of specialties.

AS medicine becomes more complex, advances in medical science have frequently been the result of such collaborations. one example is the development of the cochlear implant, a tiny device that translates sound waves into electrical impulses that directly stimulate the auditory nerves. Especially when implanted in young children, the devises have been successful in helping the deaf hear.

Much of the basic research for one type of cochlear implant was done in the laboratory of ASU researcher Michael Dorman. A physician ultimately implanted the device, but the theory behind the device and its actual engineering were done in Dorman's lab. Now that cochlear implants have become common, ASU researchers are studying the psychological impact of hearing restoration using the neural prosthesis.

"A VERY EXCITING TIME"
The increasing ties between ASU and medical professionals is creating fertile ground for all sorts of new research, sometimes in areas that people don't usually think of as having connections to medicine. Experts at the Sandra Day O'Connor School of Law, for instance, conducted a study of how the law will affect the future of medicine and found that legal liability will dramatically accelerate the adoption of personalized medicine.

It's that intellectual fertility that invigorates Matt. "We recently got together fifty faculty members from the ASU neuroscience graduate program and the Barrow Neurological Institute," she says. "The result was a fascinating conversation that ranged from neurosurgery to the social behavior of honey bees."

Such cross-fertilization is bound to lead to important discoveries that will improve our health for years to come."It's a very exciting time," Matt says.

--Christopher Vaughan is a freelance science writer based in Menlo Park, Calif.