Keynote Speakers: David Ewing Duncan and Dan Roden

PSB 2013

David Duncan David Ewing Duncan
Author and Journalist

Title: The rise of personalized health, and the coming age of human enhancement

For the first time in human history, new tools and technologies are emerging that may soon enable us to predict an individual's future health before they become ill and inform strategies for prevention or mitigation. Lagging behind are equally creative innovations in other facets of society, ranging from politics, regulation, law and commerce to how physicians are trained and medical centers are run. Big questions also surround issues of how to modify behavior, cost savings, and how to validate the rush of personal data that's swelling into a tsunami of raw information in what has been termed the "interpretome."

Part one of this talk will discuss the universe of discoveries and technologies now emerging, and the society-wide challenges to shifting the paradigm from a health system based on sick care to one focused more on staying well - with a case study featuring one healthy man's experiences in test driving thousands of high tech tests to see how they worked and their usefulness.

Part two of the talk will take us farther into the future to ponder the notion that current trends in genetics, regenerative medicine, machine-human interfaces, and other fields might one day push beyond the barriers of using technologies just to stay healthy. Is it possible that these technologies will offer enhancements to what is now considered "normal"? What would this mean for individuals and society?

David Ewing Duncan is an award-winning, best-selling author of seven books and numerous essays, articles and short stories; and a television, radio and film producer and correspondent. He is a Correspondent for; he is also the Chief Correspondent for public radio's "Biotech Nation", heard on NPR Talk. He writes for the New York Times, Fortune, Wired, Discover, Atlantic, National Geographic, and many other publications. At UC Berkeley he is the Founding Director of the Center for Life Science Policy. David's most recent book is the bestselling Experimental Man: What one man's body reveals about his future, your health, and our toxic world (Wiley). His previous book was Masterminds: Genius, DNA and the Quest to Rewrite Life (Harper Perennial). He wrote the international bestseller Calendar: Humanity's Epic Struggle to Determine a True and Accurate Year (Harper-Collins/Avon), published in 19 languages, and a bestseller in 14 countries. He is at work on a TED book on extreme aging.

David has been a Contributing Editor and columnist for Conde Nast Portfolio, and a Contributing Editor for Wired, Discover and MIT Technology Review; he has been a longtime commentator for NPR's "Morning Edition", and a special correspondent and producer for ABC's Nightline and 20/20. He has been a correspondent for NOVA's ScienceNow!, and a producer for Discovery Television. He has written for Harper' s, Atlantic Monthly, Smithsonian, Outside, The Telegraph, The Guardian, The Washington Post Book World, The San Francisco Chronicle, and The New York Times, among others.

In 2003, David won the prestigious Magazine Story of the Year Award from the American Association for the Advancement of Science. His articles have twice been cited in nominations for National Magazine Awards, and his work has appeared twice in The Best American Science and Nature Writing.

David is the Founder and Editorial Director of the BioAgenda Institute, an independent, non-profit program of events and educational initiatives that discusses and analyzes crucial issues in life sciences -- which is being folded into the new Center for Life Science Policy at UC Berkeley. He has been the host of the annual BioAgenda Summit.

David's other books include the bestselling Pedaling the Ends of the Earth (Simon & Schuster), about his bicycle expedition around the world, and Hernando Soto: A Savage Quest in the Americas, called "an astonishing tour de force" by the New York Times Book Review. He wrote Residents: The Perils and Promise of Educating Young Doctors (Scribner) and Cape to Cairo: An African Odyssey (Grove Atlantic). His fiction has appeared in two anthologies. He has taught creative writing at Stanford University. He works at the San Francisco Writer's Grotto, and lives in San Francisco.

Dan Roden Dan Roden
Assistant Vice Chancellor for Personalized Medicine
Professor of Medicine
William Stokes Chair in Experimental Therapeutics
Professor of Pharmacology
Vanderbilt University

Title: Engineering a healthcare system to deliver personalized medicine

Variability in disease susceptibility and drug response is the hallmark of human pathophysiology. While the increasing pace of discovery of genomic and other markers for these phenotypes holds the promise of personalizing care, implementing high-dimensional information in clinical practice presents major challenges. It is our working hypothesis that advanced electronic medical record (EMR) systems can serve not only as tools for delivery of decision support-guided care but also as tools for discovery and validation of novel biomarkers of drug response and of disease susceptibility and progression. Studies in BioVU, the Vanderbilt DNA repository (containing samples from >150,000 subjects) linked to a de-identified image of the EMR, have replicated known genotype associations, discovered new associations, and have provided a platform for the development of the new phenome-wide association study (PheWAS) paradigm that searches across the range of diagnostic codes and other phenotypes to identify associations with specific genetic variation.

Initial steps are also being taken to execute a popular but as yet untested vision of genomic medicine in which EMRs to deliver point of care prescribing advice based on genomic data "preemptively" embedded in individual patient records, thereby avoiding logistic hurdles in a reactive pharmacogenomic prescribing strategy. In the Vanderbilt PREDICT (Pharmacogenomic Resource for Enhanced Decisions In Care and Treatment) project, we have created a framework for evaluating "actionability"; identifying patients likely to receive target drugs (such as clopidogrel, warfarin, simvastatin, azathioprine, or tamoxifen); obtaining and analyzing raw genotypic data and depositing genotypes into the EMR; delivering point of care prescribing advice when a drug target drug is prescribed for a patient with a variant genotype; and tracking outcomes and costs. Early lessons from PREDICT, which now embeds pharmacogenomic variant data in EMRs of >10,000 patients, include the need for a highly collaborative scientific environment and extensive institutional commitment.

Aggregation of resources such as BioVU and PREDICT across multiple sites - now being undertaken in the NHGRI's Electronic Medical Records and Genomics (eMERGE) network - holds the hope of expanding discovery efforts which will in turn provide the evidence base for further implementation of an EMR-driven vision of personalized healthcare.

Dan Roden received his medical degree and training in Internal Medicine from McGill University in Montreal and then trained at Vanderbilt in Clinical Pharmacology and Cardiology. His initial career focus - that he has maintained - was studies of the clinical, genetic, cellular, and molecular basis of arrhythmia susceptibility and variability responses to arrhythmia therapies, and he is widely-recognized for his expertise in drug-induced arrhythmias. Over the last 10 years, he has led Vanderbilt's broader efforts in pharmacogenomics discovery and implementation. Dr. Roden is Principal Investigator for the Vanderbilt sites of the NIH's Pharmacogenomics Research Network (where he currently serves as chair of the steering committee) and the NHGRI's Electronic Medical Records and Genomics Network. He directs BioVU, the Vanderbilt DNA databank that as of March 2012 linked DNA samples from over 135,000 patients to deidentified electronic medical records. He is one of the key leaders overseeing our PREDICT (Pharmacogenomic Resource for Enhanced Decisions In Care and Treatment) project that since September 2010 has been depositing information on genomic variation relevant to drug responses into the Vanderbilt Electronic Medical record.

Dr. Roden served as Director of the Vanderbilt Arrhythmia Service, director of the Division of Clinical Pharmacology (1992-2004), and in 2006 was named Assistant Vice-Chancellor for Personalized Medicine. Dr. Roden has received the Leon Goldberg Young Investigator Award and the Rawls Palmer Progress in Science Award from the American Society for Clinical Pharmacology and Therapeutics and the Distinguished Scientist Award from the Heart Rhythm Society. He has been elected to membership in the American Society for Clinical Investigation and the Association of American Physicians.

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