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Center for Personalized Healthcare Fall 2012

Cleveland Clinic 2013 Personalized Healthcare Summit

Mark your calendars now for May 6-7, 2013 for the Third Annual Cleveland Clinic Center for Personalized Healthcare Summit: Topics, Tools and Tomorrow. Building on the success of our previous events, this year’s Summit will be a forum to explore the progression of personalized healthcare from concept to practice. The Summit will be divided into themes as follows:

Topics that highlight and explore new personalized healthcare discoveries with the potential to improve patient care. This section will include an overview of the exciting new area of study known as nutrigenomics by world expert Dr. Ahmed El-Sohemy from the University of Toronto. It will also feature a panel discussion on how we can improve and accelerate reimbursement of personalized healthcare approaches.

Tools that aid in the integration of personalized healthcare into clinical care. As part of this section, we will feature Dr. Mary Relling (St. Jude Children’s Research Hospital) discussing their innovative pharmacogenetics initiative. We will also cover other innovations in personalized healthcare, including next gen sequencing, mobile app development and more.

Tomorrow: thoughts for the future of personalized healthcare. On the final day of the Summit, we will be showcasing some of the most promising areas for future growth in personalized healthcare. This will include a panel discussion on Big Data, a discussion of ethical and legal issues, as well as a tribute to the ten year anniversary of the completion of the Human Genome Project.

In addition to our formal program, this year’s Summit will also include a poster session, networking opportunities, and discussions with many experts in the field. The Summit will be held at the InterContinental Hotel and Conference Center in Cleveland, Ohio and will include an evening reception.

For more information and to register, please see our website: www.clevelandclinic.org/phcsummit or email: cphinfo@ccf.org.

Thanksgiving: Not Just About the Turkey

According to the U.S. Department of Health and Human Services, 96% of Americans understand that their family health history is an important tool for predicting their risk for disease, but only one third have taken the initiative to put it on paper. The process of recording family members, living and deceased, is often shadowed in the colossal task of effectively talking to as many living family members to find out what really took Aunt Jean’s life at an early age or why Grandpa was always in the hospital.

In 2004, Thanksgiving Day was declared National Family Health History Day by the U.S. Surgeon General to mitigate the reluctance of Americans to transform family conversations into useful family health portraits. The Thanksgiving gathering is a prime opportunity for multi-generational family members to discuss the details of their own health as well as gather facts of their deceased.

Family history is one of the best indicators of an individual’s risk for conditions such as cancer, heart disease, and diabetes. Sharing a complete family health history with healthcare providers can help alert them to early warning signs of these and other diseases. Better patient care is the ultimate goal of introducing one’s pedigree into the office visit.

The U.S. Surgeon General provides tools to assist those interested in effectively recording their family history. My Family Health Portrait Tool is an easy-to-use, online resource available to everyone at www.hhs.gov/familyhistory. Users are encouraged to create their framework and update as new family health information becomes available. Until family history and risk analysis tools are integrated into the common electronic medical record, the government’s solution is an effective way for everyone to stitch together a view of the past as well as a roadmap for the future.

In the spirit of the constructs of personalized medicine, encourage your patients to become aware of where they came from. Our blog post on this topic may help them start thinking. Remind them that Thanksgiving presents an entirely new forum to fill in the blanks about their ancestors and perhaps answer some important questions for future generations.

Race, Ethnicity, and Health

Personalized healthcare encompasses many aspects of health, but one of the main foci is family health history. A significant component of family health history is race and ethnicity. Oftentimes, these two terms are used interchangeably, but there are distinct differences. Race refers to a person’s inherited features (genetics), while ethnicity refers to a person’s culture, customs, and often lifestyle choices (learned behaviors). One cannot change their race, but they can align themselves with any ethnicity. For example, if a person is adopted into a family of a different race, the adoptee’s race will not change, but they will most likely identify themselves as part of the ethnic group of their adopted family because they will participate in the same traditions, customs, and lifestyle. Both race and ethnicity can play a significant role in health and disease.

Many diseases have a genetic component. Some of these diseases are more common among specific groups of people than in the general population. For example: it is a known fact that Ashkenazi Jewish people have a higher risk for carrying a BRCA gene mutation. This does not mean that all Ashkenazi Jewish people carry a BRCA gene mutation or that they will develop hereditary breast or ovarian cancer. This just means that this specific population is at a higher risk for the BRCA mutation and that screening for these mutations and cancers should be done in a timely manner. Tay-Sachs disease is another genetic disorder that Ashkenazi Jews have a genetic predisposition to. Similarly, not all Ashkenazi Jews will have children with Tay-Sachs disease and other people who are not of Ashkenazi Jewish heritage can have Tay-Sachs disease. Other groups of people are reported to have a higher incidence of developing certain genetic disorders. Asians and Hispanics are genetically predisposed to thalassemia. Caucasians have a higher incidence of cystic fibrosis and African Americans have a higher risk of inheritance for sickle cell anemia and cardiovascular disease.

While genetics is an important part of health, learned behaviors such as lifestyle and customs that are specific to ethnic groups also should be assessed for disease risk or prevention. For example, some cultures participate in family walks in the evening after dinner, while other cultures may partake in diets high in fresh vegetables or even saturated fats. These few examples illustrate that cultures and lifestyle choices can greatly affect health. It is important to remember that a person who is genetically predisposed to a certain disease can take steps to mitigate that risk.

Race and ethnicity alone do not determine if a person or population will develop disease, but physicians can use race and ethnicity as a tool to help tailor preventive care.

Celebrating our Heroes

Please help us congratulate Dr. Carol Burke, MD, the recipient of our fall 2012 Personalized Healthcare Hero award.

The Personalized Healthcare Hero award is given quarterly to a Cleveland Clinic employee who demonstrates commitment to the personalized healthcare initiative, embraces personalized healthcare approaches in their daily activities, and advocates for integration of personalized healthcare into the standard practice of medicine. In addition, this individual has contributed to advances in personalized healthcare and supported the specific initiatives and projects sponsored by the Center for Personalized Healthcare. Recipients of this award will be announced quarterly in our E-newsletter and recognized formally once yearly.

This quarter’s recipient is Dr. Carol Burke. Dr. Burke has been a tireless champion of personalized healthcare since she joined Cleveland Clinic in 1993. As Director of the Center for Colon Polyp and Cancer Prevention, Department of Gastroenterology and Hepatology and co-director of the multi-disciplinary Hereditary Cancer Clinic for Cleveland Clinic, Dr. Burke advocates for a personalized approach to care of those at hereditary risk of cancer.

Dr. Burke’s passion is cancer prevention. Dr. Burke especially focuses on drawing the public’s attention to modifiable risk factors for colon cancer – putting the power of prevention in patients’ hands. In addition to countless community talks and other traditional outreach efforts, in 2009 Dr. Burk led the development of Score Against Colon Cancer, a colon cancer risk assessment available to the public through Cleveland Clinic’s website.

Within the medical community, Dr. Burke is committed to encouraging accurate assessment of patient personal and family history to prevent colon cancer. She joined forces with the Center for Personalized Healthcare and the Genomic Medicine Institute to author the Hereditary Nonpolyposis Colorectal Cancer risk assessment algorithm for Cleveland Clinic’s electronic medical record-integrated family history collection and risk assessment tool. This algorithm will bring just-in-time decision support to primary care clinicians serving on the front lines in the battle to prevent colon cancer.

We applaud Dr. Burke for her work, we thank her for her partnership, and we look forward to working with her on future personalized healthcare initiatives.

Ohio Governor Kasich Declares November Personal Healthcare Month

In recognition that preventing disease, diagnosing disease early, and customizing therapeutic interventions provide for better outcomes and quality of care for individuals, often times at a lower cost to patients and the healthcare system, Ohio’s Governor John Kasich has declared November to be Personal Healthcare Month in the State of Ohio.

Cleveland Clinic’s Center for Personalized Healthcare and Ohio State University Wexner Medical Center’s Center for Personalized Health Care collaborated to request this designation with the goal of bringing more attention to and educating about the impact each individual’s unique biology has on their health, and to recognize that a deeper understanding of that biology may one day help to identify the right, targeted wellness activities that will help all to live longer, healthier lives.

The proclamation includes the following language:

WHEREAS, it is known that preventing disease can often be less costly than treating it after it occurs; and that early diagnosis combined with therapeutic interventions that are customized specifically to an individual patient, can further reduce costs, shorten recovery time, and minimize human suffering; and

WHEREAS, it is known that many of the chronic diseases that are consuming increasingly large portions of our nation’s healthcare expenses can be prevented—or more effectively managed—when responsible, motivated patients, empowered by knowledge and guided by their physicians, take personal action by making healthier lifestyle choices for themselves and their families; and

WHEREAS, it is also becoming increasingly clear that compiling and understanding the details of an individual’s family health history can be a critical part of devising an informed, and focused preventive plan of action to address the health issues that a person is likely to encounter over time; and

WHEREAS, with the deeper understanding that each individual’s unique biology revealed by a focused and personalized approach to healthcare may one day help us all identify the targeted wellness activities that will help us live longer, healthier lives.

Multiple education & awareness events are being planned for the month of November throughout the State of Ohio in recognition of this proclamation. Please refer to Cleveland Clinic Center for Personalized Healthcare’s events webpage for additional information about those events being hosted by CPH.