Who Lives, Who Dies: SPIN Doctors Seek Why
The vast and ever-growing bioinformatics data at the IUSM and Regenstrief
Institute for Health Care is cast to play a leading role in cancer
research and treatment.
Why do some individuals survive cancer while others with the same
kind of disease die? One key to survival may be buried deep within
the individual's biological makeup. Digging it out is the task researchers
from IUSM and the Regenstrief Institute for Health Care have set
for themselves, with backing from the National Cancer Institute
in the form of $7.4 million grant.
Drawing on their expertise in medical informatics, they will develop,
organize and test secure databases compiled from cancer cases seen
at Clarian Health (IU, Riley and Methodist hospitals), Wishard,
Community, St. Francis and St. Vincent hospitals. The vast compendium
that results will allow scientists to study pathology findings and
DNA and protein content of stored tissues from ninety-five percent
of Indianapolis' hospitalizations and reported cancer cases. What's
not in the databases is equally important. The technical mechanisms
developed to allow the institutions to share data will strictly
preserve patient confidentiality by deleting information which could
identify individual patients.
Building this machinery and organizing the data is a challenging
task. It involves developing a natural language process, eliminating
duplications, instituting standard-ization, and 'scrubbing' the
data to eliminate person and place identifiers, says Regenstrief
Director Clement McDonald, MD, who also is Regenstrief Professor
of Health Services Research, the study's principal investigator
and an internationally known medical informatics pioneer.
In his role as investigator for the Shared Pathology Informatics
Network (SPIN), Dr. McDonald will lead a consortium that includes
the Indianapolis hospitals, the Indiana State Department of Health
and the University of Pittsburgh. The University of Pittsburgh group,
known for its expertise in pathology informatics, is led by Michael
Becich, MD, PhD.
SPIN builds on twenty-five years of experience with the internationally
respected Regenstrief Medical Records System. RMRS is a database
with more than three-hundred million laboratory results, radiology
and pathology reports, diagnostic studies, operative notes and discharge
summaries. SPIN also draws upon expertise gained from the Indianapolis
Network for Patient Care, a data repository that stores encounter
records and clinical laboratory data for use in care at emergency
rooms citywide.
"When the five-year project is completed, we hope to have
a tool that will allow other researchers to compare DNA, proteins,
and other biological factors to determine differences between the
same tissue with and without cancer, those tissues with primary
cancers and metastasis, and the differing effects of therapy,"
says Dr. McDonald.
This ability to access "de-identified" data from a whole
population will provide future researchers with a unique opportunity
to measure the importance of various factors in a large group exposed
to the same or similar environmental factors.
"Long term cancer survivors have something in their biology
that is different from those who don't survive," notes Dr.
McDonald. "If we can provide the critical tools that assist
in determining what that is, we may enable scientists in the not-too-distant
future to figure out how to alter the biology of the cancer patient,
perhaps by activating or blocking a protein or its receptor, to
save lives.
"This work may ultimately lead to studies resulting in the
discovery of drugs that activate proteins or block receptor sites
for biologic pathways," he adds.
Dr. McDonald also will work with other investigators from hospitals
affiliated with Harvard University and with UCLA. Together these
institutions will develop a mechanism to share their medical data
while strictly preserving patient confidentiality. This will give
many researchers their first opportunity to conduct large-scale
database searches on medical data, asking basic questions that cannot
be answered with small numbers of patients.
Regenstrief Gets New CEO
A primary care physician, educator and noted health services researcher
has been named president and chief executive officer of Regenstrief
Institute for Health Care. Thomas S. Inui, MD, who also will serve
as associate dean for health care research at the IU School of Medicine,
assumes his duties in August.
Dr. Inui has placed special emphasis on teaching and research in
physician/patient communication, health promotion and disease prevention,
the social context of medicine and medical humanities. Health services
research has figured prominently in his career.
"From the very beginning of my career, I have always sought
to do health services research in an environment with outstanding
medical informatics capabilities and a multidisciplinary community
of researchers dedicated to improving health," says Dr. Inui.
"I have clearly found all these elements at Regenstrief."
Dr. Inui currently is the Petersdorf Scholar-in-Residence of the
Association of American Medical Colleges where he is leading a special
research project on teaching professionalism in medicine. He also
is a senior scholar of The Fetzer Institute, a national operating
foundation dedicated to advancing mind-body-spirit integration in
health, education, social action and other arenas. Dr. Inui served
as president and CEO of Fetzer for one year ending October 2001.
He received his medical degree and a master's of science in public
health at the Johns Hopkins University. His internship and residency
were completed at Johns Hopkins Hospital, where he was chief resident
in internal medicine.
|
