(Oct. 24, 2016) Eric Dishman was diagnosed with a rare form of kidney cancer when he was in college. He was given two to three years to live. That was 23 years ago.
Today, Dishman is very much alive and cancer-free, thanks to early access to precision medicine practices that helped identify the most effective cancer treatment for him. He is currently directing "All of Us," known as the Precision Medicine Initiative Cohort Program until October. A $215 million White House initiative, All of Us is intended to create a database of at least 1 million US health records to "revolutionize how we improve health and treat disease," including psychiatric disease.
Because One Size Doesn’t Fit All
Dishman recently described the initiative and what it holds for mental illness in a briefing for the Alliance for Research Progress, a panel of advocacy organizations the National Institute of Mental Health convenes regularly.
"In medicine, we are always looking for that one-size-fits-all drug, but we are all individual," Dishman told Alliance members. Treatments may be effective for some patients but not for others. "Currently, our studies and data are too limited for us to understand what it takes to effectively individualize treatment for health and mental health conditions."
By assembling the world's largest biomedical database of health conditions and analyzing them quantitatively, the hope is to lay a data-based foundation for such individualized therapies. "What does the power of 1 million people's data give you?" Dishman posed. "What can you learn about mental health issues from it?"
The National Institutes of Health (NIH) says All of Us "will not be focused on a specific disease, but instead will be a broad resource for researchers working on a variety of important health questions." Precision medicine already has been successfully used to treat some cancers, such as Dishman's. "This cohort will seek to extend that success to many other diseases, including common diseases such as diabetes, heart disease, Alzheimer's, obesity and mental illnesses, as well as rare diseases," according to the agency.
What Does "All of Us" Hold for Serious Mental Illness?
Dishman told Alliance members that data from the initiative could create a "platform" to inform trials of targeted therapies for diseases, including schizophrenia, bipolar disorder and depression. The premise is that the data will provide an "unprecedented resource for researchers" to identify factors that influence health and disease, with the end goal of more effectively preventing and treating illness.
Last week's Research Weekly described research that illustrates the approach. A team from six US universities used statistical modeling to integrate behavioral markers of psychosis, like the ones contained in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), with biological markers that can be identified and measured. From the analysis, the researchers identified three distinct "biotypes" they said were superior to the DSM for classifying psychotic disorders. With more precise diagnosis, more precise and effective treatment is projected.
Once All of Us enrollment (projected by the end of 2016) begins, anyone in the United States will be able to volunteer online or through a participating healthcare provider organization. Providers in Arizona, California, Illinois, Massachusetts, Michigan, Minnesota, New York, Pennsylvania and Texas already have received funding to begin recruiting volunteers.
Participants will be asked to contribute a range of data about themselves by completing questionnaires, granting access to their electronic health records, providing blood and urine samples, undergoing a physical evaluation and sharing real-time information via smartphones or wearable devices. "Participants will have access to their study results, along with summarized data from across the cohort. All of this will be accomplished with essential privacy and security safeguards in place," according to the NIH website.
Widespread participation by individuals with psychiatric disease and their biological relatives will improve the likelihood that All of Us can produce meaningful findings for individuals living with serious mental illness. Federal follow-through with data-driven psychiatric treatment trials and other research will be needed to translate the initiative into better outcomes for people with serious mental illness.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- National Institutes of Health. (7 October, 2016). Precision medicine initiative cohort program - Frequently asked questions.
- National Institutes of Health. (24 February 2016). Participation: A role for everyone.
- Fuller, D.A. (20 October, 2016). "Biotypes: An alternative approach to psychiatric disease diagnosis." Treatment Advocacy Center.
- Clementz, B. A. et al. (April 2016). Identification of distinct psychosis biotypes using brain-based biomarkers. American Journal of Psychiatry.
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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