How will genomic medicine roll out nationwide? Will the USA or the UK get there first?

Thanksgiving, is a nice opportunity for me to embrace my American roots. With my thoughts on the USA, I’ve been catching up on some desk work after last week’s excitement. In particular I’ve been thinking about some of the comparisons and contrasts between the States and my adoptive home here in the UK Particularly regarding who might be best equipped to really integrate genomics into the healthcare system.

Both countries have aspirations to be world leaders in genomics. Both have considerable resources to invest in pursuit of that endeavour. Arguably, the USA has a bit more financial muscle at the moment, but both governments are committed to funding the revolution. And both have some amazing projects. The National Human Genome Research Institute, is doing some amazing work under Eric Green’s direction, in the USA, and Genomics England is undertaking some incredibly ambitious work over here in the UK.

But what about building the infrastructure that will help support genomic medicine on a national scale? That’s going to be a very big problem for both systems. Both have some fantastic sequencing centres, but what about the small regional hospitals that treat the majority of the population?

A lot of work needs to go into building a model where these kinds of centres can make use of genomic information. This will need heavy investment in IT infrastructure and developing processes. Understanding how to integrate whole genome sequencing from a diagnostic perspective is still a major issue from a technical perspective. Then you still need to deal with the lack of expertise. So one of the big questions I’m wondering about is whether a new class of healthcare worker is going to have to be introduced for the genomic era, or if it’s going to require a mass reshuffle to make sure the right people are working together effectively.

While both governments are funding research, there’s not been much said on investing into building that healthcare infrastructure and workforce. At this point I’m not sure which, out of the USA or UK, is going to get there first. Both are making phenomenal strides forward in research. In my view, whichever project starts to change lives in a way that really captures the public’s imagination and support is going to be pivotal in making the case for infrastructure funding.

There’s an argument to say that the smaller country is going to be more agile and be able to make nationwide changes with greater ease. This is certainly true, but if the potential gain is there, then you know things will change. There’s a phenomenal amount of money spent on cancer treatments that only work for 10% of the population. If we get to a point where genomics can tell us which drug to use for which person, it’s going to translate into a potentially huge saving. The key, then, is to find a way to make sure that that saving offsets the investment required to support the roll out, and use, of the technology.

Fortunately, there are strong international efforts in genomics. For the most part, people support open access and information sharing. So I don’t think anyone is going to get there first by any significant margin. I believe that we’re all going to help each other get there together.

Hopefully, that isn’t just some wishful Thanksgiving thinking on my part!