The zeal of the recently initiated – Robert Green
After retraining as a medical geneticist, Robert Green has never looked back. Today, he is one of the leading lights in the journey towards genomic medicine.
Those of you who made it out to the very first Festival of Genomics in Boston last summer, will probably remember Robert Green for his brilliant turn as chairman on the main stage. He is one of the most recognisable faces in the field, and is involved in several ground-breaking projects. We were fortunate enough to book some time in his demanding schedule to find out how he found his way into the exciting world of medical genetics.
FLG: Your CV is impressive in the scale and the quantity of achievements and projects that you are currently involved with. I think it’s safe to say that you are one of the main forces driving us towards an era of genomic medicine. When did you first decide that medicine and indeed medical genetics was what you really wanted to devote your professional life to?
RG: Well my story is unusual in that I began my career in neurology and ended up specialising in the area of Alzheimer’s disease. Gradually over the years of working in that area I became convinced by the data that Alzheimer’s disease was a genetic illness, and as that became clear I ended up working in genetic epidemiology of Alzheimer’s disease looking at environmental and genetic risk factors, including helping to lead one of the largest family studies of Alzheimer’s disease that had been conducted at the time as well as a number of clinical trials in treatments for Alzheimer’s disease that were unfortunately not successful.
This experience in epidemiology, genetic epidemiology and clinical trials was critical for the next phase of my career. At about this time in the 1990s APOE was identified as a genetic risk factor for Alzheimer’s disease, and I got very interested in the question of whether family members who wished to know their APOE genotype would be in some way harmed or potentially even helped by learning this information. At that time the prevailing opinion, expert opinion to some degree, was that it was not advisable to share such information with people since there was no medical treatment available for Alzheimer’s disease. But this really seemed wrong, to not allow people to have knowledge about themselves if they really wanted it.
So late in the 1990s we began a series of randomised clinical trials called the Risk Evaluation and Education for Alzheimer’s disease (REVEAL) Study, in which we examined, in a very rigorous way, what the impact of disclosing APOE for risk of Alzheimer’s disease to people who want to learn that information was. We ended up being funded for 15 years in a series of four separate randomised clinical trials involving over a thousand individuals, and our major conclusions were that among people who truly wanted this information, there appeared to be no actual harm and a number of benefits from learning the information even though there were no medical treatments at the time. And so in the course of the REVEAL Study we helped coin the term ‘personal utility’, and we examined in some detail people’s perceptions, reactions, recall and importantly their medical, behavioural and economic outcomes associated with learning about genetic risk information.
I was then so excited about the promise of genetics in medicine that I stepped away from my position as a full professor of neurology and retrained as a resident in medical genetics. With the knowledge and experience that I gained through that training we expanded our empirical studies in translational genomics into direct-to-consumer testing and genome sequencing in adults and new-borns.
FLG: Genomic medicine is something that you’ve really thrown yourself into. Is there anything else you can see yourself having picked as a career that you would have been just as passionate about?
RG: Well, early in my career I was passionate about neurology and cognitive neurology, but in my mind the brain and the genome are both two of the most exciting frontiers in the future of medicine. So, it just seemed natural for me to transfer my enthusiasm for neurology and cognition through the venue of epidemiology and clinical trials into this new arena of genomic medicine. I come to it later in my career than most, but with the zeal of being recently initiated!
You can read the rest of our interview with Robert on page 18 of the ACMG special edition of Front Line Genomics magazine.
More on these topics