Learning the Language of Medicine to Come

Posted in GUMC Stories

As Abhishek Pandey (M’14) recalls, it was as if, while studying in Spain, “you were told to go study in Russia for a year — and speak the language.” That’s how this fourth-year Georgetown University School of Medicine student describes the year he spent in 2011 working toward a master’s degree in systems medicine at Georgetown. Pandey was one of two students in the first year of the program, designed to teach systems biology approaches that future physicians can apply to biomedical problems. The masters program adds one year of systems-medicine coursework between the second and third years of medical school.

“The language and concepts were completely different. It was as if I had not even gone to medical school,” says Pandey.

What he means is that the program immersed him in a different medical paradigm that underlies an emerging approach to the practice of medicine. This paradigm could be summed up as “omics” — genomics, proteomics, metabolomics, trancsriptomics — all ingredients of what the Georgetown founders of the program dub “systemomics.”

Systems medicine is a personalized approach to health care focusing on the interplay between genetics and the environment with the aim of predicting who is at greatest risk for disease, rather than simply reacting to symptoms.

It will help bridge biomedical research with clinical practice, better enabling physicians to make personalized assessments of disease risk, and to manage patients’ health using individualized diagnosis, prognosis and treatments.

“We recognize that medical care as we know it is changing, and the education we offer the next generation of physicians needs to adapt accordingly. This means providing students the additional skills they will need that traditionally have not factored into medical education, such as systems biology, bioinformatics and computational biology,” says Howard J. Federoff, MD, PhD, the executive vice president for health sciences at Georgetown University Medical Center and the executive dean of the School of Medicine. It was Federoff’s vision that teaching medicine by systems makes sense, because that is how biology works.

Some of the concepts of systems medicine are being steadily integrated into the medical school curriculum to help students make sense of the new era of “big data” and targeted molecular therapies. But Federoff believes the concentrated focus on systems medicine in the MD/MS program “has the potential to shape highly critical graduates who will be exceptionally well-prepared to thrive in this complex emerging health care environment,” he says.

One of a kind

In 2011, Pandey and Brian Perry were the first two Georgetown medical students to enroll in the dual MD/MS program. Two new students have just started the 2013-2014 program. All of the students to date have received stipends and scholarships that pay for the extra year of education. 

The dual degree (MD/MS in systems medicine) they will earn sets them apart from all other graduating medical students — globally.

“As far as I can tell, there is no degree in systems medicine anywhere in the world, except at Georgetown,” says the director of the dual degree program, Sona Vasudevan, PhD. At a recent meeting in Europe where she participated in a workshop in systems medicine, representatives of the European Union asked to collaborate with her and with Georgetown so that they can develop a similar program. “They came to us, saying we are the only ones to have a formal program in systems medicine,” she says.

Vasudevan, an associate professor of biochemistry and molecular & cellular biology, built the program, which she co-directs with Elliott Crooke, PhD, chair of the department of biochemistry and molecular & cellular biology.

“It takes a village of collaborators to make this degree possible, and we have a very wonderful village here,” Vasudevan says. Faculty, staff, administrators and librarians all participate in the development and teaching of the core curricula — courses that include genome informatics, informatics grand rounds, critical readings in systems medicine, biomedical informatics, applied biostatistics, systems biology of diseases, translational bioinformatics, clinical metabolomics and cancer informatics.

The program teaches students to use “big data” to think in a different way about what disease really means, she says.

“It has changed from looking at ‘one disease – one gene’ to looking at disease as a network. For example Crohn’s disease and ulcerative colitis share a lot of common genes. Based on genome-wide studies, we now know that these genes are also related to multiple sclerosis, type I diabetes and rheumatoid arthritis as well,” says Vasudeva.

“So drugs need to be personalized. If a patient has these common genes, a drug that may help Chron’s disease could also negatively affect the nervous system, promoting development of multiple sclerosis or other conditions linked together via this common genetic pathway. So drugs used to treat one condition may affect patients in ways that are totally unintended. This is a challenger for physicians – one we are already seeing in the clinic,” she says.

“In the not-too-distant future, patients will bring their genome on a flash drive to their physician, and the doctor needs to know what to look for and how to deal with all that information,” Vasudevan says.

“Physicians must learn this new language so when they practice e-medicine, they will not be lost,” she says. “This will be a fact, not science fiction.”

“Ahead of the curve”

Now that the MD/MS program is off and running, Vasudevan is preparing for a class size of 20-25 students in the next few years.

Pandey says he learned more than he ever thought possible, and he is still actively engaged in research he started through the master’s program. His assignment was to figure out which patients with stage 2 colorectal cancer can be treated by surgery alone, and which require chemotherapy.

“Generally speaking, we currently believe 80 patients out of 100 can be cured with surgery alone, with the other needing chemotherapy as well. But because we don’t know which patients those are, we give chemo to most, producing a lot of toxic side effects in the process.”

To help solve the problem, Pandey examined gene expression profiles, as well as other “omics” from patient tissue samples to find a molecular signature that predicts benefit from surgery, and a signature that suggests chemotherapy is also needed.

He can’t discuss what he and his colleagues from Georgetown Lombardi Comprehensive Cancer Center have found because the findings may be  published in a peer-reviewed scientific journal.

“I always knew that I wanted to be academic researcher, as well as practice medicine, and this program made me understand what is possible, both in my career and for my future patients,” Pandey says. “Few medical students really understand what systems medicine is and where it is going. I think Georgetown provides a learning experience that is ahead of the curve.”

By Renee Twombly, GUMC Communications