Telehealth Secrets Conference 2018 by VSee Speaker: William P Stanford, MD, PhD, FACP (Genomicity) More info here: vsee.com/conference

1. VSee Telehealth Secrets Conference 2018
William P Stanford, MD, PhD, FACP
Genomicity, CEO
Genomic and Personalized Medicine:
An Overview

2. VSee Telehealth Secrets Conference 2018
Genomic and Personalized Medicine:
An Overview
Definitions
What’s new in genomic and personalized medicine?
Personalized Medicine: Who’s going to want it?
Personalized Medicine: What are the obstacles?

3. VSee Telehealth Secrets Conference 2018
Genomic and Personalized Medicine:
An Overview
Definitions

4. VSee Telehealth Secrets Conference 2018
Definition: Genomic Medicine
Genomic Medicine: An emerging medical
discipline that uses genetic information to
customize a patient’s health maintenance and
treatment plan

5. VSee Telehealth Secrets Conference 2018
Definition: Personalized Medicine
Personalized Medicine: The concept of using
genomic along with an individual patient’s other
molecular, biologic, and physiologic information,
along with knowledge of the individual’s
environment, to customize treatment plans to
maintain health, assist in the early diagnosis and
treatment of disease, and enhance longevity.

6. VSee Telehealth Secrets Conference 2018
Genome
Personalized Medicine: Lots of -omes
Epigenome
Microbiome
Transcriptome
Metabolome
Physiologic
parameters
Mitochondrial
Health
Telomere
Science
Proteome

7. VSee Telehealth Secrets Conference 2018
Genomic and Personalized Medicine:
An Overview
What’s new in genomic and personalized medicine?

8. What’s new in genomic and personalized medicine?

9. VSee Telehealth Secrets Conference 2018
Application of new technologies with
unprecedented success
VSee Telehealth Secrets Conference 2018
Technological advances
occurring at light speed
Costs rapidly
decreasing
Ethics a major concern,
will lag the technological

10. What’s New? Multiple Game-Changing
Technological Advancements
VSee Telehealth Secrets Conference 2018
• Advances in Basic Science and the Understanding of Disease Processes
• Rapid Nucleotide Sequencing, both DNA and RNA
• Epigenome Mapping
• Gene Editing with CRISPR/Cas 9, Individualized Cancer Therapy with CAR-
T
• Stem Cell Technology
• Big Data, Machine Learning, Artificial Intelligence
• Wearables, Telehealth

11. VSee Telehealth Secrets Conference 2018
Genomic and Personalized Medicine:
An Overview
Personalized Medicine: Who’s going to want it?

12. Personalized Medicine:
Who’s going to want it?
Healthy People:
Those that prefer a proactive approach to
healthcare and longevity
Persons that take medications on occasion--
pharmacogenomics
Elite athletes--prediction of athletic
performance and sports injuries
Concern for inherited disease based on family
history
Prenatal testing
Concern for environmental exposures
Wearables that will identify concerning trends
Diet and exercise customization for the
individual based on genome, microbiome and
epigenome
VSee Telehealth Secrets Conference 2018

13. Personalized Medicine:
Who’s going to want it?
Sick People:
Cancer patients--sequencing of the tumor
genomes to identify the precise
derangements and guide treatment
Patients that have simple genetic defects
(Mendelian inheritance) that will be cured
with gene editing. e.g. sickle cell disease,
cystic fibrosis
Patients with certain infectious diseases, for
which relatively simple genetic manipulations
of some of their cells will lead to decreased
morbidity and even cure, e.g. HIV
Stem cell treatments using inducible
pluripotent stem (iPS) cells will be used to
treat a multitude of conditions including
spinal cord injuries and organ repair
Patients that need medications for their
disease—pharmacogenomics to predict
efficacy, guide dosing, and predict side-effects
Solve “mystery illnesses”
Define the actual molecular and cellular
derangements that lead to complex chronic
disease for purposes of precision guidance of
treatments, e.g. atherosclerosis and
neurodegenerative disorders such as
Alzheimer’s dementia
VSee Telehealth Secrets Conference 2018

14. Personalized Medicine:
Who’s going to want it?
VSee Telehealth Secrets Conference 2018
Payors:
Insurance companies that want to avoid paying for treatments that have no chance at efficacy in
an individual patient or would lead to costly complications
Insurance companies that would for example, seek to pay for stem cell therapy rather than organ
transplant or joint replacement
Insurance companies seeking to deny coverage
The government (CMS/Medicare) seeking to have people stay functional and working into their
“golden years”

15. VSee Telehealth Secrets Conference 2018
Genomic and Personalized Medicine:
An Overview
Personalized Medicine: What are the obstacles?

16. Personalized Medicine:
What are the obstacles?
VSee Telehealth Secrets Conference 2018
Privacy:
Genetic Information Nondiscrimination Act (GINA)
GINA prevents discrimination on the basis of genetic information in regards to
health insurance and employment.
GINA does not prevent discrimination in regards to life and long-term disability
insurance.
Who is going to own, control and access your genetic information and what will
they use it for other than healthcare?

17. Personalized Medicine:
What are the obstacles?
VSee Telehealth Secrets Conference 2018
Cost:
Who is going to pay for testing?
How will we integrate genomic information and the needed decision support into
the EHR?
Who is going to educate physicians and patients?
Well designed longitudinal studies will be needed to demonstrate value before
payers will sign on
Machine learning and AI along with massive computing capability needed to fully
leverage genomic and personalized medicine

18. Personalized Medicine:
What are the obstacles?
VSee Telehealth Secrets Conference 2018
Ethics:
Designer babies
Germline editing
Initial access primarily to those that can afford it