Dr Calum MacRae, MD and Associate Professor at Harvard Medical School, speaks to Namrata Devikar about how genomics can help in preventive measures for cardiovascular diseases.
Q. What is genomics and how it can help the Indian population?
A. We had worked for many years looking at the role of sequencing the genome in managing the patient care. One of the things we have realised that it is useful for how you think about your health as well as testing when you actually become sick. It is very well aligned with the Indian culture as it is all about one's well-being.
Genome testing at the start of your life is a better option than waiting until you fall sick. Genome sequencing is done at the moment largely in two key areas, one is cancer and the other is cardiovascular diseases (CVD). In cancer, it helps to determine which drugs should the patient be given when it comes to curative measures. And for CVD, it helps to understand who is at risk for CVD as in many instances it goes through the family. In this case, you have to wait to happen. The treatment is now becoming very specific and they have particular treatment.
Q. Where does India currently stand in this kind of research?
A. There is a track record of activities in India but I am not certain if it is at par with the other parts of the world. However, the reason behind this may be that technology takes a while to migrate. And it also depends on the attitude of the healthcare provider. In United States of America (USA), we have noticed that one of the most important things is to educate physicians and other providers so that they can understand genetics and interpret that accordingly to help the patients.
In our hospital, every cancerous tumour is analysed quickly to interpret what drugs would be most beneficial. This should also start in India as it helps to take better care of the patients.
Training physicians and clinicians is important as they are the ones who will interpret the genome for the patients.
Q. On the policy level, how can the government intervene?
A. Former president Obama started 'Precision Medicine Initiative' to recruit a million patients to get their genome. I think Indian culture is more focused on maintaining wellness. And the mindset is also well aligned towards well-being and so analysing genome to prevent one from becoming unwell resonates with culture. The test has to be done once and it can be given more and more information. Updating the report is very important. The partnership between the lab, the physicians and the patients can make it easier. But genomics is still a growing area and I am hopeful that the government will start this for the people here very soon.
Another interesting thing is that analysing genome reduces your overall expenditure on health check. In the USA, there is 'undiagnosed diseases programme' where people are not able to find the particular diseases which keep them unwell. And through the genome, many have discovered that considerable cost of their overall health check-ups is reduced as the analysis involves predicting the disease and the expenditure is just once.
Q. Do we need more awareness about genomics in India?
A. Prevention is the best part of genomics but it can also help diagnosis. In addition to this, it can also tell which treatment will be better for the patients. So it is critical to have public awareness. Patients are driving this moment in the USA. And more awareness is needed here. To add further, the fact that genomics reduces overall health expenditure is also beneficial from a monetary point of view.