Using genetics and other individual characteristics—such as environment and lifestyle—to choose targeted treatments for disease is an emerging approach in medicine. President Barack Obama encouraged it when he announced the Precision Medicine Initiative in his 2015 State of the Union address. However, patients, policy-makers, and many health care providers may know little about precision medicine. That’s where Colleen Campbell, PhD, MS, CGC, comes in. Campbell is a board-certified genetic counselor and assistant director of the Iowa Institute of Human Genetics (IIHG) in the University of Iowa Carver College of Medicine.
Q: What is IIHG doing to help Iowans benefit from precision medicine?
A: When the institute was formed in 2012, the Board of Regents charged us with two missions: educating all Iowans on human genetics and also engaging and exciting the next generation; and bringing precision medicine— along with more genetic tests— to Iowa. Because of the technical expertise at the university, the easy part for us is developing new genetic tests. We can develop and launch a new test within months. The hard part is getting people to use it, to have the test integrated into care, and to really change medical practice. For example, our pharmacogenetic test for the drug clopidogrel can tell, by analyzing DNA from a blood sample, if a patient metabolizes this blood-thinner. Thirty percent of patients don’t, making it ineffective. By knowing this information in advance, physicians can select a different therapy for their patient. However, if providers do not understand the test, they will not order it or use the results to aid in patient care.
Q: How is IIHG educating physicians?
A: For UI Health Care, we’re working on integrating genetic tests and educational information into the electronic medical record, developing just-in-time learning modules on our website, and also holding seminars to educate and empower providers to know when to order a given test to get the answers they need. I counsel physicians about genetic tests and how to implement these new technologies into their practices. Genetics is changing so rapidly, most physicians didn’t have this when they were in training. And you need to educate the entire health care team— nurses, medical assistants, pharmacists, the front desk staff, and anyone else coming into contact with patients.
Q: What are the biggest hurdles to bringing precision medicine to Iowa?
A: Getting insurers to reimburse for genetic testing and genetic counseling will be our biggest challenge. Following that will be the personnel. For example, we need more genetic counselors (Iowa currently has 14) to help explain tests and treatments, to help with the delivery of test results, and to help the health care team and patients understand the results. Other states are using telemedicine, which would be a great way for genetic counselors to reach rural Iowans, so we’ve been talking about how to set that up in Iowa. And we need more bioinformaticians to help us interpret the data into results that are clinically relevant.
Q: How can Iowa grow the workforce involved in precision medicine?
A: UI Hospitals and Clinics is actively recruiting more genetic counselors to the state, especially in cancer, obstetrics, cardiology, and neurology. The IIHG also has hired several bioinformaticians to help with data analysis. The institute hosts events related to careers in human genetics, bioinformatics, and genetic counseling to inspire the next generation. We have an eight-week summer internship where undergraduates rotate through genetic counseling clinics at UI Hospitals and Clinics, or work with a bioinformatician. We’ve heard from genetic counseling master’s programs that our interns are doing more in the clinic after eight weeks than students in some graduate programs do in their first year. All three of our interns from last summer were accepted into every master’s program for which they interviewed, which was very exciting. This is a long-term investment in our future, and hopefully we can recruit these students back to Iowa once they become genetic counselors or bioinformaticians.
Q: How did you get into genetic counseling?
A: Growing up in Iowa City, I was exposed to many careers in the health sciences. When I was in high school, a few people mentioned I might enjoy genetic counseling. Throughout college and for two years after I graduated college I shadowed genetic counselors in Indiana and at UI Hospitals and Clinics. Those experiences solidified my desire to become a genetic counselor. The IIHG Genetic Counseling Summer Internship is modeled after the experiences I was fortunate to have when I was an undergraduate. After I obtained my master’s degree in genetic counseling, I returned to Iowa to complete my PhD in molecular genetics. The mixture of both skill sets is really a fantastic combination in the era of precision medicine