|THE AGE OF
by Richard Hellman, M.D.
|If the 21st century belongs to molecular biology and the human
genome, then it belongs equally to bioinformatics, the product of the marriage between the power of the
computer and the life sciences. It is bioinformatics that allows us to analyze the data from the Human
Genome Project, not in decades, but in days. It is also the tool that helps us to analyze the secrets of protein
structure from x-ray crystallography and to aid the pharmacologist in designing new drugs that cure hormonal
deficiencies, fight infections, and shrink cancers.
In the past, scientists in the life sciences were often overwhelmed by the mass of information that needed to be inspected, sorted, analyzed, and then stored. The sheer volume of the information made it as difficult to find the key to a puzzle as finding a needle in a haystack.
Today, with the help of powerful software tools and lightning-fast computers, we can do what we could not do before. No longer do we have to shrink from solving key problems simply because the number of calculations is too huge. As a result, we now have a much deeper understanding of the human genome.
We are also finding ways to make inroads into many diseases because of our power to create images of protein structures in three dimensions. With these new 3-D models in drug development, for instance, we now routinely perform virtual experiments that help us to quickly select the most promising pharmaceuticals from a huge number of possible compounds, thereby paving the way for new advances in many areas of medicine.
The tools of bioinformatics are as spectacular in their way as a rocket booster on a NASA spacecraft. We can search the structure of bacteria for their vulnerability to new medications, then create models of drugs that would, like a key to a lock, fit exactly into the vulnerable area and create havoc within the bacteria that cause disease. And we can do this in only a small fraction of the time that we once needed.
Who will use these tools? Probably a new group of scientists who are as comfortable with computer modeling as they are with the latest methods of molecular biology. This is probably the hottest area of graduate study today and probably will be for a long time to come. The "Bill of Fare" at the most innovative universities will be a "Fusion Cuisine" of bioinformatics, molecular biology, and exposure to the most creative and innovative entrepreneurial efforts in the private sector.
It remains a puzzle as to why the health care industry lags so far behind in the applications of bioinformatics. Perhaps the reason is its sheer size - a trillion dollar industry is not always nimble afoot. On the other hand, it may be because of the serious systemic problems of health care in our country, which, despite being the most advanced scientifically in the world today, is also over-regulated, under-funded, and often unresponsive to true market forces and consumer input. As a result, our health care delivery system is often unacceptably error-prone and unsafe in comparison to many other industries, even aviation. But help may be coming very soon. Modern technology, particularly bioinformatics, could spark a revolution in health care that would rival what is happening in molecular biology and genetics.
I see evidence of this nearly every day in the newer technologies that I embrace in my clinical practice and in my research. I have been called an unrepentant and unabashed technophile. I am guilty as charged. Although a specialist in diabetes and endocrinology, I have also been, for more than twenty years, deeply involved in both original and collaborative clinical research. Practicing physicians, if properly prepared and educated, have a perspective that is often very valuable in research. We are in a position to see the first evidence of clinically important problems and to see first-hand whether our new solutions really have any benefit for the most important person, the patient. Over the past years, as part of a multicenter, international research project, I have been doing collaborative research in the use of an implantable insulin pump. The pump delivers insulin in a more physiologic and accurate way to our patients. This technology has helped us improve the level of glucose control in those with insulin-requiring diabetes, reducing their risk of complications and prolonging their life. More recently, our use of the new technology of implantable glucose sensors - devices that painlessly measure the amount of glucose or sugar in the bloodhas shown us how much glucose control varies from moment-to-moment. The data from this study has greatly improved our understanding of how best to treat patients with diabetes.
But the most important application of bioinformatics to medicine may be the use of the electronic medical record, both in hospitals and in outpatient facilities. In the two years, since we first converted our office practice to a paperless practice, our use of an electronic medical record (EMR) has improved the quality of care in a cost-effective way. Pharmacists can finally read my prescriptions, and the improved clarity makes medication ordering safer. Communication with both patients and other health care providers are better, and our patients are pleased. The ease of my access to my patients' medical information has increased exponentially, making our plans even more thorough. Our documentation is now more accurate and complete, and patient confidentiality has improved as well.
An EMR will not make a bad doctor a good one, or a non-physician using an EMR a safe substitute, but it will make a good doctor better. If improving patient safety is a societal priority, increasing the use of electronic records in the practice of medicine should be a priority as well. As the world-wide-web improves in functionality and internal logic, the medical uses of the web will accelerate greatly, and bioinformatics will become even more important.
Kansas City is well positioned to move ahead in both genomics, other forms of molecular biology, and in bioinformatics. Both in the academic and the private sector, the scientists and their administrators, appear highly motivated to work together to advance the Kansas City effort in Life Sciences. The stakes are high. The most innovative solutions to the problems we face in these areas of human biology will be rewarded richly. The competition will be fierce, but if we can develop the needed infrastructure through the judicious and cooperative investment of both intellectual resources and capital expenditures, the prize may yet be ours.