Worcester’s collaborative gene

Enabling a precise vision at the intersection of research, medicine and health care delivery

Good afternoon. It is a wonderful privilege to have been invited by Bruce Gaultney and his colleagues at the Telegram and Gazette to spend some time with you thinking about the future of health care and biomedical research in our community and beyond. I feel especially privileged to be with those our community honors with Vision Awards this afternoon.

At our academic health sciences center, we have strong ties to two of today’s honorees, Dr. and Mrs. Pappas. Arthur was the founding chair of our Department of Orthopedics and is fondly recalled as the surgeon who admitted and operated, in 1976, on the first patient at the newly constructed UMass Hospital. Today, it brings special pride to us that he and Martha are being honored for their lifelong generosity and tremendous contributions to our community. The Pappases are wonderful people. They embody so many of the virtues that we seek to instill in our students: Compassion; empathy; and a deep devotion to caring for patients, especially children. We are grateful for all that they have done for our community, and we join in celebrating them and this year’s other honorees.

Today, I begin this reflection mindful that our city, nation and the world face tremendous challenges. Yet, we can sense great opportunity. But, as realists, we recognize that difficult economic times prevail and that there is a need for change, as we position ourselves to respond to future challenges.

Not long ago, I met a young man who lived with challenging circumstances. Once an enthusiastic athlete, he was now confined to a wheelchair and faced the difficult future posed by ALS. On the evening we met, I spoke of the immense potential of biomedical research and the wonderful privilege it is to care for patients, as we search for tomorrow’s cures. After my talk, this young man’s caretaker approached and asked me to speak with the patient, who clearly understood the realities of his illness, but, also sensed the opportunity that exists on our campus and in our labs. From his wheelchair, with a whisper of a voice, but with great urgency, that young man spoke words I will never forget: “Hurry up, Doc!”

The simplicity of that statement was profound. Those words, his words, entreat, encourage and inspire us.

Half a century ago, leaders in our commonwealth had the vision to turn acres of windswept farmland into our state’s only public medical school. Later, the leaders of our school had the vision to invest in the work of hundreds of promising scientists; among them, a tall, shy, young faculty member studying molecular biologic processes in microscopic worms called c. elegans.

He saw challenges, uncertainty and promise.

Six years ago, that scientist, Craig Mello, and his collaborator, Andrew Fire, won the Nobel Prize in Medicine, thereby bringing extraordinary renown to our institution and our community. In recent years, we have built upon Dr. Mello’s accomplishments to create one of the most advanced biomedical research centers in the world. As you pass our campus today, you see the Albert Sherman Center steadily advancing toward completion. This new structure is tangible evidence of our deep commitment to the next generation of biomedicine and a sign of fulfillment of our vision for the future.

We have received tremendous support from many of you here, and others, as we pursue our vision. Governor Deval Patrick and Lieutenant Governor Timothy Murray championed the creation of a $1 billion Life Sciences Bill in 2008, which led directly to $90 million for the Advanced Therapeutics Cluster here at UMass Worcester. This vision is creating one of the most innovative research centers in the world.

But our story and vision of the future are not just about growth and expansion. We are entering a new era in health care. One driven by breakthroughs in molecular biology and advanced diagnostics that will allow physicians to treat patients based on each individual’s specific genetic makeup, in a data-driven manner. Some call this field “precision medicine.” Already, we are seeing a move toward this approach, especially in cancer treatment, where many drugs are now targeted to specific molecular “drivers” of malignancy. There is a growing sense that this approach may revolutionize the treatment of many diseases.

At the core of this shift is the new emphasis on translational research. Instead of laboratory and clinical scientists working mainly in their own separate worlds, they are coming together in new ways. Findings from the bedside are being brought to basic scientists, giving them a clear path to clinically relevant research. Likewise, results from the lab are much more quickly, but still safely, being applied in the clinic. We are creating new avenues of communication, new opportunities for collaboration and completely new ways of preventing, diagnosing and treating disease.

This is not some pipedream, sci-fi fantasy or earnest wish. The future is fast upon us.

Much of the progress is coming from a surge in new types of data and the ability to analyze it. Our own MiCARD data warehouse already includes more than 400 million data points, including demographics, lab tests, diagnostics, procedures, and medications, for more than 2 million patients. The medical school’s Conquering Diseases Biorepository is expected to receive from donors this month, its 5000th biologic sample. While tissue banks are being established across the country, we choose to give ours a special emphasis on RNA rather than DNA, because of the extraordinary RNA-community we have created on our campus.

Already, researchers are using such tools to investigate the links between symptoms and the biologic processes that underlie them. At the same time, we have remarkable new technologies to analyze our genetic makeup. The Human Genome Project took 13 years and millions of dollars to complete the first human genome sequence. In the coming year, scientists expect to be able to sequence a human genome in a single day for under $1,000.

The time is not far off when patients will routinely have their entire genome sequenced even before they step into their physician’s office for the first time. Their personal genetic “blueprint” will be carefully examined for mutations or other variations. Their entire medical history, securely stored electronically, also will be screened for risk factors that may cause disease or accelerate decline. Their vital signs and other readings will be taken automatically, throughout the day, via everyday tools such as smart phones and iPads. Their caregivers will be able to know instantly about concerning signs or symptoms and will be able to contact the patient to address them immediately.

We can envision a day when monitors attached to blankets will assess our night-time breathing; devices will measure our blood sugar without a needle stick; and our blood vessels can be continuously monitored, non-invasively, to detect and manage hypertension. Provided regular feedback about how poor lifestyle choices impact our heath, more patients may be encouraged to improve their healthy behaviors. We may envision the day when no one smokes; our water is fluoridated, which it should be here in Worcester; and exercise is a daily habit for all. Personal choice and responsibility, after all, is one of the major influencers of health and should become more integral to insurance rating and cost.

Before we prescribe drugs, or recommend surgery or other therapies, doctors will evaluate algorithms that generate lists of potential risks and benefits for a particular patient, giving invaluable information for determining an optimal treatment plan. The large patient data bases I spoke of earlier will be used to analyze patient needs and will constitute one of the most valuable tools for clinical research.

Wherever a patient goes in the world, their data will be accessible instantly. There will be no more missing medical records, many less “puzzling” symptoms, and much more efficient and higher quality patient care.

The leap from translational science to precision medicine is as bold a vision as anyone can imagine. It is as audacious as walking on the moon, as laudable as eradicating smallpox, and as necessary as giving every American the right to an education. If we can fulfill this vision, we will save countless lives; free millions from the burden of pain, discomfort and disability; and help many more people unleash their full potential.

It sounds wonderful, yet remote. But, my firm belief is that Worcester is well positioned to be a major player in the evolution and success of this “next generation” of biomedical research and its impact on medical practice and health care delivery.

In Worcester, we are not observers standing on the sidelines, or even passive beneficiaries testing out the latest innovations. We are at the forefront, working side-by-side with other innovators to create the new technologies, paradigms, and approaches that will make this vision possible. Right here in Worcester, we have some of the greatest scientific minds, at work in some of the world’s most outstanding research institutions, well-positioned to solve some of the biggest problems facing mankind. Our world-class universities and the Massachusetts Biomedical Initiatives, which gives life to start-up companies, will continue to allow even more enterprising scientists to turn their research results into sentinel discoveries and thriving businesses.

The role our medical school can play in this crucial paradigm shift can be profound. With the exceptional talent and expertise we have gathered, we can guide the UMass Worcester campus to even greater renown. Together with Worcester’s other great universities, through the Colleges of Worcester Consortium, we can establish the partnerships, the bonds, and the inspiration within our community that will make it possible for us to create the infrastructure we need, to attract outstanding intellectual capital and to continue our ascent as a vital leader in charting the future of medicine.

This role is apparent on so many levels and in so many fields. For example, on any given day of the week, on our campus at UMass Medical School, a biologist is hunched over her laboratory bench working diligently to unveil the genetic secrets underlying cancer. Across town, a computer scientist at Worcester Polytechnic Institute is designing a smartphone application that will help diabetic patients better manage their disease. And Holy Cross graduates like Anthony Fauci and Joyce O’Shaughnessy continue ground-breaking research that helps us better understand disease processes and mechanisms. These are just glimpses of how the remarkable institutions that make up our great city fuel breathtaking innovations.

Worcester’s world-class hospitals and research enterprises are tackling the difficulties and challenges posed by medicine’s most complex diseases and developing the new technologies and tools that will make it possible to overcome them. We are pioneering such cutting-edge techniques as the application of RNA interference or gene silencing. We have gathered the world’s leading experts in microRNA, a field that opens up an entirely new biological avenue for drug development. Twenty years ago, microRNAs were not even known to exist, and today they offer a uniquely powerful means of affecting entire biological pathways. In 2008, our own Victor Ambros won the Albert Lasker Basic Medical Research Award, which is known as the “American Nobel,” for his work in discovering microRNAs.

We are developing new vaccines, medical devices, diagnostics, imaging modalities and treatment paradigms. Simultaneously, we are unleashing the potential of such sophisticated tools as three-dimensional microscopy and next-generation genetic sequencing, which will allow us to unlock even more of biology’s greatest mysteries, and cure even more diseases.

Worcester’s biomedical research engine is not only tackling major diseases such as diabetes, heart disease, and cancer; but even more, it is one of the key forces leading to the revitalization of our great city.

Looking around Worcester today, we see both the fruits of the city’s noble manufacturing heritage and a bold new economy bursting forth. Once a center of mass-manufacturing, and a key part of the nation’s industrial backbone, today Worcester has drawn upon its industrial legacy, intellectual capital and skilled workforce to become a leading center of advanced manufacturing, while we are simultaneously helping forge whole new fields of endeavor. Clark University hosts an outstanding “green” MBA program, a new field that many expect to be a hotbed of innovation. Becker College has the leading program for game design in all of New England, with broad implications for medical simulation development. Worcester Polytechnic Institute researchers are creating entirely new materials with medical applications and are at the forefront of fields such as neuro-prosthetics, which aim to create much more functional artificial limbs.

These are just a few of the glittering jewels that make up Worcester’s extraordinary educational institutions.

But while all of our institutions play a crucial role in our city and our nation’s future, I believe the centerpiece of Worcester’s economy will increasingly become our extraordinary health care and biomedical research enterprises.

The growth of Worcester’s biomedical sector as a whole has been stunning. Saint Vincent’s hospital has grown from a tiny 12-bed facility into a vertically integrated health delivery system. UMass Memorial Health Care, our region’s largest health facility and our medical school’s major clinical partner, also has earned top ranking for the quality of care provided. These outstanding clinical systems and the clinicians, who practice in them, have helped Worcester provide top-flight care to the region’s patients. Simultaneously, they are laboratories of innovation, pioneering the types of changes necessary to keep our health care system vital. We are at the cutting edge, helping to write the script for tomorrow’s health reforms.

The life sciences industry is unquestionably one of the most vibrant sectors of the Massachusetts economy. NIH-funded research creates skilled jobs and fuels economic growth. New discoveries are the basis of startup biotech companies, keeping us at the forefront of innovation and creating demand for workers at all skill levels. The discovery of RNAi alone has led to dozens of new companies and enabled the work of many others. Our research enterprises and hospitals also support our community. Restaurants, hotels, transportation services and almost every part of the local business community benefit when research funding expands.

This vision of “precision medicine,” where almost every health decision is driven by high-quality and very relevant data, is indeed ambitious, bold and inspiring. But it is well within our reach, as we have already taken the most important foundational steps. We have built the biorepositories and databases, recruited the best and the brightest, made the extraordinary breakthroughs in molecular biology and technology, and created the framework to allow the discoveries to flow.

In Worcester, the collaboration gene is dominant and fully expressed!

But, continued success will require the efforts of our entire community. Everyone in this room today must act and be responsible, for us to fulfill this vision.

To succeed, we need to have among the nation’s highest performing school systems with demonstrated success in teaching science, technology, engineering and mathematics. From grade school on, we need to challenge our youth to think critically, solve complex problems, and feel at ease working with advanced technology, all the while living healthy lifestyles.

We need an infrastructure sufficient to support a thriving biomedical hub. We must assist our city and state leaders so they can help us support a world class airport and continue their momentum in improving our surface transportation systems to better serve our community by connecting us with markets across the country and our state’s capital city.

We have one of the most unique and outstanding concentrations of institutions of higher education in the country. Every one of our colleges has a role to play. Their graduates will help make up the workforce that will inspire and grow the next generation of biomedicine. But these great universities, community colleges, and technical training centers need to collaborate much more closely. For you see, the future of technology, and not just biomedicine, will be about integration.

To accomplish these things, we need to stand behind our elected and appointed officials. Worcester’s leaders are known for their “can do” attitude, determination and willingness to think big. Let us each ask ourselves whether we can “see” the vision? And what specifically we can do to help fulfill and realize it.

The time to act is now. We have momentum, we have the tools we need and there is outstanding opportunity. I am fully confident that we are up to the task.

Will we demonstrate Worcester’s unparalleled spirit by bringing this vision to reality and further our reputation to become a health care destination as renowned as Rochester, Minnesota, where the Mayo Clinic draws patients from around the world? Will we continue to build a research concentration with the potential to be as well known as North Carolina’s Research Triangle? I believe we can and must.

That young man with ALS I referred to earlier, and the many others like him for whom we are privileged to care, are counting on us.