Live Long and Prosper
Dr. Noel Rose, director of the Center for Autoimmune Disease Research at Johns Hopkins Bloomberg School of Public Health in Baltimore, began researching the possibility of predicting disease nearly 25 years ago. And since, he’s kept a close eye on the research being conducted at OMRF. His studies have shown that autoantibodies may predict autoimmune thyroid disease in the brothers and sisters of children who have the disease.
“That really got me to thinking about using antibodies as predictors of disease before it is clinically apparent,” Rose says. “And that is what the Oklahoma group did with lupus.”
OMRF’s work, says Rose, “is on the leading edge of predictive antibodies. And if we can begin to identify people at a very early stage before the disease is clinically evident, the chance of using targeted intervention would be much greater.” Intervening before symptoms arise could cut drug doses, shorten courses of treatment and, as James puts it, “help physicians reset the body’s thermostat instead of keeping it turned off for the rest of patients’ lives.”
James, Rose and their collaborators (who come from as far away as Austria) recently presented their findings at the 2007 meeting of the American Association for the Advancement of Science, the world’s largest interdisciplinary scientific forum. That work also was featured in a recent issue of Scientific American, in a cover story entitled “New Predictors of Disease.”
The Next Generation
Will there come a time when you can visit a doctor and learn whether you’re susceptible for disease? In autoimmune diseases like lupus, that day may not be too far off.
“The question is can we do the same type of thing by looking at high-risk individuals for other disorders?” James says. And if so, do we really want to know?
From a public health perspective, Rose warns that such predictive screenings shouldn’t occur until a treatment is available. “If we just have predictors and no way to intervene, that’s not really helping the patient,” says James.
And then there are the insurance issues. If an autoantibody test determines you may someday develop lupus, what information must you share with your insurer? “People have to weigh the consequences,” Rose says. “The insurance company can say, ‘We’ll double your rate or not carry you at all.’ Or you can withhold information. It’s a real problem.”
Many national policy meetings and working groups are assembling to grapple with insurance issues. Their primary focus is to keep early detection from becoming a hurdle to insurability, because this predictive data holds too much clinical value to ignore. “We’re identifying biomarkers that can be detected in the bloodstream before a patient experiences an active flare of a disease,” says James. “If doctors treat these flares proactively, they potentially can be averted, and that can prevent damage that can’t be reversed.”
James’ research has been cited on CNN, MSNBC, the Fox News Network, as well as in The New York Times. This work has played a key role in advancing the new frontier of preventive medicine, a world not so far from what she saw on Star Trek as a child. So what’s next?
“I guess I’ll just look forward to the day when I can fly to OMRF in a car like George Jetson’s,” she says, smiling. Or maybe Scotty will just beam her to work.