Thinking healthcare inside and out

There is a small town in USA that is actually a public laboratory: Framingham.

The observatory study conducted  to collect data from the population involves the Framingham Hearth Study (FHS). This study permits to explore how habits, trends, diet and activities can influence health and explain social problems and realities.

Founded in 1948, the project already entered of a third generation of participants in 2002.

FHS contributed to discover hundreds of new genes and major hearth diseases risk factors: body mass index, blood cholesterol, cigarette smoking, blood pressure and glucose/diabetes. Practically it’s all about what we need to know is important to avoid in life, to age healthily. This success story represents a model of the importance of the epidemiological studies and can inspire to a better approach of clinical research design.

Medical research needs to propose in vitro or animal models to explain human diseases. To bridge the gap from theory and human models, for instance in a biological mechanism that is relevant to human cancer, researchers have to link statistical association of a gene expression marker (a signature) to a biological mechanism found in experimental systems to actual disease outcome in humans.

Recently a study showed that for example in breast cancer the expression of many random genes can correlate with the proliferation rate, which is prognostic in this disease (1). This is an astonishing result if we think of the costs of the research projects on finding new genes as candidates to be used as markers for a disease!

The time calls for looking at ways and priorities to improve healthcare systems especially in relationship to the cut of costs affecting our national financial plans. The uses of epidemiology and other methods in defining health service needs and in policy development could help to reshape the priority of healthcare systems devoted to prevention more than treatments.

“The placebo effect is one of the most fascinating things in the whole of medicine. It’s not just about taking a pill, and your performance and your pain getting better. It’s about our beliefs and expectations. It’s about the cultural meaning of a treatment.” (Ben Goldacre)

Enjoy the TED talk of Ben Goldacre !

References:

1.  Most random gene expression signatures are significantly associated with breast cancer outcome. Venet D, Dumont JE, Detours V. PLoS Comput Biol. 2011 Oct;7(10):e1002240. Epub 2011 Oct 20.

A blog by Nadia Ceratto