Professor Dion Morton
Professor Dion Morton, who heads Birmingham’s Institute of Cancer and Genomic Sciences, and leads the regional arm of the NHS’s 100,000 Genomes Project, gives BQ2 an insight into his work.
We’re three years into the project, which will transform diagnosis and treatment for patients with cancer and rare diseases, and there’ve been two major changes. In the West Midlands, we’ve created a new and co-ordinated structure so our 18 NHS hospital trusts can collaborate effectively. The NHS is notoriously complex and its the first time this approach has been attempted. Its been very successful, not least because we’ve introduced a linked IT system, so data and information can be shared in real-time. For instance, I could be here at the QE and look at data for a patient in Hereford.
In some sectors, that might not seem radical, but within the NHS its a huge innovation. Its been an enormous task, but its been embraced by healthcare professionals and managers, and – most importantly – by our patients. We’re all proud that the West Midlands is leading the way, and is the only region where hospital trusts and clinicians are working together so efficiently.
The second change has been the ability of the healthcare fraternity to use genome data to diagnose very rare conditions for the benefit of patients and their families. Some are so rare that previously a doctor might only see one or two cases in their career, but now we can develop and introduce genomic-led treatments for these patients.
Being able to tackle rare conditions will be huge, because although they’re very small in terms of patient numbers, they probably account for 20% for our total healthcare budget.
The genomics project is equally important for treating cancer, because its a condition driven by genetic changes in the footprint of an individual’s DNA, so only by looking at the whole of that DNA can we determine what has changed. You could even define cancer as a rare disease, because each one has a subtly different footprint. As we make further advances into genomics, the treatment of cancer will evolve because we’ll identify new and individual treatment pathways.
This project’s progress also underlines how the NHS itself is evolving. For the last century, medicine has been about the study of disease under a microscope, but in the last 20 years, the focus has increasingly been at the tissue level (DNA), which has been a profound change.
Now, thanks to our growing understanding of genomes, we’re starting to predict the onset of diseases, rather than waiting for them to happen. Medicine is moving into prevention and genomics is central to that transition.
Healthcare costs year-on-year tend to increase, largely for demographic reasons, but genomics offers a change to reduce costs because it tells you which therapies won’t work. For example, in my speciality of colorectal surgery probably 90% of patients who receive chemotherapy after surgery will receive no benefit. However, genomics will allow us to pre-determine which treatments which will – or not – work for individual patients.
So, we’ll have a tremendous opportunity to rationalise the use of medicines, rather than simply accumulate them. Driving down the cost of identifying a whole-genome sequence has been crucial. It cost around US$2bn to identify the first, but now it can be done for few hundred dollars.
We’ll also be able to develop novel and targeted therapies, which will substantially reduce the cost of treatment. In short, genomics offer a unique opportunity to transform how healthcare is delivered. Such progress couldn’t be achieved outside the NHS, where genuine collaboration can be achieved, as we have demonstrated.”