Building a Conduit For Clinical Genomics

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In the 1930s, as the United States was struggling to recover from the Great Depression, a series of public-works projects were undertaken that provided infrastructure, which in turn led to the emergence of the United States as a world power. Hydroelectric projects, such as the ones depicted by artist William Gropper, sought to control devastating flooding and harnessed the power of rivers great and small to produc e inexpensive electrical power that was distributed through a network of public utilities, transforming the country.

Metaphorically, it is the task of researchers, clinicians, and informaticists to begin to harness the vast power of the genome. Our field must learn to take the data generated from sequencing the human genome and transform it into clinically useful information. Through the application of filters and protocols coupled to databases of annotated genes, we must strive to deliver clinically relevant information to patients and their providers via electronic health record systems. We envision the day when the flood of information is controlled and used to improve health outcomes for all through clinical utility and public health.

Building a dam also creates a reservoir that can be used for recreation, and, indeed, the early use of genomics has consisted of recreational dips into the gene pool.

We now know that dams bring not only benefits but harms, including disruption of ecosystems and, when breached, the very catastrophes they were meant to prevent. Likewise, we recognize the potential perils of genomics, including breaches of privacy, incidental findings, increased costs, and the real risk of inundating the health-care system with a flood of information it is ill prepared to deal with.

Gropper studied with Robert Henri and George Bellows, founding members of the “Ashcan School,” which led to the first truly American artistic movement, Regionalism. His style was influenced by his work as a radical cartoonist, and—like that of other iconic Regionalists, such as John Stuart Curry and Thomas Hart Benton—his work always had an undertone of social commentary. Construction of the Dam is free of his usual depictions of injustice, instead showcasing the drive and intensity of the workers. Although those working to implement genomic medicine rarely exhibit the bulging muscles and hard hats of Gropper’s construction gang, we approach our work with the same drive and intensity, infused with the Regionalists’ sense of social justice for all. —Marc Williams, MD, Guest Editor