“People Aren’t One Size Fits All;” Erica Woodahl Pioneers Precision Medicine in Montana
In order for medical research to benefit us, we need to be included in the data that research is based on. This simple idea inspired the All of Us Research Program, the research initiative from the National Institutes of Health (NIH). By gathering health data about one million or more people living in the United States, especially from those historically underrepresented in biomedical research, All of Us will usher in a new era of precision medicine. The goal is to help doctors choose the most effective treatments based on an individual’s background, genetics, and lifestyle. But what does precision medicine look like in real life? What does it look like for Montanans?
Erica Woodahl is one of the first to venture into this new territory in our state. A pharmacogeneticist at the University of Montana’s Department of Biomedical and Pharmaceutical Sciences, she radiates excitement when describing her pioneering work. Born in Montana, she left at 18 to pursue her studies and returned in 2007 to begin a unique research project: studying how the genetics of Native American tribal members might affect their responses to medications.
“It was pretty ‘benchy’ lab work at that point but today it’s becoming more clinical,” she says, explaining how the data she has gathered over the past 11 years are now beginning to bear fruit. Members of the community she works with, the Confederated Salish and Kootenai Tribes on the Flathead Reservation, will know more than ever before about their potential response to a variety of medicines, including life-saving cancer drugs. Their children and grandchildren will know even more.
Woodahl took it slow when beginning to work with tribal people. Some members were skeptical about turning over their genetic data to researchers. She took their concerns seriously and spent time answering questions and building relationships with tribal leaders. Ultimately, the potential benefits of her research to future generations led to a “Yes.” Together, they formed a Community Advisory Board which began meeting in St. Ignatius, Montana to share dinner, discuss recruitment, develop informational materials, and set goals.
With the Tribes’ cooperation, Woodahl began to gather blood samples from willing participants and analyze portions of their DNA. In 2010, she and her collaborators formed a center, the Northwest-Alaska Pharmacogenomics Research Network., and she published her first paper in 2013 about the research.
“What really excites me is that we can take all of this data and look at a person as a whole. People aren’t one size fits all. We won’t all have the same result with a medicine. Some of us might get better, some might experience side effects. Precision medicine can tailor medicine to each of us based on age, genetics, diet, etc.,” says Woodahl.
Cancer treatment is an area where precision medicine is making powerful strides. Oncology medication dosages have to be carefully managed so that enough of the drug is administered to kill the cancer—without killing the patient. “Some people suffer a dangerous drop in their white blood cell count while other people might have recurring cancers,” she explains. If good data is available from precision medicine studies, an oncologist may be able to determine the most ideal dose based on genetic factors. “We used to think cancer was just one disease. But breast cancer might be dozens of different cancers. Some new therapies are more specific to a single type of cancer, with fewer side effects and toxicity,” she explains.
Mental health is a critical area for the emerging field of pharmacogenomics. Which medication is best for a given patient, and at which dose? “For some people, a low dose will be fine, for another a very high dose might be best. Titration and trial and error can take a really long time, especially in a rural state when you have to travel to visit a doctor each time,” says Woodahl.
Precision medicine is rapidly becoming a reality. “It’s moved out of the lab,” says Woodahl. “Doctors are starting to make treatment decisions based on genetic information, but this is mostly in urban areas. How do we set up implementation studies in rural states?”
When will precision medicine be routine care for everybody? This question was asked at a recent conference of the American Society for Clinical Pharmacology and Therapeutics where Woodahl listened in on the discussion. “It could be 10 years for people who are wealthy and urban. Maybe 30 for people outside those areas. That’s not what we want precision medicine to be,” she says. For this reason, Woodahl is excited about the All of Us Research Program, which aims to include underrepresented populations in Montana and across the U.S. People with disabilities are one group that needs to be studied more in-depth in order for treatment decisions to be most effective.
She is optimistic that precision medicine will also help people with specific health issues find each other and categorize rare disorders. “You can break the isolation, meet someone like yourself,” she says.
To learn more about enrolling in All of Us, visit JoinAllofUs.org. Your participation can help move people from underrepresented populations one step closer toward better medical outcomes tailored just for them.