Schafer: Computer power fuels advances in medicine

Physician John Logan Black has been in the field of genetic testing for more than a decade. As co-director of the Mayo Clinic's personalized genomics laboratory, he remembers when it was "a dream" to one day be able to provide physicians with individual genetic tests so they could prescribe the right drugs.

That dream has been realized — years early. Mayo and the Minneapolis venture firm Invenshure late last week announced the formation of Oneome, which provides just that service.

Lots of things made Oneome possible, perhaps none as fundamental as what's under the hood of the computers now stacked in a server rack in a Mayo building in Rochester — what Invenshure partner Danny Cunagin called "a big data platform."

In 2014, off-the-shelf computers running yet another big data application rarely make news. That's the amazing part, just how few people appreciate just how mind-blowingly remarkable having that kind of capability really is.

That was the powerful message delivered in Minneapolis recently by the Silicon Valley writer Michael S. Malone, author of a new history of Intel Corp.

He made a convincing case that the Intel trio of Robert Noyce, Gordon Moore and Andy Grove put the technology industry on its 50-years-and-counting trajectory of ever faster and cheaper digital devices. It's because of these three that tasks once only conceivable in an advanced research lab have by now become routine.

Malone focused his talk on the remarkable history of Moore's Law, named for scientist and Intel co-founder Gordon Moore.

When Moore put out his now famous three-page article in April 1965, Intel was still years away from its founding and the global integrated circuit market was tiny.

"Integrated circuits will lead to such wonders as home computers — or at least terminals connected to a central computer — automatic controls for automobiles, and personal portable communications equipment," he wrote.

An integrated circuit is what most of us know as a computer chip, made from the building blocks of tiny electrical switches and amplifiers called transistors. Doubling the transistors and then doubling them again and again is exponential growth, and here was Moore predicting that it would continue.

He was later proved spectacularly right, of course, and his "Moore's Law" observation was so powerful that it came to guide the research and development at Intel and much of the rest of Silicon Valley.

That, in turn, is why the beat-up Apple iPhone 5 that routinely seems to fall between the seats in my car is said to be a thousand times faster than a mid-1970s Cray-1 supercomputer, a brilliant piece of computer engineering that tipped the scales at about 5.5 tons.

Meanwhile, in Rochester the Mayo Clinic was developing its capability in individualized medicine, including what Black described as a thorough collection of data about why people react differently to common medications.

The blood thinning drug warfarin is a good example of one that is both widely prescribed and far from uniform in how it affects people. Commonly known by the brand Coumadin, it's metabolized in the body by an enzyme coded in human genes as CYP 2C9.

In some people the enzyme is slightly different, and the result is this drug could stick around, thinning the blood, for a long time.

"So I am part of a group that's getting its genotyping done," Black said. "Lo and behold, if I start taking the usual dosage of warfarin, I will be at risk of bleeding to death. If I take warfarin and I bump my head, I might bleed into my head and be a vegetable for the rest of my life. Which would be short."

There are lots of drugs that produce a different outcome depending on who takes them. The reasons vary, but the point is that most of that can be figured out with a sample of a patient's genetic material and some computing power.

"If I had been prescribed a drug, I would not be taking it unless I have done this test," said Kopischke, who is serving as CEO of Oneome. "My eyes have been opened up."

The partners agreed that they needed to provide a service that would be easy to use for physicians, as genetic information can be complicated even for them. Oneome creates a report with a green section that has drugs that can be prescribed without any concern, with yellow and red sections for drugs the doctor had better use caution in prescribing.

Black envisions a day not that far into the future when people routinely get a full genome sequencing done. The data would become part of their electronic file at the clinic or even be carried on smartphones.

Cost is still a barrier. The first commercial direct-to-consumer service launched in 2007 at $350,000, and Black said today the cost is between $7,000 and $8,000. It's conventional thinking that it becomes practical once it falls under $1,000.

Carrying around your full genetic makeup on an electronic device is just one application enabled by half a century of exponential growth in capability launched by the Silicon Valley pioneers.

Studying what the Intel founders started "isn't about the past," he said. "It's about the future."