New center will address disparities in ‘precision health’

May 2, 2016, 12:34 a.m.

The School of Medicine is establishing the Stanford Precision Health for Ethnic and Racial Equity (SPHERE) Center, thanks to a grant received from the National Institutes of Health (NIH) last year.

The grant follows a 2015 NIH call for applications for precision health centers focusing on health disparities. The Stanford School of Medicine’s application was accepted, and Stanford received a five-year, $11.5 million grant for SPHERE. The new trans-disciplinary center will draw on expertise from multiple fields within Stanford’s School of Medicine and collaborate with two other centers funded by the NIH.

The ultimate goal of the NIH funding behind SPHERE is to make precision health services universally accessible in the United States.

The Stanford initiative is co-led by Yvonne Maldonado M.D. ’81, professor of pediatrics and of health and research policy, and Mark Cullen, professor of medicine and director of the Stanford Center for Population Health Sciences.

Maldonado, whose research is in global health and pediatrics, explained that precision health is the preventative form of precision medicine.

“Precision” refers to “taking the vast medical knowledge we have and applying it to an individual person,” Maldonado said.

Precision health involves bringing together all accessible information on population health, such as genes, cultural trends and family medical history, for a wealth of information that will allow the SPHERE center to advise and treat individual patients in a more informed way.

According to Maldonado, precision health and medicine is almost exclusively available to upper-middle class Americans at present. Lower-income Americans instead receive reactive care: Because they lack access to medical information, they only seek and receive treatment after an ailment begins.

SPHERE seeks to address these disparities, which Maldonado called “a big problem in the U.S. in terms of healthcare,” by making precision health widely available. As a virtual center, it provides a concentration of information and a way of connecting people.

Maldonado, Cullen and others spearheading SPHERE believe that precision health will be particularly successful at Stanford because of the University’s surrounding communities.

“We have a great diversity of communities here in California, and we serve a lot of these populations,” Maldonado said. “This is an opportunity to build a platform to reach communities […] that might lack access to healthcare.”

He also believes that Stanford is an ideal place for this type of research due to its collaborative research practices.

“Being able to work with other people and other fields is pretty natural here,” he said. “We can help coordinate areas of knowledge and learn from each other.”

To strengthen the relationship with the local community, the NIH’s grant stipulates that SPHERE work with community organizations to determine the most effective way to make its findings accessible and clear to its users. These connections will be overseen by the Office of Community Health in the School of Medicine, Maldonado explained.

SPHERE is funding three specific projects that will start in 2017.

Michael Snyder, professor and chair of genetics, will lead a project looking for biomarkers of rheumatoid arthritis in the Lakota Sioux tribe of South Dakota.

VJ Periyakoil, clinical associate professor of medicine, will lead another project investigating how best to communicate genetic cancer risks to Latino and Asian Americans.

The project will observe how doctors and patients communicate over a one-year period as well as how families respond to information about genetic cancer risk. From this information, the researchers hope to determine how families ultimately make health decisions.

Thomas Robinson B.S. ’83 M.D. ’88 P.D. ’91, the Irving Schulman, M.D. Endowed Professor in Child Health and professor of medicine, will be in charge of the third project. For the past two years, Robinson’s team has been conducting a study on obese children in low-income Latino families in the area.

“I’m the person who brings all these populations together,” he said. “We intervene on them. We do randomized control trials. We change behavior. This, and prevention, is my focus.”

Building on his existing research, Robinson will gather data on clinically overweight Latino youth to find effective strategies for prevention and treatment of youth obesity and related health problems, particularly diabetes.

Robinson’s study provides one example of how SPHERE’s collaborative focus could benefit medical research. Robinson and his team have collected physical data, lifestyle surveys, family history and health information and saved genetic samples. Over the course of the study, they have applied two randomly assigned treatment programs. With SPHERE, Robinson’s project will continue in collaboration with geneticists, including Snyder.

Robinson is optimistic that this cooperation will allow his team to analyze changes in biology over the course of treatment and “learn a tremendous amount more about the biological factors combined with the behavioral, cultural and social factors that determine health and well-being for a group that tends to have a higher risk for poor health.”

According to Robinson, the union of his existing data with the genetic analysis done by Snyder and his team will make Robinson’s research subjects “the most thoroughly biomolecularly profiled population in the history of the world.”

Robinson summarized the goal of precision health as using available data to determine, “What to do? How to do it? To whom, when, and where?” — with the “why” being implicit.  With continued research, SPHERE aims to gather enough data points to answer all of these questions.


Contact Caroline Kimmel at ckimmel ‘at’

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