Sesame Street fans remember Cookie Monster saying “. . .Me want cookie!”. At the 72nd Annual Meeting of the American Academy of Dermatology in Denver, two of the plenary lectures that at first glance might seem to be coming from different poles of the expanding universe had an identical message: Not “more cookies” . . . but “MORE (and better) DATA!”
Jack Resneck, Jr, MD of the University of California San Francisco School of Medicine addressed the need for more and better data on how dermatology is practiced to ensure that care is delivered effectively and efficiently and that dermatologists are being appropriately compensated for their efforts. He emphasized that data are going to be necessary and that dermatologists should require that decisions be data driven and that dermatologists be involved in the generation and analysis of this data. One might argue that this is advocating for the fox guarding the hen house, but DATA — when excellent and complete — may save both the fox and the hens.
Starting from a molecular perspective, Lynda Chin, MD (MD Anderson University of Texas, Houston) inferred that reducing health disparities and improving inadequate or less-than-optimal medical care requires more and better DATA. The data in the studies she recounted emphasized the molecular and biological heterogeneity among cutaneous melanomas. Her experience creating large data warehouses for clinical, biological, and therapeutic data sets was a compelling path to the future. She clearly showed that multiple agents to treat individual cases of melanoma may be the evolving new norm based in the molecular biology of lesions and cross-talk and interactions between molecular pathways.
The entire village of medicine will be necessary for these studies to succeed. Molecular studies are often technology -based, and although errors that may creep in, their data integrity can be high and seems straightforward. Capturing the essential clinical data on patients, especially when multiple clinicians are involved, could be much more challenging — and even more so when an international consortium is involved. Capturing retrospective data on historical nutritional and environmental exposures for individual patients represents an additional complexity. How credit will be distributed for participation in studies, in terms of publication, tenure, time for academic affairs, salary, and bonuses, will be issues the academic and medical care systems must address. Will the cookie be in so many crumbs that the bits will not be very appetizing to those necessary for successful and useful studies?
Since conclusions are often tentative, and they are moving targets considering anticipated additional DATA, the role of the individual patients and their physicians in deciding what therapy should be used will be the next challenging frontier, and DATA tailored for patient and doctor education will be necessary.
Resneck, JS, Jr: The Future of Our Specialty in a Time of Unprecedented Change
Chin, L: Genomic Medicine: Transforming Research and Patient Care
Presented at the Plenary Session, 72nd Annual Meeting of the American Academy of Dermatology Sunday, March 23, 2014, Denver, CO, USA.