Vertigo, nausea, headache, fatigue, confusion. For years someone close to me has experienced severe and periodic bouts of these symptoms. It's clear something is wrong and yet, despite countless tests and visits with specialists in cardiology, neurology, ophthalmology, pulmonology, otolaryngology, and immunology, no one has been able to figure out what that something is. At one of his last appointments - to the great disappointment of this patient and (perhaps even more so) his worried and frustrated wife - my loved one was gently told that he may have to face the very real possibility that he'll never get a definitive diagnosis.
Unfortunately, this patient is far from alone: Plenty of people are living with mysterious symptoms that affect their quality of life (or worse), and it's not uncommon for patients with rare diseases to have waited years for their diagnosis. With this in mind, the National Institutes of Health launched in 2008 its Undiagnosed Diseases Program, a pilot program designed to "provide answers to patients with mysterious conditions that have long eluded diagnosis" and "advance medical knowledge about rare and common diseases." (Since that time, 600 children and adults have been evaluated, and approximately 100 patients were given a diagnosis.)
Now, the program is being expanded into the Undiagnosed Diseases Network, with the NIH announcing last week that six medical centers - including Stanford - will be joining and contributing local medical expertise. The NIH will work with experts from these centers (including Euan Ashley, MD, PhD, Stanford's principal investigator) to, as described in a release, "select from the most difficult-to-solve medical cases and together develop effective approaches to diagnose them." The physicians will "collect and share high-quality clinical and laboratory data, including genomic information, clinical observations and documentation of environmental exposures," and they'll "benefit from common protocols designed to improve the level of diagnosis and care for patients with undiagnosed diseases."
In our online story on the network and the $7.2 million grant that Stanford received, Matthew Wheeler, MD, medical director for the grant, notes that “Stanford was chosen for our informatics expertise, our experience with clinical interpretation of whole-exome and whole-genome data, and our scientific potential to follow up any lead.” As my colleague Erin Digitale further explained:
The team will use cutting-edge genomics and medical phenotyping techniques to diagnose patients, and will also aim to understand the underlying biology of patients’ conditions so they can generate targets for new therapies, Wheeler said. “We aim to make a deep dive into each patient’s biology,” he added.
By the summer of 2017, each new clinical site is expected to see 50 or more patients per year. Referring clinicians can submit applications on behalf of undiagnosed patients on the program website.
Previously: Using crowdsourcing to diagnose medical mysteries, New search engine designed to help physicians and the public in diagnosing rare diseases and The road to diagnosis: How to be insistent, persistent and consistent
Photo by Adrian Clark