Help me, Obi-Wan Kenobi; you’re my only hope.


“The question we ask today is not whether our government is too big or too small, but whether it works” President Barack Obama, Inauguration Speech, 2009

A wave of change is breaking over the United States. Whether that wave will sweep in a much needed change into a 21st century biomedical system or harden the silos of 20th century paradigms is yet to be determined. One thing is certain, the developing legislation – the American Recovery and Reinvestment Act of 2009 will change the landscape of biomedicine. Two provisions are noteworthy: the Act’s support for electronic health records and comparative effectiveness research. There is substantial investment in both areas. The devil will be in the details. How the noble ideas are translated into action will determine success or failure of the intentions.

The BIG Health Consortium™ represents a prototype of the 21st century health care “system”. Our ecosystem could serve as a model for the Learning Health Care System needed to inform and sustain a stable, knowledge-based system that focuses on quality and effectiveness. The BIG Health Consortium™ is in an ideal position support a 21st century model of comparative effectiveness – molecularly-informed comparative effectiveness. Traditionally comparative effectiveness studies examine average effectiveness based on broad populations. Such broad comparisons do not account for what we now know about the molecular characteristics of diseases and individuals, and the critical relevance of that knowledge in effectively preventing or treating disease. For example, molecular characterization has already elucidated cancer as a family of sub-types that can only be identified at the molecular level. There are a plethora of molecular tests now used in clinical practice that define subgroups and guide intervention and treatment. 21st century comparative effectiveness must include these stratifications to “do no harm”.

The Obama team squarely confronted the realties of the 20th century this week. The Washington Post reported the Obama team found itself in the “Technologic Dark Ages” as it moved into the White House and “encountered” the realities of federal information technology. Masters of the use of 21st century technology, they experienced first hand the labyrinth of policies, procedures, and interpretations that hobble national efforts. Most symbolic was the attempt to separate President Obama from his Blackberry. In what may be the first true victory for 21st century thinking in information technology in the executive branch, the President retained his Blackberry. Hope springs eternal that this enlightened approach to technology will similarly clear the Byzantine barriers that slow the deployment of an electronically-connected, 21st century ecosystem in biomedicine.

“General Kenobi: Years ago, you served my father in the Clone Wars; now he begs you to help him in his struggle against the Empire… This is our most desperate hour. Help me, Obi-Wan Kenobi; you’re my only hope.” Princess Leia – Star Wars.

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