The Harvard Biomarker Study's big plan.

Clemens Scherzer is caught between centuries. As a researcher-clinician, and one of three co-directors of the Harvard Biomarker Study, he spends much of the time with his eyes fi rmly on the future—personalised medicine for people with Parkinson’s and Alzheimer’s diseases. But he is also a practicing neurologist at Brigham and Women’s Hospital, MA, and as such has weekly reminders of just how urgent the need for progress is. “I see Parkinson’s patients every Thursday or Friday”, he tells The Lancet Neurology. “The questions I get pretty much every time I’m in the clinic, and which always make me squirm, are ‘Doctor, how am I doing? What’s my prognosis for the next few years? Am I responding well to my medicines?’ Unfortunately, in Parkinson’s we just don’t have the answers to any of these questions. It’s essentially 19th century medicine.” At present, assessment for Parkinson’s disease is based on a physical exam and clinical history, which are then used to monitor disease progression. These assess ments are not only unspecifi c but also highly variable, diff ering from day to day and from neurologist to neurologist. Alzheimer’s disease, too, lacks a simple defi nitive diagnostic test. “We want to transform this process from a symptoms-based approach to an approach focused on the molecular disease process”, he explains. “The future neurologist will not only do the clinical exam, but will also ask patients for a blood sample, a lumbar puncture, and will run these specimens to assess DNA, RNA expression, and metabolite profi les, and will be able to see the exact molecular disease process of his or her patient.” His interest in this idea was sparked back in 2003, during a number of conversations with Peter Lansbury, a colleague at Brigham and Women’s Hospital who 2 years earlier had set up the Laboratory for Drug Discovery in NeuroDegeneration, part of the Harvard NeuroDiscvovery Center.