The 4 Ps: Quantifying Wellness and Demystifying Disease
P4 Medicine has two major objectives for every individual—quantifying wellness and demystifying disease. The quantification of wellness will become increasingly important over time, ultimately becoming the focal point for most individuals.
Predictive and Preventive
In 10 years everyone will have his or her genome sequenced. “Actionable genetic variants,” those whose identification opens the door to a course of action that will improve physical health or relieve anxiety—will drive forward the acceptance of the complete genome sequence as a part of the individual’s medical record. In addition, P4 Medicine will make blood a window for assessing health and disease. Organ-specific proteins found in the blood will be analyzed in a longitudinal manner across the individual’s life. Changes in baseline measurements at the molecular level will enable early disease warning.
Systems analyses provide insights into the dynamics of disease-perturbed networks, which is a critical step in moving the focus of P4 Medicine from disease to wellness. A new “network-centric” rather than “gene-centric” approach to choosing drug targets will employ multiple drugs to “re-engineer” a disease-perturbed network to make it behave in a more normal manner. Scientists at the Institute for Systems Biology are now exploring this possibility in microorganisms. This could make drugs more effective—and far less expensive—because there will be a rationale for the choice of drug targets and their perturbations by drugs.
Moreover, P4 Medicine will be able to predict the potential future emergence of disease-perturbed networks in patients and then design “preventive drugs” that will block the emergence of these disease-perturbed networks and their cognate diseases. A systems approach to the immune response will, in time, provide a deep understanding of how to create effective cellular as well as humoral immune responses—and enable the development of effective vaccines for scourges such as AIDS. Stem cells will provide powerful possibilities in the future for replacing damaged cellular and even organ components (as well as being powerful tools for understanding disease mechanisms and stratifying disease). Finally, the digitalized data defining the quantized self will provide powerful new insights into optimizing wellness for the individual.
On average, humans differ from one another by about 6 million nucleotides in their genomes. Therefore, each person is genetically unique and must be considered as a unique individual—not as a statistical average. We must take into account that individuals vary in ways that significantly impact effective treatment. Individuals should each serve as their own controls to determine when their own data reflect transitions from health to disease.
There is a growing sentiment that observations on single individuals may collectively provide fundamental new insights into the disease (or wellness) process (the experiments where patient number N equals 1) that may open up powerful new approaches to more effectively address the individual patient and aggregate the useful data they generate.
The existing healthcare system is not well positioned to exploit the new capabilities of P4 medicine. Today, physicians as well as pharmaceutical and medical device companies are compensated solely for delivery of specific procedures and products. As a result, they have limited financial incentive to deploy new innovations to predict or prevent disease or to maintain wellness. Further, the healthcare industry is locked into financial and regulatory models based on large-scale population studies that ignore crucial genetic and environmental exposure differences between individuals.
Although demand for change is emerging as the medical profession faces the looming challenge of increasingly being compensated for outcomes as opposed to service delivery—the most important demand for change will emerge from newly activated and networked patients and consumers. Collectively, they will constitute a vital new stakeholder group in P4 Medicine. It will be dramatically different from the passive recipients of expert advice, characteristic of pre-digital medicine. In fact, activated and networked consumers will do more than demand more effective healthcare–they will help lead the changes necessary to achieve it.
P4 Medicine will respond to these growing demands by providing patients and consumers with actionable information which they can use to improve their health. This information can be cost-effectively mediated by clinical institutions using wellness coaches and genetic counselors in addition to physicians. It will be conveyed largely through digitally linked social networks, the most important of which will be family networks. As an example, one effective strategy may be to identify family members who are the most active in setting familial health-related standards and in caring for members with health problems—and then to guide those highly activated people to help them be more effective.
Ultimately patients and consumers will be recognized as not only a source of disease problems to be solved but as a source of disease and wellness solutions as revealed by their data. Creative new forms of engagement with these active participants in healthcare—as opposed to passive recipients of expert advice—will become a major source of value tapped by the healthcare revolution.
Networked and activated participants will find new ways to adjust diet and exercise to move their biomarkers in the direction of better health. Crowdsourcing these problems will yield many benefits. For example, researchers will be able to correlate behavior changes with biomarker impacts, genomes, medical histories and other key parameters. Such data from millions or even tens of thousands would provide researchers with deep insights into the effects of nutrition and exercise that have never before been possible. These large scale personalized data sets would be the basis for the quantization of wellness, providing society with a far more effective understanding of the effects of diet, exercise and sleep on highly stratified population sectors.