A call for the medical community to support reforms for the rapid adoption of new scientific breakthroughs in personalized health
David Ewing Duncan
Director, Center for Life Science Policy, University of California at Berkeley; Author of Experimental Man: What one man's body reveals about his future, your health, and our toxic world
Modern society is on the cusp of a vital new era of health care, one in which medicine will shift from primarily addressing illness to a greater emphasis on prediction and prevention, improved diagnosis, and on individualized care. This historic transformation comes from a deepening understanding of biology and new technologies, and a rising demand for individuals to understand and take charge of their own health.
The promise of this new era of medicine is for healthy people to get a personal snapshot of their bodies—organs, cells, DNA, proteins, and a whole molecular universe of other tiny structures—cross-referenced with environmental input. Indeed, changes in diet and lifestyle, in medications, and in other treatments will be tailored to an individual's specific profile.
In fifteen to twenty years, a visit to the doctor will provide a profile of a person's entire body, which will reveal hundreds or thousands of bits of data—all of which can be seamlessly integrated by a computer into a health scorecard. Eventually, this information may be downloaded onto handheld devices—perhaps a modified iPhone or Droid loaded with personalized health apps—that will contain detailed information about our physiology, genetic proclivities, and safe scans of our brain and body. The device will input real-time environmental data about what we are exposed to as we walk around, eat, and work: levels of mercury and benzene, say, and exposure to UV rays.
This personal stream of information will be referenced against massive global databases to come up with a constant and dynamic assessment of not only a person's health status, but also risk factors for health and disease based on choices in diet, medications, procedures, and lifestyle.
But turning this vision into an everyday reality depends on overcoming a number of obstacles.
First, the U.S. health care system is dominated by one-size-fits-all medicine, in which care is focused on diagnosing and treating disease, and drugs and protocols are focused more on averages and populations than on individuals. A small but illuminating example: Cholesterol scores are treated the same by physicians, even though the significance of the scores depends on an individual's genetics and physiology.
Second, despite almost $1 trillion of spending on life science research and development in the public and the private sectors this decade (twice the amount spent in the 1990s), there has been a sharp decline in the number of drugs approved by the U.S. Food and Drug Administration—from a peak of fifty-three in 1996 to an average of twenty-one a year between 2005 and 2009. One reason for this unexpected outcome is a failure of biomedicine to translate the unprecedented discoveries in basic research into drugs and other products, and the resistance of new technologies such as genomics in the clinic.
To mobilize support for reforms and for the rapid adoption of new scientific breakthroughs in personalized health, luminaries in the life science field have signed a "Personalized Health Manifesto."
Third, the medical system today invests considerable time and resources on basic research and on creating an ever-more-specialized phalanx of experts. While this research has produced critical insights into human health and disease that has made this burgeoning age of personalized health possible, there is also a downside. The research has encouraged a parsing of knowledge and a silo effect that has made it difficult to integrate discoveries into a systems and holistic approach that is necessary for translating findings into real-life applications.
"Scientists are so caught up in doing the best science that they are failing to translate that science into anything useful," said Intel CEO and Parkinson's disease activist Andy Grove.
To mobilize support for reforms and for the rapid adoption of new scientific breakthroughs in personalized health, luminaries in the life science field have signed a "Personalized Health Manifesto." It calls on the biomedical community, policymakers, patients, and society to:
- Understand and acknowledge that this new era of prediction, prevention, and personalized health is upon us, and to promote philosophical and structural changes to optimize its timely adoption;
- Promote a new system of health care that emphasizes the whole human organism as much as its parts, and individual patients as much as populations;
- Restore a balance between reductionist and specialized science, and the need to integrate discoveries into systems and larger trends; and
- Create a comprehensive and dynamic plan to develop and implement a new life science paradigm focused on personalized health.
An important consideration for this new age of personalized health is to use new discoveries and protocols to not only improve health, but also to reduce medical costs. Eventually, the hope is that personalized health technologies will be available globally, in both the developing world and developed countries.
Shifting to a health care paradigm that embraces healthy wellness and personalized health is a formidable challenge, one that will take many years. In the meantime, the goal is to use all the available tools to promote predictive and preventive health for people before they get sick, and then to use science to target disease when it comes. The end result will be people living longer and healthier lives around the world.
To read the entire "Personalized Health Manifesto," go to www.kauffman.org/manifesto.
