What We Get Wrong About the Future of Medicine

What We Get Wrong About the Future of Medicine
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Why you should care

Because incurable diseases like diabetes and Alzheimer’s could soon become a thing of the past. 

Medical breakthroughs have always served as beacons of hope. We pin our optimism to findings that might eradicate — or even reverse — the diseases we fear most. Over the past couple of years, looking to genes to determine predisposition to illness and disease has been lauded as the big answer in a new era of health care. But is it really the key to unlocking the future of medicine? Ask some of the world’s top doctors and they’ll tell you the future is already here. “Twenty-first-century medicine is going to revolutionize health care,” says Dr. Leroy Hood, senior vice president and chief science officer of Providence St. Joseph Health. “And the real game-changer is big data and a systems or global approach to disease.”

Hood is among a group of scientists pioneering health care driven by technology, big data and systems-driven strategies that aim to more effectively decipher human disease and create wellness. For Hood, this concept led to the idea that care should be “predictive, preventive, personalized and participatory” — what he calls “P4 medicine.” By collecting, analyzing and quantifying massive amounts of data about a patient, including the individual’s genome and microbiome, doctors can now analyze and suggest what actions to take to improve wellness and avoid, or ameliorate, disease. This is where environmental factors, diet and lifestyle come into play.

“The real key is to identify the earliest disease transition and learn how to reverse it at that earliest stage,” explains Hood. “That is the preventive medicine of the 21st century.” He says that in principle, doctors can now reverse diabetes if diagnosed at that earliest stage — and soon, hopefully, they’ll be able to do the same for Alzheimer’s. In the coming years, Hood predicts, that will apply to many more diseases, including cancer.

Our genes are our destiny? According to a number of experts in the field of genomics — actually, no.

So, does this mean our genes are our destiny? According to a number of experts in the field of genomics — actually, no.

“A lot of people think about the genome as something passed down from our parents as DNA, but it’s just sheet music,” says Dr. Joel Dudley, director of the Institute for Next Generation Healthcare at the Icahn School of Medicine at Mount Sinai.

“I think genomics is really overblown,” adds Hood, who says too much focus on genetics can create “one-dimensional” care. “People should get a test, but they should be given information on what the genome is and what it really means. To say you have a 70 percent chance of getting, say, Alzheimer’s, is a crime. I think you want to have wellness coaches to explain what these possibilities are and what the tests mean.”

“When we talk about genetics, I’m not focused on a specific gene,” says Dr. Raphael Kellman, director of the Kellman Center for Integrative and Functional Medicine. “What I’m interested in are the genes that code for different enzymes — that play a major role in our overall health and origins of our health.”

“One thing is to identify a gene,” says Dudley. “It’s changing minute by minute. Genes can be activated or deactivated in seconds. The function is very dynamic. That’s where the big data comes in; you have to measure it.”

Dudley and his team at Pillar Health are taking that idea one step further, launching the doctor’s office of the future. Using artificial intelligence and millions of measurements, they are building a new type of clinic.

Pillar Health will leverage longitudinal sampling and in-depth measures of a person’s blood, genome, microbiome, metabolites and environment to reveal altered or missing molecular components needed to accelerate wellness. These components of what he calls “precision wellness” can then be prioritized, customized and ordered online for each individual. Arivale, a Seattle-based company that launched publicly in 2015, offers similar data-based guidance. In the two years since it introduced this innovative approach — which includes personal coaching services — Arivale has received widespread attention from both the media and individuals looking for a newer, smarter approach to wellness.

Personalized medicine is really the medicine of the future, the medicine of today,” explains Kellman. “No two people are alike, even when it comes to disease. No two cancers are alike. We are so different, and there are so many levels that play a role in the development in any disease. Cancer is not just a tumor, it is systemic metabolic disease.”

For Kellman, understanding the microbiome, the trillions of bacteria in us, is one important key to unlocking good health. “They aren’t the bad guys, they are the good guys. They play a major role,” he says. “It’s like a grand conductor. No two microbiome is the same. A healthy microbiome for one person might not be healthy for another. It is all about the person.”

So, where does that leave us? While we’ve made great progress in using genomics, according to these doctors, we’re really just getting started.

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