There are certain ideas that hover in the ether, hinting at some perfect future where our cars will fly and robots will fetch our slippers. Personalized medicine is one of these - an idea that someday, somehow, we will all enjoy customized medical care that keeps us healthier and enables us to live better and longer. In the meantime, though, we're stuck with the healthcare we have now: an inefficient system with cookie-cutter predictions and trial-and-error treatments.
Part of the problem, so far, is that personalized medicine has often been understood as mostly about drugs - specifically, the idea that one day pharmaceuticals will be tailored to us, individually. This has been slow to happen. Aside from a few cancer drugs like Gleevec and Tamoxifen, the science of pharmacogenomics (the term for matching drugs to specific genetic traits) has been largely a disappointment. And until more personalized drugs emerge from the pharmaceutical pipeline, the thinking goes, personalized medicine will remain a pipedream.
But personalized medicine isn't just about drugs. It's also about data - our personal data, the stuff in our medical records, as well as less clinical information like how much sleep we get or how often we exercise. All this data can personalize our healthcare right now, today - it can be worked back into the equation of how we care for our health, improving decisions like what we eat, how to reduce our risk factors for disease, and what we get tested for (and when). When you start thinking about our healthcare this way, it starts to look like a series of choices, opportunities we have to make better decisions to affect and improve our health. Line all these choices up in sequence from prevention to diagnosis to treatment, and it takes the form of a Decision Tree - which is what I've called my forthcoming book.
Consider, for instance, Lose It!, a free diet tracking tool for the iPhone. Just click on what foods you eat, and the software, using a database of thousands of foods, can calculate the calories and nutritional value of your meal. Choose a weight loss goal and the app will calculate how much you can eat each day to get you there. The easy, engaging tracking tool has become one of the iTunes stores most popular apps.
Or log on to EPSS, short for the Electronic Preventive Service Selector. Based on recommendations by the U.S. Preventive Service Task Force, this free tool (it also comes in iPhone and Blackberry versions) uses a few bits of personal data - your age, your gender, whether you smoke - to crunch a personalized list of recommended screening tests. (Turns out for someone like me - a 41-year-old non-smoking male - there are 10 recommended tests, and 17 not recommended).
Or take a look at Nike Plus, the ingenious exercise system that lets runners track not just how much they've run, but also how many calories they've burned, and how close they are to accomplishing personal exercise goals. More than five million people have discovered that tools like Nike Plus not only make exercise more fun, they also make it more productive.
In this respect, it turns out that personalized medicine is already here. Personalized medicine is what happens when we go online and do our own research at MayoClinic.com before we check in with our doctor. It's what happens when we use iPhone apps to monitor our exercise or weight. And it's what happens when we ask our doctor for our lab test results, and then work with her to make a treatment decision (instead of just leaving it up to them). These tools and opportunities are just the tip of the iceberg though, the first signals of a new mode of healthcare, where individuals will be able to readily track their health and control their healthcare.
Now all this talk about data and statistics can sound intimidating. After all, not all of us are math geniuses, and most of us don't go looking for ways to brush up on high-school algebra. But it doesn't have to be all that scary. After all, we've already gotten used to dealing with numbers and statistical information in all sorts of situations. We manage to handle interest rates when we take out a mortgage. We're quick to calculate prices during a 30 percent Off sale at Macy's. And in our health, many of us already mind our cholesterol level, our blood pressure, and other numbers. If we can handle the math in balancing our checkbook, certainly putting these same skills to work for our health shouldn't be beyond any of our reach. Personalized medicine isn't something that happens to us; it's something that we have to choose to engage in. And the thing is, that's not as hard as it sounds.
Of course, engaging patients is only half of what personalized medicine is about. The other side of the coin requires that healthcare itself get better, in the form of better research and more patient-friendly clinicians. Medicine must be able to deliver more tailored, patient-specific predictions, diagnoses and treatments. This means that geneticists need to keep interrogating the human genome for the links between our DNA and disease, so we can identify our risks earlier. It means biochemists and molecular biologists need to keep spelunking for the biomarkers in our blood that can turn up a disease in its earliest, most treatable stage. And it means that healthcare providers - our doctors, nurses, and nurse practitioners - need to be trained to engage with more informed patients who may be bringing self-generated research and records to the doctor's office.
Thankfully, both components of personalized medicine are making rapid progress. Patient empowerment, long paid lip-service but given little heed by a medical profession steeped in paternalism, has made great strides in recent years, bolstered by the Internet and other consumer technologies. Genetics, proteomics, and other molecular sciences have all made stunning advances the past decade, fueled by bioinformatics (the combination of huge data sets and massive computing power). The pieces are coming together, and personalized medicine is starting to take shape.
In the coming weeks, I'll be sharing some ideas here at the Huffington Post for how personalized medicine is playing out, right now, today. As is so often the case with new tools, engaging in personalized medicine right now takes some work; it's still a piecemeal experience that demands diligence and initiative. But for those willing to do the work and make the effort, the returns can be nothing less than better health and a better life.
Thomas Goetz is the executive editor at Wired Magazine, and holds a master's in public health. His book The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine comes out in February. You can follow him on twitter and read his Decision Tree blog.
Follow Thomas Goetz on Twitter: www.twitter.com/tgoetz
Thomas Goetz: Cancer Is a Preventable Disease -- So Why Don't We Prevent It?
Beth Comstock: Treating The Patient-Doctor Disconnect
Thomas Goetz: How To Make Better Decisions For Your Health
Dr. Cindy Haines: Why Patients Are Gaining More Power
Personalized medicine - Wikipedia, the free encyclopedia
Personalized Medicine Moves Beyond Cancer, Entering Heart Care and ...
Pharmacogenomics: When drug treatment becomes personalized ...
ObamaCare Threatens Personalized Medicine
Report: Personalized medicine market to reach $452M by 2015
PwC Report Warns Drugmakers of Potential Tax Pitfalls of Personalized Medicine
Personalized Medicine Market To Grow 11% Annually
Pharma's Next Big Thing: Personalized Medicine
Health Care: Understanding Functional Medicine
Most Western diseases are acquired through injuries to your autonomic nerves at different times of life. Often by straining during defecation, straining during childbirth, trauma, surgery, etc These injuries make you susceptible to infection and other noxious agents e.g. stress, tobacco, alcohol, drugs and medication. Prevention relies on a proper diet, bowel habit, exercise, childbirth, posture and gait. I am in the Mankowitz /Weil/Ornish/Esselstyn/Harkin camp. This view is published this month as "Autonomic denervation and chronic Western diseases" in peer review.
See www.bristolanatomycourse.co.uk for this view of prevention. Is there any vested interest in US healthcare that I have not offended ? - BIG FOOD, PHARMA, INSURANCE, POLITICS, MEDICINE, etc.
No - I think I got them all.
In the 30 years of genome research we have had NO insights into the primary causation of any Western disease. The enthusiasts want to go on spending billions of dollars doing "genome-wide translational studies" or "post-genomic interrogation of SNP intercalated sequences" - but there is no reason to believe in genes for most diseases.
As to not being able to be tested by RCT, theoretically there is no problem. Homeopaths prescribe remedies, subjects randomly receive the remedy or a placebo and you measure the subjects reaction. Of course, we'd like to see a measurable difference from a physical test, such as blood test, but we understand that homeopathy doesn't do physical changes well.
Some of these tests and variations have been done. Small scale, poor quality tests have favored homeopathy. Large scale, good quality tests have not found a benefit beyond that of placebo.
http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article3798760.ece
Vaccination: Older than homeopathy, much much more natural than homeopathy (homeopathy uses arsenic) and unlike homeopathy, it works.
they rest of us are forced to buy a shady, shoddy product with no price caps and JAIL if we refuse to add to the coffers of companies who make money by denying care.
XML (http://en.wikipedia.org/wiki/XML) ,
XML schema (http://en.wikipedia.org/wiki/XML_schema) ,
XForms (http://en.wikipedia.org/wiki/Xforms),
Dita (http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture) and
web-services (http://en.wikipedia.org/wiki/Web_service)
(savings Director Orszag's 700b, no medical errors) which are IETM Class V compliant documents (http://en.wikipedia.org/wiki/IETM) that when filled out are checked for accuracy and completeness in real-time and saved to a third-party (local telecom, savings malpractice 100b). The workbooks are created, maintained and continuously updated (always learning) by the regional Health Information Technology Research Centers, CDC, NIH, FDA and HHS in conjunction with the Healthcare Industry to provide an effectivity rating for the different treatments, the ability to produce a prognosis and cost of treatment in real-time. Senator Sanders 400b in administration costs would be greatly reduced because the forms are already filled out and there's nothing to deny. DOD for their interactive-electronic-training-manuals are already using these technologies the CBO can score the savings.
The second is that when it comes to Health matters I prefer the budgetary model of HHS rather than relying on private industry which is paid for through upgrades or ads.
The workbooks can be thought of as extremely customizable computer programs, an example would be the electronic 1040 tax form which is a pdf.
Sounds nice. But it won't cure anyone.
Why do people go to doctors?
To tell them what's bothering them, what hurts.
No one at home will listen or there is no one
at home TO listen.
If it ain't broken, why do you need a doctor?
I know.
Lot's and lot's of "Well, my Aunt's, Well, my father's,
Well, my husband's and Well, my child's".
So, why did this member of your family or this friend
choose to get sick? Or, perhaps the better question
is 'why did this person choose this particular way to
show their displeasure' with something happening
in their life?
Show some compassion. Try asking them. Give them
"personalized care" instead of medicine.
UNTIL health becomes a
not-for-profit concern.....
this thinking must change
before anything else can change.......
Robert
Care bill, the pros and cons, it struck me that what is actually being
done here is the creation of a bill that will insure that people continue
to get sick. This bill is a road map to the illnesses that will be available
to the people.
Do a survey now, what people go to doctors and hospitals for now, the
top ten reasons (Huff 'n Puff LOVES the Top Ten of Everything!)--cancer,
HIV, gout, sniffles, STD's, stress, texting thumbitis, elongated noses,
infected tattoo or piercing, collengen overloads or whatever, the
numbers should be available. And once this bill is passed, in whatever
form, wait five years, and then compare the reasons for going to a doctor
or hospital in five years to the reasons given now. The new, 'socially
acceptable', reasons will change to reflect the bill.
Good health is free.
From my frame of reference, what we need is primary prevention - avoiding the development of disease in the first place, thus also avoiding the medical community, except in the case of accidents or injury. In other words, the goal of primary prevention is that you never have to set foot in a doctor's office or a hospital or take a drug. Primary prevention is an anathema to the medical business model, so it is not taught in medical school. In fact, it is not even a recognized discipline.
The beauty of primary prevention is that it does not have to be personalized. For example, I know of no living species where diet varies by individual. A cat anywhere in the world is an obligate carnivore. A cow anywhere in the world is a grass-eating herbivore. Nature has evolved each species to live a long healthy life by following her directions. Unfortunately, we have lost our owner's manual.
For one example of a program of primary prevention for all humans (designed by nature, not the medical community), see "The Wellness Project" or "The Original Diet."
Roy Mankovitz, Director
http://www.MontecitoWellness.com
The point I am trying to make is that we have the tools today to follow a program designed to keep us healthy regardless of whether we are a winner or an other. The only penalty to following this approach is that those who actually are winners will be following a lifestyle that is more restrictive than was required.
The other approach is to continue as is, hoping that personalized medicine will materialize within our lifetime in a way that will actually benefit us. However, bear in mind that if personalized medicine actually did lead to illness prevention, doctor's offices, hospitals and BigPharma would eventually become ghost towns. I believe it is naïve to expect such an outcome.
Is this the point?
Standardization (ie., "cookie cutter medicine") is an application of Management Science (nee Taylorism, Fordism) that enables health care to be provided to the masses with tremendous economy of scale ~ perhaps 80% of public maladies can be remedied (or otherwise prevented) via refined Standard Operating Procedures and Generic pharmaceuticals, requiring only "Nurse Practitioner" level skills.
One innovative feature of 21st century health care will be the de-criminalization of "medicine," that is: self-directed health care, where people can acquire "medical know-how," diagnostic test "kits," and "pharmaceutical remedies," etc., without the archaic notion of "a prescription" = permission from the State for a person to heal themselves.
Another innovative feature of 21st century health care will be the proliferation of malady : remedy know-how through the mass media means of Social Networking; this being a 24/7 "conversation" involving patients and physicians, professionals and general public participants from all over the globe, resolving health care dilemmas to "This is what we know so far," and "This is what we know works best," as archaic medical prose noise and duplication of efforts (constantly having to re-invent the wheel) are resolved into ever more refined, FAQ -like knowledge bases.