Plenary - New Frontiers in Preventive Medicine: From Faster Cures to Faster Health
Wellness and prevention, fueled by precision and prediction
As health care moves increasingly from treatment to prevention and from reactive to proactive care, new opportunities and challenges are emerging for researchers, companies and consumers. However, true preventive medicine doesn't start in the doctor's office, but in everyday life, with habits and behaviors and on a truly personalized level. Intersecting with this shift toward wellness are precision medicine -- which centers on test, treatments and solutions that are tailored to the individual, rather than the masses -- and predictive health care, which allows clinicians to anticipate probable diseases before they materialize in a patient.
A panel at Partnering For Cures discussed these shifts in health care in Tuesday's first plenary session. As moderator and Executive Director of FasterCures Margaret Anderson said in opening remarks as she kicked off the conversation, "It's not just about prevention, but about precision health."
Behavior is key to wellnessIt was on the behavioral side of this new age of medicine that Kelly Close, who founded the diaTribe Foundation, focused her opening remarks. She noted that 30 years ago, when she was diagnosed with type 1 diabetes, the diagnosis rate was one case for every 180 Americans. Yet, even as medical research has advanced considerably over the decades, the diagnosis rate today is much higher: one case for every 11 Americans. "The science isn't the problem, it's all the pieces around it," she said. "We need to focus on behavior changes, public attitudes and the stigma surrounding certain diseases like diabetes."
Joe Selby, executive director of the Patient-Centered Outcomes Research Institute, echoed Close's focus on changing behaviors, which he said the evidence supports. However, necessary behavior changes to support health include more than lifestyle choices: Consumers also must be proactive about getting screenings, particularly those who are at risk of a condition. A few years ago, Selby was involved in a big data study that looked at the efficacy of a new type of colorectal cancer screening. The results were clear. "The test dramatically saved more lives than any other type of colorectal cancer screening," he said, but a "precision medicine approach to screening," that tailors screening approaches to the individual can yield even more benefit.
Even as precision health technology advances, lifestyle remains critical to wellness, said Michael Milken, chairman of the Milken Institute and founder of FasterCures. When Michael was diagnosed with prostate cancer, he was given 12 to 18 months to live. His condition was worse than that of any of his relatives who had died of cancer, which led Milken to ask: "What could I do differently?" He focused on his eating habits. "I decided I wouldn't eat anything except fresh fruit and vegetables." The lesson from his experience? "There's a link between what goes into your body and what happens medically," he said.
The financial implicationsThere are broad implications for behavioral changes to support wellness, Anderson said: "If we can take some of the savings we incur from behavioral changes, if we can keep people healthier longer, we can reinvest that money in research. But why aren't we?"
Lloyd Minor, dean at Stanford University School of Medicine, picked up that point, noting that health-care organizations need to prioritize behavioral, social, and environmental factors into their overall budgets. "Spending in the U.S. health care system is focused on a very small part of the pie," he said. "We can and should be investing more on changing behaviors at the patient level, but the biggest share of our health care dollars is spent treating the most advanced stages of diseases."
Change isn't straightforwardGreat strides have been made in establishing a wellness mindset in the last few decades, Selby said. "American diet and smoking has improved dramatically in recent years," he said. "We also use seat belts, bike helmets, ski helmets – things change." But he noted that a lot of this change has concentrated in the upper income brackets of society. "We wind up with a health-care landscape that is spread like the income gap," he said, adding that "mortality is increasing among lower economic whites in America."
Milken argued government actions can spark behavioral change to support wellness. He cited Mexico's recent tax on soft drinks, which he said has decreased soft drink sales by 10 percent. However, returning to the lens of personalization, Milken cautioned that applying the same wellness principles to individuals with different bodies does not always have the desired effect. For example, research on prostate cancer shows that diet changes for unhealthy men can dramatically decrease the growth rate of tumors. "Yet with healthy men, diet didn't affect the growth rate for a quarter of them," he said.
The role of data and technologyAnd that is what precision medicine is about. While we know that certain behavioral changes both at the individual and organization level can substantially improve health outcomes, technology has progressed to a point where we must expect more. Esther Dyson, founder of Way to Wellville, argued that too often the technology we have is being put to "frivolous use." She emphasized the need to innovate technological solutions that put patients in control of their own care, in the framework of precision medicine. "We want to give people the tools to manipulate themselves," she said. "Everyone knows their blood type, but no one knows their glucose levels."
And data points like that pose challenges of their own, Selby noted. "Reaching a precision medicine approach will take more people, very big data," said Joe. It will also require major strides in electronic health record technology, which right now is inadequate for fueling precision medicine research and the delivery of precision medicine itself: "The EHR have a long way to go before they serve patients or have the capacity to do research."