BOSTON—Wellness is difficult to define or measure, for both rheumatologists and their patients. However, wellness should be our ultimate goal as we move into the future of medicine, said Leroy Hood, MD, PhD, president of the Institute for Systems Biology (ISB) in Seattle.
Bold New Direction
This paradigm shift won’t be easy, because scientists are conservative and reluctant to embrace change, Dr. Hood said.
“Most biologists were firmly opposed to the Human Genome Project, as was the National Institutes of Health!” he noted. “I realized then that biology departments of the future needed to be cross-disciplinary to develop the analytical tools we needed to process all the data.” Medicine embraced technology and engineering, and new diagnostic and treatment tools were the result, Dr. Hood said.
In 2005, Dr. Hood and his organization articulated their concept of systems or P4 medicine: predictive, preventive, personalized and participatory. By 2008, he began a strategic partnership with the government of Luxembourg to develop new, systems-driven technologies with a $100 million investment over five years. In 2013, Dr. Hood and his team proposed the 100K Wellness Project, a longitudinal, digital, Framingham-like study of 100,000 well participants to analyze their genetic data, laboratory test results and lifestyle factors, such as smoking and diet, to create disease-risk profiles.
Using a cloud-based, systems approach, rheumatologists could one day match patients to proper drugs for their conditions or identify new drug target candidates.
This ambitious project seeks to examine healthy people to determine their disease-risk profiles and help develop early diagnostic tools to stop chronic disease in its pre-symptomatic stages. “We will begin to generate for every person a virtual cloud of billions of multi-scale data points,” he said. “We will use a systems approach to blood diagnostics, transforming blood into a window to distinguish health from disease” by identifying blood biomarkers for numerous conditions.
Using a cloud-based, systems approach, rheumatologists could one day match patients to proper drugs for their conditions or identify new drug target candidates, he said.
Demystifying Disease
P4 medicine brings patients into a more active role in their own care than they have ever had before, said Dr. Hood. Technology and social media drive this change.
“Consumer-based networks are important for medicine. Inform patients about new technology. Let patients do the crowdsourcing. Social networks are a powerful wedge and a driving force in transforming health care,” he said. “P4 is about quantifying wellness and demystifying disease.”
In the next decade, Dr. Hood foresees a wellness industry will develop to outreach the current healthcare industry focused on disease and treatment. “I think the wellness industry will be transformative. We will investigate wellness-to-disease transitions at the origin of disease. If the trend of the last 10 years continues, 50% of the babies born in the developed world this year will live to 100,” Dr. Hood said.
The 100K Wellness Project launched in March 2014, when ISB researchers began analyzing 107 individuals. They sequenced each person’s whole genome; conducted three annual tests on blood, urine, saliva, and stool; performed three annual gut microbiome tests; and asked participants to self-track exercise and diet with wearable electronic devices. Relevant data are being integrated into a graph that currently has 227,979 nodes connecting genetic and environmental factors. The result is a personal health status profile that is like an “N-of-one” study, Dr. Hood said.
“There will be a time when we can look back and see that those 100,000 people have split into two groups: those who remain well and those who have transitioned to disease,” said Dr. Hood. These collective, personalized data are a “wellness well that can optimize your potential. We will be creating diagnostic and therapeutic tools to enable us to move an individual from disease back to wellness.” This transition would help cut the tremendous costs of treating chronic illnesses, he added.
Data Fueling Action
Integrated data can fuel actionable health interventions based on an individual’s genetic and blood profile, said Dr. Hood. For example, 90 of the pioneer participants in the wellness study show low vitamin D levels. Analyzing vitamin D levels is complicated, as six genetic variants block it. Patients with multiple variants may need higher doses of supplements, he said.
“Disease is still utterly, incredibly complicated, but analyzing disease at the level of the individual is necessary to understand disease,” said Dr. Hood. “Nutrition is still in the Dark Ages. N-of-one experiments will bring it out of the Dark Ages.” Gut microbiome testing also has enormous potential to predict disease risk and affect wellness, he said.
Armed with data on their disease risks, patients and their physicians could consider tailored health interventions. Integrated genomic data may one day identify an individual’s most effective weight-loss diet, for example.
“Your genome determines your potential, but not your destiny,” said Dr. Hood.
In the future, patients may take more responsibility for their own healthcare. “We will see a digitalization of medicine that will lead to the democratization of medicine,” said Dr. Hood. Smartphone technology could help level the playing field for medicine in the developing world as well. “We will elevate individuals to their highest level in the wellness well. We can use metrics to optimize individual wellness and maximize human potential.”
Susan Bernstein is a freelance medical journalist based in Atlanta.
