Category Archives: P4 Medicine Update

Medical Science May be Answer to Budget Woes

The Hill’s Congress Blog

“Sequestration” has forced the National Institutes of Health – the leading founder of biomedical research – to halt or cut funding to thousands of potentially groundbreaking research projects. On the 10th Anniversary of the completion of the Human Genome Project, we can’t let the ongoing tug-of-war in Congress over spending priorities threaten the revolutionary work that is taking place in medical science. Quite the opposite, recent advances in science and medicine have the potential to reduce healthcare’s drain on the federal budget and spur economic growth.

I have seen transformative innovation pay significant economic dividends in the past. In 1986, the automated DNA sequencer I invented was first brought to market, paving the way for the Human Genome Project completed in 2003. In 2010 alone, human genome sequencing activities generated $67 billion in U.S. economic output and created 310,000 U.S. jobs.The Human Genome Project helped to catalyze a transformational approach to medicine that has already begun to revolutionize healthcare, and we are quickly approaching a point where the cost to sequence your genome will be equal to what you might pay for a high-tech flat screen TV. Soon, a virtual cloud of billions of health-relevant data points will surround each individual.

The convergence of Big Data, technology and patient-activated social networks has led to what I call P4 Medicine—medicine that is predictive, personalized, preventive and participatory. It will drive a shift from disease-focused to wellness-focused care; it will improve the quality of care delivered to patients through better diagnoses and targeted therapies; it will reduce the skyrocketing costs of healthcare; and it will open the door to new markets and companies in a wellness sector that doesn’t even exist today.

Here is what is at stake.  Read more…

Could Clinical Decision Support Empower Patients?

Captured by Information Week

Ideas long espoused by medical informatics pioneer Dr. Lawrence L. Weed but shunned or ignored by the medical establishment might find a perfect fit in a world of “participatory medicine,” suggests a well-known proponent of patients taking an active role in their own care in concert with healthcare professionals.

As he explained this month at the Healthcare Information and Management Systems Society (HIMSS) conference in New Orleans and in a 2011 book he co-authored with son Lincoln, Weed believes in “coupling” medical knowledge to specific patient problems with the aid of computers. Any attempt to practice medicine based on a physician’s knowledge alone invites diagnosis error, according to Weed.

That opinion struck a chord with Terry Graedon, co-editor-in-chief of the Journal of Participatory Medicine. “Recent research reports have shown that misdiagnosis is an Achilles heel for the current practice of medicine,” Graedon wrote in a commentary published this week.

[ A study suggests patients don't like it when doctors use computers to diagnose them. Read Clinical Decision Support A Turnoff For Patients, Says Study. ]

Indeed, the Journal of the American Medical Association’s JAMA Internal Medicine just last month published a study showing that physicians missed a surprisingly high number of common diseases in ambulatory care. Although Graedon’s article does not mention this study, it does raise similar themes.

Proper diagnosis, Graedon argued — as Weed, creator of the problem-oriented medical record, has been doing for decades — starts with a complete problem list. Then, a computer system couples problems to specific medical knowledge.

“If diagnosis begins with standardized data collection, doctors bring clinical judgment to bear at the final stage of diagnosis. Treatment should then be evidence-guided but individualized for the particular patient,” Graedon wrote. “We trust that at this point the patient would make his or her preferences known and share in the decision,” she added, bringing in the element of patient empowerment, because the Journal of Participatory Medicine is a publication of the Society of Participatory Medicine. Graedon, along with her husband, Joe, helped the late Dr. Tom Ferguson develop the idea of participatory medicine and patient empowerment that led to creation of the society after Ferguson’s 2006 death.

“Diagnosis needs to be much more precise,” Graedon told InformationWeek HealthcareRead more…

Mining Electronic Records for Revealing Health Data

Captured by The New York Times

Over the past decade, nudged by new federal regulations, hospitals and medical offices around the country have been converting scribbled doctors’ notes to electronic records. Although the chief goal has been to improve efficiency and cut costs, a disappointing report published last week by the RAND Corp. found that electronic health records actually may be raising the nation’s medical bills.

But the report neglected one powerful incentive for the switch to electronic records: the resulting databases of clinical information are gold mines for medical research. The monitoring and analysis of electronic medical records, some scientists say, have the potential to make every patient a participant in a vast, ongoing clinical trial, pinpointing treatments and side effects that would be hard to discern from anecdotal case reports or expensive clinical trials.

“Medical discoveries have always been based on hunches,” said Dr. Russ B. Altman, a physician and professor of bioengineering and genetics at Stanford. “Unfortunately, we have been missing discoveries all along because we didn’t have the ability to see if a hunch has statistical merit. This infrastructure makes it possible to follow up those hunches.”

The use of electronic records also may help scientists avoid sidestep the rising costs of medical research. “In the past, you had to set up incredibly expensive and time-consuming clinical trials to test a hypothesis,” said Nicholas Tatonetti, assistant professor of biomedical informatics at Columbia. “Now we can look at data already collected in electronic medical records and begin to tease out information.”

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UPMC Opens New Institute for Personalized Medicine

Captured by UPMC

A new endeavor that will focus on the development of individualized disease treatments and prevention approaches has been established by the University of Pittsburgh Schools of the Health Sciences and UPMC, and its founding director has been named.
 
The Institute for Personalized Medicine will apply new knowledge in genetics, genomics and other disciplines to advance evidence-based medicine, and will be led by Jeremy M. Berg, Ph.D., associate senior vice chancellor for science strategy and planning, Pitt Schools of the Health Sciences, and professor of computational and systems biology, Pitt School of Medicine.
 
“This institute is one of our most far-reaching basic and clinically applicable research efforts,” said Arthur S. Levine, M.D., senior vice chancellor for the health sciences and dean, School of Medicine. “Dr. Berg’s leadership will undoubtedly make the most of our strengths in identifying individual factors that influence disease and tailoring care.”
 
“Pitt Health Sciences and UPMC are committed to research innovation and treatment excellence,” said Steven D. Shapiro, M.D., executive vice president, and chief medical and scientific officer, UPMC. “We must strive to learn more about the genetic and environmental factors that shape individual vulnerability to illness and response to therapy and then apply that knowledge to improve the lives of our patients.”
 
Dr. Berg joined Pitt in August 2011, ending his eight-year tenure as director of the National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health. At NIGMS, he oversaw a $2 billion budget that primarily funded basic research in cell biology, biophysics, genetics, developmental biology, pharmacology, physiology, biological chemistry, bioinformatics and computational biology, as well as clinical areas related to trauma and burn injury, sepsis and wound healing.

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Insight: Think Preventive Medicine Will Save Money? Think Again

Captured by Reuters

It seems like a no-brainer.

Since about 75 percent of healthcare spending in the United States is for largely preventable chronic illnesses such as Type 2 diabetes and heart disease, providing more preventive care should cut costs.

If only.

In a report released on Tuesday, the non-profit Trust for America’s Health outlined a plan “to move from sick care to health care” by putting more resources into preventing chronic disease rather than treating it, as the current system does. There is a strong humanitarian justification for prevention, argued Trust Executive Director Jeffrey Levi in an interview, since it reduces human suffering.

But the report also makes an economic argument for preventive care, highlighting the possibility of reducing healthcare spending — which in 2011 reached $2.7 trillion, just shy of 18 percent of gross domestic product — by billions of dollars. And that has health economists shaking their heads.

“Preventive care is more about the right thing to do” because it spares people the misery of illness, said economist Austin Frakt of Boston University. “But it’s not plausible to think you can cut healthcare spending through preventive care. This is widely misunderstood.”

A 2010 study in the journal Health Affairs, for instance, calculated that if 90 percent of the U.S. population used proven preventive services, more than do now, it would save only 0.2 percent of healthcare spending.

Some disease-prevention programs do produce net savings. Childhood immunizations, and probably some adult immunizations (such as for pneumonia and the flu), are cost-saving, found a 2009 analysis for the Robert Wood Johnson Foundation. The vaccines are cheap, and large swaths of the population are vulnerable to the diseases they prevent. The cost of providing them to everyone is less than that of treating the illnesses they prevent.

Counseling adults about using baby aspirin to prevent cardiovascular disease also produces net savings. The counseling is inexpensive, the aspirin even cheaper and the costs of heart disease, which strikes one in three U.S. adults, are enormous. Screening pregnant women for HIV produces net savings, too.

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$11.8 Million Contract Funds Microbiome Work in Type 1 Diabetes

Captured by Baylor College of Medicine

An $11.8 million, three-year contract with the http://www.nih.govwww.nih.gov and the University of South Florida in Tampa will enable the Alkek Center for Metagenomics and Microbiome Research at Baylor College of Medicine in Houston to help determine if and how the communities of bacteria, viruses, fungi and other single-celled organisms that inhabit the body (the microbiome) affect the risk of, or are associated with, development of type 1 diabetes—a disease that usually starts in childhood or young adulthood.

“The goal of this research is to look for microbial association and a potential viral trigger for the initiation of this disease in people who are genetically susceptible to it,” said Dr. Joseph Petrosino, director of the CMMR and an assistant professor of molecular virology & microbiology, molecular and cellular biology at BCM. Dr. Richard E. Lloyd, professor of molecular virology & microbiology at BCM is a co-principal investigator on the project, and Dr. Rob Knight, associate professor of molecular biophysics at University of Colorado in Boulder, is a lead co-investigator.

Others working with Petrosino at Baylor include Dr. Aleksandar Milosavljevic, associate professor of molecular and human genetics, who will provide analysis of the data, and Dr. Richard Gibbs, director of the Baylor Human Genome Sequencing Center, where the sequencing will take place.

The contract is part of The Environmental Determinants of Diabetes in the Young project funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. The international project involves clinical centers at the University of Colorado in Denver; the Medical College of Georgia (involving Florida and Georgia); Pacific Northwest Diabetes Research Institute in Seattle, Washington; the University of Turku in Finland, the Diabetes Research Institute based in Munich, Germany; and Lund University in Malmo, Sweden. The data coordinating center is at the University of South Florida in Tampa. Dr. Jeffrey Krischer is director of the data coordinating center and the study co-chair of the TEDDY project.

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20 to Know in Health Care: Clay Marsh

Captured  by Business First of Columbus

Why did you get into this profession?

I am fascinated by the complexity of our bodies and the foundational opportunity to improve people’s lives – quality and quantity. Moreover, I am fascinated by understanding the critical issues that determine human health and balance, which is the foundation for P4 (predictive, preventive, personalized and participatory) medicine. To realize P4 medicine, we need to create tools to promote health, create the environment or ecosystem that makes change easy and create the design to deliver a superior user experience. These principles of designing the tools, the world and the user experience is the secret to making health care transition from the doctor’s office and hospital to all parts of our life.

Is it as fulfilling as you thought it would be?

It is even more fulfilling that I originally planned. The ability to help people achieve beyond their expectations is tangible. I now appreciate the personal relationships, the ability to impact people’s lives and the extraordinarily important simple gifts of love, health, independence, family and purpose.

What’s the most exciting thing happening today in your industry?

Many exciting things are happening, including an expanded understanding of the genetic basis of human health and disease through research efforts, the rapid lowering of the cost of genetic sequencing, new precision drugs for a number of diseases based on genetic targets, including cancer, heart disease and neurological disease, are few examples of precision medicine. While these advances are exciting, they largely are dealing with sickness. Tomorrow, we want to move medicine from clinical disease to health and understand how we predict the risk of developing these problems, prevent these problems from occurring, personalize the approach and have true participation from our communities which is the basis of P4 Medicine.

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Becoming Your Own Doctor In The Brave New World Of Personalized Medicine

Captured by Forbes

Lately there’s been a lot of talk about personalized medicine. There’s a bold idea going around that people should take control of their own healthcare and manage the flood of new data stemming from a whole bunch of new technologies, including, but hardly limited to, personal genomes, biomarkers, wireless sensors, and iPhone ECGs.

It is unclear how much any of this is ready for prime time in actual medical practice. Although the science and technology advance every day, and there is no question that these will one day play an important role in medical care, there are still very few actual instances where personalized medicine has been shown to benefit patients, and no reason to think that widespread application in the general population would result in significant benefits.

But let’s assume for the moment that the technology does work and can benefit people. Does that mean most people would benefit if they took a more active role in obtaining this information (for example, by ordering a personal genome from 23andme.com), and then interpreting and acting upon the information?

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Ohio State’s P4 Medicine Update, Jan. 16, 2013

Captured by Sherri Kirk

Researchers Identify an Early Predictor for Glaucoma

Captured by American Academy of Ophthalmologists

A new study finds that certain changes in blood vessels in the eye’s retina can be an early warning that a person is at increased risk forglaucoma, an eye disease that slowly robs people of their peripheral vision. Using diagnostic photos and other data from the Australian Blue Mountains Eye Study, the researchers showed that patients who had abnormally narrow retinal arteries when the study began were also those who were most likely to have glaucoma at its 10-year end point. If confirmed by future research, this finding could give ophthalmologists a new way to identify and treat those who are most vulnerable to vision loss from glaucoma. The study was recently published online byOphthalmology, the journal of the American Academy of Ophthalmology.

Open-angle glaucoma (OAG), the most common form of the disease, affects nearly three million people in the U.S[i] and 60 million worldwide.[ii]  Vision loss occurs when glaucoma damages the optic nerve, the part of the eye that transmits images from the retina to the brain. Unfortunately, because glaucoma does not have symptoms, many people don’t know they have the disease until a good portion of their sight has been lost. Early detection is critical to treating glaucoma in time to preserve vision.

The findings of the new study, led by Paul Mitchell, M.D., PhD, of the Centre for Vision Research, University of Sydney, supports the concept that abnormal narrowing of retinal blood vessels is an important factor in the earliest stages of OAG. Tracking nearly 2,500 participants, the study found that the OAG risk at the 10-year mark was about four times higher in patients whose retinal arteries had been narrowest when the study began, compared with those who had had the widest arteries.

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