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OSU Medical School Adds Personalized Medicine Curriculum with P4 Program for New Doctors

Captured by GenomeWeb (PGx Reporter)

Twenty students from the Ohio State University College of Medicine’s class of 2014 are spending the summer in a pilot program with an emphasis on genomics as well as lower-tech methods to individualize care.

Led by Kandamurugu Manickam, a geneticist at OSU’s Center for Personalized Health Care, the inaugural class takes place this summer as a pilot project to determine how to integrate P4 — short for predictive, preventive, personalized, and participatory medicine — material into the medical school’s new curriculum beginning in 2012.

Manickam told PGx Reporter this week that many universities are interested in adding programs in personalized medicine, but that OSU’s P4 approach sets the program apart. “Places have talked about doing [this], but [they have placed] most of the emphasis on genetics, which is why we are really unique, in looking at all these factors,” he said.

P4 medicine is the brainchild of Leroy Hood, president of the Institute for Systems Biology, which partnered with OSU in 2009 to form the P4 Medical Institute (PGx Reporter 10/7/2009). The program’s goal is to transform healthcare “from a reactive system to one that predicts and prevents disease, and tailors diagnosis and therapy to the individual consumer.”

P4 encapsulates a broad approach that includes an emphasis on low-tech and low-cost preventative measures in addition to ‘omics based personalization, according to Manickam. ” I’m a geneticist, but one of the things we’ve kind of recognized is that genetics is expensive to do, but there are less expensive ways to get good outcomes,” he said. However, genomics is still a large part of P4, he explained, and will become more and more so, as pharmacogenomics and genetic testing develop further.

OSU plans to explore P4 through a variety of clinical programs and the pilot course is a separate push by the university to integrate P4 principles into its educational programs. “We’ve been trying a lot of clinical ideas at Ohio State in this area,” Manickam said. “But we wanted to [provide] a little more education [on the P4 paradigm] for medical students.” Read more…

Realizing the Potential of P4 Medicine and Systems Medicine

Presentation to the 10th Annual Systems Biology Symposium, Systems Biology & P4 Medicine, held in Seattle on May 15 and 16, 2011:

Health care today is reactive, expensive and variable and is in need of value innovation (lower cost and higher quality). We have partnered with the Institute for Systems Biology to form the P4 Medicine Institute, focused at realizing the potential of P4/Systems Medicine. As a large academic health care system, we have constructed a new rubric for health care delivery that has four pillars: 1) Reducing variability of health care delivery by automating systems of care; 2) Stratifying patients into smaller, more precise groups through biomarker discovery; 3) Constructing computational and environmental approaches to the complexity of human health, disease and health care delivery; and 4) Engaging participants through network activation (social, behavioral, environmental, games). The ultimate goal of this program is to provide each person a health care experience and strategic plan that facilitates wellness, a multi-dimensional state (genetic/molecular, environmental, behavioral, and physical) and brings the right solutions to the right person at the right time.

A Video Look at P4 Medicine at Ohio State

The Foundations of P4 Medicine

By: Leroy Hood, MD, PhD
Co-founder and Board MemberP4 Medicine Institute

There is an emerging revolution in healthcare that will lead to a kind of medicine with new dimensions—it will be predictive, personalized, preventive and participatory. That is why I call it P4 medicine.   The essence of this new medicine is that it will be data driven and information rich. I see a time in the near future, when each patient will be surrounded by a virtual cloud of billions of data points uniquely defining each of us.  We will have the information technology to reduce this enormous data dimensionality to simple hypotheses about health and disease for each individual patient.  Early in the life of each patient, physicians will for the first time be able to define a life-long strategy for optimizing wellness. The focus in P4 medicine will move from the current emphasis on disease to an optimization of wellness for each of us.

P4 medicine has its origin in several new concepts, strategies and emerging technologies.

First, medicine will truly become an informational science.  We will need to understand how the two fundamental types of biological information–our individual genomes and the environment to which we are exposed–combine to effect human development, physiological responses (for example, to infections) and the initiation and progression of disease.  The collision of these two types of information leads to our phenotype: that is the assembly of features that provide a unique description for each individual of the molecular, cellular and organism components that make us a functioning organism. These two types of biological information are connected to our phenotypes by biological circuits or networks that capture, transmit and integrate the collisions of these two types of information—passing this information off to molecular machines (often proteins) that execute the functions of life.   Therefore understanding informational medicine requires us to focus on how this collision manifests as phenotype through the operation of biological networks and molecular machines.

Second, a new approach to doing biology—systems biology—takes a holist approach it attempting to understand these informational challenges.  Systems approaches attempt to analyze all genes and all proteins rather than studying them one or a few at a time.  These systems approaches allow scientists to attack complex biological and medical problems and begin to understand, for example, how diseases arise through disease-perturbed biological networks in the relevant organs.  These systems approach to disease open up new avenues for exploring diagnosis, therapy and prevention that will be at the heart of the emergence of P4 medicine.

Third, new technologies are emerging that will allow us to explore many new dimensions of patient data space.  For example, automated DNA sequencing is now moving into a third technology generation. I predict that in less than 5 years we will be able to sequence an individual’s genome for under $1000.  Thus, your genome sequence will soon become a vital part of your medical record, thereby providing critical information about how to optimize your wellness.

Finally, powerful new computational and mathematical tools are emerging that will allow us to handle these enormous amounts of information and to generate models of disease that are both predictive and actionable.

These four elements–medicine as an information science, systems approaches to disease, emerging technologies and new computational and mathematical tools–lie at the heart of P4 medicine.  They will drive the coming P4 revolution by providing metrics that will allow us to define each individual’s personal dimensionality of wellness.  And this personalized understanding will provide us with the information to optimize each individual’s wellness in the future.

Ohio State and Institute For Systems Biology Leading Innovation of P4 Medicine

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By: Frederick Lee MD,MPH
President & CEO, P4 Medicine Institute

“…what a piece of work is man…” Hamlet, Prince of Denmark Act II, scene II

What Hamlet says in melancholy, I quote in fascination. Consider that there are roughly 100 trillion cells in every human body, and that there are nearly 2 meters of DNA (representing 6 billion+ base pairs) wrapped and coiled in each nucleated cell. There is no invention of man as complex as the human body, yet it is this level of complexity that we seek to solve in biology and medicine.

It has been said that revolutions in science are often preceded by revolutions in measurement. Consider the impact that the microscope had on cell biology, the telescope had on astronomy, and of the particle accelerator on physics. We are undergoing a similar renaissance of measurement in molecular biology, propelled by automated nucleotide & protein sequencing technologies invented by Lee Hood, and embodied by the outputs of the Human Genome Project (HGP).

As Lee Hood has said, our phenotypes (our observable characteristics & physical traits) can be considered to be the interaction between the digital information in our genomes and our environments. Thus, having the complete ‘parts list’ of human biology that the genome sequence represents is an important and transformative asset in our attempts to demystify the complexity of human biology. As Dr. Clay Marsh has blogged, we are also beginning to understand the molecular machinery that mediates the collision between the genome & our environment through the epigenetics, RNA, and proteins. These are profoundly exciting times in biological research, and many in the community feel that we are on the verge of exponential, not linear, leaps in our understanding. Continue reading