Tag Archives: personalized healthcare

Micronarratives and Wellness: Learning from the Community as a Complex System

Ann Pendleton Julian; Walter H. Kidd Professor, Austin E. Knowlton School of Architecture, The Ohio State University

When a spider makes a web the first step is to send out a thread, and then it uses the environment to send out the thread. The entire web sits on some type of construct. Once finished, the web must be strong enough to survive on its own. Some spider webs are able to stretch to 20 times their actual size and can even catch birds without breaking.

Elasticity and Resiliency in a Micro (Nano) Ecosystem:

The spider produces something that uses the environment and allows it to live. The spiders recycle the web each night.

A few important questions:
How do we measure and positively impact resiliency? Is understanding data enough to change behavior?  How do we really effect outcomes for wellness and do it at scale?

Behavior and perception are integrally linked. Reductionism is how we have been operating. From reductionism, laws that regulate the end universe have been transitioned more to Darwin and evolutionary processes. Small events can change the entire system over night. Causality is an adaptation of the internalized change to the environment.

Ecosystems are complex emergent systems. Everything you do changes the system and you’re looking for patterns of change.

As a designer working on these complex systems, there are three things you can do:

  1. Boundary conditions
  2. Probes (things you put in the system to read the system)
  3. Create new mechanisms (things to put into the system to create change)

Modulators are microprobes because they read the system backwards. Ambiguity is one of the most effective ways for us to understand the complexity of a system.

We must understand networks to design strategies for change. Networks have structure and function. The size of the network impacts how it functions. The shape relates to the relationships within the network, texture of the network and the function of the network.

Designing for emergence – Movement from low level rules to high level sophistication. The cobweb and snowflakes both emerge. There are 12 different environmental factors that impact these networks.

A term that comes from cinema and relates directly to the narrative. We aren’t going to have an entirely new healthcare system, but we can look at ways to improve the complex system that already exists. How do you close the gap?

Systems of action = frameworks for evolution in society

Reshaping contexts to impact positive change. The change triangle is focused around several things:

1. Vision

2.  Macro-narrative: translating the vision

3. Micro-narrative

Vision is about sight, perception and the imagination. Without imagery you have nothing to engage other people or a way to look ahead or sell a project. Meta-narratives are things that are at the top. Meta-narratives can be myths, political slogans or other stories that we use to make sense of events and are deisgned to evoke the vision of the future. We need to be strategically ambiguous, positive and aspirational. “The American Dream” is ambiguous and can evolve over time and is something we can each adopt in a different way.

We have an entirely new way of looking at meta-narratives. In health it’s about resiliency and creating a wellness ecosystem. Behavior Modification encompasses modification, ability and triggers. The triggers are what begins to change a system. Social networks are at the center of the triangle. The networks have shape, structure and function and these factors determine how they work within the system.

Shape of the triangle – has changed, will change and will be more effective as it changes.

A Cambrian moment: over a very short period time, a large number of things started to appear (species, relationships between species and functions). A large number of things have come about recently in health care and are helping to impact the future of healthcare. How do we create a coherence around all of these new things?

Q & A

Q: In the design triangle and building of ecosystems, a lot of them seem to get back to the functioning of the social networks. Macro narratives lead to micro narratives. When we think about the tipping point of social epidemics, are there ways we can encourage people to change the way they act based on the ecosystem they’re living in?

A: How does it become a part of the persuasive way of understanding what’s going on? We need to begin to sense when there’s an epidemic. Could the micro narratives be the push in the system to change the system?

Q: Are the meta stories and myths the conceptual frames of reference for thinking about one’s relationship with the environment?

A: Yes, and they are the things that begin to bind together. The beauty is when you can see the shape of the triangle changing.

Q: In order for meta and micro narratives to be valuable, someone has to gather them and listen really well. For the mechanisms to be used, somebody has to figure out which one(s) to use. The who and what of social networks is involved in bringing this together and creating the change that we’re directed to do. How do we identify the who and what?

A: Who and what is important. The micro narrative is more about letting the system talk for itself because of the patterns that begin to develop. Who is trying to do what and what is the project of change that someone is involved in? OSU is taking a large role in the “who” of the complex involved and needed within the system. Think about the relationship of boundaries to scale: you need to get something small enough to work on, but large enough to imply a larger scale change.

Systems Approaches to Disease and the Emergence of Proactive P4 Medicine

Leroy Hood, MD, PhD, President, Institute for Systems Biology

P4 Medicine is a convergence of 3 revolutions:

  1. Digital
  2. Patient driven social networks
  3. Systems Medicine

Data is multi-scale. The way we integrate data types together to create predictive models is one of the challenges of systems biology. Data dimensionality is mostly noise. The opportunities systems approach gives us the ability to sort out signal from noise.

There are five main pillars for attacking complexity:

  1. Biology and medicine are informational sciences
  2. Systems biology infrastructure and strategies
  3. Holistic, systems experimental approaches – allows us to study the dynamics of disease
  4. Emerging technologies
  5. Analytic tools to allow you to analyze the data you collect

Biology has enormous complexity and arises as a direct consequence of the chaotic nature of Darwinian evolution. It builds complicated solutions to environmental challenges.

Modularity at one level gives you understanding of related modularity at higher levels. Living organisms have both digital genome and environment which go together to create the phenotype.

Biological networks and dynamic molecular machines allow us to understand the fundamental mechanisms of disease.

A cross disciplinary environment encourages researchers to speak the language of other scientists.

Important things to remember:

  • Make sure data is global in all components
  • Dynamic data means that it must be in living organisms
  • Integration of different data types is critically important

There are two types of noise: biological and technical. Systems biology doesn’t demean mathematical models, but sometimes descriptive models are better.

Living organisms are encoded by networks of networks (DNA, molecular, cellular, tissue, organ and individual levels). In the end, it’s important to understand how the networks work, so we can understand the disease process itself.


Family genome sequencing is important to diagnosing disease. It is important to determine chromosome type. Predictions are that genome sequence will become a fundamental part of the medical record in the next 10 years. Identify actionable genes which can improve your health.  In 5 years, the cost will become $500 or less to determine a person’s genome.Error rate is 1 in 10 million – so this data is very accurate.


Blood is a key vital organ. Analyze samples in a longitudinal manner, which makes this multi-parameter so you can assess multiple disease networks

Organ specific blood markers:

  • 100 specific blood markers in humans and mice

Levels of proteins will change when the body becomes disease perturbed. The blood allows you to:

  1. Diagnose the disease 10 weeks prior to any clinical signs (pre-symptomatic diagnosis)
  2. Identify exactly when each network becomes disease perturbed

P4 Medicine:

  • Preventive component is the one that leads to wellness
  • Quantifies wellness and demystifies disease

5 implications to transform the practice of medicine:

  1. Revised business plans
  2. Digitalization of medicine for the individual patient
  3. Will sharply turn around the escalating costs of healthcare
    1. Early diagnosis
    2. Stratify the disease
    3. Re-engineer disease perturbed networks
    4. Benefits of wellness
    5. Digital technologies increasing measurement potential and decrease in cost
  4. Creation of significant wealth

Check out his Ted Talk: http://www.youtube.com/watch?v=ZRHcTlCZXrE&feature=player_embedded


Patent Rights Decisions are a Turning Point in Biomedical Science

The recent landmark decision to reverse the patent rights to BCRA1 and BCRA2 may be a turning point in biomedical science and the application of precision medicine. The decision supported the idea that components of our genome are not patentable. Although there is much concern that this decision will reduce the willingness of investigators and companies to do innovation research to identify new genetic/genomic targets, an important foundation of P4 (predictive, preventive, personalized and participatory) medicine, this decision may also dramatically improve access and speed of implementation of actionable genetic and genomic tests for individuals. One of the impediments to creation of low cost genetic/genomic panels are validation studies, FDA approval, CLIA-certified laboratories and patent rights which tend to push cost higher. This decision should improve access to genetic testing that direct precision in treatment and prognosis. Our goal is to provide patients with the critical diagnostic and therapeutic information they need at low costs to improve outcomes and to this end, the recent decision should enhance our ability to execute this goal. While any decision has positive and negative implications and considering the business models to build the pipeline of innovation to realize the goals of P4 medicine is important, this decision may open up less expensive, quicker access pathway for Americans to receive the benefit of P4 medicine for others. While this is only a step in the eventual transformation of the health care ecosystem, accelerating access and lowering costs of molecular diagnostics should benefit us all and realize a better future.
Dr. Clay Marsh, director of the OSU Center for Personalized Health Care

Personalized Medicine: A Shift from Reactive to Proactive Medicine

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Leroy Hood, inventor of the first automated DNA sequencing machine and founder of the Institute for Systems Biology, recently granted an interview with MIT’s Technology Review to discuss his future plans for the company. Hood plans to help shape medicine to be more predictive, preventative and personal–and how The Ohio State University will play a role. When asked about his thoughts on the future of personalized medicine, Hood responded:

“I think personalized medicine is too narrow a view of what’s coming. I think we’ll see a shift from reactive medicine to proactive medicine. I define it as ‘P4′ medicine–powerfully predictive, personalized, preventative–meaning we’ll shift the focus to wellness–and participatory. That means persuading the various constituencies that this medicine is real and it’s here. Physicians will have to learn a medicine they didn’t learn in medical school.”

Hood continued on, highlighting the challenges ahead: “I think the biggest challenges will be societal acceptance of the revolution. We are putting together something we call the P4 Medical Institute. The idea is to bring in industrial partners as part of this consortium to help us transfer P4 medicine to the patient population at Ohio State University, which is both the payer and provider for its employees. We plan to announce further details of this project in two or three months.”

To read the full article and interview, please visit: http://www.technologyreview.com/biomedicine/24703/.

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Ohio State To Pioneer National Genome Study

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Researchers at the Ohio State University Medical Center are partnering with one of the world’s most prestigious and leading biomedical research institutions, to provide personal genetic information to more than 100,000 people.

Ohio State’s Medical Center and the Coriell Institute for Medical Research, home of the world’s leading biobank resource for human cells and DNA, have officially announced their partnership in the Coriell Personalized Medicine Collaborative (CPMC). The personalized genetics study will involve an integrated approach to recruiting and enrolling 2,000 study participants at Ohio State, free of charge.

OSU Medical Center is one of only five centers in the country participating in the project with Coriell. Other participants will be enrolled at Fox Chase Cancer Center, Cooper University Hospital, Virtua Health and Helix Health. Study participants will also include volunteers from the Camden, N.J. community, where Coriell is headquartered.

Dr. Clay Marsh, executive director of Ohio State’s Center for Personalized Health Care

Dr. Clay Marsh, executive director of Ohio State’s Center for Personalized Health Care

“Through this collaboration, we will provide the unique opportunity for our community to participate in this ground-breaking national study and move toward wellness-based care that is predictive, preventive, personalized and participatory,” says Dr. Clay Marsh, executive director of Ohio State’s Center for Personalized Health Care.

“We are very excited for this opportunity for Ohio State to partner with the Coriell Institute and to help support their precedent setting study,” adds Marsh.

The Coriell Personalized Medicine Collaboration brings together doctors, patients, geneticists, counselors and information technology experts to create a protected environment for participants to see and understand their personal genomic information, and allow them to make individualized decisions about their health care. This platform will also enable health care providers to utilize the genetic-based information of participants to develop tailored medical and therapeutic treatments.

“Coriell recognizes the Ohio State University Medical Center’s established leadership in personalized healthcare and how this offers a unique setting for the CPMC research study,” says Dr. Michael Christman, president and C.E.O of the Coriell Institute.

“We are committed to creating the future of medicine to improve people’s lives through personalized healthcare,” Marsh adds. “Partnerships like this one will allow us and our community to experience the future of medicine today.”

Coriell Institute for Medical Research is a non-profit, biomedical research institution and the world’s leading biobank resource for human cells and DNA. Founded in 1953, the Coriell Institute conducts research on human genetic variation, mechanisms of cellular differentiation, and inherited genetic disorders. Visit http://cpmc.coriell.org for more information.

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