Personalization, Prediction and Prevention Drive the “Second Transformation of Medicine”
“The pandemic is a wake-up call to humanity to understand the perils of not appreciating the importance of health and healthcare,” said Ralph Snyderman, once dubbed “the father of personalized medicine,” and chancellor emeritus, Duke University, said during Demy-Colton’s first virtual salon, “The Future of Healthcare: Innovation, Change and Urgency.” He believes it will usher in the second major transformation of medicine.
“We knew the importance of health and healthcare, but it wasn’t front of mind,” he said. “Faced with the possibility of losing it, we have stopped dead in our tracks.”
Now, the healthcare system is innovating to address the pain points the pandemic revealed. Specifically, it is becoming more proactive, preventative and personalized.
Genomics is making those innovations possible. With whole genome sequencing, it’s finally clear that health is determined by a combination of genetics, individual actions and exposure to environmental conditions throughout life. As Snyderman said, “The improvement of health is a dynamic continuum.” It must have the individual at the helm.
Sweeping changes will come in the next decade.
“I anticipate the ability to predict an individual’s susceptibility to disease, to determine the factors that enhance or diminish that disease, and to track them over time. That will be the second major transformation of medicine, behind germ theory.
“Millions of people have had their genomes sequenced,” he noted, and wearables are commonplace.
That makes it easy for individuals and their physicians to monitor and track activity, sleep, electrolytes, glucose levels and many other elements of health. Apps even remind patients when to take their medications, thus improving medical compliance. The ability to accumulate, aggregate and analyze massive quantities of data only adds value to the sequencing.
Machine learning, a subset of artificial intelligence (AI), can tease apart the factors that affect health. As this occurs, he pointed out, “The ability to predict an individual’s health pathway is becoming more and more vivid.” When genome sequencing and the aggregation of information from wearables becomes a global phenomenon, predictive healthcare will become more accurate and more powerful.
Snyderman equates the healthcare system of the future to GPS systems in cars today.
“We’re far from it now, but in 10 years, there will be meaningful tools (to plot personalized pathways) for individuals to navigate their own health,” Snyderman said.
Today, concierge medicine plots such pathways for those who can afford it. In the future, with digital tools, that can expand to the much larger middle ground of people.
The health delivery infrastructure will be transformed, too. We’re already seeing that.
“Until recently, healthcare was delivered by large groups of physicians from specific locations. But, as the COVID-19 pandemic showed, “The existing hospital network isn’t sustainable for the future. We need to distribute care.” While hospitals will continue to be a hub where severe illnesses are treated, Snyderman advocates moving many of the less critical procedures to community hospitals.
CVS and Walgreens, among others, already are embracing the distributed healthcare model by placing primary care clinics in many of their retail stores. CVS is augmenting that with onsite telemedicine. With health advice available through online symptom checkers and Google searches, healthcare clearly is moving online.
“This represents a major transfer of power from the provider to the individual,” he said, helping patients navigate their own health. “In the future, this trend will be much greater, and also is more cost-effective,” he added.
The brave new world of healthcare comes with cautions. Research published May 18 in the Medical Journal of Australia found that online symptom checkers were right only 36% of the time.
There also are privacy concerns.
“With your health records a part of a large ecosystem, who owns them?” Snyderman asked. The Health Insurance Portability and Accountability Act (HIPAA) provides clear guidelines and severe penalties for those sharing patient-identified information beyond the care team, but the rapidly evolving climate around medical information makes it essential to ensure the HIPAA protections remain adequate.
Another concern involves the risk of replacing one monolithic structure with another, as commercial players – including multiple healthcare systems, third party payers and digital health partners – become involved. “Privacy and ethics go hand-in-hand,” Snyderman said.
Ultimately, Snyderman predicted a hybrid model will emerge. He envisions virtual caregiver visits for some things and personal visits for others. “There’s value to human interaction with a caregiver who knows you and can identify your current health status, proximate risks and ways to mitigate them.”
Personalization, prediction and prevention are increasingly possible and will form the basis of the transformation of 21st century medicine that began decades ago with genomic sequencing. The traditional healthcare system is changing as researchers learn more about what drives health and disease. We are learning, Snyderman says, that, “Regardless what we do, the most important individual in one’s health is oneself.”