Previously, I wrote about some wondrous developments that are taking place in medical science. Implantable or attachable devices already exist — or soon will exist — that can monitor the conditions of diabetics, asthmatics, heart patients and patients with numerous other chronic conditions. These devices will allow patients and doctors to modify therapeutic regimes and tailor treatments to individual needs and responses. Genetic testing is reaching the point where patients can be directed to take certain drugs or avoid other drugs, based solely on the patient’s own genes.
Almost all HIV treatment these days involves therapy cocktails tailored for each individual patient. The FDA has approved a breast cancer drug only for women with a particular genetic makeup. Patients are being advised to steer clear of an ADHD drug and certain blood thinners if they have particular genetic variations.
We are entering the age of personalized medicine, where the therapy that’s best for you will be based on your physiology and genetic makeup — and may not be right for any other patient.
Yet standing in the way of this boundless potential is an Obama administration whose entire approach to health reform revolves around the idea that patients are not unique and that bureaucrats can develop standardized treatments that will apply to almost everybody with a given condition. When former White House health adviser Ezekiel Emanuel told CNN recently that “personalized medicine is a myth,” he was fully reflecting the worldview of the authors of health reform.
Personalized medicine is the future. It is where the science is going. It is where the technology is going. It is where doctors and patients will want to go. Yet unfortunately for many of us, this is not where the Obama administration wants to go.
First, the good news. Biosensors that can be worn on clothing or jewelry, or held against the skin by a Band-Aid-like patch, or inserted beneath the skin are capable of monitoring a whole host of chronic diseases. Among the technologies that have been, or soon will be, developed are devices that can continuously monitor the blood glucose levels in diabetics; the rate of breathing, blood oxygen saturation, etc., of asthmatics; and the heart rate and other parameters of patients with heart disease. There are even heart attack and stroke attack detectors. In some cases, personalized devices can activate therapies. A wearable, automatic insulin pump can be coupled with a blood glucose measuring device to create a virtual artificial pancreas. (See this fascinating summary.)
The science of genetics is also about to explode. There are as many as 1,300 genetic tests currently available that relate to about 2,500 medical conditions. Gene tests can predict your probability of getting particular types of cancer, whether you will respond to routine chemotherapy or whether there is a special therapy that only works on people with your particular physiology. The days when experts argued over whether men should get a prostate cancer test could be long gone. A simple test can tell if you have a high probability of contracting the disease, or a low one.
HealthCamp Boston is a forum for people with interest in all areas of health and wellness to gather, to generate ideas, and to take practical steps towards building the future of health care. HealthCamps are different from traditional conferences where speakers talk at you. At HealthCamp Boston, an “unconference,” attendees set the agenda, and all contribute to the event according to their interests.
The Boston area is a center of innovation for all aspects of health care, so you can be certain that people at HealthCamp Boston will be discussing things like:
· Big Data in health care
· Improving engagement and outcomes through mobile devices and social media
· Personalized medicine and translational medicine
· Empowered patients
· Practical impacts of health care reform
· and more…
Last year Priceline founder Jay Walker bought TEDMED –a conference that licenses the TED style and brand but is separately owned from its famous cousin. While there was some fun controversy about the sale, Walker made two key decisions. First he moved the conference from San Diego to Washington D.C. to try to get it more central to the health policy debate, and second he initiated a set of 50 Great Challenges from which the community voted a top 20. These are things like tackling the obesity crisis, getting transparency in medical research, training next generation of leaders and more.
Much of the fun and high production value entertainment from previous years stayed, but there was a new sense of urgency in the air concerning making changes from a top down and bottom up level in the way policy works for science and technology. There was rather less information technology than in years past and more emphasis on things like training of physicians, food policy, and basic science.
Like TED there’s a strong sense of celebrity at TEDMED with entrepreneurs like Walker and buddy AOL founder Steve Case on hand, mixing with newscaster Katie Couric and volleyball pro Gabby Reece. There’s also an interesting (and we hear not cheap) sponsorship model with the exhibit hall being more about zones for discussion rather than tradeshow demos. We like Philips sleep discussion and Booz Allen Hamilton’s discussion area.
Hospital leaders are busy trying to cope with the changes brought on by the Patient Protection and Affordable Care Act and the realization that the federal budget deficit translates into less money for all healthcare providers in the future. The seemingly inevitable transition from fee-for-service to global payments creates anxiety about how quickly the financial incentives will shift.
While the above-described issues are certainly enough to monopolize any busy hospital executive’s time, there are other large-scale changes on the horizon that may impact hospital operations just as much. Leaders who ignore these trends will do so at their organization’s peril.
The important trends include: personalized medicine that concentrates on the individual not the population; the “quantified self” movement with constant remote physiologic monitoring; the smartphone health applications explosion, and the artificial intelligence, healthcare robot movement.
Personalized medicine: Advances in genomics and digital technology are making it possible to shift the focus of evidence-based medicine from the population to the individual patient. Today drug treatment and disease screening follow a one-size-fits-all approach that leads to overtreatment and unnecessary expense. Genetic testing allows us to individualize the treatment for the patients.
For example, about 20 percent of diabetic patients treated with metformin do not respond to the drug, a condition that can be identified by genotyping that is not routinely done today. Likewise, cancer screening by mammography after age 40 in women and colonoscopy after age 50 in men and women does not take into account the different genetic predispositions for breast cancer and colon cancer in individual patients. Two new books should be on every hospital executive’s reading list because they explore the implications for hospitals of personalized medicine: Eric Topol’s “The Creative Destruction of Medicine” and David Agus’ “The End of Illness.”
The public perception of “personalized medicine” is askew: the term is often viewed as a common treatment option for rare genetic disorders. The truth is that the power of genetic and genomic information allows physicians to offer personalized health care to their patients.
Yet personalized health care is not new: ABO blood typing is a superb example of widespread genetics-based personalized healthcare dating back to World War II, and continues to have universal applicability and will for centuries to come.
Consider a more recent example: common associations for breast cancer accounts for almost three percent of all breast cancers whereas a “rare mutation” (BRCA1-2) alone accounts for 10 percent of all breast cancers. There are currently at least nine other breast cancer predisposing genes which help knowledgeable healthcare providers make the correct diagnosis and inform patients of risks of other cancers.
Ryan Phelan started DNADirect to expand the power of genetic testing to everyone, using the Web. She’s been ploughing a tough furrow but been making some real progress in the last few years, including getting an investment from Lemhi Ventures and working with Humana to provide genetic testing to its members (and the utilization management going along with it), to go along with their initial DTC approach.
Late last week DNADirect was purchased by Medco. I spoke with Ryan and Robert Epstein, Chief Medical Officer of Medco to get just a taste of what this will mean for the future of DNA testing within Medco.
Here's the interview.
Each year at Health 2.0, we present Launch!, a debut of new products and services to the Health 2.0 community.
This year we were able to hear from many great companies, including AccessDNA, a new site that generates personalized genetics reports that help you identify which genetic tests could be right for you. I had the opportunity to chat with Jordanna Joaquina, Director of Genetics and Co-Founder, about the site and genetic counseling.
Here's the interview.
For an introduction to AccessDNA, check out Lee Essner's demo at Health 2.0:
Podcast: Play in new window | Download
We live in a time of such great progress in so many arenas that, too often and without a second thought, we take significant advances for granted. But, now and then, we should catalog the steps forward, and then look backward to appreciate how these steps were made possible. They sprung from grand conceptions of possibilities and, then, the persistent focused toil that is required to bring ideas to useful fruition.
We could see this in a relatively quiet announcement this week at HIMSS 09. Microsoft unveiled its “Amalga Unified Intelligence System (UIS) 2009, the next generation release of the enterprise data aggregation platform that enables hospitals to unlock patient data stored in a wide range of systems and make it easily accessible to every authorized member of the team inside and beyond the hospital – including the patient – to help them drive real-time improvements in the quality, safety and efficiency of care delivery.”
This post came as a comment by SR to Dr. Kibbe’s piece on electronic medical records. It’s a great consumer perspective and worth reprinting in full. — THCB Staff
Health Care consumers and patients have a wide range of interests,
needs and values that vary across our lifespans and circumstances and
hopefully there will be many different tools, products and services
provided to both providers and users of health care.
For example, my 70-year-old retired father is the head of a neighborhood
wellness program with over 3,000 people and maintained a family blog
during my mom’s cancer treatment but doesn’t own a cell phone and would
rarely change physicians despite differences in quality. I am rarely
ill, and yet expect SMS alerts if a lab test is done and want my
clinical records to link with my Nike tracker in my shoe as well as
apps on my Iphone.
I envision a system similar to the financial sector (bad example
right now perhaps) where you are able to move your information from
clinician to clinician (online bank statements = EMR) supplement that
with information gathered via other ancillary providers (investment
account at E-trade) take all of that information into my PHR (without
entering most of the data so it is similar to downloading into
Quicken) adding in some personal data (from my nike+ sensor and mobile
apps that track my diet and yoga classes) and generate reports (like
turbo tax) to share with some of my providers