Scientific Wellness (quantitative health): A real life example
The creator of the P4-medicine definition, Leroy Hood, luckily did not restrict his work to scientific research but engaged in a collaboration with a rather big heath care provider: Providence Health & Services.
This is a (catholic) non-profit health care provider serving 34 hospitals and 600 physician clinics in five states (Alaska, California, Montana, and Washington) out of its Renton, Washington head quarters. More than 3.3 million patients are being cared for by more than 82,000 employees based on a yearly budget of close to a billion US $ (2015 : 951 million US $). Most certainly this is a representative quorum of patients. Leroy Hood accepted the position as Senior Vice President and Chief Scientific Officer at Providence Health & Services bringing the research results directly to the patients. If one wants to learn about practical experience with applied personalized medicine this will be one of the prime places and institutions to look at.
Projects dealing with Scientific Wellness based on personal parameter-clouds of individual patients are in the focus of activities. They want to elucidate how a person can slip out of health into disease in general as well as conduct long-term studies to better understand the development of Alzheimer’s disease. Another topic is restoring the wellness/health of breast cancer patients after a demanding medical treatment. Last not least, reduction in the overall health care cost is also a goal. Leroy Hood summarizes all that as “optimizing wellness”.
Last year he gave a talk at a personalized Medicine conference in Tübingen, Germany, where he talked about results from pilot study carried out on a smaller scale before the cooperation with Providence Health & Services started:
A panel of 108 healthy people was assessed with respect to scientific wellness using several molecular analysis methods:
- Whole genome sequencing (determination of the complete DNA sequence)
- Epigenome analysis (chromatin modifications not changing the DNA nucleotide sequence)
-Transcriptome analysis (all the mRNAs that finally lead to the production of proteins)
- Phenome analysis (Symptoms, appearance, etc)
- Metabolome (Metabolites are the compounds resulting from digestion of food and other intake such as drugs, providing both building block for our cells as well as providing the energy to enable life or influencing the control of such processes)
- iPS proteome (iPS are (induced) pluripotent stem cells capable of differentiating into a variety of different cells types; the proteome is the total of all proteins; in this case with an iPS cell)
Figure 2 Pilot study for Scientific Wellness
Fig 2 summarized graphically the study. The assays to collect all this data cost about 6,000 US $ / year for an individual without the evaluation costs. The first round of analyses was completed in 2014. Results were complemented by self-reporting of the participants about lifestyle and continuous self-observation of the participants.
100% of all participants showed abnormalities in their blood blood measurements and 100% have received actionable recommendations. It is remarkable that all were classified “healthy” prior to the study! Although 50% of the participants were initially skeptical about the study, almost all reported having developed a positive attitude feeling empowered to change their fate by their own actions. They also realized that all were less well than they thought. Already this change of mind set is remarkable and clearly demonstrates that quite ordinary people can be motivated by objective arguments and measurements.
Of course, not every participant would have ended up as diseased patient without changes in lifestyle. However, it is safe to assume that a significant number would have progressed that way giving rise to avoidable treatment costs.
As a general result it became clear that systems medicine does not consist of individual measurements and observations but resembles a well-structured network or a “network of networks” as Leroy Hood puts it. The aim of the study was to elucidate disease-related perturbations of these networks.
A few things emerged:
Blood proved to be a window into wellness and disease. Measuring blood parameters indicated aberrations even inside organs. Feeling healthy with no apparent problems does not automatically indicate optimal scientific wellness.
Leroy Hood summarized the experience himself as follows:
Wellness quantified (scientific wellness), disease demystified.
Change disease industry into a scientific wellness industry.
Wellness to greater wellness, less wellness, onset of disease, disease progression to therapy, individuals acting on actionable aspects.
In the end he mentioned the four major pillars of translational medicine (in the collaboration with Providence Health & services):
- Scientific wellness
- Breast cancer survivor wellness
- Alzheimer’s disease (200 individuals followed, 36 point regiment to delay onset of disease symptoms)
Most certainly only long-term follow-up studies will yield the final proof whether the Providence Health & Services model will be a financial success. However, extrapolating from what has been seen so far in various pilot studies it seems possible and maybe even likely that the financial bottom line of a sincere Scientific Wellness will be positive.
What’s coming up next?
Next week I will focus on concrete lifestyle changes that contribute to wellness and health in more genreal terms. The week after that I will mention a few examples where omics-based recommendations reach beyond the usual measures.