Why Predictive Health Should Be the Future of Medicine
Two advocates for reinventing health care say we'll all benefit when individualized, preventive medicine replaces disease management
Kenneth Brigham, M.D., (left) is a professor of medicine and associate vice president for health affairs at Emory University in Atlanta. Michael M. E. Johns, M.D., is chancellor of Emory and former dean of the Johns Hopkins School of Medicine. The pair are co-authors of Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years (Basic Books, 2012), and, along with others, have developed the Emory-Georgia Tech Predictive Health Institute.
Most of the chronic diseases that plague us, like heart disease, stroke, diabetes, lung cancer and hypertension, can be prevented. We know what needs to be done. But knowledge is not enough. If it were, we wouldn’t be misbehaving ourselves into an unprecedented epidemic of obesity and its myriad consequences. We must promote healthy behavior, get people motivated to take care of themselves and empower them to take control of their health.
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Predictive Health in Action
In the Emory-Georgia Tech Center for Health Discovery and Well Being, approximately 700 randomly chosen, essentially healthy people (most of them employees of the medical center) are engaged in a program that educates and empowers them, and tracks their health. The participants undergo measurements of their body fat, bone density, physical fitness, brain function and cardiovascular function — and of four key biomarkers of genetic and metabolic health:
- Inflammation, which is a signal that the body's natural response to injury or infection is in overdrive, and is a predictor of the most common chronic diseases.
- Immunity, a measure of antibodies targeting toxic invaders that can turn against body tissue and cause autoimmune diseases.
- Oxidative stress, products of oxygen that can damage tissue when their production is uncontrolled.
- Regenerative capacity, a gauge of the stem cells that repair injuries and are essential to keep organs functioning normally.
All of this data, plus extensive information about the person's environment and behaviors, is compiled into a health assessment report. Each participant reviews this report with a health-focused professional, or coach, who identifies opportunities and helps develop and implement a health action plan.
When participants follow those individualized plans, they get healthier: their blood lipid levels and biomarkers of inflammation improve; their weight, body-mass index, blood pressure and blood sugar levels decrease; and their risk for chronic disease drops. We've found that the greater a participant's health risks when he or she starts the program, the more those risks decrease. People who entered the program with a 30 percent risk of developing heart disease within 10 years experienced, on average, a 15 to 20 percent decrease in that risk. People who had a 30 percent risk of developing type 2 diabetes within 10 years saw an average 20 percent drop in that risk. The model has economic implications as well: Postponing or preventing chronic diseases through predictive health presents a significant opportunity for decreasing health care costs.
But real health is a way of life, not just a commodity to be purchased or “consumed” at the clinic or doctor’s office. While we can measure the health care savings generated by predictive health, that doesn't tell the whole story. Other benefits are just as important: The people in this program are not only physically healthier, but they are also happier — with lower levels of perceived stress and incidence of depression.
Why We Need Systemic Change
For predictive health to succeed, we must change the game. Until we all understand that health is an integrated function of biology, behavior and environment, we will not be as healthy as we can be. We need a health-focused system that captures the attention (and imagination) of healthy people and of those charged with participating in their care. But a societal shift from disease care to health care threatens to disrupt the routines of American medicine, with economic, professional and social consequences. For example, doctors today are not very interested in people who are well.
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Shifting paradigms of this sort are not for the faint of heart. It will require major education on all sides. We need a new mindset, one in which measurements are taken not to establish a diagnosis but to define the status of a person's health, and in which data predicts not the chance of heart attack or Alzheimer's disease, but of staying healthy.
A confluence of science, technology, social pressures and political and economic realities is gathering. The result can be a healthier America, but getting there will be complex. This vision is bold. Realizing it will take courage. We need a new vocabulary, new kinds of health facilities and health care providers, and new social attitudes. Most of all, we need to feel and share the ecstasy of discovering our healthy selves.
Predictive health aims to disrupt everything you and the medical community know about health care. It can do that given the right groundwork. Indeed, given the right groundwork, disruption is not just possible, it's inevitable.
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