Most of my talk will look toward the future and it makes the point, one, we’re at an enormous tipping point or even maybe a paradigm change in healthcare that is driven by systems biology approaches towards medicine, we call that systems medicine, and by a new field in medicine we call scientific wellness. In beginning to think about this at my institute in the early 2000s we realised that medicine and healthcare really should be predictive, preventive, personalised and participatory, we call this 4P. The essence of what 4P is about is saying there should be two major thrusts in healthcare: one to deal with disease, the other to deal with wellness. We, in 2014, took on a pilot project for the first time really to look at the question of wellness using what we call personalised dense dynamic data clouds. This allowed us to collect from each of 108 individuals an enormous amount of data over the course of a year. We used that to verify the power of being able to use the data clouds to identify for each individual a multiplicity of actionable possibilities which, if acted upon, could either improve wellness and/or let you avoid disease.
The really striking fact is that scientific wellness in the end may be really the key to understanding disease because once you get large numbers of patients undergoing the scientific wellness objective you’ll begin in time to see wellness to disease transitions for every single common disease including cancer. That will let you identify the earliest tipping point when you went from wellness to disease, to develop biomarkers for detecting that point and using systems approaches to develop therapies that can reverse the disease at that point. You’re reversing the disease before it ever manifests itself as phenotype.
So my view is that this whole vision of scientific wellness will over the next 10-15 years become much more broadly accepted in the healthcare system and it will give us the keys for looking at these critical transition points for cancer but for all major types of diseases.
Can you tell us more about personalised data clouds?
The personalised dense dynamic data clouds are really powerful tools for studying disease as well as for studying wellness because you can use them to follow the course of disease, to follow the response to therapy, to follow the resolution after therapy and the return to health or the failure to return to health. So the dense dynamic data clouds are really the essence of what everybody is now calling precision medicine. Although I will say most people think about precision medicine primarily in terms of genomics. The data clouds we generate include genomics and regular omics, proteomics, microbiome, gut microbes and so forth. So you need a global holistic picture to really be able to see the key transitions that we’d like to follow in either understanding wellness and/or in following disease and its response to therapy.
Is personalised treatment becoming diluted when a patient is turned into a set of data points?
I couldn’t agree more with your point and I think the sociology is much harder than the engineering to deal with. In scientific wellness what we’ve done is created a whole cadre of coaches that not only understand the actionable possibilities but have been trained in psychology so they can persuasively argue for the individuals to change their lifestyle and behaviour in accordance with the opportunities they have for becoming well. Physicians are not at all good at dealing with patients in those kinds of terms. I think there will come to be a whole new field in healthcare that is called scientific wellness coaching where people will be trained in biology and medicine and nutrition and inflammation but they’ll be trained in psychology as well and have the ability to become your mother so that you feel responsible for changing your behaviour in appropriate ways.
That’s the fourth P actually, that’s the participatory P and it’s really what’s missing in people’s thinking about precision medicine today. P4 medicine is really precision medicine or at least a part of what people think. I like the four descriptors because they tell you what medicine really should be and not just give it some arbitrary definition of precision. First of all, medicine is anything but precise so it’s not a particularly felicitous term, I don’t think.
Do you think there will need to be a shift in regulations and practices if we are to facilitate all of this?
There’s going to be. I really think we’re at a tipping point and P4 as it gets embraced in the healthcare systems are going to cause an enormous reorganisation of the healthcare system, an enormous reorganisation of how we think about wellness and disease. We’re just at the very beginning of seeing how profound these revolutions are going to be. I see physicians that can operate almost in total isolation from healthcare systems with three or four coaches and a thousand patients practising scientific wellness, the physicians concentrating on the transition points to disease and everything. I see a whole new field emerging with these scientific wellness coaches. I see hospitals themselves becoming largely delocalised. The point of care will shift from the hospital to the home and, in fact, in the future we’ll be able to generate all the measurements we need with a device equivalent to the tricorder that will be used at home - take a drop of blood, make the 5,000 measurements and ship it to an analytic centre. That will come back through a scientific wellness coach to give you recommendations about what your next steps are.