Much of what we write about at Medgadget deals with advances in diagnostic and preventive medicine, such as the smart bra that may help detect breast cancer and the contact-less camera thermometer. We are optimistic that as technology develops many of these diagnostic tests will experience a reduction in cost with a simultaneous increase in accuracy. This will be essential in order for us to transition from a disease care system to a healthcare system.
A new book published in October by Basic Books aims to provide a road-map for how we can leverage existing and future technology to do just that. Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years was written by two physicians, Dr. Kenneth Brigham and Dr. Michael Johns, who founded the Emory-Georgia Tech Predictive Health Institute. This author had the opportunity to interview the two about the book and learn more about how developments in predictive medicine may impact societal health.
Shiv Gaglani, Medgadget: What motivated you to write Predictive Health, and who is your audience/why should they take heed?
Dr. Kenneth Brigham & Dr. Michael Johns: There were several reasons why we felt compelled to write the book. Foremost was the fact that our health care (really disease care) system in the US is on a financial path to implosion and it doesn’t have to be. We were convinced that a radical change in the focus of biomedicine was both possible and essential if we are going to be able to keep people as healthy as possible for as long as possible. And we also felt strongly that the book needed to be aimed at a general audience, not only to experts in the relevant fields. If the needed shift in the health care paradigm is to happen it will have to be broad based, driven by societal needs, desires and priorities.
Medgadget: What diseases and health problems, specifically, could be prevented, if not eliminated, if tested for and treated early on?
Brigham & Johns: It is no secret that we are in the midst of a serious epidemic of obesity which leads to a host of chronic diseases including type II diabetes, high blood pressure, heart attacks, strokes and probably mental deterioration. Although we don’t understand all of the factors that are at play in this epidemic, we know what it is, we can measure it, and we know the cure. If we could implement what we know on a population scale, the increasing incidence of diabetes, cardiovascular disease, etc. could be stopped. And the consequence would be more healthy, happy and productive people for longer than is true now. The opportunities will multiply as our biomarkers of health become more robust.
Medgadget: How difficult would it be to institute a Predictive Health system nationally? What larger impact would this Predictive Health model have on our health care system in the long term?
Brigham & Johns: It will be difficult. Changing the focus of bioscience—research, education and practice—from disease to health would impact a host of people who are invested in and derive both their personal satisfaction and their income from the disease focused system. But, the current system is not sustainable—the costs continue to increase out of proportion to other costs and we are not getting healthier—so something will change either by evolution or as a consequence of catastrophic failure of the current system. We will always need to treat people who develop diseases and our efforts to improve treatments should continue. An increased focus on measuring and maintaining health will augment those efforts to the benefit of society.
Medgadget: What do you think about the current controversies surrounding screening tools such as mammograms, PSA, etc? Unlike tests for, say, phenylketonuria, these screening tools have lower sensitivity and specificity. Wouldn’t future Predictive Health tools have the same shortcomings and lead to increased controversy due to false positives/negatives as well as escalating costs?
Brigham & Johns: The biomarkers we propose to use are measures of normal function and structure, not disease focused preventive measures. We contend that there are some basic metabolic processes that characterize optimal health and can indicate the earliest deviation from optimal health so that interventions can be done long before there is any evidence of disease (e.g. increased PSA or a shadow on a mammogram). As our capacity for obtaining and interpreting information expands, redundancy will decrease errors in health prediction.
Medgadget: What are the four metabolic pathways that produce biomarkers in the blood that are harbingers of health, and can help predict disease risk? How can identifiable “biomarkers” be integrated with other characteristics, such as behavior and environment?
Brigham & Johns: We propose that inflammation, immune function, oxidative stress and regenerative capacity are fundamental determinants of health. Markers of these four processes can be measured in blood and we believe that they predict not disease risk, but future health and any risk of becoming unhealthy—they are not specific for a disease, but are markers of health. In a system that deals with healthy people and is aimed at keeping them that way, the disease focused biomarkers would become a measure of failure and last resort and the arguments about their specificity irrelevant. Biomarkers that measure near terminal failure of the organism will be valuable in planning for and experiencing the good death.
Medgadget: What are the true costs and pitfalls—financially and health-wise—of our current health care system due to its focus on researching and treating diseases? How do we compare to other nations?
Brigham & Johns: We spend more on health (mostly disease) care than any other developed country and our average life expectancy is shorter. That in spite of the fact that we probably do have the best disease care system in the world. The costs of keeping people healthy and prolonging productive life are not limited to costs of diseases care, but include costs of education, social support programs, making health care accessible, etc. The US spends less on such programs than many other developed countries which likely impacts life expectancy. But disease care is expensive and that cost will continue to increase. The only way to solve the escalating cost problem is to decrease the demand—keep people healthy for as long as possible. That is what we mean by Predictive Health.
Medgadget: As doctors, what would you define as a “good death”? How do most people want to die?
Brigham & Johns: Doctors are probably the least prepared to define what a good death is and helping in that process than are many others who regularly deal with terminally ill people. Doctors are focused on cures and keeping people alive. There is a lot to learn here and we are beginning to see that happen with the new specialty of Palliative Care Medicine. So with that in mind we first need to accept that death is inevitable and integrate that knowledge into how we deal with our own lives and the lives of those for whom we care. All of the advanced science and technology in the world will not confer immortality on any of us. Most people do not want a prolonged death if it can be avoided and they want to spend their final days in the company of loved ones and as free of pain as possible, aware of who and where they are and of their circumstances. Hospice care programs address these issues for people with clearly terminal diseases. We need to make the welfare of the person dying paramount in how we deal with the end of life.
Medgadget: Given your projections on the use of Predictive Medicine, do you recommend any changes to the way we train clinicians?
Brigham & Johns: We do need to provide more health focused education, and more emphasis on health as in integral of biology, behavior and environment in the training of doctors, nurses and other existing health professional training programs, but if we expand the system to care of the healthy, there will be a need for people specifically trained to do those things. In the book we advocate a new kind of health professional who is specifically trained to deal with healthy people and with the knowledge base and skill set to engage them in health related behaviors and environments that are aimed at optimal health.
Hardcover on Amazon: Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years