Will Personalized Medicine Help in 'Transforming' the Business of Healthcare?

Future Perspective: A Personal Vision of Personalized Medicine

I mentioned at the beginning of this perspective that I did not find the present direction/definition for personalized medicine optimal. I will now present my personal preference of the direction that I consider personalized medicine should follow.

The September 2007 Department of Human Health and Services document on personalized healthcare provides a very detailed and informative overview of what this could mean and how we could get there. It also details how this will become the norm, and in certain cases has achieved this status.^[114]

However, perhaps in these rapidly evolving times of technology development, what I consider to be the most relevant definition is that found in Wikipedia:

'Personalized Medicine is the concept that managing a patient's health should be based on the individual patient's specific characteristics, including age, gender, height/weight, diet, environment and so on. Recent developments in genetic testing allow the development of 'Genomic Personalized Medicine' and Predictive Medicine, which is the combination of comprehensive genetic testing with proactive, personalized preventive medicine. Personalized medicine is not solely about genomics, however, as personalized medicine is about you, the health consumer. Personalized medicine also allows your healthcare provider, such as your physician, to focus their attention on what makes you, instead of abiding by generalities' ^[115]

This definition is much broader than that which is often debated at personalized medicine meetings and in related publications. The question is could we move directly to this definition, which a number of stakeholders in healthcare, particularly the patient, would most willingly accept? I believe so. We are presently at a stage where we have many, if not most, of the components that are required to implement a successful program that would encompass these various pieces.

The present problem is that the solutions are being developed as individual solutions, whereas the reality is that the solution is made up of multiple components that need to be integrated. The Wikipedia definition of personalized medicine requires multiple product development and subsequent integration. At a recent Arrowhead Publishers Personalized Medicine meeting (held in Baltimore, MD, USA, April 23-24, 2009), Patrick Terry, CEO of Technic Solutions (Washington DC, USA) and a co-founder of Genomic Health, talked of the integration of diagnostic macromolecules (DNA, RNA and protein), and the use of systems approaches to provide the necessary information for defining personalized medicine. Entelos (CA, USA) uses a systems approach to define the 'virtual patient'.^[116] At the recent 16th International Molecular Medicine Conference in San Francisco (CA, USA), the popular National Public Radio spokesperson, David Ewing Duncan, spoke of his experience being exposed to the tremendous diversity of personal scientific tests, imaging, protein, genetic and so on, that are available to the average consumer. This is an expensive 'experiment' providing massive amounts of personal data, but the overall relevance of the majority of tests was unclear. His presentation made the case that it is not about simply collecting lots of personal scientific-related data. What was missing from his personal analysis was integration and subsequent decision-making processes. Theranos (CA, USA) combines the systems approach with protein diagnostics and personal lifestyle and regular behavioral information to create a patient health record that can provide an individualized phenotype that captures the evolving nature of personal health and healthcare.^[117] In this perspective of personalized medicine, the most important technologies are what I refer to as the 'glue' technologies, health IT. It will be the collection, aggregation and analysis of the information that will be the most important component of achieving a value-driven healthcare solution.

While personalized medicine is a reality, it is not a matter of developing new and 'better' technologies. While this still needs to continue, we have to focus on the approaches we now have and determine improved approaches for capitalizing on this data. It is not a matter of one technology, or one test, versus another, rather what we can learn from the combined information of these technologies.

As mentioned earlier, healthcare is presently a 'technology-push' industry. My analogy for the consequence of this approach is that each stakeholder in this space considers themselves to be the 'iPod' and the other stakeholder is the 'accessory'. The reality is that what is required is that the patient becomes the 'iPod'. See Figure 2A&B in relation to the desired changes in healthcare models. Optimally, for disease management/treatment, the patient would partner with the provider to determine the best path to reach a nondisease state. There needs to be significant transparent technology activities that the patient and provider do not necessarily understand, but rather they both experience the products that would be expressed as choices; choices that provide the best outcome in terms of disease management, but those choices that also fit the individual lifestyle of the patient to ensure that they will adhere to the recommendations. Managing healthcare should be seen as a 'team' concept. In terms of health and wellness or keeping healthy, the consumer would work alone or with a trainer (real or virtual) to map out their path forward and tools for managing their progress. This would lead to individualized health and medicine, which would result in best outcomes.

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Figure 2.

The future implementation of healthcare? (A) The scenario today. Each of the healthcare stakeholders considers themselves to be the 'iPod' and the others to be the 'accessories'. A 'technology-push' business model. (B) The scenario of the future. The consumer/patient becomes the 'iPod' and they play a critical role in the decision-making of which 'accessory'. The 'market-pull' business model.