With a stellar speaker line-up that included leaders in preventive health science research, biotechnology, academia and functional medicine, last Fall’s Personalized Lifestyle Medicine Institute (PLMI) Thought Leaders Consortium was a vivid snapshot depicting the ways in which communication technology and whole-systems thinking are converging to transform healthcare.
The consortium took place in Seattle, a forward-looking city and a very appropriate location for both the Personalized Lifestyle Medicine and Systems Biology Institutes. Tech-based businesses are big there. Microsoft is based in metro-Seattle, and Amazon calls the town it’s home, with offices for 30,000 people. Greater Seattle has also been a hotspot for functional medicine, being the home turf of one of its leading lights, PLMI founder Jeff Bland, PhD.
A recurring theme throughout the conference is the “quantified self,” a phrase originally coined by editors of the tech magazine Wired to describe a movement that began in the 1970s in Silicon Valley, where early-stage computer geeks experimented with wearable computers for self-tracking health variables. Today, IT solutions such as cell phone apps to “biohack” optimum health are the rage. This movement, in synergy with developments in capacity to store and analyze “big data” is nothing less than revolutionary for healthcare.
Perhaps the technology development best known to practitioners is 23andme, the DIY consumer-focused genetic testing company founded by Silicon Valley entrepreneur, Ann Wojcicki, where for just $99 people can order broad genome profiles, something that used to cost thousands of dollars just a few years ago. But many other technologies are emerging that will reshape medical practice in the next few years.
Dr Bland and the PLMI succeeded in attracting a diversity of speakers this year that ensured not just an exchange of inspirational ideas but importantly, support for applying these ideas and these technologies in reality where the “rubber hits the road.”
P4 Medicine and Systems Medicine
Perhaps the highlight of the conference and certainly the most anticipated presentation was by Leroy Hood MD, PhD, founder of the Institute for Systems Biology. Dr Hood is the recipient of 17 honorary degrees, has published over 750 peer reviewed papers, and while at Caltech, co-developed the DNA gene sequencer and synthesizer which paved the way for the completion of the human genome project.
A pillar in biotech and genomics, Dr Hood took the audience through a fascinating personal journey which overlapped with the history of systems biology, from the beginnings of his career in 1970 at Caltech where he helped lay the conceptual framework to deal with complexity and analysis of “big data” in biology, and paved the way for designing predictive models for health.
In the early 1990s Dr. Hood moved to the University of Washington to create a systems biology department with funding from Bill Gates. He later resigned after becoming frustrated with interdisciplinary obstacles, reductionistic thinking and academic conservatism. He says of that time: “Bureaucracies struggle to deal with the present, and almost never can they deal with the future.”
He went on to found the Institute for Systems Biology, and with the help of $100 million in 2005 from the health minister of Luxembourg, created strategies to develop what he calls “P4 Medicine.”
The term stands for a vision of healthcare that is predictive, preventive, personalized and participatory. Dr Hood explained that the convergence of systems biology, the digital revolution and consumer-driven/online crowd-sourced healthcare is forcing medicine to shift from its current reactive mode, which is focused on treating disease, to a P4 Medicine mode. This is a very positive trend.
Knowledge gained from The Human Genome Project have blown apart much of the basis of conventional medicine. Principles such as “recommended daily allowances” (RDAs) of nutrients, or prescription of drugs for an “average person,” simply don’t conform to genomic realities. The idea that there is a single linear solution (usually a drug) for a single cause of a chronic illness collapses in a world redefined by network biology, as does the notion that there is a one-size-fits-all dietary for everyone (e.g. the government food plate).
Statistical averages may be convenient intellectual shorthand, but the Genome Project tells us plainly that the “average person” simply doesn’t exist in reality.
“I would argue the whole field of nutrition is in the dark ages and the only way we’re going to move it forward is with strategically targeted experiments and patient activated social networks,” Dr. Hood told PLMI attendees.
The digital revolution, which enables people to collect and analyse huge amounts of data is fundamental to P4 Medicine and to what Dr Hood is calling the “democratization” of healthcare. “One essence is the idea that we will, for each individual patient create virtual data clouds of billions of data points of many different types of data, very heterogeneous, scaling from molecules all the way up to social networks, and we’ll be able to mine those data to create models that will let each individual’s wellness be optimized and disease avoided.”
The 100K Wellness Project
Dr Hood’s main strategy to bring the P4 vision into conventional medicine is the 100K Wellness Project, a huge Framingham-like longitudinal study tracking 100,000 healthy people over a 20-30 year period. Like Framingham, the study has the potential to define the clinical (and corporate) winner and losers in healthcare in the coming decades.
The project began with 100 volunteer “pioneers” in March 2014, and is set to expand next to 1000, 10,000 then eventually 100,000 (funding permitting). Large amounts of data will be collected every three months from participants, starting with sequencing their complete genome profiles, then collecting data on their microbiomes, heart rates, weight, respiration, blood pressure, quality of sleep, and so forth.
Key objectives are:
- To prove that people can and will control their own health through the self-tracking (such as using cell phone apps to monitor key health data).
- To prove that “your genome is not your destiny. Rather, it merely sets the limits of what you have to work with.”
- To “quantify wellness” and to identify “perturbed networks” early which could lead to disease later.
- To identify multiple “actionable opportunities” – diet and lifestyle interventions that will allow participants reset their biological courses to maintain and optimize health.
Dr Hood and his team are looking to raise a cool $10 billion from US Congress to fund the 100K Wellness project. It remains to be seen if a deadlocked and highly partisan Congress will approve funding for such an endeavor, one that has the potential to vastly reduce unsustainable downstream healthcare costs.
Elementary, My Dear Watson
Continuing the digital revolution theme, Michael Nova, MD, PhD from Pathway Genomics gave a mind-blowing presentation on his ongoing project “Panorama” - a consumer healthcare App powered by non-other than IBM Watson – the most powerful super-computer in the world. Soon we may all have our very own “HAL” to rely on to simplify our health concerns (hopefully Panorama will be kinder to us than HAL was to astronaut Bowman in Kubrick’s classic, 2001: A Space Odyssey).
Dr. Nova, with degrees in biochemistry, physics and medicine, is founder of multiple health and biotech companies and developer of the original “barcode bead” patents used by many diagnostic and DNA companies. He took PLMI attendees through the realities of the current data explosion.
Did you know that 90% of the world’s total data was created in the last 2 years and healthcare data has been doubling every 2 years? Now you do! By 2020, healthcare data will be doubling every 3 days. There’s a reason you’re feeling overwhelmed!
A theme from Dr Nova’s presentation was: Data is worthless unless it can be analysed. If healthcare is a big systems/big data problem, who better than Watson?
Other interesting takeaways from Dr. Nova: Roughly 70% of doctors are expected to order some form of genetic testing in 2015; the new focus of testing will be on gene-environment interactions, as genes are non-deterministic in most major illnesses; the focal point of healthcare in the next decade will be targeted/customized therapies, cost reduction and prevention.
Yale University graduate Rui Chen PhD from the Department of Genetics at Stanford University School of Medicine gave a dazzling “high science” presentation on results from a study on “integrated personal ‘omics profiling” (iPop).
To begin with, the iPop project involved sequencing the genome of one male individual, and then tracking the epigenome, trascriptome, proteome, metabolome, autoantibodyome, microbiome and envirome over a 4 year period, during which time the subject was diagnosed with type II diabetes. The study found corresponding changes in the iPop data concurrent with physiological state changes. The significance of iPop is that it provides first proof of principle for detailed personal health monitoring with integrative ‘omics.
Academia Goes “Functional”
The functional medicine revolution is not going unnoticed by medical researchers, pharmaceutical developers or corporate leaders. Roger Newton, PhD, the co-discover of drug, Lipitor, gave a detailed presentation on cardiometabolic diseases demonstrating how the current pharmaceutical paradigm does not adequately address the multifactorial etiology. He believes the reductionist “silo” mindsets of the “ologists” need to be changed and that systems biology and personalized approaches are the future.
James Fries, MD, Emeritus Professor of Medicine, Stanford University, a true pioneer in researching strategies for healthy aging, covered his “Compression of Morbidity” hypothesis which provides the conceptual foundation for healthy aging programs.
In case you’re curious, the single most effective way to delay aging is lifelong exercise!
Wayne Jonas, MD, a retired Lieutenant Colonel from the US army, ex-Director of the Office of Alternative Medicine at the Natural Institute of Health, and President of the Samueli Institute, gave a powerful, moving, and inspirational talk on resilience, and the healing process and integrative wellness systems.
Joseph Pizzorno ND, founder and Professor Emeritus at Bastyr University, presented a tool using artificial intelligence to implement a corporate wellness program based on personalized medical approaches. He shared data demonstrating how the technology created at his company SaluGenecists, was able to produce an average disease risk reduction of 25%, at a corporation of 9000 employees. Among the employees deemed “high-risk” at baseline, the average risk reduction was 40%. Employee engagement with the SaluGenecists online program was over 90%.
Edgar Staren, MD, PhD, MBA, who served as Chief Medical Officer for Cancer Treatment Centers of America, gave an important presentation on how to manage and implement personalized medicine in an organizational setting from his uniquely qualified perspective as a medical professor, surgeon, business leader and, himself a cancer survivor.
Systems-Based Medicine in the Clinic
Sara Gottfried MD, a functional medicine practitioner and author of the popular book, The Hormone Cure, gave an insightful and unique presentation into the role of the estrobolome (the aggregrate of enteric microbial genes whose products metabolize estrogens), dys-circadianism (dysfunctional circadian rhythms) and diurnal cortisol imbalances affect female hormone health and influence breast cancer risk.
Deanna Minich PhD, scientific advisor to the PMLI gave her customary powerful and thoroughly research-based guide through the application of nutrigenomics and personalized medicine in clinical practice using toxin exposure and metabolic detoxification as a case study.
Stacie Stephensen, DC, Chair of Functional Medicine at Cancer Treatment Centers of America, guided the audience through the Patient Empowered Care model of integrative medicine in the practice of oncology, including a comprehensive look at how CTCA clinicians work with core physiological systems and apply genetic testing in cancer treatment and recovery.
Dr. Dale Bredesen, Professor of Neurology at UCLA presented some of his pioneering systems-based approaches to the treatment of Alzheimer’s Disease. Dr. Bredesen talked about his early training at Caltech, where Dr Lee Hood, no less, was his biochemistry lecturer. His published papers on the 36 causes of Alzheimer’s—and the comprehensive, multi-factorial therapeutic strategy he’s developed shouldn’t be missed by any functional medicine practitioner) and are already classics in the application of a systems biology approach to chronic disease.
The Unquantifiable Heart
According to Dean Ornish, MD, founder of the Preventive Medicine Research Institute, and one of the world’s most respected advocates of lifestyle change as “real” medicine, one of the most important factors for the health of cardiovascular disease patients is whether the felt loved or lonely and isolated.
In a world where we’re all increasingly dazzled by data and the devices that deliver it to us, that’s a very important fact to keep in mind.
“Not everything that counts can be counted,” Dr. Ornish told the PLMI assembly, emphasizing that while the quantified self movement has much to offer, some of the most important influences on our wellbeing are not quantifiable.
Lastly (and my personal favourite presentations), were the talks first by David Jones MD President Emeritus of The Institute for Functional Medicine who was directly followed by Dean Ornish MD.
Whether it is because Dr Ornish is just incredibly bright, or because his pioneering research has proven over and over again that lifestyle changes can stop or reverse the progression of heart disease and cancer, his presentation at PLMI was breath-taking and unforgettable. There is a reason why Forbes magazine named him as “one of the 7 most powerful teachers in the world.”
Dr. Ornish payed homage to David Jones, MD, the physician who founded the Institute for Functional Medicine, for opening the space to openly talk about love in a medical and scientific context. Dr Jones himself went on to explore how intuition, pattern recognition, practical reasoning and empathy are fundamental tools in clinical practice which differs great from the kind of rationality that science idealizes. He underscored a point made long ago by Frances Peabody: “The secret of the care of the patient is in caring for the patient.”
Overall the PLMI conference covered a depth and width that could only be made possible by the capacities of Dr. Jeff Bland whose own presentations and panel discussions enhanced and supported the themes explored by other presenters.
Two major take-aways emerged from the meeting:
1) The principles that underlie the functional and personalized medicine movement aren’t just a passing fad, nor are they the province of “quacks” and fringe CAM practitioners or an interesting past-time for health tech nerds. They are based on clearly defined and in many cases measurable principles of how reality works. Systems biology and complex adaptive systems explain how everything works. Despite this, conventional medicine marches on as if in a parallel universe basing its version of reality on a limited Newtonian linear understanding of the human body—a worldview that is already several hundred years out of date. The linear, reductionist model is not sustainable, not based in truth, nor is it rational. Millions of people are suffering as we result.
2) “Rational science,” even if based in systems biology and implemented via the best of the quantified self technological innovations will not be enough on their own to trigger a transformation in healthcare. The needed changes will only come about when enough people have a change of heart, a change in inner consciousness, and enough personal sense of empowerment to affirm that we all can and DO deserve a better system, stewarded by government and corporate leaders with enough basic humanity to actually care about the people they are entrusted to serve.
Niki Gratrix is an internationally renowned, award-winning nutritional therapist and coach who originally co-founded one of the largest complementary and alternative health clinics in the UK. Niki was Director of Nutrition where she formulated the nutrition protocol, trained 5 other therapists and completed over 7,000 consultations. Niki trained at the Institute for Optimum Nutrition in the UK and served as the Vice Chair of the British Association for Applied Nutrition and Nutritional Therapy in 2012-2013. She speaks internationally, writes in a range of health magazines. Niki also has a certificate in NLP (Performance Partnership) and originally got her degree in Economics and International Politics from the University of Warwick, UK. Reach Niki via her website: www.NikiGratrix.com