P4 medicine: A shift from disease to wellness

“Systems medicine is at a tipping point and is transforming healthcare,” said Leroy Hood, MD, PhD, president and co-founder of the Institute for Systems Biology, in his keynote address at the Cleveland Clinic Medical Innovation Summit on Oct. 28.

Soon healthcare will witness the emergence of P4 medicine, which stands for predictive, preventative, personalized and participatory. This shift will spur a revolutionary change in healthcare leading to better quality and a striking decrease in disease, he said.  

Hood shared the experience of the P4 pilot program, a longitudinal, digital-age study that will include 100,000 well patients from around the world. The project creates metrics for wellness that offer a multidimensional analysis of a patient’s health, and these metrics are generated, mined and integrated into personalized dynamic data clouds.

Individual data captured in the study includes a complete genome sequencing; continual measures that are self-tracked (weight, blood pressure, exercise and sleep); and data from blood, urine and saliva that are taken every three months. Information generated from available online data also are utilized.

“If you examine such patients, in a period of time you can distinguish them into two groups--one healthy and the other as transitioning into disease,” he said.

Using these data, patients can be motivated to change behavior to help them reach a more optimal state. If a transition toward disease occurs, it’s possible to look through data and see where the divergence occurred. This could spur the development of early diagnostics that allow individuals to move away from the disease trajectory and to the wellness trajectory, saving the healthcare industry money, Hood said.

Actionable data, coaches and positive reinforcement all reinforce behavioral change. “The wellness metric is key in this regard.”

The P4 study “is only at the very beginning of integrative analysis,” he said. In the first batch of 107 participants (which he called “pioneers”), 91 percent had nutrient abnormalities that could be corrected and three individuals had diabetes that were missed by physicians. Some were discovered to have “blazingly high” mercury levels. One participant was able to change his eating habits from tuna sushi to salmon sushi and cut his mercury level in half in two months, Hood said.

Other participants were identified as having Hemochromatosis, a disease that affects 1 in 10 Caucasians. It requires bloodletting every two weeks to bring iron levels back to normal. “This is a striking example of how you can correlate the gene effects with clinical chemistry and show you have to do something,” he said.

The study also included a family of 10 for whom data showed correlating cholesterol levels with 72 single nucleotide variants. Although at risk, the triathlete in the family had remarkably good cholesterol levels. “Genes are not your destiny. You can change your behavior.”

The study is at the “early discovery phase” in analyzing the microbiome of the first group of participants. So far, they have discovered “enormous variability” of the 107 normal individuals in regard to the different microbes in their gut. The study, thus, is an ideal opportunity to look at nutrition’s impact on the body, Hood said. 

All 107 have actionable possibilities, and personal clouds are dynamic and should be followed up, he said.

“Your genome determines your risks but not your destiny. You need to take control of your own health and wellness and disease. Contemporary medicine focuses on docs telling patients what to do and never turns around escalating cost,” he said. Through the P4 study, “we’ll create a vast catalogue of actionable possibilities that will be enormously useful.”

In the future, wellness companies will emerge, eventually overtaking the disease industry. “I see emergence of the wellness industry, and my prediction is that in 10 to 15 years, the market capital for wellness will far exceed that of the disease industry,” he said, noting that companies forming today will be the Microsofts and Apples of tomorrow.

“Wellness will be a big industry and right now we are at that junction point,” he said.