Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years
“Overall, a convincing read.”
Predictive Health presents a new vision for health care, emphasizing caring for the healthy and keeping them healthy rather than only treating people after they contract a disease or disorder.
Drs. Kenneth Brigham and Michael Johns are eminently qualified to write this book. As physicians, they have broad clinical experience. Recognizing the shortcomings of the current health system, they founded the Emory Georgia Tech Predictive Health Institute.
By all indications, the authors have succeeded in presenting their argument; however, they are cognizant it will be an uphill task to realize their dream, including an entirely new way of looking at health care as well as a need for new facilities and personnel. Ideally the mission should “go viral” with a groundswell of popular interest to lead the way.
In each chapter, the authors discuss themes related to predictive health in a clear, concise manner. The resources they used are provided in the Notes. Each note is identified by page number with a short phrase pulled from the text; however, there are no corresponding superscripts or other indication in the text to guide the reader. There is a valuable listing of references in Additional Reading.
Part I sets the theme of the book as Drs. Brigham and Johns present their new vision of health care.
The current practice of health care is exemplified by the case of Carleton Hensley. Mr. Hensley was only in his early 60s when he entered the emergency room with a host of problems. The medical staff worked heroically but futilely to save his life. Since medicine is obsessed with prolonging life at all costs, the result was deemed a failure.
Ms. Echt, on the other hand, serves as the new model for health care. One hundred years old, she lived a full and active life, the result of a positive interaction of biology, environment, and behavior. She lived what the authors call a “square wave life,” living as healthy as one can for as long as possible, followed by a brief, dignified end.
In Part II, the authors discuss recent discoveries in molecular medicine that could be used in the diagnosis, prevention, and treatment of diseases.
Recent scientific advances in the omics: studies of the genome (genomics), the proteome (proteomics), and the metabolome (metabolomics), provide many layers of information that can be assimilated into an integrated model known as systems biology. The authors have high hopes that this systems approach will enable workers to predict a person’s health.
The epigenome is the three-dimensional structure of DNA that can determine which genes are expressed. The authors point out that as we become more knowledgeable about each person’s unique epigenome, it may be possible to determine what effect certain chemicals, drugs, or foods may have on their health.
In the chapter The Wild Genome the authors discuss how personal behavior (diet, exercise, emotions) can influence gene expression. They point out that people are not totally captive to the genes they inherit and that environment also influences gene expression.
In Part III, the authors discuss applying theory and diagnostic tools to the development of a new predictive health care system. As they so aptly point out, “the primary need is a new mindset—measurements are not made to establish a diagnosis but to define the status of a person’s health.”
The authors describe the activities at the Predictive Health Institute. The “participants” (not patients) undergo a battery of tests, plus information on the person’s environment and behavior. These tests measure normal functions necessary for health such as inflammation, immunity, oxidative stress, and regenerative capacity.
The authors contend that concentrating on these fundamental processes is much more efficient than using biomarkers to test for a vast number of individual diseases. The results are compiled into a health assessment report, and a health plan of action is developed. The authors state that although it is still too early to tell the results of the program, the signs are very encouraging.
The authors like the idea of a horizontal arrangement between health provider and participant. The current physician-patient relationship is top down. In a horizontal arrangement, participants decide for themselves what to do and get help in doing it, rather than being told what to do.
Interestingly, Drs. Brigham and Johns do not seek medical professionals for the program. They prefer to choose people from diverse backgrounds and train them in the principles of predictive health. These “health partners” have people related skills to engage participants in the program to care about their health. It would not be appropriate to assign these tasks to current health professionals who have a different mindset, are too expensive, and would be significantly unhappy performing tasks considerably below their levels of competence.
In Part IV, The Broader View approaches the task of what needs to be done to change the paradigm of health care. The authors see three potential forces for change: politics, economics, and education. Although the authors admit to a bias, they feel that universities present the most promise for change.
In the Epilogue, the authors discuss the relationship of a good life to a good death. The characteristics of a good death are well known, and the authors feel it makes no sense to expend futile efforts to postpone the inevitable in a high-tech hospital.
Overall, a convincing read.