The Future of P4 Medicine

By Marc Singleton

The debates over healthcare costs have dominated our political discourse in recent years.  These debates highlight the need for major reform aimed at lowering costs while providing better and more personalized healthcare for an aging population.  Chronic disease treatment and emergency medicine bleed the health care system driving up costs for everyone.

Using the home as an analogy for the body, our current healthcare system spends little time maintaining and monitoring the health of the home when everything appears to be in working order.  Only when an emergency strikes, such as a pipe bursting and flooding the basement, do we take the time to assess the status of our home.  When healthy, most people rarely go to the doctor.  Not until some chronic pain develops or life-threatening ailment brings our poor health to light do most Americans seek medical assistance.  Back to the home analogy, our healthcare system attempts to treat all burst pipes the same, despite significant differences in home construction, materials, location and age.  This universal approach to treatment options neglects to evaluate efficacy or cost appropriate nature of the repair.

Emerging from the healthcare debates, a new way of thinking about medicine has put the focus on the individual patient.  Coined by the term P4 medicine, this new healthcare design creates a corporative relationship between the patient and physician(s) in hopes to address health issues before the “pipe bursts”.  Maintenance, while never convenient, is always cheaper and less detrimental than allowing disease to progress.  P4 medicine utilizes four interconnected aspects to improve both the effectiveness and efficiency of health management.  Predictive medicine; learning what risk factors, predispositions, and genetic susceptibilities exist before issues arise gives the patient and their health care team warning signs long before disease be diagnosed.  Preventative medicine; with knowledge of risk factors changes in behavior, pre-disease treatments and early screening can be initiated to cut off the development more serious conditions.  Personalized medicine; each individual responds to treatments, what works and what does not work, is very personal, yet the current system of healthcare attempts to treat in a universal fashion.  Having the knowledge and access to multiple treatment options as well as prediction on what will work effectively; patients and their healthcare team can tailor treatment to best meet the patient needs, thus personalizing the healthcare experience.  Participatory medicine; accurate diagnosis and effective treatments are meaningless unless the patient is willing to do what is necessary to prevent, or treat the disease.  However, most Americans treat the current health care system as a magical black box; you go to the doctor they tell you what they are going to do for you and that is that.  This of course has its advantages, not sure how many of those with hernias would know the best way to repair them, or what antibiotics best target strep throat.  However, this method does relinquish responsibility of ones health from the patient to the doctor.  Participation in health care decisions empowers the patient and can encourage innovation among the health care team.

Taking a real world example of P4 medicine, lets look at a common condition that many in the United States face:  high cholesterol.  We have all seen the commercial for cholesterol lowering medication that pronounces that high cholesterol comes from a mixture of family history and diet.  Following the P4 medicine methodology, the prediction of risk would be established through genetic testing, family history, behavior monitoring, and routine blood cholesterol testing; raising a warning flag for high cholesterol.  With a predicted risk, the health care team will develop a personalized health plan to change eating habits, reducing the intake of cholesterol long before the cholesterol becomes high.  Ownership of the cholesterol levels at this point is in the hands of the patient, requiring their participation to control the success or failure of their treatment.  Changing eating habits and implementing cholesterol achieve lowering medication prevention of the major health care effects.

Laboratory sciences will play a crucial role to fully realize P4 medicine.  Predictive and genetic testing, risk factor monitoring and treatment optimizations are all areas where the specialized skills found in laboratory sciences will enhance patient care.  Additionally, the cost associated with ordering typical laboratory tests, even when the results are inconclusive is more cost effective than treating even relatively benign conditions.  With laboratories, as the driving force behind health care reform, it is important that the information management and laboratory informatics be prepared to handle the impending influx of testing.  The days of recording results in a lab notebook, handwritten logs or even excel spreadsheets are behind us.  To keep up with ever changing, highly complex, data rich information coursing through the laboratory each day, even the smallest lab must develop flexible information management systems (LIS) that can meet data challenges while complying with regulatory standards.  As a laboratory professional, my work has focused on developing and bringing to market new, clinically relevant laboratory tests.  In my opinion, the UNIFlowÔ LIS framework has provided the basis for meeting the challenges of the new emerging laboratory focused health care system.

I look forward to the day when our medical records exist electronically and can be moved between physician, laboratory and patient seamlessly.  Only then will we be able to truly make the connections between environment, behavior, health and treatment.

Marc Singleton is a PhD candidate in Human Genetics at the University of Utah School of Medicine, and former laboratory scientist/LIMS developer for Axial Biotech