Systems medicine, or a systems view of disease, offers powerful tools for changing how we think about health care, says Leroy Hood, President and Co-Founder of the Institute for Systems Biology. Central to this is the concept of P4 medicine, or the notion that health care can and should be predictive, preventive, personalized, and participatory.
Systems medicine has three major components, according to Hood:
- Our bodies’ biological networks are the information conduits for development, physiology, and aging, and if we can learn the difference between disease perturbed versus normal systems, we can then understand the pathophysiology of disease, biomarkers for detection, and create drugs for reversal.
- Systems biology is driven by powerful strategies, technologies, and computational tools. For example, we can now sequence the complete genome of a family and within that identify a disease gene that causes the simple Mendelian trait.
- The generation of dense, dynamic, personalized data clouds that consist of billions of data points, which when analyzed and integrated “lead us to actionable possibilities that either optimize wellness or let one avoid disease,” says Hood. Hood believes that when we can follow a large pool of patients with these data clouds, “we’ll begin to see transitions from wellness to disease for every single common disease and use the systems biology approach to get diagnostic markers and to learn about the drugs that can reverse disease before it ever manifests itself as disease. This is the preventive medicine of the 21st century,” he says.
“The convergence, then, of systems medicine, of big data, and of the digital revolution all together sharpened our view of what P4 medicine is. And it differs from contemporary medicine strikingly,” says Hood. It’s proactive, focused on individuals rather than populations, and emphasizes both wellness and disease. In P4 medicine, dense dynamic data clouds are the most effective way to assess the contribution of genetics and environment for an individual, he explains. It would also mean a complete reworking of clinical trials. “Taking 20,000 [individuals], giving them a drug or placebo, recording the data is fatally flawed because every individual is unique genetically and unique environmentally, and average disparate objects increase the noise over the signal enormously,” says Hood.
After founding the Institute for Systems Biology and focusing in on the concepts of systems medicine and P4 medicine, the next question for Hood’s team was how to bring what they call “scientific wellness” to the health care community. “I persuaded 108 of my friends to agree to have dense dynamic data clouds executed on them for a period of a year to analyze what it meant to be well and how to improve wellness,” explains Hood. That meant whole genome analyses and other periodic tests and measurements that, when integrated together, led to “actionable possibilities” to optimize wellness and avoid disease.
“The results were dramatic. The data we gathered are absolutely going to revolutionize many aspects of how we think about health care,” says Hood, “but what was really spectacular is what it did for the patients.” For example, Hood, who was one of the 108, says that “today, at 78, I feel exactly like I did when I was 40. When I’m 95, I expect to be feeling like I’m 50.”
“What we aspire to, through scientific wellness,” says Hood, “is to be able to let you go up this grand staircase motivated by these actionable possibilities, and to reach a state of what we call the ‘well-derly.’”
After the original 108, the Institute for Systems Biology grew to 1,200 customers. Hood expects it soon to grow to 10,000, and with this larger population size — and an affiliation with Providence St. Joseph Health — the institute can begin clinical trials on scientific wellness. They hope to see transitions from wellness to disease for multiple common diseases and be able to work to transform them. For example, they plan to follow breast cancer patients with dense dynamic data clouds through diagnosis, treatment, and recovery, and bring them back to wellness as rapidly as possible.
The other step is to educate patients and health care professionals on the new opportunities scientific wellness can bring. Hood believes that individuals’ data over time will become the fuel for transforming all health care industries.
“Finally, what excites me most,” says Hood, “is the fact that within a 10-year period, we’ll bring down by several orders of magnitude the cost of the assays to the point where we can bring scientific wellness to the developing as well as the developed nations and provide proper health care for the poor as well as for the rich — a democratization of health care that was really inconceivable to think about even a few years ago.”
From the NEJM Catalyst event The Future of Care Delivery: Relentless Redesign at Providence St. Joseph Health, January 19, 2017.