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must be measured longitudinally in time, and can track
changing wellness and disease states)
[10]
. They are also
beginning to push for new ways in which to engage with our
science-based healthcare system to maintain wellness and
achieve life goals as well treating disease. Because of the
reactive nature of the existing healthcare system, which is
more accurately described as the 'disease management
industry', the vast bulk of healthmanagement in areas such as
nutrition, exercise and sleep takes place in the home, without
the assistance of physicians or other professionally trained
care providers. The writers of bestsellers about the latest diet
and purveyors of unregulated health products operate largely
outside the constraints of science-based healthcare. Today's
educated consumers are increasingly conscious of this fact
and are beginning to demand that science-based healthcare
address their need for assistance in managing these other
areas of their own health. They are stimulating the growth of
a new market for devices that deliver increasingly real-time
digital data about every aspect of their health (quantifying
their wellness), ranging from activity levels to vital signs, and
many of them are starting to come to their physicians for help
in interpreting these data. The digital revolution is beginning
to help fashion a new dimension for healthcare
maintaining this gold standard will require a close working
relationship between clinical, systems-based scientists and
patients. In addition, we need to develop ways to actively
counter misinformation that might begin to spread through
social networks and to correct misinformation often found
on the current medical websites and in other sources of
medical information. While significant, these challenges
are outweighed by benefits to be gained by wide dissemi-
nation of actionable 'gold standard' of personalized health
data reviewed for consistency with the standards of our
science-based healthcare system.
Ultimately patients will be recognized as not only
a source of disease problems to be solved but as a source of
disease and wellness solutions as revealed by their data.
Creative new forms of engagement with networked and
activated consumers as active participants in healthcare, as
opposed to passive recipients of expert advice, will become
a major source of value tapped by the healthcare revolution.
Networked and activated participants will find new ways to
adjust diet and exercise to move their biomarkers in the
direction of better health. Crowd sourcing these problems
will yield many benefits. For example, researchers will be
able to correlate their behavior changes with biomarker
fluctuations, their genome, their medical histories and other
key parameters. Such data from millions or even tens of
thousands of patients would provide researchers with deep
insights into the effects of nutrition and exercise that have
never before been possible. These large-scale personalized
data sets would be the basis for the quantification of
wellness, providing society with a far more effective
understanding of the effects of diet, exercise and sleep on
highly stratified population sectors.
The digitization of P4 medicine enables its distribution
to all citizens of the world
thewellness
e
arising from the quantified self.
P4 medicine responds to these growing demands by
providing patients and consumers with actionable infor-
mation that they can use to improve their health. Clinical
institutions using wellness coaches, genetic counselors and
physicians can provide this information cost-effectively. It
will be conveyed largely through digitally linked social
networks, the most important of which will be family
networks. One effective strategy may be to identify family
members who are the most active in setting familial health-
related standards and in caring for members with health
problems, and then to work with those individuals to help
them do a better job. Medicine today systemically
approaches patients as statistical abstractions, relying on
the efforts of time-pressed physicians to achieve some
degree of personalized care. Working with family and
social networks will allow P4 medicine to systemically and
more effectively deal with the reality of the social context
in which patients and consumers are embedded and which
largely determines how they eat, exercise and sleep. Acti-
vated patents and consumers working effectively within
their family and social networks to utilize the increasingly
real-time flow of personalized health-related data will be
able to reduce the incidence of and to better manage
complex diseases such as type II diabetes, which account
for a huge percentage of total healthcare costs and, of
course, to optimize their wellness.
To achieve this goal we need to develop and continually
update a 'gold standard' of reliable data, information and
explanations of disease and health that will meet the needs
of
both developed and less
developed. For example, we remember those who thought
the initial large brick-like cell phones of the early 1990s
were ridiculous and could not imagine their widespread
acceptance (there are now more than 4 billion cell phones
worldwide). Today, a woman in a rural village in India can
make a living for her family with a cell phone thanks to the
digitization of communications, with its potential for
transforming the economic conditions of even the poor. So
we will see a 'democratization of P4 medicine' throughout
the world as inexpensive and digitized P4 medicine
becomes available (see below).
To summarize, we argue that P4 medicine has two
major objectives for each participant: to quantify their
wellness and to demystify their disease (
Figure 23.2
).
Our feeling is that the quantification of wellness will
become increasingly important over time, ultimately
dominating as the concern of most individuals. Table
23.1 provides a striking comparison of proactive P4
medicine with contemporary,
e
reactive evidence-based
both
physicians
and
patients. Developing
and
medicine.
