Since time immemorial doctors have focused their work primarily on treating disease. That’s how we’ve been trained, how we’ve practiced, and how we’ve thought for as long as the medical profession has existed. The gold standard of medicine has always been to find treatments that work for large numbers of people, and match them appropriately to the conditions our patients face.
Today, most people’s interactions with the medical system are sporadic or driven by disease. They may have an annual physical exam, or routine checkup, but only go to the doctor when they have an issue. Our healthcare system is built around this model, with physicians compensated by insurers and government programs primarily for providing sick care.
This doesn’t have to be the case. In fact, given the medical community’s now unprecedented access to innovative technologies and research, it is time we rethink our approach entirely—focusing on prediction, prevention, and, ultimately, cures. Today we can approach medicine from a more personal angle, tailoring health care to the unique biology and life circumstances of each individual. This approach is called precision health, and it has the potential to transform both our profession and our patient’s lives.
One of the most promising vehicles for ushering in this transformation is a new study initiated by Verily Life Sciences, formerly Google Health. In partnership with Stanford Medicine and Duke University, this study—called Baseline—is an ambitious attempt to actually map the fullest picture of human health instead of merely defining it as the absence of disease.
Baseline will begin registering volunteers over the next few months and will ultimately follow 10,000 of these participants over four years, collecting enormous volumes of data that will aim to show a complete picture of what health really looks like. Scientists will analyze participants’ genomes, microbiomes, and other biomarkers. They will collect data from wrist-worn devices and other bodily sensors, medical imaging, surveys about health status and lifestyle, as well as clinical visits.
The data that emerges from this study will be an unmatched trove of information for researchers, aiming to help them uncover new insights in health and sickness and drive findings to better prepare health professionals to provide predictive and preventive care.
An area in which precision health stands to have a huge impact is in communities that have been traditionally underserved by healthcare providers. It’s important that everyone benefits from the precision health revolution, and that we address not only genetics and medical care, but also the environmental factors that so heavily influence individual health.
The Stanford Precision Health for Ethnic and Racial Equality (“SPHERE”) Center, a project we launched last year, is one way that Stanford is applying precision health principles to critical health issues. Among the initiatives at the SPHERE Center is an effort to better understand how various factors contribute to obesity in low-income Latino children in a Santa Clara County neighborhood.
Through this program we are seeking answers to some vital questions. For example: Are Latino children more likely to be obese than Caucasian children in low-income communities? What is the role of genetics in determining obesity? What potential cultural factors exist, such as dietary customs, daily schedules, and more?
Understanding the answers to these questions will inform the medical community’s approach to make a difference in the children’s lives and the community’s long-term health. For instance, if we can find ways to reduce obesity in this community, that should bring reductions in diabetes, heart disease, and other chronic conditions over the course of their lives. That kind of forward-looking approach represents a new direction for medical research, which has traditionally focused much more on disease treatment than prevention. It is a change that is long overdue.
Of course, getting better at prediction and prevention in the lab can also lead to cures. For example, Stanford researchers have developed specific molecular inducers that are only ingested by cancer cells. These inducers then cause cancer cells to create proteins that serve as biomarkers that can be detected in blood. In other words, they’ve created a provoking molecule that tricks cancer into announcing itself early. This is critical, because early detection of cancer greatly increases the likelihood of successful treatment.
These are exciting times for biomedical research, but research alone isn’t enough. The real transformation will happen when we translate the lessons from projects like these into daily clinical practice. We as doctors and other healthcare professionals must train ourselves to think proactively, and use the tools that science is developing to do so. Healthcare systems must follow suit, finding ways to provide support for ongoing wellness care—not just sick care.
Lloyd Minor is the dean of the Stanford University School of Medicine.
