Predictive Health and Society
Health is the essential infrastructure for
all that humans are capable of being
doing or becoming individually or
together
American health compared to that of other developed
countries
“America's health care system is second only to Japan ... Canada, Sweden,
Great Britain ... well, all of Europe. But you can thank your lucky stars we
don't live in Paraguay!” - Homer Simpson
Cost
• US spends more
(15+% of GDP)
• US has steeper rate
of cost increase
“Benefit”
• Shorter life
expectancy in US
• Slower rate of
increase in life
expectancy
We are at serious risk of losing our health while paying dearly for it
The Health/Disease Continuum
Normal
Low risk
H
E
A
L
T
H
Normal
High risk
Pre
disease
Early
disease
Late
disease
Predictive Health
Contemporary Medicine
D
I
S
E
A
S
E
Predictive Health
A personal matter
The Emory Model: A limited number of generic
processes can define individual health and predict
premorbidity
DIABETES
NEURODEGENERATIVE
DISEASE
Determinants
of
Health
INCREASED
CAROTID
IMT
ATHEROSCLEROSIS
IMMUNE
HEALTH
PSYCHIATRIC
DISORDERS
Generic Processes
CANCER
Premorbid Conditions
0
10
20
30
25 yr, nanoscreen, elevated ox stress detected,
revised diet, exercise and therapeutic
40
62 yrs, fatal MI with 5 days
in ICU
53 yrs, follow-up PCTA
50
60
70
30
80
direct cost
indirect cost
$42,720
$37,920 (lost productivity)
direct cost
indirect cost
$15,000
$12,000 (lost productivity)
direct cost
indirect cost
$65,000
$500,000 (lost economic value x 20 yrs)
$672,640
Total
Increased life span
Neonatal genomic risk assessment
Emory model, risk evaluation
and early intervention
20
18 yr, metabolome screen change,
prescribed diet
10
Begin annual phys exams with metabolome,
psycho-social evaluation, depression score
and cognitive function
0
32 yr, change in metabolome and nanoscreen,
update medications
Conventional medicine
47 yr, acute MI
22 yr, silent atherogenic
changes
Figure 4: Hypothetical comparison of a disease focused health care model (Conventional medicine) with a health focused system (the Emory model)
for a person born with a predisposition to coronary artery disease
40
50
60
70
80
Neonatal risk assessment:
direct cost
indirect cost
Annual physical exam
direct cost
indirect cost
Nanoscreen added
direct cost
indirect cost
$9,300 ($150/yr x 62 yrs)
$0 (combined with annual physical
Add therapeutic
direct cost
indirect cost
$2,555 (7 yrs of drug at $1/day)
$0
Revise therapeutic
direct cost
indirect cost
$18,250 (50 yrs of drug at $1/day)
$0
Total
$500
$0
$10,500 ($150/yr X 70 yrs)
$4,500 (time off work, .25 day/60yr)
$45,605
Predictive Health
A societal matter
Interdependence of Individual and Group
Health
Healthy
People
Healthy
Societies
Health matters because
it is inextricable from individual
happiness, productivity and
quality of life, but also because
human beings do not thrive
in units of one.
Humans don’t thrive in units of one
• Individual health is defined in a social
context
• Defining societal health
• Healthy societies
healthy people
• Changing the health system means
changing society
Predictive Medicine
What others are doing
Johns Hopkins ad in Sunday NYT: April 25, 2005
Predictive Medicine
• Duke University
• Broad Institute
• Washington University
• Institute for Systems Biology
• Johns Hopkins
Predictive Health and Society
It takes a universe
It takes a University
Research Institute for Predictive Health
Determinants of
Health
Environment
Genomics/
Metabolomics/
Proteomics
Genetics
Population
Biology
Behavior
Molecular Imaging
Systems Biology
Generic Pathways
Bioinformatics
Some
Enabling
Technologies
Nanomedicine
Quantitative
Medicine
Ethics
Immunology
and
Inflammation
Development
Oxidative
and
Stress
Senescence
Public Policy
Finance and
Economics
Other Generic Regeneration
and Repair
Pathways
Novel
Therapeutics
Education
Specific Diseases
Cardiovascular
Diseases
Chronic Lung
Diseases
Cancer
Diabetes
Neurological
Diseases
Other Diseases
Some
Enabling
Disciplines
Why Emory University?
•
•
•
•
•
A focus on health
Generic processes as definers of health
A special environment
Unique combination of technologies
Integration of science, technology, ethics, humanities,
law, business, health policy, economics
• Systems science---cells to societies
• Building bridges between population health and
individual health
A Transforming Theme
•
A destination university---Emory, a recognized destination for the new biomedicine
•
Internationally recognized---New knowledge and practical experience with health care innovation
will have global implications and will identify Emory as a leader in health care innovation
with global implications
•
Inquiry-driven---The entire effort will be driven by a passion for new knowledge and how it can be
used to impact individual and societal health.
•
Ethically engaged---Predictive health is fundamentally an ethical concept.
•
A diverse community---Diverse scholars and new definitions of health related diversity that
transcend traditionally defined ethnicities.
•
Working collaboratively---The nature of the theme dictates dynamic interactions among a diverse
group of scholars
•
Positive transformation in the world---It is difficult to imagine an effort with as great a potential to
impact every aspect of society
•
Courageous leadership in teaching, research, scholarship, health care and social action---This is a
bold theme with a grandly ambitious goal that integrates research, scholarship and
education in an innovative effort aimed directly at revolutionizing care of people to
preserve and prolong the health of individuals and of society.