10 No. 3
December 2007/January 2008
Prediction as the Cure
Gazing into the human body's crystal ball
The "engineers" in bioengineering
“I find it interesting that it’s incredibly difficult to define health without talking about a default position—you know you have health because you’re not sick.”
“There’s significant new ethical ground to be broken here. . . . We’re collecting a large amount of personal information. How do you protect it, who stores it, how do you store it, who has access to it?”
Defending basic science
Looking South Exploring Southern Spaces
The new terrain of Emory's multi-media scholarly journal
The Near Past
Tone and tension in writing about the modern South
Stories from the Frontlines
Or, How to survive co-authoring a book (with your spouse
Academic Exchange: How did the PHI begin?
Ken Brigham: About four years ago, leadership within the Woodruff Health Sciences Center and others brainstormed to identify new opportunities that might be the next “big ideas” in biomedicine, and how Emory, along with sister institutions and the resources it has available, might be able to position itself at the leading edge. Our health care system is not functioning very well and needs to change. Emory leaders thought that the developing science and technology would give us an opportunity to change the system in ways that were beyond our imagination until recently. During the development of the Strategic Plan, the idea of predictive health in society emerged as a broad theme, and it was recognized that science and technology will make it possible to change health care, but that it won’t change unless a variety of other changes occur in society, such as how people think and behave and where they spend their money.
AE: What impact could the PHI have on health care?
KB: One of the broad goals is to revolutionize biomedicine—that is, change biomedicine materially from the way it is currently pursued to a new model, to true health care and not such a heavy focus on disease. Most of the research is focused on abnormalities, disease—what’s wrong rather than what’s right. The idea of the PHI was that we would initiate a program focused on defining health, devising new ways to measure and predict health, and then devise strategies for changing individual health and also social health as well. Predictive health is preemptive and preventive, rather than treatment-focused.
AE: How is the PHI structured?
KB: There are three pieces. One is the basic science initiative that relates to the discovery and invention of medical interventions, then there will be a piece that relates to how you apply practice and policy to society. Finally, there’s the Center for Health Discovery and Well Being, which is the personal part, and also the part that’s most well developed. All of the parts will interact. We’ll need data to know if this novel idea of focusing on health and partnering with people to help them care for themselves has any impact. So we’ll first look at Emory employees and look at the influence of the program by comparing people who are in it to those who are not, and see if it’s cost effective and how it affects utilization of traditional health services.
AE: What ethical considerations does the PHI raise?
KB: There’s significant new ethical ground to be broken here. Much of it revolves around information. We’re collecting a large amount of personal information. How do you protect it, who stores it, how do you store it, who has access to it? There are a variety of ethical issues surrounding the handling of information. When you start talking about using that data in research, protecting people from adverse consequences related to the accumulation of such a large amount of personal data becomes a big issue. Then there are some “angels on the head of a pin” issues. We’re going to store genetic information, though we won’t do gene analysis to start with. But at some point we will. Suppose you determine some important medical information from genetic analysis—you think you’ve found something but you’re not sure. Does the person whose DNA it is deserve to know? Would they want to know? Do you have any right to have it connected to them?
AE: What does your crystal ball say about the future of PHI?
KB: I think this approach to health care will become dominant—that is, taking care of healthy people and keeping them healthy. I think the resources, particularly human but also financial, will migrate more toward health and preventive care. There are some real challenges of how you shift the system while meeting the obligations of the health care profession at the same time, not to mention the financial interests. I think there will have to be big savings from the healthy person’s view, but the denominator is going to go way up: Suddenly we’ll have all these people in the health system that you haven’t seen before. The response to that is that they don’t need to be seen by a doctor or an expensive highly trained person. The center’s health partners will have very focused training and a narrower skill set of knowledge than most current health care providers, and will be less expensive to employ than physicians or nurses. The way we save money now is to not see patients whenever possible.