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February 20 , 2006
Time for a health care revolution?

BY Holly Korschun

Will the greatest benefits of predictive health come from breakthroughs in molecular biology, genomics and nanotechnology, leading to “personalized medicine?” Or will society benefit most from behavioral and cultural changes that improve the health of large populations? And is predictive health a metaphor for humanity refusing to accept its own mortality?

Such were the questions considered last week by a diverse group of faculty, staff and students gathered at Goizueta Business School for the first in a series of seminars devoted to six scholarly initiatives of Emory’s strategic plan. Deliberation on the “Predictive Health and Society” initiative ranged from practical aspects of health care delivery and accessibility to philosophical questions about the meaning of life and the meaning of health.

Ask 10 people what “predictive health” means, and one is likely to receive 10 different answers, and the elusiveness of a commonly accepted definition was evident during the discussion. Though it yielded perhaps more questions than answers, the seminar served as a lively reminder that building a new model of predictive health will require the expertise of many disciplines and that Emory is poised to turn such a challenging enterprise into reality.

President Jim Wagner, Provost Earl Lewis and initiative leaders Kenneth Brigham (medicine) and Michelle Lampl (anthropology) were joined by a panel of discussants, including Campus Life Dean John Ford, Center for Ethics interim Director Kathy Kinlaw and faculty and staff from biology, public health, medicine, business, religion, journalism, student life and Campus Services.

“There is going to be a revolution in health care,” Brigham said, “mainly because new technologies will make it possible, and because there are social pressures to change our health care system.”

Given that impending revolution, cultural and economic changes will be essential. How would a new model of health care be funded? Is it more important to support expensive laboratory research (that may take many years to pay off), or should the focus be on cultural changes that could more quickly affect a greater number of people? And, if massive amounts of new medical data become available, thorny questions of privacy, insurance coverage and equal access will not be far behind.

Several participants emphasized the importance of a holistic definition of health that includes behavior and culture. In some cases, societal changes have led to improvements just as dramatic as those realized by new drugs or vaccines—as in the case of tuberculosis, said anthropologist Melvin Konner.

“We need to balance the great effort of breakthroughs in science versus the major breakthroughs we could make using the information we already have available,” Wagner said. “We already have many indicators of health and disease, and we should not minimize these factors in defining predictive health.”

Others pointed out that, even if major behavioral changes prevent thousands of cases of diabetes or lung cancer each year, many individuals will still develop other kinds of cancer or suffer from inherited diseases.

Much of the discussion centered on how Emory might lead in developing internal health interventions, educating its own students, integrating health with ethics, developing improved methods of health care delivery, and making an impact in the Atlanta metro area.

“We are proposing to lead a major shift in health care over the next several years,” Brigham said. “Science and technology will make it possible, but the only way to make it happen is to involve a range of disciplines, including behavioral approaches, new business models and ethics.

“Technology will be moving at one pace and our ability to absorb the technology may be moving at another,” he said. “We have the opportunity to reconcile the two.”

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