January 29 , 2007
BY michelle lampl
What is “predictive health?” What does it mean to predict health and what are the implications? These are the common questions that we encounter, followed by concerns ranging from issues of privacy to the ethics of presenting people with what could be construed as “bad news” regarding risks for conditions we can presently do nothing about. A number of people have commented, “I don’t want to know which diseases I’m programmed to get!” — feeling that prescience of one’s health “destiny” is more information than they care to have. The idea that medical care is intervention for disease or injury is so embedded in our cultural experience that the shared assumption regarding predictive health most often focuses on disease prediction rather than health prediction.
Enhanced disease predictability is part of the translational value to society of basic scientific research. Disease-associated genomic markers assist in early diagnosis and the promise of predictive health histories from knowledge of genes is part of a pre-emptive and personalized vision of a transformation in medicine.
Emory scientists have made groundbreaking discoveries in these areas. Advances in imaging technology have resulted in increasingly sensitive devices for identifying pathology at ever earlier stages. Research in disease-specific processes is providing measurable chemical markers that may provide for early interventions and more targeted drug therapy. And novel research into generic, root-cause cellular processes gives us the earliest window into indications of potential disease as well as points of intervention to prevent disease from happening. But genes alone are only part of the predictive story as environmental and epigenetic effects influence genomic expression. The predictive efficacy and financial feasibility of biomarkers in the medical toolkit are presently under study.
Specific disease prediction in itself is not a new approach to medical care. Health prediction, by contrast, is a fundamental paradigm shift. The proposition of predictive health requires articulating a conceptual framework that defines the meaning of health beyond a medicalized vision of the human body and experience. This is a fundamental challenge and we do not yet share semantics for such concepts. One of the first steps in attaining a “new model of health and healing” is to put the emphasis on health in “health care.”
Scientific inquiry has drawn the broad outlines of possibility for reconceptualizing health in medicine: there are fundamental processes that contribute to human biological function, including oxygen pathways, immune function, inflammatory pathways and regenerative potential. Throughout the life cycle, flexibility in these basic processes contribute to maintaining health, and perturbations lead to multiple outcomes that may become manifest as disease. Better understanding of these processes will permit us to intervene and maintain biological stability in ways we have yet to discover.
Critical to the success of this transformative vision is to inspire the University’s overall research protocol to move from a traditional model of vertical foci to cross-disciplinary, collaborative teams that span departments, schools and external institutions.
In the relatively short time since the initiative began, it has sponsored a quarterly University lecture series, two national conferences and 18 projects that are under way, involving faculty from across the University. Research objectives range from trying to determine how health status can best be defined to explorations of how immune system function may be useful for non-infectious neurodegenerative disorders. A Center for Health Discovery is scheduled to open in late spring 2007.
Cutting edge technologies will, no doubt, be critical to clarify human biological flexibility across the life cycle. But implementing these discoveries into daily life is the greater challenge. Issues of ethical, legal, religious and cultural values challenge society, as will the continuing issue of health disparities. The impact of shifting emphasis from remedy to preemption in the established medical/pharmaceutical/health care complex challenges business and government. Addressing these issues is the work of an entire University community. Taking the concept of predictive health to practice requires fundamental realignment not only of health care delivery modalities, but involves educating individuals in their personal responsibility for their well-being. As research progresses, it is ever more important to break the barriers between the laboratory and community, bridging the gap between discovery and societal/cultural concepts. We need to ignite innovation in our University, merging cutting edge bench science with public health, community outreach and school education projects, teaching the youngest members of our community to think about their own health.
Exploring new ideas and paradigms with colleagues across the University, engaged in a fundamentally important issue in everyday life, is exciting. The vision of predictive health is a challenge in terms of how we educate the next generation to function not only as independent scholars and scientists, but as intuitively collaborative contributors to the significant, not yet recognized questions that we will face in the future.