Clinical OMICs - Issue 3 - (Page 21)

Nathan D. Price, Ph.D. is associate director and Leroy Hood, M.D., Ph.D., is president of the Institute for Systems Biology. P4 Medicine The convergence of systems medicine, big data and its analytics, and patient-activated social networks has led to a medicine that is predictive, preventive, personalized and participatory-P4 medicine. It differs from traditional evidence-based medicine in six ways: 1) it is proactive; 2) it focuses on the individual patient, 3) it emphasizes wellness; 4) it generates the personalized data clouds that provide fundamental insights into each individual, 5) it notes that the traditional path of clinical trials is ineffective and wasteful, and it suggests that clinical trials start with a deep analysis of the individual and not populations of dissimilar individuals; and 6) it contends that patient-activated social networks will be a major driving force www.clinicalomics.com in the medicine of the future. P4 medicine embodies two central concepts-quantifying wellness and demystifying disease. The question is how do we bring P4 medicine to current healthcare systems? We believe the answer to that is through largescale, information-rich longitudinal studies such as we are launching via the P4 pilot 100K project. The 100K Project The idea is to take 100,000 well patients and then carry out detailed genomic, proteomic, epigenetic, metabolomics, and phenotypic measurements on them four or more times a year-examining blood, saliva, stool as well as other physiological and psychological parameters. After time, these individuals would separate into two classes-those who remained well (or enhanced their health) and those who transitioned into disease. From the data of those individuals who remained well or improved their health we could extract metrics for wellness. We could study those individuals transitioning from wellness to disease at the earliest stages of this transition-deciphering early disease mechanisms and generating early diagnostic markers. In time, the insights gained offer the possibility of transitioning patients very early on from the disease trajectory back to a wellness trajectory, saving the healthcare system enormous dollars by greatly shortening the costly disease trajectory and, most importantly, greatly enhancing the individual's quality of life. Assays and Analytics The starting basis will be a whole genome sequence for each participant in order to have information about the building blocks of each individual's physiology. This will only need to be done once, but a host of other measures will provide details on the dynamic changes in health that occur over time by interaction with the environment. Thus, we will employ digital devices that continuously measure physiological parameters like heart rate, activity, sleep quality, blood pressure, and weight. We will periodically measure the gut microbiome, clinical chemistries with a focus on nutrition, blood (continued on next page) May 15, 2014 Clinical OMICs 21 http://www.clinicalomics.com

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Clinical OMICs - Issue 3