The Future of Personalized Lifestyle Medicine: Application to the Clinic
www.plminstitute.org
Lifestyle-Induced Chronic Disease Obesity Metabolic Syndrome
Diabetes
Chronic Obstructive Pulmonary Disease
Stroke
Heart Disease
LifestyleInduced Chronic Diseases
Some Cancers
Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. Minich DM, Bland JS. ScientificWorldJournal. 2013 Jun 26;2013:129841. doi: 10.1155/2013/129841. Print 2013.
Health is personal.
Are we looking at a global shift in health towards personalization utilizing developments in science and technology?
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The century as the age of personalization in modern healthcare • Genome decoded at the turn of the century • Emergence of point-of-care diagnostics • Deconstruction of molecular pathways • Advances in technology
Medicine is least personal now. “Experts point to the irony that, at the dawn of an age of personalized medicine, the doctor-patient relationship is at its least personal. Doctors are paid by the number of patients they see, not for the time they invest in a personalized health maintenance regime or for health outcomes.�
Rick Mullin, Personalized Medicine, www.cen-online.org, February 2008.
What is personalized medicine? The practice of tailoring therapies to the specific genetic profiles of patients and their diseased cells.
“With the potential to transform medical practice across global communities, personalized medicine is emerging as the flagship of modern medicine.� Zhang et al. Complementary Therapies in Medicine Volume 20, Issue 1 , Pages 93-99, February 2012
“Application of personalized medicine paradigms aims to achieve the right diagnosis and right treatment for the right patient at the right time at the right cost.� Zhang et al. Complementary Therapies in Medicine Volume 20, Issue 1 , Pages 93-99, February 2012
Personalized Medicine Growth Drivers Treatment cost savings
Patient compliance
Early detection
Optimization of therapies
Drug safety
Myshk D. Creating a Personalized Medicine Strategy. PharmaVoice, May 2011
Have we reached the tipping point for personalized medicine? • Advances in technology • Dropping price points • Increased knowledge of biology & molecular basis of disease • Healthcare reform • Shift from volume-based business model to value-based business model • Upswing in adoption of molecular diagnostics by physicians and their acceptance by payers. Myshk D. Creating a Personalized Medicine Strategy. PharmaVoice, May 2011
Personalizing health care: feasibility and future implications. “Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.�
It’s already happening. “The public is not waiting. Awareness of personalized medicine is increasing with the rise in news coverage of technologies for early cancer detection and determining genetic propensities for disease. Do-it-yourself genetic testing kits are now available, and private companies offer routine screening.” Rick Mullin, Personalized Medicine, www.cen-online.org, February 2008.
Levels of personalized health Genetics
Typing
SNPs
Epigenetics
Methylation
Phosphorylation
Biochemical
Standard Labs
Functional Biomarkers
Challenges • Identifying the right biomarkers • Conducting clinical trials with smaller patient populations • Managing co-approval pathways of companion diagnostic/therapeutic offerings • Optimizing value propositions for sophisticated payers and benefit managers. • Understanding the basic biology of the disease and drug target at the preclinical stage. Myshk D. Creating a Personalized Medicine Strategy. PharmaVoice, May 2011
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Century Healthcare Concepts • Emergence • Systems Biology • Network Medicine • E-health • Virtual coaches • Telemedicine • Health Apps
The World of E-Health http://www.dfrobot.com/community/e-health-sensor-platform.html
Definition of E-health is debated. • Electronic health records • E-Prescribing • Telemedicine • Consumer health informatics • Health knowledge management • Virtual healthcare teams • Mobile devices • Medical research grids • Healthcare Information Systems 9/11/2013
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E-health 10 factors for successful implementation of personalized e-health services: • Anxiety, trust, attitude toward using, computer self-efficacy, perceived system quality, search strategy, user's condition, health specific knowledge, Internet dependency and satisfaction with medical care. Stud Health Technol Inform. 2013;192:965.
Personalized Medicine vs. Personalized Lifestyle Medicine What’s the difference?
What is “Personalized Lifestyle Medicine”? “Personalized lifestyle medicine is a newly developed term that refers to an approach to medicine in which an individual’s health metrics from point-ofcare diagnostics are used to develop lifestyle medicineoriented therapeutic strategies for improving individual health outcomes in managing chronic disease.” Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. Minich DM, Bland JS. ScientificWorldJournal. 2013 Jun 26;2013:129841. doi: 10.1155/2013/129841. Print 2013.
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SYMPTOMS & DIAGNOSIS
The Trajectory of Disease and Role for Personalized Lifestyle Medicine • • • • • • •
Preclinical Syndromes Low or High Normal Blood Values Low or High Penetrance of Genetic Variants Epigenetic Modifications
• •
Diagnosis
INTERVENTION
Pre-Pathological Changes
Disease Diagnosis Abnormal Blood Values Well-defined Symptoms
Disease Progression Symptom Worsening
Progression
Aggressive Pharmacological Intervention
PERSONALIZED LIFESTYLE MEDICINE Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. Minich DM, Bland JS. ScientificWorldJournal. 2013 Jun 26;2013:129841. doi: 10.1155/2013/129841. Print 2013.
What is Personalized Lifestyle Medicine? DIET
ACTIVITY
PERSONALIZED LIFESTYLE MEDICINE
STRESS
ENVIRONMENT
Differentiation Among Medical Systems
Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. Minich DM, Bland JS. ScientificWorldJournal. 2013 Jun 26;2013:129841. doi: 10.1155/2013/129841. Print 2013.
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Patient characteristics to consider in establishing a PLM therapeutic protocol • Age • Lifecycle • Gender • Past medical hx • Family hx • Ethnic background & ancestry • Lifestyle habits • Nutritional status
• Medication use • Dietary supplement use • Physical location & travel frequency • Home and environment • Genetics and mutations • SNPs • Epigenetic patterns
Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. Minich DM, Bland JS. ScientificWorldJournal. 2013 Jun 26;2013:129841. doi: 10.1155/2013/129841. Print 2013.
Diet
4 Facets of Personalized Lifestyle Medicine
Activity
Environment
Stress
The power of biomarkers •Laboratory tests •Functional tests •Point-of-care diagnostics
The Interpretation & Translation • Genetic tests • Laboratory biomarkers • Functional tests • Physical diagnosis • Patient education (PLMI)
A typical patient’s experience with Personalized Lifestyle Medicine INITIAL • Genetic tests run by major labs • SNP evaluation • Laboratory biomarkers • Evaluation of physical symptomatology • Assessment of lifestyle factors ONGOING • Tracking using applications • Virtual coaches
Our Mission: Transforming health care through personalized lifestyle medicine Our Vision: To be the global leaders in the promotion of personalized lifestyle medicine
Our Website: www.plminstitute.org
The Interrelationship of Medical Systems PREVENTION
TREATMENT
Lifestyle Healthcare Public Health Recommendations
P4 Medicine Personalized, Preventative, Predictive, Participatory
Personalized Medicine
Lifestyle Medicine Personalized Lifestyle Healthcare Individualized Therapies
Functional Medicine Operational System
Conclusions • The sequencing of the genome together with cuttingedge technology advances has resulted in the application of personalized medicine in the area of drug metabolism. • Personalized lifestyle medicine incorporates an individualized approach to food, supplements, activity, environment, and stress modulation. • Tailoring therapies to a patient should result in the best outcome for the patient. • The mission of PLMI is to provide information to the patient and practitioner that aligns to the best health outcomes.