The Era of Personalized Medicine is Upon Us

A revolution in healthcare is beginning to move from the lab to the bedside.  The first practical applications are emerging based on the mapping of the human genome, which was essentially completed in 2003.  Over the next 10-15 years there will be a profound transformation of healthcare based on the new knowledge created and the use of health information technology to store and manage that information.  The era of Personalized Medicine is just beginning.  What is “Personalized Medicine”?  Personalized Medicine (PM) uses new methods based on analysis of individual genetics and predictive modeling to better manage a patient’s disease or risk for a disease.  It aims to achieve optimal medical outcomes by helping physicians and patients to choose the right medicines and treatments most likely to be successful based on that patient’s unique genetic and environmental profile.  Personalized Medicine will allow us to have an enhanced ability to detect disease early, even before symptoms begin, optimize therapies and reduce the chances of side effects and manage health in a proactive manner over the course of a patient’s life.  We will longer lives with less illness and disabilities.

We are all genetically unique in some way.  As a result, medications work differently in different patients.  One medication may work very effectively in one person with few side effects while it doesn’t work at all with many side effects in another person.  Up until now we had no way to predict who would benefit and who would not.  PM would allow us to use genetic information to better predict what medicines would work in a particular patient.  For example, the effect of the “blood thinner” drug warfarin, used to prevent blood clots, is partially mediated by genetic variations in a drug metabolizing enzyme (CYP2C9) and a vitamin K activating enzyme (VKORC1).  Dosing is typically adjusted for the individual patient through multiple rounds of trial and error, during which time the patient may be at risk of excessive bleeding or further blood clots.  Every year over 400,000 patients experience adverse and sometimes life-threatening bleeding from warfarin therapy.  Dosing based on the genetic factors cuts in half the amount of time necessary to get to a stable dosing regimen (e.g. from 32 to 14 days).  PM will reduce or eliminate the trial and error risk for many drugs.  This would be especially important for the dangerous drugs that we use to treat cancers.  If we could be more sure that a particular regimen would work, it would save precious time and suffering that occurs when trial and error results in failure.

PM will result in profound changes in how medicine is practiced.  Instead of waiting for you to develop a disease and the resulting symptoms, doctors will obtain a genetic profile and put you into a customized risk reduction programs to prevent onset of the disease and/or aggressive monitoring programs to begin early customized treatments at the first sign of the disease.  The best treatment will be selected based on your personal genetic profile resulting in faster improvement and less side effects.  Keep your eye on this promising trend.

For Your Healthy Future:

• Ask your doctor if there are any new tests based on your genetics that he or she would recommend you obtain.  This is especially important to consider if there are any diseases that “run in your family” like breast cancer.
• Be sure to participate in any recommended screening tests and health risk appraisals offered by your doctor or your employer.  The most proven tests are often included in those and as PM approaches become more established, they will likely begin to be included as well.
• If you have a particular condition and want to know if there are personalized medicine options, you can do a Google search that will likely identify information and research organizations involved in that area.  For example, search for ‘asthma +”personalized medicine”’ to find PM resources for asthma.  Include quotes around “personalized medicine” to make the search more specific.  Focus on reputable and known institutions because, as in any new treatment options, there will some who are promoting unproven methods just to make money.

Resources:

• Vanderbilt Your Genome and the Future of Medicine: nice series of informative videos on the potential of PM.
• Introduction to Personalized Medicine: by Duke University, overview and background on PM.
• Personalized Medicine Coalition: The Personalized Medicine Coalition (PMC), was launched in 2004 to educate the public and policymakers, and to promote new ways of thinking about healthcare.  PMC represents a broad spectrum of over 200 academic, industry, patient, provider and payer communities.  They seek to advance the understanding and adoption of personalized medicine concepts and products for the benefit of patients.

 

How to live longer without starving yourself

We are seeing more and more evidence of the importance of diet for health and longevity.  We have to look at food as a sort of medicine.  In fact, there is a burgeoning industry growing around using foods as medicinal products called nutraceuticals.  Now we have study that says not only is the right diet important but eating less is important.  In a very intriguing study, rheus monkeys were studied over 20 years with the only difference being one set of monkeys were fed 30% less calories.  They were both healthy diets.  They found that 37 percent of the comparison monkeys have so far died in ways judged to be due to old age, compared with 13 percent of the low calorie group.  Very importantly, the low calorie group also had less disease and seemed to age better, with most parameters of aging slowed or decreased.  They looked and acted like much younger monkeys (see photo).  It is estimated that the dieting monkeys would enjoy a extended lifespan of 10-20%.

The monkey on the left is 27 years old, while the one on the right is 29 years old. The age difference appears to be greater than 2 years.

Now before we start starving ourselves, it is important to note that this is study is not definitive and the findings may not apply to humans for various reasons.  Also, it is very difficult to sustain such a low calorie intake for an extended period of time.  Scientists are investigating substances such as reservatrol, that may have a similar benefit with the constant hunger of calorie restriction.  Nevertheless, we know for sure that losing weight, if you are overweight or obese, and reducing your calories will do wonders for your health and cure or improve many diseases such as diabetes and high blood pressure.  There is also very good evidence that a certain kind of diet, called the Mediterranean diet, can have a similar effect that calorie restriction may have.  This diet has been consistently shown to decrease mortality and heart disease.  There seem to many benefits of this diet for several chronic conditions and diseases of aging.  Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%).

The Mediterranean diet is rich in vegetables, legumes, soy products and essential fatty acids.  Essential fatty acids are fats that are needed in the body but can only be obtained from food.  They cannot be constructed in the body.  They are the good fats found in foods such as fish and shellfish, flaxseed (linseed), hemp oil, canola oil, pumpkin seeds, sunflower seeds, leafy vegetables, and walnuts. The Mediterranean diet is also low in refined carbohydrates (carbs) and “junk foods.”  Therefore another important element of the diet is eating food with a low refined sugar content or low Glycemic Index (GI) (see Nutrition data for a GI calculator).  Carbs  that break down quickly during digestion release glucose rapidly into the bloodstream, have a high GI and generally demand a strong insulin response from the body; carbs that break down more slowly release glucose more gradually into the bloodstream, have a low GI and tend to be healthier for the body.

So until we have more conclusive evidence for calorie restriction, the proven Mediterranean diet has similar benefits without the starvation.

For Your Healthy Future:

• For the first time, caloric restriction has been demonstrated to potentially have some anti-aging benefits in primates, raising the possibility that it will have the same impact in humans.  However, studies at this time are inconclusive.  Await more suggestive studies which we should see in 2-5 years although conclusive studies may take another 10-15 years.
• Reduce caloric intake if overweight or obese too lose weight.  Key is to get to ideal body weight or reduce your weight by at least 10%
• For any weight level, the Mediterranean diet seems to provide important health and anti-aging benefits.

Resources:

• Nutrition Data : excellent source for detailed information about various foods including glycemic index.
• Mayo Clinic – Mediterranean diet: Choose this heart-healthy diet option: overview of the Mediterranean diet

 

Don’t let the recession hurt your health

Our current recession, one of the worse we will see in our lifetime, is not only bad for your bank account and 401K but it is also bad for your health.  Recent surveys of medical associations have identified the many ways that the economic crises is adding to the healthcare crises.  The American Heart Association surveyed 1,000 people in March 2009. Its survey showed that 57% reported the economy had affected their ability to take care of their health. The AHA survey also found that:

• 32% had delayed preventive care, skipped doctor’s appointments, or stopped taking medication to save money.
• 25% with gym memberships had canceled them in the past six months.
• 42% percent planned to buy fewer fruits and vegetables.

These are all things that we should be doing MORE, now that our stress levels are higher.  An American Academy of Family Physicians survey of its membership found that 66% said they were reducing fees to cut patient costs or making other arrangements to help people pay and 54% reported seeing fewer total patients since January 2008, which is about when the recession began. People are delaying care and putting off taking care of their medical concerns.  This will lead to catching cancers later, heart disease after the heart attack and strokes after the damage is done.  This is particularly an issue for those with chronic conditions such as diabetes or hypertension, where continuous care and monitoring is so important even if you feel fine.  The high cost of healthcare is not only preventing Americans from seeking preventive or monitoring care but it is also pushing them over the edge when they get sick enough to need care.  A study from the American Journal of Medicine in 2007 showed that nearly two out of three bankruptcies stem from medical bills, and that due to high out-of-pocket costs, even people with health insurance can face financial disaster if they experience a serious illness.  The study likely understates the full scope of the problem today since the data were collected before the recession began.  The healthcare affordability crises was  worsening before the recession began.  Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by about 50 percent.  We are in dire straits and the most important thing you can do is to take care of your health.  An ounce of prevention is really worth at least a pound of cure, and today you cannot risk needing that pound of cure.  It may bankrupt you!

Coping with stress

Stress is any situation of perceived threat.  This may be physical or psychological and it is based on an individual’s perception and what is most valuable to them.  One person may feel very threatened and stressed by the loss of their job while another may be excited and see it as an opportunity to start their own business.  Stress-causing situations do not necessarily have to be negative.  Marriage as well as divorce may generate the same level of stress.  Stress affects many bodily functions that, in the short term, is adaptive and helpful.  Any stressful situation causes the body to release stress chemicals such as cortisol and adrenaline which causes rapid changes in the nervous, cardiovascular, immune and endocrine systems.  This is called the “fight or flight” response where the body prepares to respond and protect itself from harm.  The problem today is that because of the constant and long-term stress of something like a recession, this acute response becomes ongoing and repetitive.  This situation cause long-term effects on the body that are damaging and raise your risk of having a psychological and/or physical breakdown.  Therefore, managing and coping with stress today is critical for your health as well as your financial situation.

How should you cope with stress?  You should first assess whether your coping strategies and support are adequate.  Even if you think they are, you should focus on them more now because of the additional stress and fact that effects of stress can mount and create a serious event without you realizing it.  When you are stressed, what do you do to cope?  What do you do for fun?   One of the most important factors is your social support system.  Who can you turn to in times of stress?  Do you feel like you have the help you need to cope?  Do you have a close friend or family member you can share anything with?  Who has “been there for you”?  Can you call on them now?  It is important during times of stress to spend time and communicate with friends and family to deepen bonds.  However, avoid or take a break from any relationships that are creating more stress or not supportive.  Most importantly do not seek escapism with drugs, alcohol or inappropriate sexual behavior.  A healthy sexual relationship can be a critical coping mechanism but studies have shown that many people under stress take more and inappropriate sexual risks.  Increase your exercise routine, go to the movies more often, read more books and, in general, find and create more time for you to decompress.  Whether it means spending more time with people or getting away from everyone for a period of time, do what recharges you in a healthy way.  It is also valuable if you are a religious or spiritual person to connect and participate in your usual practices.  For more intense stress reduction, consider relaxation training, meditation and/or cognitive-behavioral therapy.  Stress can lead to more serious issues such as depression and anxiety disorder.  In these cases, seeing a healthcare professional is essential, as there are very good medical treatments and professional counseling can be very effective in getting you back on your feet.

The stress of the recession can lead to a vicious cycle of neglecting to take care of yourself.  You become a ticking time bomb waiting to explode or breakdown.  Here are some tips for managing during tough economic times.  For a healthy future, it is even more important to do the things you don’t want to do during this time: exercise, see your doctor, find a way to pay for and take your medicines, spend time with those you enjoy being around and take time for yourself.

 

The Future is Now!

Predict the future.  Your future.  It has been said that the best way to predict the future is to create it.  Along with all of the dreams and goals you want to achieve, what about your health?  Regardless of your current age, your lifestyle today will have impact on your health in 5, 10, 15 or more years.  Take a look around at your grandparents, parents, aunts and uncles.  Who carried that weight for years until they died of a heart attack?  Who is blind or on dialysis because of diabetes?  Who smoked for years and died of cancer way too young?  Who developed liver problems due to drinking?  Who skipped their colon screening test and now have colon cancer?  Who has allowed stress to drive them into a depression or to have a heart attack?  Because of the amazing ability of the body to cope with insults, often the damage you are doing to your body today is silent for years.  But then your body runs out of its capacity to compensate.  Then you have a life-changing health event.  You did not apply the ounce of prevention and now must pay for the pound of cure.  These health events are often drama filled, affecting the whole family in some way.  Most importantly they affect your dreams.  A heart attack, a stroke, cancer and/or the onset of a chronic illness that you will have to live with the rest of your life often make your dreams harder or impossible to achieve.  Unfortunately, for many, the first event is a final event and the dream is over.  There are many things we do not have control over but there are many we do.  We are learning more every day about how our future health is controlled by today’s choices.

We have a new president that supports science.  As a result, even though the pace of medical advancement is accelerating, expect the pace to pick up even more over the next few years.  Evidence is mounting that we can delay aging, prevent disease and more effectively treat disease.  We are close to cures and effective treatments for diseases that have plagued mankind since the beginning of time.  The problem is that science is advancing so fast that it is nearly impossible to keep up with it all.  Even more importantly, it is becoming more difficult to sort out good science from bad, and credible sources from charlatans trying to make money from desperate people.  For many reasons, our healthcare system is not able at this time to guarantee that everyone receives the best and the most up-to-date medical care.  In fact, studies show that patients only receive about 50% of care that the best evidence says they should receive.  This applies to every age group and for just about every condition.  Until the healthcare system is fixed (don’t hold your breath), it will be important for every individual and every family to take more responsibility for their health.  This is extremely important because we are finding that our modern lifestyles are killing us.  If we would just stop smoking, lose weight and exercise, up to 80% of heart disease and 50% of cancers would be prevented.  If you combine lifestyle changes with applying the best medical science and healthcare, you have the potential to create a long lifetime of health. By “health”, I mean not just the absence of disease but also the state of optimal well-being, mentally, physically and spiritually at every age.  This is important because healthy people are energetic, creative and productive, and they are able to make their dreams real.  We sorely need more people like this in our families and communities.  A long, healthy life is a blessing we can claim by becoming informed, active and committed to creating health for ourselves and our families.  I include families because health is greatly based on your family ecosystem.  What Mom or Dad buys at the grocery store affects everyone eating at that table.  That second hand smoke can have an effect on a child’s asthma.  If no one in the household is exercising, why should I?  Bad habits are often passed down and rapidly spread through our clans.  We can do the same with good habits.

The objective of this blog is to share what I am seeing on the horizons of healthcare, wellness and prevention as well as spreading the word on well-established evidence-based practices that are sadly underutilized.  I use the term “evidence-based” because it is very important to make choices based on good evidence in the medical literature.  Many claims on websites and in news articles are merely speculation that you apply to your own life at high risk.  At best they waste time and/or money but sometimes are dangerous.  Unless there is some evidence of a good research study and publication in a respected peer-reviewed medical journal, then you are probably dealing with opinion and not science.  Also, there are certain kinds of studies that are better than others even though both are published in medical journals.  The weaker studies may still be useful, but you have to be more careful about drawing conclusions.  I will try to help you to sort through these questions and issues.

You can predict the future by creating it.  Create a future of dreams and goals achieved.  By fully realizing your potential, you make your unique contribution to society.  Create a future free of devastating illness and injury by how you live your life today.  Do this for yourself and your family.  Your life should be boring as far as healthcare is concerned but rich and exciting as far as your health is concerned.