November 3, 2016:
We are embarking on an exciting time in health care. All doctors may not share this realization, but if you look in the right direction, the future is bright.
To this point, I want to share my experience in attending the Personalized Medicine Lifestyle Institute (PLMI 2016) in October 2016 in Arizona.
What is the essence of personalized lifestyle medicine?
This simple concept actually represents a complete paradigm shift in the way that we conduct research in medicine, and offer care to patients.
It is quite a dramatic shift from the conventional model. It involves shifting the mindset from large-scale population strategies to understanding the individual genetic and physiologic differences in people. One would then use that information to develop personalized health advice.
What is the current model of scientific study?
The current scientific model is based on a number needed to treat (NNT) analysis.
In essence, a large-scale study is done to see how many patients will need to be treated with a drug over a certain time period to gain a significant enough benefit to bring that drug to market.
A good example of this phenomenon is crestor. This statin drug has been used to treat high cholesterol and heart disease. In the widely publicized JUPITER study, conducted by pharma giant Astrazeneca, the NNT of crestor was 20.
This means that you would have to treat 20 patients over a period of 5 years to avoid a heart attack in 1 person. The other 19 people had no benefit, but were exposed to the potential risks of the drug. If this statistic sounds poor, consider that previous studies on statin drugs showed NNTs of 40 to 70, which was sufficient to bring them to market.
Similar NNT values can be appreciated on the following chart.
The NNT approach is the mainstay of scientific medicine, and treats people in herds. This shotgun approach to medicine has been used for decades, and I am hopeful that we are seeing signs of this system fading away.
What is the proposed new model of scientific study?
The talk at the conference the really grabbed my attention was by Dr. Nathan Price, PhD. He is co-founder of Arivale, a company who is conducting the hundred persons wellness project.
The essence of this project is to build a neural network of data, and apply it to the personalization of medicine. They are starting with 100 test subjects, and plan to move to 100,000 subjects as the computational algorithm evolves.
A neural network is computational approach using a large collection of data to solve complex problems.
This concept is better illustrated using an example. Let’s refer to an intestinal disease called ulcerative colitis. In the process of collecting data from 100,000 people, the algorithm notes that these subjects have a high level of cystine (an amino acid) in their blood. The algorithm would analyze all combinations of cystine levels, intestinal symptoms, diagnoses of ulcerative colitis, and dietary and medication treatments.
Over time, people who are treated with interventions will generate more data into the system through ongoing testing and symptom reporting. We can then generate unbiased data to prove what compounds will lower cystine levels and whether this lowering leads to improvements in ulcerative colitis symptoms.
If you take this approach, and apply it to thousands of analytes, thousands of diseases, and thousands of possible interventions, you can see how only a highly sophisticated computer algorithm can solve these problems.
The 100 hundred persons wellness project neural network:
The reality is that we do have the technology to solve these problems, and the details will be considerably more valuable than trying out drugs on random test subjects.
I am thankful to say that the future is bright in medicine. This transition towards truly understanding body function, and working with the human body is the hallmark of personalized medicine.
I suggest you follow doctors like myself and Dr. Nathan Price if you want to stay apprised of new innovations in medicine.
Dr. Rishi Verma, MD
Latest posts by Dr. Rishi Verma, MD (see all)
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- Dr. Verma Featured on CKNW News on January 31, 2015 - January 29, 2015