Discovering Precision Health. Lloyd Minor

“This is an effort to change the world of medicine and health,” he says. “I see this as a way to refocus the key priorities of biomedical research.”

      The vast majority of biomedical research has focused on treating diseases. A much smaller part has focused on maintaining health and maybe some prevention efforts. But there’s very, very little research that has tried to look at the big picture—what makes people happy, resilient, creative, fully exploring their potential and living not only healthy, but more‐than‐healthy lives [18].

      The center’s research has involved enrolling 40,000 people—10,000 each in the United States, China, Taiwan, and Singapore, and possibly also other countries downstream—and asking them 76 questions that are connected to 10 different dimensions of well‐being. Blood samples, as well as other biological samples collected from participants in most sites, will be available to be studied. These analyses, says Ioannidis, may reveal biological markers for wellness and well‐being. “Just as we can monitor diabetes by looking at blood sugar levels, is there some biomarker that can tell us something about how one feels about one’s life? Are there biomarkers that indicate levels of wellness and well‐being and that change as people’s levels of well‐being increase or decrease?”

BEHAVIORS CAN CHANGE—AND DO CHANGE

      I recognize that encouraging health‐promoting choices is not an easy task—I once heard a Silicon Valley venture capitalist say he would never invest in a company that was trying to change human behavior, no matter how promising. But I believe that while it’s certainly not easy, it can be done. Stanford Medicine research has already demonstrated how.

      Abby King, whom I mentioned earlier, has spent her career studying how to encourage health‐related behavior change, particularly among older adults and those living in disadvantaged communities. Again and again, she has found that motivationally targeted mobile apps significantly increase key health‐promoting behaviors such as physical activity and spending less time sitting throughout the day. Analytical facts‐and‐figures approaches, which include personalized goal setting and self‐monitoring, are effective, and so are social approaches, which include social comparisons, norms, and support.

      The demand for diagnostic and motivational tools is growing. In March 2015, Stanford researchers introduced MyHeart Counts, a mobile health app developed by Stanford Medicine faculty that runs on Apple’s ResearchKit platform. Just six months later, nearly 50,000 people had agreed to participate in a cardiovascular study connected to the app [19]. Its users can monitor their daily activities and risk factors for cardiovascular disease and then share this data with researchers. Though most people visit their doctor only a few times a year, their phone is almost always at hand. With MyHeart Counts, they can get continual feedback about their behaviors and how to improve those behaviors in a way that promotes heart health.

      There are many other such tools, and they are helping to reorient health and health care throughout the world. One of them, a mobile app called reSET, manufactured by Novartis, is used to treat substance disorders. It was approved by the Food and Drug Administration in September 2017, and Novartis launched it in November 2018. The app is intended to be used as part of a 90‐day prescription that also includes outpatient clinician‐delivered care.

      While digital technology can help drive behavioral change, the proliferation of this technology can contribute to an always‐on environment, which leads many people to never quite disconnect. That interferes with activities like meals, exercise, social engagements, and sleep. It’s a toxic combination that contributes to a variety of social maladies.

      The writer and entrepreneur Arianna Huffington knows the cycle all too well: one day in 2007, she collapsed from exhaustion and broke her cheekbone in the process. She was diagnosed with acute burnout, and she says that as a result of the episode, “I made changes in my life, including renewing my estranged relationship with sleep and redefining my idea of success” [20]. Today, she’s the leader of Thrive Global, which declares that its mission is “to end the epidemic of stress and burnout by changing the way we work and live.”

The company is strongly focused on advancing prevention by changing behaviors. Huffington talks about “going upstream … identifying and addressing stress triggers before they become symptoms.” She believes that health outcomes can be changed “by focusing not just on the root causes of chronic and stress‐related illnesses, but also on how well‐being enhances performance.”

      Thrive Global emphasizes “Microsteps,” which are small changes in behavior that eventually lead to healthier habits. They take many different forms: leaving electronic devices outside the bedroom (to foster better sleep), sitting down to eat (to promote more mindful consumption), holding meetings while walking (to promote exercise), responding to email only at certain times (to reduce distractions).

      Huffington is a fan of B. J. Fogg, who is director of the Persuasive Tech Lab at Stanford. He talks about changing behavior through simplifying it. “The more you succeed, the more capable you get at succeeding in the future,” Fogg says. “So you don’t start with the hardest behaviors first, you start with the ones you want to do and you can do and you persist” [21].

      * * *

      There is a clear need for new ways of thinking across the entire health care community.

      The focus of medicine today is still on the clinical signs and symptoms that we can easily see and measure, such as an elevated blood‐pressure reading or a patient’s reports of fatigue. Rarely addressed are the factors that matter most and would yield rich insights into why the disease occurred in the first place.

      Fundamental to the new thinking must be a recognition that medicine should not be seen as a game of catch‐up—a matter of reactive, after‐the‐fact treatment. Instead, we must commit to not only curing disease definitively when it strikes but keeping people from getting sick altogether. This means transforming the societal view of health from negative (“We have it and then lose it”) to positive (“We can optimize and enhance at any stage”).

      The encouraging news is that we are increasingly able to quantify the factors that affect our health and untangle the relationships among the four factors listed at the start of this chapter, thanks to data from electronic medical records, genomic sequences, biospecimen repositories, insurance records, and wearable sensors. We can now start to answer such questions as: How does our behavior affect our genes? How do our genes affect our social status? How does our socioeconomic status affect our behavior?

      The more precisely we can answer these questions, the more we will be able to tailor treatment for that disease and, best of all, predict and prevent other diseases altogether.