with former IBM CEO Samuel J. Palmisano, of Re‐Think: A Path to the Future, a book about the globally integrated enterprise and the emergence of the global economy.
Mr. Rees is also a senior fellow at Dartmouth’s Tuck School of Business. He was the founder of FT Newsmine, a weekly email brief he produced in partnership with the Financial Times from 2009 to 2017.
Mr. Rees’s government experience includes serving as a speechwriter for President George W. Bush; the national security adviser, Condoleezza Rice; and the U.S. trade representative, Robert Zoellick. He also served as a speechwriter and senior adviser for the chairman of the Securities and Exchange Commission, William Donaldson.
During a 10‐year career in journalism, Mr. Rees wrote for many of America’s most respected publications. He was employed in Washington for the Weekly Standard, the Economist, and the New Republic, and in New York and Brussels for the Wall Street Journal. Mr. Rees’s writing has also appeared in the New York Times, the Washington Post, the International Economy, Reader’s Digest, and Finance & Development (a publication of the International Monetary Fund). He is a frequent contributor of book reviews to the Wall Street Journal. A native of Lafayette, California, Mr. Rees is a graduate of Wesleyan University.
ACKNOWLEDGMENTS
The idea for a book describing Stanford Medicine’s vision for Precision Health was suggested to me in 2016 during discussions with faculty and staff who were working on plans for the initiatives that have become a part of this vision. Bob Harrington, chair of the Department of Medicine, and Priya Singh, chief strategy officer and senior associate dean for Stanford Medicine, were leaders of this planning process. It has been heartening to see the engagement of our communities in the planning, communication, and execution of the strategy for Precision Health. Those who encouraged me to write the book were correct that the process of writing would help us to shape ideas and plans for the future. The book is also a reflection of a dictum, first emphasized to me by Jay Goldberg (my scientific mentor at the University of Chicago), that concepts only become meaningful and incisive when they are written, revised, and refined.
I have the honor of working every day with wonderful colleagues at Stanford. Their work is a constant source of inspiration for me and for so many others. The patients who entrust their care to us provide a grounding and focus to our scientific and educational pursuits. Our partnership with them is a privilege never to be taken for granted.
Although this book turned into a larger and lengthier project than initially envisioned, I want to express my regret that I could not describe all of the people, projects, and activities that are having a transformative impact. The same can be said for my description of companies focused on digital health, where there are also many more than I can cover here.
I want to thank Harry Clark for introducing me to Matt Rees. Matt’s keen insights and his assistance with the interviews and writing enabled this book to be completed. Jessica Best, director of strategic initiatives and communications, is an exceptionally talented writer and gave us valuable feedback on the manuscript. Sandy Yujuico, chief of staff in the Dean’s Office, arranged and coordinated the interviews and helped us keep the project on track. Esmond Harmsworth, our literary agent, provided valuable assistance during every step of the process.
Finally, and most importantly, I want to express my appreciation to my family. Lisa Keamy, my wife, has been my partner, companion, and adviser for these past 32 years. Her love and support energize and motivate me every day. Our children, Emily and Sam, amaze and inspire us as we watch their journey through life. Phoebe and Watson, our canine companions, make even the most challenging days seem a lot better.
Lloyd Minor Stanford, California 2019
Working on this book has been the most intellectually stimulating project of my professional life. It has been a privilege to collaborate with Lloyd Minor and help explain his inspiring vision for a new approach to health and well‐being. I am particularly grateful to Lloyd for enabling me to interview so many distinguished members of the faculty at Stanford’s School of Medicine, as well as a remarkable collection of entrepreneurs and investors. Harry Clark is a valued friend who introduced me to the School of Medicine’s leadership—making this one more in a long line of fascinating projects he has referred to me. I want to thank my wife, Nina, and my daughter, Sophia, for their everyday love and support, and for accommodating my sometimes‐chaotic schedule. My parents, Don Rees and Marilyn Rees, both Stanford graduates, laid the foundation that has enabled me to have a rewarding career and a fulfilling life.
Matthew Rees McLean, Virginia 2019
INTRODUCTION THE POWER OF PRECISION HEALTH
Imagine yourself in the not‐too‐distant future. Routine genomic screening tests, available at the time of birth, have shown that you have genetic variants that place you at high risk for pancreatic cancer in your adult years. Because of this propensity, you have elected to participate in a regular program of non‐invasive screening tests that are designed to provide early detection of any tumor development in your pancreas. Every six months you take a pill that will cause a pancreatic tumor (if one exists) to shed a novel synthetic biomarker that can be detected in the urine.
Several days after you take one of the early cancer detection pills, your home’s “smart toilet” automatically detects the synthetic biomarker in your urine. A device that is part of the smart toilet sends an alert to you on your smart phone, and to your primary care physician, who has your consent to receive information about these screening tests. To ensure the signal from the smart toilet is not a false positive, the signal is monitored in your urine over several days.
You follow the physician’s recommendation to undergo imaging studies with molecular tracers that will identify the location of the tumor and ensure the toilet device was correct. A pancreatic tumor is detected that measures 1 cubic millimeter and there is no evidence that it has spread to other sites. You are given targeted therapies, which activate your immune system and destroy the tumor while it is still at an early stage of development. You continue the plan of close surveillance and monitoring with an early cancer detection pill every six months.
As I will describe in the pages that follow, all the components of this scenario are within our grasp today. We are in the midst of a revolution in science and technology related to the mechanisms of disease and, of equal importance, to the determinants of health and well‐being. The impact of these advances and their broad dissemination are going to have a profound effect on our ability not just to treat diseases but to prevent them from developing in the first place. And in those instances when diseases cannot be prevented, they will be diagnosed much earlier and therefore treated much more effectively.
The example above illustrates just how transformative the results of this revolution are going to be. With pancreatic cancer today, there are no good tools for early detection, which means it is typically diagnosed much later in the course of tumor progression. In 80–95 percent of diagnoses, the cancerous tumor is locally advanced or metastatic [1]. As a result, 74 percent of all people with pancreatic cancer die within one year of diagnosis [2]. In 2017, this cancer resulted in the deaths of more than 43,000 people in the United States [3].
This vignette is emblematic of what the future of medicine should look like—and what I think it will look like—soon. Because for the first time in history, the world is starting to see the possibility of a new kind of medicine and health care. Instead of a race to cure disease after the fact, we can win the race before it even begins by preventing disease before it strikes—and curing it decisively if it does.
This approach is what we in Stanford Medicine have labeled “Precision Health” because it helps individuals thrive based on all factors specific to them, from their genetics to their lifestyle choices to their environment. It is based on the powerful idea that health care should promote health and wellness as