IEEE Spectrum June, 2015 - 57

Special RepoRt

Hood calls his approach P4 medicine-medicine that is predictive,
preventive, personalized, and participatory. Expounding on it, he can
sound more like an evangelist than an
empiricist. He's free with phrases like
"profound revolution" and "paradigm
shift." And he will do his darndest to
convince you that a health care system
based on "optimizing wellness" would
"save enormous amounts of money."
But not everyone is convinced.
a ll 105 pa rti cipa nts Wh o

health care in the process. Modern
medicine, he laments, focuses on sickness, not wellness. Doctors treat symptoms after they emerge rather than
trying to prevent them. But what if
doctors could track thousands of minute changes in their patients' bodies
and make sense of that data? Could
they stave off disease much longer?

completed the pilot study got
results they could act on. Lazowska
learned that his mercury levels were
distressingly high. "So I switched from
tuna sushi to salmon sushi, and my
blood mercury dropped in half," he
says. He also had elevated levels of a
blood biomarker called homocysteine,
which may increase risk of heart disease and stroke. That spike might have
been a mystery if not for a second data
point: Lazowska's genome scan
showed a gene variant that made it difficult for his body to absorb the B vitamin folate, which keeps homocysteine
in check. After he tweaked his vitamin
regimen, his homocysteine levels settled down to normal.
Yet some researchers caution that
the project's ability to predict and prevent illness isn't yet proved. There isn't
clear evidence, for example, that taking B vitamins to lower homocysteine
levels actually reduces risk for heart
problems. And it's tough to ferret out
the origins of disease while simultaneously trying to avert it. "Active intervention changes the thing you want
to study," says Vasan Ramachandran,
principal investigator of the Framingham Heart Study, which began in 1948.
Hood and his colleagues are confident that big-data analytics will enable
scientists to sort through that complexity. By observing a large popu-

hacking the human os

lation over time, his team expects to
identify many smaller cohorts that
can be compared. "Not everyone will
follow the advice they get," says Joel
Dudley, director of biomedical informatics at the Icahn School of Medicine at Mount Sinai, in New York City.
For example, some people with high
mercury will keep eating tuna. Some
will switch to salmon. Does that menu
revision alter well-being? "You can see
in real time what little interventions
send one group one way and another
group another way," says Dudley, who
plans to collaborate with Hood's team.
Another concern: Intensely monitoring healthy individuals could
make them less well, not more. Take
today's screenings for prostate cancer,
which often flag benign lesions and
slow-growing tumors that will never
become life threatening. Worried that
patients were undergoing unnecessary
surgeries, medical groups recently
scaled back screening recommendations. The more measurements you
take, the more likely you are to find
something wrong. "As my internist
friend likes to say, 'Nobody's healthy-
they just haven't been tested enough,' "
says Nigel Paneth, a professor of epidemiology and biostatistics at Michigan State University.
Hood disag rees. By track ing a
variety of biomarkers, he contends,
health professionals will gain a deeper
understanding of disease and ultimately produce smarter diag noses. But even if doctors have better
information, will people make better health choices? Even the fanciest
genetic sequencers, chemical assays,
and data analytics may simply state
the obvious: Eat better, quit smoking,
reduce stress. As for Lazowska, he's
still enjoying his wine. n
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Table of Contents for the Digital Edition of IEEE Spectrum June, 2015