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P4 Medicine

A proactive approach to preventing and treating diseases

The epidemic of chronic diseases, a better understanding of the underlying mechanisms and causes as well as technological advancements are transforming medicine from a reactive to a pro-active and preventive discipline.

Modern biology and medicine provides deeper insights into disease mechanisms, makes blood a diagnostic window for viewing health and disease for the individual and generates metrics for assessing wellness.

P4 is an approach to make medicine more Predictive, Preventive, Personalised and Participatory. Its two major objectives are to quantify wellness and predict and prevent disease.

P4 medicine aims to be able to detect and treat perturbations in healthy individuals long before disease symptoms appear, thus optimizing the wellness of individuals and avoiding disease. P4 medicine represents a move away from models of reacting to illness to maintaining health across the lifespan.

It would mean that data collected through diagnostic tests, health ‘apps’, and other tools can help people to understand risk factors and counteract them.

Many academic institutions and experts see P4 medicine as an important area for research and development, and have identified positive steps and barriers to progress in this area. Moving to a P4 model will involve patients and stakeholders from across the healthcare sector working together.

P4 medicine aims to 1) improve health care, 2) reduce the cost of health care, and 3) stimulate innovation and new company creation. Health care is not the only subject that can benefit from such integrative, cross-disciplinary, and systems-driven platforms and cultures. Many other challenges affecting the modern world, such as energy, environment, nutrition, and agriculture can be transformed by using such an integrated and systems-driven approach.

P4 medicine is the convergence of systems medicine, digital technologies and consumer-driven healthcare.

  • P4 medicine is the clinical face of systems medicine.
  • P4 medicine will make blood a diagnostic window for viewing health and disease for the individual.
  • P4 medicine will provide new approaches to drug target discovery.
  • P4 medicine will drive profound economic, policy and social changes.

P4 medicine aims to revolutionize the practice of healthcare in the coming decades. Today, medicine is largely reactive. It waits until a person is sick and then treats a disease, with varying levels of success. The revolution will emerge from the convergence of systems biology and the digital revolution’s ability to create consumer devices, generate and analyze “big data” sets and deploy this information through business and social networks.

Predictive

By providing an understanding of disease at the molecular level, systems medicine will eventually be able to predict when an organ will become diseased or when a perturbation in a biological network could progress to disease. Alterations in biological networks can be reflected in the structure, quantity, or location of the proteins making up those networks. For example, ISB researchers have been developing tests that can flag the presence of particular cancers by detecting proteins in the blood, allowing those cancers to be treated at an early stage. As more such tests are developed, the proteins in blood could reveal the health status of every major organ in the body, enabling detailed predictions of disease causation and progression.

Personalised

The ability to predict and prevent disease will in turn make it possible to personalize medicine. Within a few years, it will be possible to sequence an individual’s genome for less than a thousand dollars. The DNA differences between individuals contribute to not only their unique physical characteristics but also to their differing susceptibility to disease. Medicine will be able to take into account how these DNA differences — along with each person’s environmental exposures and experiences — influence an individual’s biological systems. The result will be personalized predictions of disease and personalized treatments to prevent disease.

Systems-Based approach to diseases

Why Systems Biology

When biological networks are disrupted by disease, they typically produce proteins not seen under healthy conditions. The identification of these biomarkers would allow diseases to be detected and treated much earlier than is possible today. This research could revolutionize cancer management by providing markers for cancer risk, early detection, prognosis, and therapeutic response. Many such biomarkers could be measured in a single blood sample, providing a fast and easy screen for a wide range of medical conditions.

Human biology is a complex system

Biology is a complex system. P4 medicine, along with systems biology, has forced researchers to collaborate in new unprecedented ways to develop the appropriate tools to deal with the complexities of biology and disease. The key is to attack the ―big science problem‖ of health care with a systemsdriven, integrative, cross-disciplinary, and milestone-driven ISB-like platform and culture. Small science, individual investigators, and their laboratories will play an important role in deciphering the complex details of the broad pictures that are painted by systems biology and systems medicine. The ultimate objectives of P4 medicine are simple: 1) improve health care, 2) reduce the cost of health care, and 3) stimulate innovation and new company creation.

However, biology and medicine are not the only complex systems problems that society is struggling with. All the major problems in society, for example health care, energy, environment, nutrition, and agriculture, are susceptible to the same kind of integrative systems approach which has been presented here. Therefore, institutions that create an appropriate systems-driven, cross-disciplinary, integrative, and milestone-driven environment for researching complex or big science problems will be uniquely positioned to transform and revolutionize the deciphering of many of society’s current challenges. The question of how academic, industrial, and governmental institutions will accept, build, and deploy these systems-driven and cross-disciplinary infrastructures is a fascinating one.

Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA

Systems-Based approach to diseases

Medicine will move from a reactive to a proactive discipline over the next decade—a discipline that is predictive, personalized, preventive and participatory (P4). P4 medicine will be fueled by systems approaches to disease, emerging technologies and analytical tools. There will be two major challenges to achieving P4 medicine—technical and societal barriers—and the societal barriers will prove the most challenging. How do we bring patients, physicians and members of the health-care community into alignment with the enormous opportunities of P4 medicine? In part, this will be done by the creation of new types of strategic partnerships—between patients, large clinical centers, consortia of clinical centers and patient-advocate groups. For some clinical trials it will necessary to recruit very large numbers of patients—and one powerful approach to this challenge is the crowd-sourced recruitment of patients by bringing large clinical centers together with patient-advocate groups.

Medicine has always focused on treating disease after it occurs, with both treatment and diagnosis based largely on population averages, and patient decisions confined to choices among alternatives provided by their physicians.

We are now poised to transition to a new medical paradigm that is predictive, preventive, personalized, and participatory (P4).

The European Society of Preventive Medicine supports the development of P4 Medicine by bringing together an exploratory community of scientists, physicians and other health care professionals, and people – both healthy and sick – who want to benefit themselves, their families, and their community. This community will come together in different projects which ESPREVMED is working to launch in the relatively near future.

The convergence of systems biology, the digital revolution and consumer-driven healthcare is transforming medicine from its current reactive mode, which is focused on treating disease, to a P4 Medicine mode, which is medicine that is predictive, preventive, personalized and participatory.

Systems-based approach to diseases

Big data tracking multiple dimensions of individual health + ongoing systems analytics = personalized, actionable health information.

  • Physicians will use personalized actionable information in clinics and hospitals to make more cost-effective diagnosis and treatments;
  • Patients (sick people) and consumers (healthy people) will use personalized actionable information in their homes and workplaces to live healthier, more productive lives;
  • Personalized data will be de-identified and aggregated to provide further insight into both health and disease which will yield more productive personalized actionable information.

Taking psycho-social factors and neurobiology into account

P4 Medicine aims to improve the quality of care delivered to patients through better diagnoses and targeted therapies. These advances facilitate new forms of active participation by patients and consumers in the collection of personal health data that will accelerate discovery science. Soon a virtual data cloud of billions of health-relevant data points will surround each individual. Through P4 Medicine, there will be an opportunity to reduce this complex data to simple hypotheses about how to optimize wellness and minimize disease for each individual.

The health continuum – repairing and regenerating

In the middle of the last century, medical science began to understand the links between metabolism, aging damage, and age-related disease and disability: that the side-effects of metabolic processes ongoingly add to the burden of cellular and molecular damage in our tissues, and that this damage drives the diseases and disabilities of aging. So medicine became focused on developing drugs that would “manage” the so-called “risk factors” for age-related diseases, pushing the body to produce less of the metabolic precursors of some particular kind of cellular or molecular damage in the body. By doing so, these drugs would slow the accumulation of damage in a vulnerable tissue, and thus bend the curve of a particular age-related disease.

 

Tomorrow’s Medicine: Repairing the Damage

Scientific developments in the last few decades have laid the foundation for a new class of medicines: rejuvenation biotechnologies. Rejuvenation biotechnologies are targeted therapies that apply the principles of regenerative medicine across the entire scope of the damage of aging. In other words, instead of merely slowing down the accumulation of aging damage in our tissues, rejuvenation biotechnologies will remove, repair, or replace the damaged cellular and molecular machinery. This means that with every round of therapy, a person’s eyes, hearts, arteries, and bones will not just suffer less ongoing degradation of their structures, but will actually become more youthful and healthy in their structure and function, as the fine cellular and molecular order of these and other tissues are progressively restored to their youthful integrity.

Today research efforts are accelerating the transition of medical science from risk factor management to regenerative medicine-based solutions to the diseases and disabilities of ageing.

References and continued reading