In the last decade, noteworthy advancements in medical applications of nanotechnology have become more prevalent. As SingularityHub points out, researchers are developing nanoscale patterns on medical implants that can stimulate bone cell growth and positive gene expression. Others are working to make guided nanoparticles that detect (and even destroy) cancer cells.

Multiple groups, like the Center for Cancer Nanotechnology Excellence at Stanford, are altering various nanoparticles to get behaviors useful to medical professionals. For example, nanoparticles are being created that give off a detectable color signal when a cancer cell is found or that hold onto a cancer cell until it can be studied.

More unique reactions have been developed in the lab. For instance, some nanoparticles absorb light and then produce very low-power acoustic vibrations when a tumor is located or even release heat to kill a cancer cell.

At the University of Chicago, scientists are testing a way to spur checkpoint blockade into more potent action using nanoparticles. Checkpoint blockade therapy works by interfering with cancer’s ability to turn off the body’s immune reaction. When cancer cells first develop, the body is able to recognize them as foreign, triggering T-cells to attack and eliminate them.

As malignant cells multiply and form tumors, they release biochemical signals that suppress the immune system, and the T-cells no longer function properly. Checkpoint blockade therapy obstructs those signals, makes T-cells see the cancer cells as invaders again and allows the immune system to do its job. The problem, says chemistry professor Wenbin Lin, is that if a tumor has been growing for years there are no longer any T-cells inside it to activate. This causes the therapy to fail.

“So, what we’re trying to do is to come up with ways to recruit T-cells to the tumor,” he says, “and if you have a way to make the T-cells recognize cancer cells, the T-cell will be able to kill the cancer cells.”

The treatment Lin and collaborators invented is a drug cocktail contained in nanoparticles. The nanoparticles assemble themselves from zinc and a drug called oxaliplatin, which is widely used against advanced-stage metastatic colon cancer. A photosensitizing agent called pyrolipid forms the outer layer.

When light is shined on the pyrolipid, it generates molecules that can kill cancer. It also activates T-cells that can recognize cancer cells thereby enabling the nanoparticles to pack a triple punch.

Used in concert, the nanoparticles and a checkpoint blockade agent eliminated tumors in a mouse, even when the tumors were widely separated and one tumor had received no treatment. This ability to activate T-cells in one place and have them travel to disease sites in the body could be a powerful tool for treating cancer.

Most patients that struggle in their battle with cancer do so because of metastatic disease, not their primary tumor. When patients have surgery, doctors don’t know if there are other, smaller lesions elsewhere in the body.

“You cannot treat them because you don’t know where to look for them,” Lin says. “If you activate immune cells, they can home in to cancer cells selectively. So, you have a better chance of getting rid of these small metastatic tumors throughout the body.”

Although ongoing research is still needed to ensure the safety and success of nanotechnology medical applications, recent discoveries definitely make you think about what is to come. Treatments, such as those for cancer, could look very different in the near future.

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Ryan Lahti is the managing principal of OrgLeader and author of The Finesse Factor. Stay up to date on Ryan’s STEM organization tweets here: @ryanlahti

(Photo: Nanotechnology Book Cover by jurvetson)

How is your experience at your doctor’s office likely to change? The Human Diagnosis Project (also referred to as “Human Dx”) could be a big factor. Human Dx is a worldwide effort led by the global medical community to build an online system that maps the best steps to help any patient. By combining collective intelligence with machine learning, Human Dx constructs an online map designed to help physicians diagnose illnesses quicker and connect patients to the appropriate specialists. Ultimately, Human Dx intends to enable more accurate, affordable and accessible care for all.

The project is structured as a partnership between the social, public and private sectors. Its partners include the American Medical Association, the American Board of Internal Medicine, the American Board of Medical Specialties, the Association of American Medical Colleges, the Association of Clinicians for the Underserved, the National Association of Community Health Centers and the Dartmouth Institute for Health Policy and Clinical Practice.

Currently, Human Dx includes more than 6,000 doctors across 70 countries. An alliance with some of the country’s largest medical groups offers more weight to the initiative and provides an influx of new users. The project plans to focus its efforts on making specialty care more accessible for patients at safety net hospitals. These patients often delay care because of the high out-of-pocket costs associated with seeing a medical specialist.

Human Dx’s development was inspired by other scientific projects (e.g., the International Space Station, the Large Hadron Collider at CERN and the Human Genome Project) and open technology efforts (e.g., Wikipedia, Linux and the Internet Protocol Suite). The global medical community submits clinical case contributions to Human Dx similar to the way people around the world contribute encyclopedia articles to Wikipedia or engineers contribute code to open source software projects like Linux. This can be done from any connected device. As medical practitioners, residents and students give and receive input on clinical cases within Human Dx, the open system automatically puts their clinical insights into context.

A recent Wired article provides a good example of how it works from a physician’s perspective. When a primary care doctor gets a patient with a perplexing issue, the doctor describes the patient’s background, medical history and presenting symptoms via Human Dx. The doctor may add an image of an X-ray, a photo of a rash or an audio recording of lung sounds. Human Dx’s natural language processing algorithms will mine each case entry for keywords to funnel it to specialists who can create a list of likely diagnoses and recommend treatment.

Since getting back 10 or 20 different doctors’ viewpoints on a single patient can be cumbersome, Human Dx’s machine learning algorithms comb through the responses to check them against all the project’s previously stored case reports. The network uses them to validate each specialist’s finding, weight each one according to confidence level and combine it with others into a single suggested diagnosis. With every solved case, Human Dx gets a little smarter.

Some physicians are skeptical about the quality of information generated by Human Dx. Because of this skepticism, researchers at Johns Hopkins, Harvard and UCSF have been assessing the platform for accuracy and recently submitted results for peer review.

The next big hurdle for Human Dx is money. The project is currently one of eight organizations in contention for a $100 million John D. and Catherine T. MacArthur Foundation grant. If Human Dx wins, the project will spend the money on a nationwide roll out. Human Dx is not dependent upon the $100 million award, but it would certainly be a nice way to kick-start the process.

If all goes well, it is possible your experience will be different the next time you have a medical issue that stumps your regular physician. Instead of seeing a specialist across town, you will see five or 10 specialists from around the country.

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Ryan Lahti is the founder and managing principal of OrgLeader. Stay up to date on Ryan’s STEM organization tweets here: @ryanlahti

(Photo: Doctor with Tablet, Public Domain Pictures)

The United States is currently experiencing an epidemic of opioid abuse. According to the Centers for Disease Control and Prevention, the amount of prescription opioids sold in the U.S. nearly quadrupled since 1999. Opioids include codeine, fentanyl, morphine and forms of oxycodone (e.g., Oxycontin and Percocet) as well as hydrocodone (e.g., Vicodin). They are typically prescribed to treat moderate to severe pain that do not respond well to other pain medications. This large increase in opioid prescriptions might lead you to believe that there has been an increase in the amount of pain experienced by Americans, but this is not the case. Unfortunately, the impact of this abuse can be tragic. More than 165,000 Americans died from overdoses related to prescription opioids from 1999 to 2014.

Given these statistics, you might question what is being done about opioid abuse. The implementation of drug-monitoring programs has provided some positive results. A study by Bao and colleagues at Cornell Medical College found that doctors in states that track painkiller prescriptions were nearly one-third less likely to offer patients dangerously addicting opioids. Twenty-four states have implemented drug-monitoring programs. In these states, the probability of a doctor prescribing a Schedule II opioid dropped from 5.5 percent to 3.7 percent – a more than 30 percent reduction. The results were immediate and held for three years.

Dr. Caleb Alexander, who directs the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore, believes that many overdoses could have been avoided if doctors had been able to check a prescription drug-monitoring database. A database could show when patients are obtaining opioids under their own name from multiple doctors, which might assist in identifying potential abuse and dependency.

Bao and colleagues feel that drug-monitoring databases may make doctors think twice before prescribing pain medications for a variety of reasons in addition to uncovering “doctor shopping” by patients. Knowing that they’re being watched may serve as a deterrent, and the programs may generally increase awareness of the dangers of prescribing opioids.

According to the Washington Post, health insurance companies also believe monitoring the prescribing of opioids can bring positive results. Using the vast amount of data it collects from insurance claims by pharmacies, Aetna has begun contacting doctors whose prescribing habits are far outside the norm. In a letter it wrote to 931 physicians across the country earlier this month, Aetna stated, “You have been identified as falling within the top 1 percent of opioid prescribers within your specialty.”

Harold Paz, Aetna’s chief medical officer, said his experience has convinced him that the best way to change doctors’ behavior is to provide them with the numbers. “By nature, doctors are data-driven…If you show them how they’re doing, they’ll want to do better,” he said. Paz shared that if the 931 doctors brought their refill rate in line with the average for all physicians who prescribe opioids, 1.4 million fewer pills would be dispensed annually. The physicians receiving the letter had an average refill rate of 4.5 for each prescription written (the overall average was 0.3 refills per prescription).

The opioid abuse epidemic is real. Fortunately, physicians, researchers and insurance companies are recognizing it and taking steps to address the issue. While there is no quick fix, actions taken to date are showing some promising outcomes.

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: pop life, Flickr)

In the last few decades, shared decision making in healthcare has been a popular topic. According to the New England Journal of Medicine (NEJM), a consensus has emerged that decisions involving the choice among more than one reasonable treatment option should involve the patient (i.e., clinicians provide patients with information about all the options and help them to identify their preferences based on the patients’ values). While this makes sense, there are many ways in which decision making can be shared between clinicians and patients. Physicians describe processes that range from explaining the clinical situation and making a recommendation that the patient can accept or reject to outlining the treatment options and leaving the final decision to the patient.

Unfortunately, the role the patient is asked to play in the process is frequently not appropriately matched to the medical circumstances underlying the decision. The greater the uncertainty surrounding the options and the greater the clinician’s ambivalence about the “right” choice, the greater the likelihood that the patient will be asked to make the decision. Conversely, the greater the precision with which a decision’s outcomes can be predicted, the greater the likelihood that the physician will make a strong recommendation.

In reality, decisions that need to be made without clear information about the potential benefits and risks of treatment options are the most difficult ones to make and require the greatest input from a clinician. If a clinician is more likely to leave these decisions to patients, this results in missed opportunities to truly help patients and enhance patient engagement. These are the decisions for which patients, faced with complex information and uncertainty regarding benefits and risks, may gain the most from a recommendation. Furthermore, the clinician could use that recommendation to model for the patient how to think about the available information, including the areas of uncertainty.

Dr. Terri Fried, the author the NEJM article, believes that finding the sweet spot for shared decision making will require clinicians to work against their natural impulses to tell the patient what to do when they’re certain of what’s best and to leave the patient to decide when they’re not. “I’m not sure what the right answer is, so why don’t you decide” can be replaced with “This is a really hard decision because we aren’t sure what will happen if you choose option x; let me show you how I think about this, and you can tell me whether it fits with what’s important to you.” And, equally important, “I’m recommending option x because it provides better outcomes than option y” can become “Let me tell you about the pros and cons of options x and y so that you can decide which one matches your priorities.”

Massachusetts General Hospital (MGH) has actually tried to test the impact of shared decision making on patient engagement in the Shared Decision Making Program it implemented back in 2005. This program involves providing decision aids – booklets, videos and online resources – to patients to help them learn about their options and participate in decisions about their care. Dr. Leigh Simmons, medical director of the MGH Health Decision Sciences Center and a co-author of the Health Affairs report, shared, “After incorporating decision aids into their practice, physicians tell us that the conversations they have with patients are at a more advanced level, and they are able to focus on the things that matter most to their patients. Often they are surprised at how engaged patients are after using a decision aid.” In addition to the better quality of conversation being an indication of better patient engagement, the MGH study found a significant increase in the number of decision aid orders placed when patients were given the opportunity to select topics. The orders placed by patients also gave clinicians new insight into areas of patient interest.

According to Karen Sepucha, PhD, director of the MGH Health Decision Sciences Center and lead author of the report, the next step will be evaluating how successful the program has been in improving patient care. Sepucha says, “We survey patients to determine whether they are well informed about their treatment options, involved in conversations and receive treatments that match their goals. Ultimately, that will help us ensure that patients receive the care that is right for them.”

Related news briefs:

Too Much Patient Satisfaction?

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Laser Consult, Flickr)

While there still may not be a consensus on the interpretation of the term “population health,” healthcare leaders in a George Washington University survey agreed that it is “an opportunity for health care systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve.” Defining it is one thing, but taking action to address population health presents the challenge of figuring out what role each system, agency and organization plays on its own and in collaboration with other entities to have a noticeable impact.

Taking action begins with the willingness to change perceptions from the past regarding hospitals, agencies, healthcare systems and community resources. According to a recent article published in the Journal of the American Medical Association, hospitals can make their neighborhoods and communities healthier by addressing non-medical factors that contribute to population health. Despite arguments that population health depends on community factors outside the control of hospitals, Stuart Butler (senior fellow at the Brookings Institution) believes that hospitals are well positioned to help build healthy neighborhoods. A substantial number of hospitals have had ongoing collaborations with community resources. In fact, nonprofit hospitals are even required to regularly evaluate their communities’ health needs and how these hospitals plan to address the needs.

Butler points out that hospitals are frequently seen as the last resort in their communities, because they are often the place people go when everything else fails. If one adopts a different perspective, hospitals actually have great potential to improve the general health of the community on the front end. One way is to integrate the basic needs of patients into care delivery. Contra Costa Medical Center found a way to do this by partnering with Health Leads. In this partnership, a Health Leads help desk is placed at the medical center in order to direct patients to resources that affect health (e.g., food and housing).

In order to enable hospitals to serve in this capacity, Butler recommends that the healthcare industry:

• Ease the process of information-sharing to help government agencies, hospitals and community institutions coordinate
• Standardize the way social and economic benefits of hospital efforts are measured to ensure efficiency
• Adjust government budgets and payment systems toward the goal of a joint return on investment when community benefit is achieved
• Explore new ways to finance community health improvements that don’t generate hospital revenue

The U.S. Department of Health and Human Services has offered a way to address financing community health improvements. It announced this month that it will provide $157 million to fund a new Accountable Health Communities model that will offer the financial resources for up to 44 bridge organizations to conduct screenings and refer Medicare and Medicaid recipients to clinical and community services. Hospitals as well as community-based organizations can apply for this funding.

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Entrance of the University Hospital, Flickr)

Virtual reality (VR) research and development in the medical field started to catch hold in the late 1990s when VR headsets were being marketed to the public. Since then, VR has been used in a range of healthcare-related applications. The applications are not just related to treatment and training. More recent applications of VR are being explored in the medical diagnostics arena.

PTSD Treatment

According to TechRepublic, clinics and hospitals are using VR simulations of warfare akin to Iraq and Afghanistan to help veterans who are suffering from post-traumatic stress disorder. In a safe and controlled environment, veterans can learn how to deal with instances that might otherwise be triggers to behavior that could be destructive to themselves and others.

Medical Training

Virtual reality is allowing medical professionals to practice procedures in a way that is less risky for patients and more cost effective for hospitals and clinics. Fortune reported that VR company Next Galaxy Corp has partnered with Nicklaus Children’s Hospital to develop VR medical instructional software for procedures like cardiopulmonary resuscitation, nasal gastric tube insertion, Foley catheter insertion, intubation, starting an IV, wound care, and the Heimlich maneuver.

Stanford University has taken it one step further by leveraging VR for surgical training. Stanford’s Surgical Simulation allows surgeons to practice surgery on a virtual patient and experience realistic sights, sounds, and forces like they were actually in the operating room.

Although still in its early days, VR usage is paying off. According to Dr. Narendra Kini, CEO at Miami Children’s Health System, the retention level a year after a VR training session can be as much as 80 percent, compared to 20 percent retention after a week with traditional training. Kini says people are actually creating memories. So, it’s like they’ve done the procedure before.

In addition to increasing skills, VR training also helps hospitals and medical facilities reduce costs. Mary Spio, CEO of Next Galaxy, says that medical professional training and proficiency are a large part of healthcare costs. For example, the 65,000 elderly care facilities in America currently spend on average $3,000 per employee to learn tracheal insertion. Tracheal insertion training in VR, which also eliminates the need to travel to specialized training centers, costs just $40 per employee. Because healthcare knowledge doubles every six to eight years, there will be an ongoing need for new proficiency training.

Medical Diagnostics

Researchers at the University of Bonn are working on a VR test that could be used to monitor the very earliest signs of Alzheimer’s disease in people aged 18 to 30. The researchers studied interactions between parts of the brain linked to navigation and memory then compared the results across participants who had different genetic likelihoods of developing the disease. They found that those with a higher genetic likelihood of developing Alzheimer’s showed different neural activity during the trial.

In work related to glaucoma, researchers at the Donald K. Johnson Eye Centre at Toronto Western Hospital are utilizing VR equipment to develop a test that could diagnose glaucoma in its early stages. “Currently, ‘early’ detection of glaucoma isn’t actually occurring in its earliest stage,” says Dr. Martin Steinbach, the principal investigator in the study.  Consequently, the study focuses on peripheral vision and vection that is made possible by peripheral vision, because glaucoma first affects peripheral vision. Vection is like an illusion where a large moving scene can make the viewer feel like he or she is also moving. In early results, patients who had mild glaucoma showed that vection was either impaired or completely absent.

Market research company Technavio forecasts the global VR market in healthcare to grow at a CAGR of 19.37 percent over the period 2014-2019. Therefore, the medical field to date is just scratching the surface of VR applications.

If you’re interested in other ways that technology is enhancing medicine and your health, take a look at this post:

8 Ways Technology Is Improving Your Health

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Oculus Rift Prototype, Flickr)

Patient satisfaction is an important consideration, but hospitals and health systems may be focusing too much on it as a key metric. According to a national study conducted at UC Davis by Dr. Joshua Fenton, patients who reported being most satisfied with their doctors actually had higher healthcare and prescription costs and were more likely to be hospitalized than patients who were not as satisfied. What’s even more concerning is the finding that the most satisfied patients had a 26 percent greater mortality risk.

According to Fenton, these results could reflect that doctors who are reimbursed according to patient satisfaction scores may be less likely to talk patients out of treatments they request or to raise concerns about smoking, substance abuse, or mental-health issues. Consequently, healthcare providers may not be looking out for the best interests of their patients if they are overly focused on patient satisfaction.

In order to measure patient satisfaction, most health systems currently use a survey developed by the Centers for Medicare and Medicaid Services (CMS), the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), to gauge how patients perceive their hospital stay. When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they probably assumed that transparency and accountability would improve healthcare. The CMS officials even wrote, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.”

Patient satisfaction surveys have their place, but they need to be viewed with a realistic eye. Dr. Fenton explains that in most settings the technical quality of healthcare is invisible to patients and subsequently has a weak relationship with patient satisfaction. Several health systems are now using patient satisfaction scores as a factor in calculating nurses’ and doctors’ pay or annual bonuses. These health systems are ignoring the possibility that health providers, like hospitals, could have fantastic patient satisfaction scores yet higher numbers of deceased patients.

There is no doubt that physicians, nurses and other hospital staff members need to be mindful of patient satisfaction, but this should be balanced with quality of care as well as hospital performance. HCAHPS results do not fully assess the patient experience, and they are poor indicators of operational outcomes. As a recent McKinsey & Company article points out, HCAHPS was not designed to link the patient experience with a hospital’s financial performance. In fact, McKinsey’s analyses show that there is little correlation between HCAHPS scores and net revenue, inpatient gross revenue, or the percentage of patients with commercial insurance. While the intentions behind gauging patient satisfaction with the HCAHPS survey are good, the information from McKinsey combined with Fenton’s findings indicate that more work is needed to ensure the optimal measure is used as healthcare continues to evolve.

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Listeria Food Poisoning, Flickr)

Shifting from a volume-based healthcare model to a value-based model makes sense when you consider that the U.S. trails other wealthy nations on improving health outcomes. As the healthcare industry makes this shift, hospitals and other healthcare organizations are continuing to experience a growing consequence of the pressure to assess and improve the quality of care. As Ian Morrison points out in Hospitals & Health Networks Daily, this consequence is known as “improvement fatigue.” Improvement fatigue was first discussed in a 2007 Journal of the American College of Cardiology article. It affects clinical leaders, medical directors of physician associations and health systems as well as nurses and physicians who provide care. More specifically, these providers can feel overwhelmed as they try to modify the way care is delivered while they are actually delivering care.

There are a number of factors that drive improvement fatigue, but the key ones include:

Obamacare

The Affordable Care Act has been the reason for a lot of change as health plans, health systems and consumers pressure caregivers to make improvements.

Inadequate Commitment

Harris surveys discovered that boards, CFOs and management teams are bought into the need for change, but doctors, nurses and patients need a better understanding of it.

Multiple Initiatives

The variety of improvement projects underway in most clinical areas and the related complexity creates confusion.

Electronic Health Records

Although the intent and ultimate benefit of an electronic version of a patient’s medical history is positive, switching to this from hard copy is an arduous process.

Given these factors, what can healthcare leaders do to reduce improvement fatigue? There are some essential steps.

Reconsider Physician Leadership

Explore different approaches that will enable physicians to take the lead in getting all clinicians to embrace the work that needs to be done. This includes using dyads of physicians and administrators (e.g., Mayo Clinic) and providing these leaders with the budgets and authority to make lasting change.

Share a Concise, Consistent Story

There is no such thing as over communication when it comes to helping people understand the need for change. This is especially true for busy, front-line caregivers. Just make sure the message you want to deliver is clear and genuine.

Offer Ongoing Support

Look for lessons learned to inform your approach and provide guidance, training and relevant resources on a regular basis. This will build momentum that will ultimately ensure the capabilities are developed to sustain the change in the healthcare organization.

Connect to the Mission

Strong leadership, a clear message and ongoing support will get even more traction to overcome improvement fatigue if you help front-line caregivers see that the change will benefit patients, families and the communities the healthcare organization serves.

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Fort Belvoir Community Hospital, Flickr)

Whether you are a critic or an advocate of President Obama’s precision medicine initiative, it is worth noting that it did not come about in the last few months. The initiative was influenced by a 2011 National Academy of Sciences report that recommended the federal government invest resources into a new way of classifying diseases by their molecular and environmental causes instead of their physical signs and symptoms. Since the initiative was announced in President Obama’s State of the Union address, The White House has provided more details for how the funds for the proposed $215 million initiative would be used:

• $130 million to the National Institutes of Health for development of a voluntary national research cohort of a million volunteers
• $70 million to the National Cancer Institute to increase efforts to identify genomic drivers in cancer and develop more effective cancer treatments
• $10 million to the Food and Drug Administration for additional expertise and to develop high-quality databases that advance innovation in medicine
• $5 million to the Office of the National Coordinator for Health Information Technology to develop privacy standards and secure data exchange

The Benefit

Using these funds, this federal effort would create a personal healthcare information database of over a million people. This national resource would include the United States with countries such as Japan, the United Kingdom and Iceland that have built vast population databases for research and medical care. According to a recent Scientific American article, the proposed database would include patient histories, genetic data, information from wearable health monitors and facts on bacteria, fungi and viruses found in and on the bodies of individuals. With this wealth of information, the objective is to provide medical care that would be more individually customized to each person’s unique genetic makeup and other factors.

Reactions to Date

So far, there has been mixed support from the medical community. Advocates of the precision medicine initiative include Dr. Charles Sawyers who directs the Human Oncology and Pathogenesis Program at Memorial Sloan Kettering Cancer Center. In a New York Times article, he explained, “No matter what tumor type you have, a certain percentage of patients, often a small percentage, have mutations that would likely result in a treatment that would work and that we never would have thought of.”

In contrast to this perspective, Dr. Michael Joyner (a physiologist and anesthesiologist at the Mayo Clinic) shared his skepticism in an op-ed in the New York Times. He refers to precision medicine as a “moonshot” medical research initiative that is likely to fail to meet expectations, because medical issues and their underlying biology are not linear engineering exercises.

Critical Challenges

In addition to these differing perspectives, there are critical challenges that need to be addressed. Kristen McCaleb (program manager of the Genomic Medicine Initiative at the University of California, San Francisco) pointed out that the initiative will utilize existing information from patients in clinical trials instead of collecting data from scratch. She explained that this complicates things, because scientists often disagree on the importance or meaning of particular genetic variants for disease. For example, two scientists looking at the same list of more than 30,000 genetic variants for each person may have differing opinions about whether or not those genetic mutations are strongly related to disease or worth further exploration. Incorporating 30,000 variants from over a million people would require a supercomputer to capture all the raw data. Without it, investigators would be relying on a series of subjective interpretations of that information which would be difficult to use.

Another critical concern is data privacy. Information from over a million people being consolidated in one place would be an attractive target for hackers. Even if identifiers such as a patient’s name and birth date are removed from the data, a hacker with enough information about an individual’s genealogy could connect the data with the right individual. Although having genealogical information may sound far-fetched, the number and sophistication of recent cyber security breaches suggests that obtaining this information may not be that difficult.

The precision medicine initiative does appear to have some potential. In order to see if realizing this potential is truly feasible, a number of crucial issues need to be resolved.

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti

(Photo: Dollar Photo Club)

Dr. Mark Hyman, chairman of The Institute for Functional Medicine, is serving as the director of the new center. You may recognize Dr. Hyman as the physician friend of the Clintons who helped Bill Clinton refocus his health regimen after Mr. Clinton’s quadruple bypass surgery in 2004. According to The Deseret News, Dr. Hyman made some bold predictions that got the attention of Toby Cosgrove, the CEO of the Cleveland Clinic who also is a cardiac surgeon. In Hyman’s own words, allowing him to create a program at the country’s top medical center for heart procedures “would cut the number of angioplasties and bypasses in half, and reduce hospital admissions.” He further told Cosgrove, “hire me and I’ll do what I can to put you out of business.” Hyman said his approach would be to optimize functional medicine by teaching patients to care for themselves so they could avoid the hospital altogether. If these predictions come true, it would decrease patient demand for some Clinic services but enhance healthcare offerings in other ways.

According to the Centers for Disease Control and Prevention, Americans spent more than $2.7 trillion annually on healthcare in 2011 with more than 80% of it ($2.16 trillion) focused on chronic diseases like heart disease, obesity and diabetes. Most often, chronic conditions are managed with medications and procedures but not cured. Functional medicine doctors like Hyman take a different approach. The Cleveland Clinic explains that the foundation for functional medicine is the evidence that lifestyle factors (e.g., nutrition, sleep, exercise, stress levels, relationships and genetics) are major contributors to disease. Instead of managing symptoms, providers of functional medicine work with chronic disease patients to address these underlying causes of illness to better prevent, treat and reverse disease.

Critics’ descriptions of functional medicine range from pseudoscience to quackery given some of the studies supporting its use lacked the rigor of standard scientific methods. This being said, functional medicine and other forms of complementary and alternative medicine are worthy of further exploration. As Cosgrove points out in his book, The Cleveland Clinic Way, medicine must consider new approaches to understanding and treating diseases, because chronic diseases “are now so prevalent and so costly that they’re threatening to destroy America’s broader economic health.”

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Ryan Lahti is the founder and managing principal of OrgLeader, LLC. Stay up to date on Ryan’s STEM-based organization tweets here: @ryanlahti