As a youth, I found the Loch Ness Monster fascinating. You would see grainy pictures of what looked like a head or part of its snakelike body breeching the surface of the water. This raised many forms of imaginative thoughts.
There is a modern-day monster surfacing in healthcare. The Loch Ness of Scotland is anecdotal, but the emerging technological monster in healthcare is fact. The fact pattern is the wave of disruptive technology that will be found in individualized medicine. Unless you are paying attention, you may not see any portion of this monster, but it is coming.
The core of individualized medicine deals with our genetic makeup. When the human genome mapping was finalized in 2003, this set the framework for science to gain a deep understanding of human pathology. The human genome is like a giant, complex laboratory with almost infinite segments to be explored. One section of the human genome contains the potential biomarkers for colon cancer. In another the biomarkers for breast, prostate or pancreatic cancer can be found. Around the next curve of genetic material are the biomarkers for diabetes, rheumatoid arthritis, obesity or many other components of our costly chronic diseases. From a high-level perspective, we have developed tools to diagnose these diseases or develop pharmacology agents to treat the disease manifestation. However, these are Band-Aids on the core expression of our disease mechanisms.
If one has the opportunity to review the American Society of Clinical Pathology e-publication, Daily Diagnosis, you will find a constant flow of new information in the role of an individual’s genomic makeup and its impact on the human disease process. Separately you can find organizations like Rochester, Minn.-based Mayo Clinic, with its Center for Individualized Medicine. The professionals represented in this center are some of the brightest and best minds in medical care.
To showcase some of this work, Mayo Clinic held a conference last fall on the concepts of individualized medicine. Those attending realized the scientific advances in the genomic understanding of pathology are breathtaking. However, the information flows much like the parts of the Loch Ness Monster. You get glimpses of the monster, but it is segmented with the technology and not easily understood for those of us that work in administrative healthcare. Nonetheless, when observed, it's clear that what is occurring is of great substance. Mayo would not be making such an investment in individualized medicine if this was just pop technology.
A nugget of knowledge disclosed at the Mayo Conference involved potential pancreatic cancer solutions. Today, this disease has an unfortunate outcome with marginal modalities of treatment. However, the biomarkers for pancreatic cancer are the same for all with this disease. Therefore, it would stand to reason that these biomarkers could be explored for potential solutions.
Observations from the meeting lead one to conclude that our ability to identify the predisposition for this and other diseases is considerably ahead of having a solution to treat the disease, thus the current dilemma of individualized medicine.
Another emerging understanding is the appropriate design of pharmacology use for certain pathologies. An example would be showing a picture of Danica Patrick and Shaquille O’Neil and asking if the standard medication being prescribed would work the same in both of these individuals. Research is being conducted to gain an understanding of the efficacy of medication use based on individual bio makeup.. Millions of dollars are spent each year exploring if a certain medication will work for an individual’s situation. It would be much more cost efficient if an individual could be tested to identify a predisposition for treatment success. This is particularly true in the use of oncogenic drugs.
These examples just scratch the surface of what can be achieved with an appropriate understanding of the human genome.
From a futurist point of view, if you carry these concepts further, each child could be tested to determine a predisposition to certain types of costly diseases. If we had science-fiction-like treatments that neutralized the gene expression, thus preventing the disease from ever occurring, this would get medicine upstream to human pathology and prevent many of the maladies that economically choke our current healthcare system. The use of this disruptive technology would change the need for costly hospital care.
The title of this article would lead one to believe that disruptive technology such as individualized medicine could lead to the extinction of hospital care. This is not, however, on the immediate horizon. The current pool of pathology is replete with future hospital admissions. However, let’s consider the scenario in which solutions are found for some of our most costly chronic diseases, using specific pharmacogenomic medications or maybe nanotechnology or gene splicing. We stand on the edge of technology being able to accomplish these advanced leaps.
When this occurs, the pool of pathology as we know it will begin to shrink. Some of the commonplace, complex and costly diseases known today will go the way of other historical diseases where treatment or cures have been developed. It could effectively be argued that research in the human genome and mitigation of pathology could be the next wave of technological advancement that would equate to our recent years of advancement in Internet and information technology.
Others in the medical field may say the practical use of this technology is years away. Many do not understand the implications of what is coming. It could effectively be argued that we are marching forward with our vision turned to the past, not unlike the wagon manufacturer who said the new horseless carriages would not be successful. If the pool of pathology is effectively drained, our acute-care system as we know it today will be a shadow of its past.
For many years Jim Hamilton has been a senior executive in physician practice and hospital/health system leadership. Additionally, Mr. Hamilton has provided consulting services to clients across the U.S. In addition to his leadership roles, Mr. Hamilton has been an adjunct faculty member for multiple colleges and universities with instruction in health care economics, law/compliance, strategic planning, leadership and entrepreneurial management. Mr. Hamilton has written many articles on health care leadership as well just published a book on the futurist view of medicine, "A Short Treatise on a Common Sense Framework for Health Care Reform." Mr. Hamilton is a Fellow in the American College of Medical Practice Executives, as well a member of the American College of Healthcare Executives and a senior member of the American Society for Quality.
More Articles on Individualized Medicine:
The Future of Hospitals: Visions of the Healthcare Landscape in 2035
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What Personalized Medicine Means for Hospitals