Turn Healthcare Right-Side Up: Focus On Wellness Not Disease
Shifting from disease to wellness, and how behavioral coaching is key to success
Posted Mar 19, 2018
By Leroy Hood, MD, Ph.D., and Nathan Price, Ph.D.
Nearly 20 percent of the U.S. GDP is spent on health care—the highest tab in the world—so shouldn’t we also have the best health outcomes? Unfortunately, a huge gap exists between spending and outcomes. In fact, Americans lag near the bottom when it comes to health outcomes among wealthy countries.
One problem is that today’s health care system focuses almost exclusively on responding to symptoms and illnesses after they arise. In the United States, we spend 97 percent of our health care resources on disease care. The economic costs of neurological conditions, for example, total more than $800 billion annually, according to research in the journal Annals of Neurology.
But another vision for health care is emerging—one that is focused on wellness rather than disease. One that is proactive instead of reactive. One that takes a systems approach to biology and medicine rather than studying one gene, one cell or one protein at a time.
So, what does it mean to be well? What does it mean to optimize our wellness?
Within the past decade, big data, analytics, and social networks, as well as advances in technologies such as Fitbit and other wearable health tracking devices, are giving us the ability to learn more about individual wellness than ever before.
Unlocking the code to your best health
It’s likely we all know someone who, seemingly out of the blue, has developed a life-altering health condition. It’s frightening to consider that while we’re taking our wellness for granted, a serious disease or chronic illness could strike us without warning—and especially scary to realize that we have no way to predict or anticipate how or when such an event might occur.
But what if, encoded within each of us, were clues that not only signaled the visible signs of disease but gave us the means to potentially transform us back to wellness? What if we could tap these signals in our bodies before they develop into serious health conditions? And what if, according to what we learn, we could make meaningful, effective biological, chemical and lifestyle changes that could prevent the crisis altogether?
That’s the premise behind Scientific Wellness, which starts with a systems approach to analyzing highly specialized large datasets of individual human biomarkers such as genes, proteins, and microbiomes, combined with personalized health coaching to influence our health.
Optimizing wellness and avoiding disease
In 2014, we conceived and co-led the Pioneer 100 Wellness Project (P100), a study of 108 individuals that demonstrated that combining dense, personalized datasets with tailored behavioral coaching can help optimize wellness. The P100 pilot group consisted of 64 men and 44 women, who ranged in age from 21 to 89-plus.
Over a nine-month period, we collected an unprecedented amount of information on each of them, including whole genome sequences. Every three months, we did analyses of blood, urine, and saliva and measurements of the gut microbiome—thousands of measurements for each person at each time point. We also encouraged our participants to track their daily activities using a wearable Fitbit and collected lifestyle and psychological data from an array of questionnaires.
Using this information, we created what we call personal, dense, dynamic data clouds for each individual that measured many factors over time. By analyzing these extensive data, we identified substances and relationships associated with both health and disease.
This range of data has never been measured before in a group of individuals, and what we’re discovering has profound implications for the future of wellness—and disease. The results of this study were recently featured in the journal Nature Biotechnology.
Just as the Hubble Telescope provided a new view into the universe, personal, dense, dynamic data sets will be transformational for providing new insights into both human biology and disease.
We have termed this transformational approach Scientific Wellness, a data-informed approach to maintaining and improving health and avoiding transitions to disease. It’s a radical departure from the way our current health care system operates.
Scientific Wellness uses genetics and a breadth of personalized data, along with tailored coaching, to help us thrive, now and into the future.
This approach can help us better understand the genetic and environmental factors that determine our health status. Over time, this will enable us to identify the earliest transitions from wellness to disease, which is the key to both predictive and preventive care for individuals.
By integrating and analyzing different types of data—including a genetic predisposition (based on more than one genetic variant) for complex conditions—we are discovering how a transition from wellness to disease occurs and learning more about possible future interventions.
Data + coaching and an action plan = results
Unfortunately, simply providing large amounts of data to people doesn’t drive lifestyle change—in fact, it may paralyze people into inaction. By using evidence-based behavioral strategies delivered by a behavioral coach, we brought the data to life in a way that allowed our participants to make major improvements in their lifestyle and blood chemistries to optimize their wellness. The coach translated risk factors we identified in the complex participant profiles and developed actionable possibilities for change.
The coach customized specific recommendations in consultation with the study physician and with each participant. Coaching focused on four primary health areas: cardiovascular, diabetes, inflammation, and nutrition. The major individual recommendations fell into the data-informed categories of diet, exercise, stress management, dietary supplements, or physician referral, as relevant for each participant. The coach achieved remarkable success—70 percent compliance— and was a vital part of the program. As the amount of data increased for the participants, more and more actionable possibilities were discovered to improve their wellness—especially new actionable possibilities integrating different data types.
For example, a 65-year-old male participant who loved hiking told his coach that he’d been slowed down by cartilage damage in his ankle. When he joined the study, the baseline data revealed that he had a high blood ferritin level (too much blood iron) and a genetic variant that is associated with hereditary hemochromatosis. If untreated, hemochromatosis can be associated with serious complications later in life, including cartilage damage, liver disease, diabetes, and heart disease. Based on these results, our clinical team referred him to a hematologist, who diagnosed hemochromatosis and prescribed therapeutic phlebotomy. At the next blood draw, his ferritin levels had dropped within the normal range where they stayed for the remainder of the study. Moreover, the discovery meant he avoided organ damage and other complications that accompany undiagnosed hemochromatosis.
After completing the P100 study, key members of the Institute for Systems Biology (ISB) research team transitioned to Arivale, a company that ISB spun out in 2015 with a commitment to bring data-driven wellness to consumers. Arivale offers a program that leverages scientific insights from hundreds of published interventional research studies and lays out a data-intensive program as was prototyped in our Pioneer 100 study. Arivale takes an integrative look at an individual’s sophisticated biological system—from genetics to inflammatory markers—and brings the myriad information together in one place. Participants are assigned an Arivale Coach, each of whom is a Registered Dietitian, Certified Nutritionist, or Registered Nurse. Coaches provide knowledge, support, and accountability—translating the complex data into actionable recommendations to optimize wellness and help avoid disease. Arivale has already transformed thousands of lives.
Some studies estimate just 10 percent of our lifetime health status is attributable to our current disease-focused health care system. The remaining 90 percent is a result of our genetics (30 percent) and behavioral and environmental factors (60 percent).
It is time our health care approaches focus on the 90 percent. We are convinced that by leveraging a data-rich environment and combining it with personalized coaching, we are poised to positively impact these factors by empowering individuals to take action and optimize their wellness—and transform the health care system in the process.