P4 Medicine is Predictive, Preventive, Personalized and Participatory. Its two major objectives are to quantify wellness and demystify disease.
- 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.
Systems biology will 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.
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.
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.
Realizing the promise of P4 medicine will require — and will drive — profound economic, policy, and social changes.
P4 medicine also will require new standards and new policies for handling biological and health care information about individuals. Genomes may contain information that people wish to keep private, and predictions of future health status raise complex questions about how much people want to know or want their insurance companies to know. Complex data sets will need to be handled securely and interpreted knowledgeably and thoroughly.
P4 medicine has a number of interesting implications. First, the development of systems approaches together with pioneering new technologies (individual genome sequencing, measurement of thousands of blood proteins from a fraction of a droplet of blood) and new computational and mathematical tools will lead to a digitalization of medicine. Namely, the ability to obtain disease-relevant information from single molecules, single cells or single individuals. This will lead within 10 years to billions of data points for each individual patient. How one reduces this enormous data dimensionality to simple hypotheses about health and disease is one of the grand challenges of computational medicine.
Third, P4 medicine will necessitate a fundamental change in the business plans of virtually every sector of the health care industry over the next 10 years. This will provide challenges to existing companies and opportunities to create new companies specialized in the needs of P4 medicine.
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.
Why Use Blood as a Window
Nanotechnology and microfluidics devices exist that can measure 50 organ-specific blood proteins from each of the 50 organs in just five minutes using only a fraction of a droplet of blood.
100K Wellness Project
The Institute for Systems Biology (ISB) has been extremely successful in its 15 years of existence and now has an exceptional opportunity to launch a new industry — scientific wellness — and establish Seattle as its epicenter. This opportunity has been catalyzed by the convergence of systems medicine, which is the application of systems approaches to disease; big data and the emergence of multi-dimensional individual data clouds; and patient-activated social networks. ISB’s 100K Wellness Project, a longitudinal study of 100,000 people, has achieved proof-of-concept from 107 people who pioneered the project in 2014. ISB is focusing its efforts on its core scientific strengths—assays, analytics and network biology. ISB is also forming strategic partnerships with companies and organizations focused on enrollment and direct engagement with participants. Arivale, which has recently been spun out of ISB, anticipates enrolling tens of thousands of consumers while ISB pursues complementary partnerships ranging from healthcare systems in the U.S. to Iceland, Indonesia and other countries in the EU and Asia.
