Elsevier

New Biotechnology

Volume 29, Issue 6, 15 September 2012, Pages 613-624
New Biotechnology

Research paper
A personal view on systems medicine and the emergence of proactive P4 medicine: predictive, preventive, personalized and participatory

https://doi.org/10.1016/j.nbt.2012.03.004Get rights and content

Systems biology and the digital revolution are together transforming healthcare to a proactive P4 medicine that is predictive, preventive, personalized and participatory. Systems biology – holistic, global and integrative in approach – has given rise to systems medicine, a systems approach to health and disease. Systems medicine promises to (1) provide deep insights into disease mechanisms, (2) make blood a diagnostic window for viewing health and disease for the individual, (3) stratify complex diseases into their distinct subtypes for a impedance match against proper drugs, (4) provide new approaches to drug target discovery and (5) generate metrics for assessing wellness. P4 medicine, the clinical face of systems medicine, has two major objectives: to quantify wellness and to demystify disease. Patients and consumers will be a major driver in the realization of P4 medicine through their participation in medically oriented social networks directed at improving their own healthcare. P4 medicine has striking implications for society – including the ability to turn around the ever-escalating costs of healthcare. The challenge in bringing P4 medicine to patients and consumers is twofold: first, inventing the strategies and technologies that will enable P4 medicine and second, dealing with the impact of P4 medicine on society – including key ethical, social, legal, regulatory, and economic issues. Managing the societal problems will pose the most significant challenges. Strategic partnerships of a variety of types will be necessary to bring P4 medicine to patients.

Introduction

Medicine is undergoing a revolution that will transform the practice of healthcare in virtually every way. This revolution is emerging from the convergence of systems biology – a holistic approach to biology (and medicine) – and the digital revolution with its ability to generate and analyze ‘big data’ sets, deploy this information in business and social networks and create digital consumer devices measuring personal information.

Systems biology focuses on analyzing the incredible complexity of biological systems (normal and diseased) by (1) defining the components of the system, (2) determining how these components interact with one another and (3) delineating the dynamics of these components in space and time which are necessary for carrying out their biological functions. This means that the analyses must be global, integrative and dynamical. Systems medicine, the child of systems biology, is beginning to alter the face of healthcare through (1) a systems approach to disease, (2) driving the emergence of technologies that permit the exploration of new dimensions of patient data space (e.g. sequencing the individual human genome) and the analyses of the quantized units of biological information – single genes, single molecules, single cells, single organs – to provide disease-relevant information on health or disease for the individual and (3) the resulting explosion of patient data that are transforming traditional biology and medicine into an information science 1, 2, 3.

The digital revolution is harnessing big data sets through computational analyses and by creating powerful new business and social networks that have already transformed communications, finance, retail and information technology. The digital revolution is contributing to healthcare for the individual in several important ways: (1) providing tools and strategies for managing and analyzing large biological and environmental data sets; (2) catalyzing the invention of personal monitoring devices that can digitalize biological and social information to access, thus enabling an assessment of wellness and disease for the individual (e.g. the ‘quantified self’); and (3) providing models for the creation of consumer (patient) driven social networks that focused on optimizing wellness and/or dealing with disease.

The convergence of the digital revolution and systems approaches to wellness and disease is beginning to lead a proactive P4 medicine that is predictive, preventive, personalized and participatory 4, 5, 6. Thus P4 medicine is the clinical application of the tools and strategies of systems medicine to quantify wellness and demystify disease for the well-being of the individual. The digital revolution has given scientists the ability to generate and analyze previously inconceivably large quantities of digital data. Using these new capabilities and employing the domain expertise of biology to direct the development of software, systems biologists have developed powerful suites of new tools for mining, integrating and modeling ‘big data’ sets of heterogeneous biological data to generate predictive and actionable models of health and disease for each patient. ‘Actionable’ means that the data provide information that is useful for improving the health of the individual patient. Thus, systems biologists have transitioned from the reductive studies of traditional biology that focus on a few genes or proteins to the new holistic and comprehensive analyses of systems biology, analyzing how all of the components of biological system interact.

Unlike the reactive, pauci-data, population-based, hierarchical approach of our contemporary evidence-based medicine, P4 medicine will not be confined to clinics and hospitals. It will be practiced in the home, as activated and networked consumers use new information, tools and resources, such as wellness and navigation coaches and digital health information devices and systems to better manage their health. In what follows, we will provide a brief picture of systems medicine and its role in the emergence of this proactive P4 medicine.

Section snippets

Systems medicine

In 10 years we see every consumer of healthcare surrounded by a virtual cloud of billions of data points (Fig. 1). These data will range from molecular and cellular data, to conventional medical data, to enormous amounts of imaging, demographic and environmental data. Big data sets are required to deal with the complexities of disease and wellness. This complexity arises naturally from Darwinian evolution – a random and chaotic process that builds current solutions to environmental challenges

P4 medicine

Systems medicine is focused on developing biological, technical and computational tools to decipher the complexities of disease. P4 medicine employs the tools of systems medicine for quantifying wellness and demystifying disease for the well-being of the individual, as well as dealing with the societal opportunities and challenges created by this revolution in medicine.

The convergence of systems approaches to wellness and disease with newly activated and networked patients and consumers will

Acknowledgements

Thanks to Kristin Brogaard, Nathan Price and Lee Rowen for advice and counsel in preparing this paper. LH would like to acknowledge the support of the Luxembourg Center for Systems Biomedicine and the University of Luxembourg, the General Medical Sciences Center for Systems Biology GM076547and a Department of Defense contract on Liver Toxicity W911SR-09-C-0062.

References (16)

  • R. Bonneau

    A predictive model for transcriptional control of physiology in a free living cell

    Cell

    (2007)
  • L. Hood

    Systems biology and new technologies enable predictive and preventative medicine

    Science

    (2004)
  • N.D. Price
  • C. Auffray

    Systems medicine: the future of medical genomics and healthcare

    Genome Med.

    (2009)
  • A.D. Weston et al.

    Systems biology, proteomics, and the future of health care: toward predictive, preventative, and personalized medicine

    J. Proteome Res.

    (2004)
  • L. Hood et al.

    Predictive, personalized, preventive, participatory (P4) cancer medicine

    Nat. Rev. Clin. Oncol.

    (2011)
  • Q. Tian

    Systems cancer medicine: towards realization of predictive, preventive, personalized and participatory (P4) medicine

    J. Intern. Med.

    (2012)
  • L. Hood

    Deciphering complexity: a personal view of systems biology and the coming of big science

    Genet. Eng. Biotechnol. News

    (2011)
There are more references available in the full text version of this article.

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