Personalized Medicine

(The Hill, July 10, 2012)

It’s time to think of health in a disruptive way. Policy must set the enabling landscape, but the truly dramatic and the transformative will come from the exploding but still very young field of personalized medicine.

All healthcare is local, and all health is personal.

Personalized medicine is healthcare targeted to YOU, and just you. It means your individual health interventions — prevention, diagnosis and treatment — are custom-tailored specifically for you. Our individual needs — based on our personal DNA, the expression of powerful proteins and each of our unique biological responses — determine how our bodies respond to diet, to medicines, to exercise and to various modes of treatment.

A more individualized and personal approach translates to earlier prevention and diagnosis, and more targeted and appropriate treatment. By eliminating overspending in prescribing drugs that don’t work and under-spending on prevention and wellness, it opens the door to slowing the relentless growth of healthcare costs.

Personalized medicine is coming of age. Genetic testing, when coupled with massive clinical data sets made possible by privacy-protected electronic health records, can show predisposition to a growing list of conditions so that preventive action can be taken to maximize health and well-being and minimize expensive interventions in the future.

For example, if you know your genetic code demonstrates a risk for breast cancer, you can proactively engage in more prevention, be it more frequent self-exam and imaging or adjusting your diet. If you need to take a medicine to keep your blood thin after a stent placed to reverse a heart attack, you can be assured you will take one that not only works but also causes the fewest bad side effects. And this earlier detection of disease and targeted use of drugs leads not only to better life but also real cost savings.

The conditions for which we have genetic and proteomic tests for risk profiles is growing daily. They include heart disease, such as atrial fibrillation; cancers of the stomach, colon, lung and breast; vascular aneurysms and thrombosis; multiple sclerosis and Alzheimer’s disease; Crohn’s disease and type 2 diabetes. For the most part, we don’t know the exact cause of these diseases; it’s a combination of genetic and environmental factors. But the tests can give us predisposition to and risk for disease, and thus allow us to take early action.

One exciting field that will have a measurable clinical and cost-saving impact is pharmacogenomics, which focuses on how people with different genetic variants respond to certain medicines. It is transforming the pharmaceutical industry. For my field of organ transplantation, a genetic test at Vanderbilt shows whether an anti-rejection drug is likely to be effective —this can be a matter of life or death. Your genetic code can show whether a drug will work, or even whether it will have side effects. It can determine the appropriate dose to achieve the best and safest effect for you.

Obesity is destroying our children’s futures. We are today raising a generation of children who will not live as long as their parents. It is currently thought that two-thirds of the risk of obesity is associated with genetic markers on particular genes, while about a third is attributed to pure environmental effects. The genes might not cause obesity, but knowledge of increased risk markers just might give us the motivation to alter our nutrition and exercise habits, and modify our lifestyle and behavior.

Increasingly we will see individual genome sequences become a formal entry in our medical records, just like allergies and history of previous surgeries. As information technology in healthcare matures, we will see more connectivity among providers and labs, more support to eliminate costly and deadly medical errors, more automation to reduce the chances of making bad mistakes, and more data mining that will lead to science-based predictions of how to reverse disease and prevent it in the first place.

Government investments can really pay off — we shouldn’t forget that in the spending debates that are sure to follow in Congress. For instance, the government-funded Human Genome Project, begun in 1990, was completed two years ahead of schedule in 2003, and under budget! That project determined the sequence of nearly all of the more than 3 billion chemical building blocks that comprise the human genetic code.

Personalized medicine is more than DNA. Your individual genome is the original blueprint, or plans, but the final human body actually reflects a complex system of environmental and genetic influences, expressed through more than a million different proteins. Advanced computing and a systems-engineering approach to massive databases will open even more sophisticated and useful personalized medicine fields, and a new healthcare revolution will begin.

Frist is a former heart and lung transplant surgeon and is currently an adjunct professor of surgery at Vanderbilt University. He served as majority leader of the U.S. Senate from 2003 to 2007.

This article was originally featured in The Hill http://thehill.com/blogs/congress-blog/healthcare/237155-personalized-medicine-

 

How to wean America from its dangerous food addiction

(The Week, posted on May 22, 2012 )

By Bill Frist, M.D.

The nation’s obesity epidemic is as much about brain chemistry as it is poor diet and laziness — a fact we must realize if we’re going to treat obesity effectively

In ancient history, eating was for survival. Food was tough to come by and we consumed what we needed. Food was a necessity. In today’s America, it is an addiction.

Much of the conventional wisdom about obesity, including what your doctor has probably told you, is wrong. My fellow doctors, for the past four decades, have preached a “calories in — calories out” approach, suggesting that weight loss must be achieved by restricting calories or expending more energy. That approach is failing… miserably.

Contemporary medical research, most of which has not yet made it to mainstream understanding, suggests we should focus on two other more promising areas: Food addiction and diet. Consider it an “it’s what you eat” approach that takes into account human biology and the response to certain food types.

According to the research of Nicole Avena of Princeton University, eating sugar triggers a dopamine-mediated response in the same part of the brain that is similarly targeted by cocaine, nicotine, and other highly addictive substances. Originally, this “reward center” evolved to reinforce behaviors, such as food and sex, that maximize species survival.

To combat this epidemic, we may have to start with the brain, not the stomach.

Sugar, however, seems to hijack the same neural and biochemical connections in the brain. The intense cravings for sugar may be explained by the intensity of dopamine secretion in the brain when we consume sugar and high-fructose corn syrup, both of which are staples of the common American diet. Consistent eating of sugary and processed food literally rewires our brain. In 2011, 28 studies, from animal investigations to clinical studies of compulsive eaters, all point toward unhealthy foods as being addictive.

So why do we get fat? It’s not a simple matter of calories consumed and calories expended. It’s probably wiser to think of obesity as a result of a hormonal imbalance, with the dominant obesity hormone being insulin.

Insulin secretion is stimulated by eating easily digestible, carbohydrate-rich foods: Refined carbohydrates (including flour and cereal grains, starchy vegetables such as potatoes, and sugars) and high-fructose corn syrup. Eating more of these makes us fat, hungrier, and even more sedentary.

Why does all this matter? First, your kids are going to live a life with more disease and will die younger than they should. This does not have to be the case, but we can only reverse course if we act. With a third of adolescents in the U.S. overweight, and adolescent diabetes and prediabetes skyrocketing from 9 percent in 2000 to 23 percent in 2008, we are on the path to an explosion in heart disease, high blood pressure, and cancer.

Second, healthcare spending is driving you and the country bankrupt. Obesity, a problem which didn’t really exist even 40 years ago, today accounts for almost a fifth of our nation’s health spending, which amounts to more than $150 billion every year. That is an annual tax of $1,400 on every household, and it continues to escalate.

The good news is that the obesity problem is solvable. It is reversible, if we act smartly, both individually by our own life choices and collectively through wiser, more active public policy.

What can we do?

1. Focus on the root causes of why people crave food, often hungering for the unhealthiest options, and not just deal with the aftereffects. Studies show that exercise alone does not lead to weight loss (but it is very healthy for you!), replacing lost calories with increased appetite. It’s what you eat that you should concentrate on. Weight loss regimens succeed long-term when they get rid of the fattening carbohydrates in your diet.

2. Think out of the box. If the increasingly strong hypothesis that sugar is addictive is correct, we need to treat it as such. An addiction demands attention to replacement foods, development of new classes of anti-craving and relapsing medicines, and possibly even more intense use of 12-step programs for therapy.

3. Public policy tools and tactics that affect advertising, availability, and cost (including taxation) have been effective in fighting alcohol and tobacco addiction. Our society instinctively rejects policy that suggests “food police.” In the future, however, expect these tools to be considered much more aggressively since obesity stands as an even greater public health threat than tobacco.

We cannot afford to ignore obesity. But let’s be open to changing our approach. To combat this epidemic, we may have to start with the brain, not the stomach.

 

This article was originally featured in The Week http://theweek.com/article/index/228248/how-to-wean-america-from-its-dangerous-food-addiction

What Childhood Poverty Means

(Huffington Post, February 3, 2012)

By Bill Frist, M.D.

This post is part of a series on childhood poverty in the United States in partnership with Save the Children and Julianne Moore. Moore leads the organization’s Valentine’s Day campaign, through which cards are sold to support the fight against poverty in the U.S. To learn more or to purchase the cards, click here.

More than one in five American children lives in poverty. In my home state Tennessee it is an astounding one in four.

And it’s only getting worse. Less than four years ago, the national number was one in six children. Childhood poverty has increased 18% since 2000, as 2.5 million more children live in poverty today. But those are just cold, hard numbers. It’s what happens to kids who happen to be born into poverty that matters.

Childhood poverty does not just mean a family of four makes below $23,050 a year (it’s estimated that a family needs over twice that income to actually meet basic needs). No, childhood poverty limits access to the simplest, most basic things such as healthy foods, books, the Internet, and a secure place to play, exercise, or even sleep.

It means poor children,nearly half of whom are overweight, grow up with worse health..

It means at the age of four, poor children are already 18 months behind developmentally.

It means without early education programs, poorer children struggle and are 25% more likely to drop out of high school.

It means they are more likely to become teen parents, commit a violent crime, and be unemployed as adults.

It is a sad fact that at birth, one in five Americans today is well behind in the pursuit of happiness. The evidence increasingly points to the fact that once a child falls behind in the crucial early years, they may never catch up.

As a doctor, I focus on the devastating, long-lasting impact poverty has on a child’s health. Simply put, on average, the lower on the “socio-economic ladder” a child falls, the shorter life he will live. Americans in the lowest income category are more than three times more likely to die before the age of 65 than those in the highest income bracket.

For a child, a healthy body, a strong heart, normal development, and progressive learning all require adequate and balanced nutrition. But poor families too often don’t have access to nearby, affordable healthy foods. This stands as a major reason that debilitating chronic conditions like obesity and diabetes disproportionately afflict these impoverished youths.

“Food deserts” are those all too frequent regions of a city or rural areas, wherever poverty may exist, where affordable, healthy, fresh and nutritious foods are nowhere to be found. A 2011 Food Trust Report found that nearly one million Tennesseans, including 200,000 children, live in communities underserved by healthy food-providing supermarkets.

Across America 23.5 million live in areas that lack stores selling affordable, nutritious food. Without access to healthy foods, the cheap, fried, over-processed foods that accelerate the path to obesity become the mainstay diet. And the cause of early death.

This can be fixed. And an effective way to do so is for enterprising grocery retailers to partner with others in the private sector.

For example, just this year the Partnership for a Healthier America secured commitments from seven leading grocery companies to build new stores in areas where they’re needed most. All told, these commitments will bring fresh, affordable foods to ten million people!

Calhoun Enterprises alone will be building ten new stores in Alabama and Tennessee, creating 500 new jobs while figuratively bringing water to these deserts. And forward-thinking companies are increasingly learning that such “social partnering” not only helps the health and welfare of millions of Americans, but it also improves their own bottom lines.

And our government can also be a lot smarter. For many impoverished children, the majority of their meals, breakfast, lunch and even an afternoon snack, come from their schools. In 2010, almost half of all Tennessee students received government-subsidized school lunches. However, for longer life and better learning, we as tax-paying parents and citizens must insist on trading out pizza and tater tots for more whole grains, fresh fruit and vegetables.

Tennessee has recently started on this process. In June of last year, Tennessee, along with Kentucky and Illinois, joined a USDA pilot program for the “Community Eligibility Option,” allowing kids in low-income areas to skip the applications and red tape and receive the benefits of a free, healthy breakfast and lunch at their schools.

Nationally, last month the Obama administration overhauled the school lunch program for the first time in 15 years. Overall the menu will include items with less sodium, more whole grains and a greater selection of fruits and vegetables. Don’t worry, pizza will still be on the menu, but made with better ingredients.

Partnerships that focus on health and nutrition between the public and private sector, and between faith-based and secular nonprofits, will help lift children from the dire consequences of poverty.

America is the wealthiest nation in the world. The most technologically advanced. The most generous and accepting. We are the fastest car on the fastest track. We cannot afford to leave more than a fifth of our children behind.

To see the full article on the Huffington Post, please click here