For the past 2,000 years, medicine has been in a steady state, and the first time that the average patient was likely to receive benefit from an encounter with the average physician was about 100 years ago. Even today, although they have far better understanding and tools than in the past, physicians generally treat patients the same way Galen did - by addressing symptoms rather than the underlying course of disease.

However, with genomics and proteomics, predictive modeling, informatics, AI, and algorithms that can apply scientific data to individual disorders, medicine is gaining the capacity not only to dig deeper into the root causes of disease, but to get personal. Increasingly, doctors can determine the exact nature of the individual patient’s tumor - Fred’s tumor or Margaret’s tumor - not how it appears in the context of the average tumor. Moreover, they can begin to determine which specific interventions - at the molecular and systemic levels - will work most effectively for Fred or Margaret based on Fred or Margaret’s individual genetic makeup, lifestyle, and physiology.

Prompted by unexpected side effects of certain medicines recently brought to market, our regulatory system now adds to the pressure to move quickly beyond one-sizefits-all in every aspect of health technology. Patients vary from one to another, and their responses to drugs, medical devices, and diagnostics will also vary. In the past, therapeutics was the high value, high cost part of the formula, and diagnosis was cheap. With personalized medicine providing better tools to identify individual reactions to interventions, that proposition is reversed. Diagnostics becomes the key driver of value, and therapeutics becomes relegated to commodity status, the medical equivalent of high fructose corn syrup.

Gaining diagnostic access to illness at the deep, molecular level allows for medicine to become not only personalized but also predictive, which means that it can become preventive, which moves the name of the game from the treatment of illness to aggressive promotion of wellness. The shift to more personalized, predictive, and preventive medicine (the three Ps) will revolutionize the health care system and - especially when we consider costs and incentives - the rest of our lives as well. As custodians of public health and welfare, the federal government long ago imposed health warnings on cigarettes and alcohol. Then states outlawed smoking in public places, and made seat belt compliance and motorcycle helmets mandatory. Now New York City insists that restaurants ban trans fats and list the caloric content of their meals. In each case, new knowledge produced new possibilities for better outcomes that prompt new patterns of behavior. In medieval Europe, the primary objective of one’s brief life on earth was to prepare for the world to come. Now, we can expect to live 80 years or more, and we hope to live it in good health.

For pharmaceutical and biotechnology companies, the transformation of everything from diagnostics, to expectations, to social norms, represents both a constraint and a vast new opportunity. Until recently, big pharma has focused on discovering blockbuster drugs. Now, with the convergence of information technology, telecommunications, nanotechnology, power supplies, genomics, and proteonomics, smarter drug delivery and diagnostic labs on a chip, the smart money will move away from “blockbusterology” to spotting early warning signs of impending health problems. This transformation should expand pharma’s focus beyond the needs of the 10 percent who are sick to include the needs of the 90 percent who are well.

Fifty years ago, Philip K. Dick wrote Minority Report, a science fiction short story about future technology that provides specific, advance knowledge of crimes. Thirty years from now we will have technology that gives us specific, advance knowledge of illness. By that time, the cost of sequencing an individual’s genes will be down to $100. We may not only genotype every baby at birth but also implant a miniaturized smart card, updated throughout life via monitors circulating in the blood.

The ability of physicians to manage wellness through a combination of molecular access and IT will require equally dramatic changes in business models and investment strategies. Already, genome/proteome projects that are the first point of access to this systems approach are under way all over the globe, and Western companies take note: Chinese and Indian approaches to medicine have involved systems thinking for 5,000 years. Western, reductionist medicine must work harder to incorporate nodes and networks, along with an appreciation of how the social environment and belief systems affect the physiological environment.

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