The Quantified Self Awaits
Measuring a long list of biomarkers with the help of wearables, lab testing, medical imaging, and genomic sequencing is the future of precision medicine. Creating these integrative personal omics profiles (iPOPs) has the potential to transform health care.
By John Halamka, M.D., president, Mayo Clinic Platform, and Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform
If you’re old enough to remember a TV series called The Six Million Dollar Man, you probably recall his bionic enhancements, including various implants that gave him super-human speed, strength, and vision. The lead character in the series had been injured in a test flight accident, and the show’s premise was based on the notion: “We can rebuild him; we have the technology.” Today, much of the technology to rebuild damaged body parts has become a clinical reality and technologists have expanded their reach, focusing their attention on developing new digital tools that measure a long list of physiological and biochemical markers. These “enhancements,” combined with genomic sequencing, have the potential to reinvent the way medicine is practiced.
The digital tools include smart watches that measure blood pressure and heart rate, wrist bands to track physical activity, portable meters to check blood glucose levels and record EKG readings, and much more. Collecting all this data is enabling patients and clinicians to create a detailed picture--a “quantified self.” There is mounting evidence to show that this 21st century bionic human will have the ability to accurately predict his or her health status and risk of disease. At Mayo Clinic, for instance, cardiologists have demonstrated that patients who attended a cardiac rehabilitation and used a smartphone-based app to record their weight and blood pressure experienced greater improvements in cardiovascular risk factors and were less likely to be readmitted to the hospitals 90 days after discharge, when compared to patients who did not have access to the app.
This is only one of many experiments to demonstrate the value of collecting such data. Some innovative scientists are taking this approach further and measuring a massive collection of biomarkers on themselves and others. Michael Snyder, Ph.D., with Stanford University, is at the forefront of this movement. Dr. Snyder is using himself as a N of 1 experiment on the value of the “quantified self.” As director of Stanford’s Center for Genomics and Personalized Medicine, he oversees several projects designed to find the many actionable insights that can be derived from measuring all the omics data currently available, including one’s genome, proteome, microbiome, and transcriptome. With the assistance of several smart watches, a subdermal chip, fingertip pricks to obtain blood samples, and several whole-body MRI scans, he has compiled a large database that can be analyzed for trends. With the help of his physician and this data set, he created an integrative personal omics profile (iPOP), which enabled them to predict the onset of diabetes and Lyme disease.
Taking the approach one step further, Synder and his associates used the iPOP technique to analyze the health status of 109 participants for up to 8 years. They discovered more than 67 clinically actionable health discoveries while identifying multiple molecular pathways associated with metabolic, cardiovascular and oncologic pathophysiology. “We developed prediction models for insulin resistance using omics measurements illustrating their potential to replace burdensome tests. Finally, study participation led the majority of participants to implement diet and exercise changes. Altogether, we conclude that deep longitudinal profiling can lead to actionable health discoveries and provide relevant information for precision health,” the study says.
No doubt, some observers will point out that this kind of comprehensive data collection is currently impossible to implement on a population basis—for several reasons. To date, there are no large-scale clinical trials to convince thought leaders in medicine to accept this approach as standard of care. Equally important, most insurers remain reluctant to reimburse for all these tests without evidence of their cost effectiveness. And finally, the general public is disinclined to sign up for so many preventive procedures or collect all the needed data. Despite these obstacles, this comprehensive approach can serve as a starting point for a more holistic, precise approach to healthcare. It may not turn us all into super men and women, but it will likely translate into better patient care.