The role of medicine as a practice must be about individual health, not just the treatment of disease generically. It’s telling that the most pervasive medical conditions today — diabetes, cardiovascular- and cholesterol-related conditions, and depression — are not new by any measure, nor is controlling them complicated. And they are exacerbated by very simple, straightforward things: imbalances in diet, exercise, and mental hygiene.
Could the next generation of medicine be about health management? Even as medical breakthroughs evolve our understanding of the mechanism of disease and the action of targeted therapies upon them, there is a vast frontier of individualized health management that has been left up to people on the fringes of formal medicine — from nutritionists and holistic and alternative practitioners to neutraceutical manufacturers. And, of course, none of it is within the scope of health insurance, outcomes documentation, or clinical trials.
“It is far more important to know what person the disease has than what disease the person has.” - Hippocrates
Over the past 15 years, genomic research has begun to reframe medicine in foundational ways — first through a new understanding of how to treat cancer in a personalized manner, but quickly evolving to understanding risk and predictability across multiple areas in order to take evasive health maneuvers. The more variants in the helical structure of our DNA that are identified and correlated across conditions including cholesterol, cardiovascular disease, diabetes, bipolar disorder, MS, celiac, Lou Gehrig’s, Alzheimer’s, and Parkinson’s, the more we’ll understand why different people progress differently with the same disease, and which compounds will be most effective in treating them. Correlating genotypic markers to the mechanism of disease will allow us to intervene at the molecular level and change the trajectory of disease even before it manifests.
From my perspective as a social scientist, the greatest obstacle is capturing the collective social consciousness around our existing health model to change focus from a reactive to a proactive approach. And this will require every tool in the toolbox — from commonsense diet and exercise behavior modification to leveraging genomic advances to understand what it will take to stay healthy at an individual level.
The culture code of science and social science
The underlying belief of science and most scientists is that truth exists, and that it is discoverable. And social scientists intuitively understand that the subjective interpretation of any truth will manifest in any number of ways for the individual and social groups. There is perhaps no greater area in medicine that draws the most extraordinarily diverse responses from people as the subject of genomics. Everything that ranges from excitement at the promise of truly understanding the cause, not just the symptoms of disease and what treatment will be efficacious, to moral and ethical challenges posed by hypotheticals and the ability to play God.
If genomics is the information highway of future medicine, if not health management, then it needs a powerful yet simple metaphor to capture the imagination of people and reframe the relationship between the practice of medicine and health.
“If health is wealth, where is my wealth manager?”
“Health is wealth” is an old adage, but also a powerful idea. It holds the keys to capturing the imagination of people when it comes to health intelligence, insight, and a desire to shift the norm from reactive to proactive health management. Unlike wealth, we are usually born healthy. And unlike wealth, which is accumulated, cherished, and managed through expert services including banks, brokerages, and fund managers, health is only managed when it is lacking. If health is wealth, then the current health system is a debt collection agency, not a wealth management system.
As the idea of health being managed like wealth takes hold, new branches of the healthcare system will emerge that will incentivize, not compensate; inspire, not terrify; personalize health, not genericize it; and ultimately simplify personal health management, much as a good wealth manager does. In the end, it is our own evolved human body that has within it the ability to find balance — which is another word for being healthy.
“Natural forces within us are the true
healers of disease.”
Reference: Culture Code by Clotaire Rapaille