The Relationship Between Predictive and Preventive Medicine

I have become interested lately in the relationship between predictive and preventive  medicine, about which I have posted previous notes. Today and tomorrow I have been giving a mini-lecture at the Sunquest booth at HIMSS on this topic. Here is that lecture in PDF format (see: How Predictive/Preventive Will Change Healthcare Delivery and the IT That Drives It).

As the name suggests, predictive medicine is involved in the prediction of disease and preventive medicine relates to the avoidance of disease or the amelioration of its effects. Both are related to the early health model, which is term used to describe the attempt to diagnose disease in its earliest state, either pre-clinical or pre-symptomatic. In a previous note (see: Wellness, Preventive Medicine, and the Classic Disease Model), I included a schematic diagram illustrating the relationship between the wellness domain and the overt disease domain with the early health model largely synonymous with the former. I reproduce the diagram here with some slight modifications.

We are currently in the throes of a healthcare reform movement with the need to provide care to the large group of uninsured and also to reduce the unnecessary costs of healthcare delivery. Part of the solution to this problem will be the participation of the patients themselves in preventing and ameliorating chronic disease. This can be described as a renewed emphasis on preventive medicine. Cell phones are now ubiquitous and can serve as a device for promoting public health education (see: Making e-Health Information Accessible with Smart Phones).

Pathologists and lab medicine specialists, unlike their clinician colleagues, are almost entirely engaged in the diagnosis of disease. However, predictive medicine is experiencing an accelerated growth phase lately, fueled by the discovery of new biomarkers which can be grouped into panels of tests called IVDMIAs. Although biomarkers are currently being used mainly to diagnose clinically evident disease as described above, they also can be used to monitor wellness. Put another way, biomarkers and genomic testing can be used in predictive medicine for assessing the predisposition to disease and early disease itself.

In a previous note, I grumbled about the absence of a preventive medicine infrastructure in the U.S. (see: The Need for a Preventive Medicine Infrastructure in the U.S.). These facilities and resources do exist but lie largely outside the ambit of traditional healthcare. Examples include health clubs, classes on healthy lifestyles, and self-help organizations such as Weight Watchers. Nevertheless, I now understand that the clinical lab industry is well-positioned to provide important support for preventive/predictive medicine as it evolves as an important element of healthcare reform. The emergence of the direct access testing (DAT) industry and consumer genomics will enable healthcare consumers to play a more direct role in maintaining and monitoring their health status. Also, the extent to which personal health records (PHRs) evolve as web-enabled e-records for storing test results can only add impetus to this movement (see: Lab Test Results as Essential Components of PHRs).

Comments

[Brian Jackson]

Bruce,

When most people think about preventive care, they picture "healthy" individuals. But the benefits of preventive care, including screening and other "wellness" tests, are much higher in individuals who are at high risk. This particularly includes those with chronic diseases. E.g. LDL monitoring is much more important in a diabetic than in someone with no risk factors for CAD.

This suggests an even stronger relationship between predictive and preventive testing than what you state above -- the predictive testing identifies patients who need additional monitoring (i.e. preventive or wellness testing).

I'd also suggest that instead of talking about preventing chronic disease, that we talk about preventing the complications of chronic disease. This is to some degree semantics (if you improve your blood glucose levels through diet and exercise, are you still a type 2 diabetic?) but I think it refocuses our attention in useful ways.