0
Personalized Health Care
Through Basic, Translational and
      Applied Research
   A Case for Improved Care, Lower Costs ...
Vision for Ohio State University

• It is Ohio State's time to be the university
  of the American dream, an institution
 ...
Create the
   Future of
  Medicine to
   Improve
   People’s
Lives Through
 Personalized
 Health Care
                Harv...
What is the goal of Personalized
  Health Care at Ohio State
          University?
Improve People’s Lives
by Transforming Disease-
 Based Care to Wellness
P4 Medicine
•   Predictive:
    – Probabilistic health
      history--DNA
      sequence
•   Personalized:
    – Unique in...
What is the Compelling Argument
to Change the Way Health Care is
        Delivered to You?
National Health Care Trends
• Health Care - one of the top three issues of
  American concern along with Iraq war,
  econo...
Health Care Expenditures as % of GDP
Between 2001 and 2016, health spending is projected to grow 2.5% per
 year faster tha...
USA outspent other developed countries in
              health care
Higher Spending Does Not Necessarily
        Lead to Higher Quality




                        Source: Baicker and Chandr...
Life Expectancy
  While much higher than developing countries, US life
  expectancy is lower than most developed countries...
% Finding Difficulty in Receiving Care
More than 1 in 4 in the population finds accessing care
             difficult in t...
Trends in Health Care – Chronic Disease




  •   By 2025, nearly 49% of U.S. population will have one chronic disease
  •...
Limitation of Standard Drug Treatment
Drugs prescribed for patients are effective in fewer than

     Reate of Efficacy wi...
Summary:
      The need for transformation
• Total health care spending was $2.5 trillion in 2008,
  representing 16% of t...
What Makes Each One of Us
Unique and What Defines Health?
Patient Phenotype




    home.honolulu.hawaii.edu/~pine/variation3.jpg
http://genomics.energy.gov/
The Human Genome Project
• A 13-year project coordinated by the U.S.
  Department of Energy and the NIH

• The total numbe...
NY Times Magazine:
   My Genome, My Self




          Steven Pinker, Jan 7, 2009
Complex Relationships Determine
      Health and Disease
              • Complex interactions of
                genes and...
Systems Biology
• Emergent field that aims at
  systems understanding of
  biological systems.
   – Systems view focuses a...
Systems Biology Opportunity in Clinical Medicine
 Identify Networks and Key Regulatory Nodes Controlling Networks




    ...
PLoS One
How Will Personalized Medicine
     Look in the Future?
The Future
What Does the COM Contribute to
   Research at Ohio State?
• $34.1 M over 5 years
• CTSA is an outcome
  of the Roadmap for
  Research from NIH
NIHIdeas
  People
Resources
Leadership
NIH Roadmap for Medical Research

                 New Pathways
                  to Discovery




                      N...
NIH Roadmap Strategy
          Interdisciplinary Research
          Pioneer Award
          Nanomedicine                  ...
Molecular
                                    Libraries     Building Blocks,
          Re-engineering the
                ...
How Has the Stimulus Package
Affected Research in the COM and
         Medical Center?
American Recovery and Reinvestment Act 2009
ARRA Stimulus Funding Proposal by Type
                 OSUMC
                        As of 6/2/09

                  $4,9...
How Does Personalized Medicine
Align with the Research Mission?
Personalized Health Care


               DISEASE TO WELLNESS
      Translation             Application/       Disseminati...
BHAG for Personalized Health
         Care planning at Ohio State
• We will develop and execute a demonstration
  project ...
Tools
Applied Research and Systems Biology

• Emergent field that aims at
  systems understanding of
  biological systems.
   – ...
PHR and Portability




Microsoft HealthVault
Telemedicine
Social Networking
Systems and Process Focus

                                                Make your car last
                            ...
FROM




                                           TO




*Number of ICU beds is subject to change
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
Personalized Healthcare and Research
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Personalized Healthcare and Research

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A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.

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  • Predictive:Probabilistic health history--DNA sequenceBiannual multi-parameter blood protein measurementsBiannual blood cell measurements--dynamicIn vivo and single cell molecular imagingPersonalized:Unique individual human genetic variation mandates individual treatmentPatient is his or her own controlPerturb blood cells for dynamic measurementsGo directly to patient and skip doctor--patient will have all medical informationPreventive:Strategies for re-engineering the behavior of disease- perturbed networks with drugsVaccinesFocus on wellnessParticipatoryPatient understands and participates in medical choicesSource: Leroy Hood, presentation at NIH. http://www.itl.nist.gov/Healthcare/conf/presentations/LH%20NIST%209-24-07.pdf.
  • Source: pollingreport.com. In a variety of national polls, when asked what are important issues facing America today, healthcare ranks as one of top 3 “very important” issues.Source: National Coalition on Health Care (health care spending). Rising cost of coverage, reason for decline in coverage.Source: CDC (chronic disease)<number>
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  • Closing Slide
  • SourcePoisal Ja Fau - Truffer, C, S Truffer C Fau - Smith, A Smith S Fau - Sisko et al.: Health spending projections through 2016: modest changes obscure part D's impact. Health Affairs 26, w242-w253 (2007).Tom Daschle: New facts on U.S. health care:U.S. ranks poorly with other wealthy nations http://www.americanprogress.org/issues/2007/11/daschle_health.htmlThe World Health Report 2000. World Health Organization (2000).Brian B. Spear, Margo Heath-Chiozzi, and Jeffrey Huff, “Clinical Application of Pharmacogenetics,” Trends in Molecular Medicine (May 2001).
  • Personalized health care is enabled by having a lifetime transportable medical record that follows the patient everywhere to ensure they receive the safest and most effective care based on their history.The most personalized medicine will occur when each of us has a transportable version of our fully sequenced genomes available to optimize care for the diseases we are likely to develop – John Halamka, CIO of Harvard Medical SchoolMicrosoft HealthVault vs. Google HealthBoth systems share the same objective of creating an online tool for patients to store personal medical records, get information, find doctors, make medical appointments, communicate online, manage medications, share information with providers and more. Both put users in control over what goes into the record and who has access to it. Both are free Web-based services, meaning you can access the records without cost from any computer. The services are described as being as secure as online banking.
  • *Number of ICU beds is subject to change
  • Transcript of "Personalized Healthcare and Research"

    1. 1. Personalized Health Care Through Basic, Translational and Applied Research A Case for Improved Care, Lower Costs and Transformation from Disease to Wellness Clay Marsh, MD
    2. 2. Vision for Ohio State University • It is Ohio State's time to be the university of the American dream, an institution worthy of the public trust and the front door to the future. – Gordon Gee, President, The Ohio State University
    3. 3. Create the Future of Medicine to Improve People’s Lives Through Personalized Health Care Harvard Business Review | October 2007 | hbr.org
    4. 4. What is the goal of Personalized Health Care at Ohio State University?
    5. 5. Improve People’s Lives by Transforming Disease- Based Care to Wellness
    6. 6. P4 Medicine • Predictive: – Probabilistic health history--DNA sequence • Personalized: – Unique individual human genetic variation mandates individual treatment • Preventive: – Focus on wellness • Participatory: – Patient understands and participates in medical choices • Precise: – Deep understanding of health and disease Wellness and Risk Management
    7. 7. What is the Compelling Argument to Change the Way Health Care is Delivered to You?
    8. 8. National Health Care Trends • Health Care - one of the top three issues of American concern along with Iraq war, economy/jobs in 2008 • In 2005, total health care spending represented 16% ($2.5 Trillion) of the GDP and is projected to increase to 20% ($4 Trillion) of the GDP by 2015 • Chronic Diseases like heart disease, asthma, cancer, diabetes are primarily responsible for the rise in health care spending Sources: pollingreport.com, National Coalition on Health Care, CDC
    9. 9. Health Care Expenditures as % of GDP Between 2001 and 2016, health spending is projected to grow 2.5% per year faster than GDP, so that by 2016 it may constitute 20% of GDP. $14,000 20.0% 16.0% $12,000 15.9% 13.7% 13.8% 15.0% $10,000 12.3% In Billions ($) $8,000 10.4% Percent 9.1% 10.0% 8.1% $6,000 7.2% $4,000 5.0% $2,000 $- 0.0% 1970 1975 1980 1985 1990 1995 2000 2005 2006 National health exp. GDP Health Exp as % of DGP SOURCE: CMS, Office of the Actuary, National Health Statistics Group.
    10. 10. USA outspent other developed countries in health care
    11. 11. Higher Spending Does Not Necessarily Lead to Higher Quality Source: Baicker and Chandra (Health Affairs 2004)
    12. 12. Life Expectancy While much higher than developing countries, US life expectancy is lower than most developed countries. 81.5 79.7 79.9 80 79.4 78.5 78.1 77.1 Age 75 70 U.S. U.K. Germany France Canada Italy Japan Source: OECD, 2004 & Health Affairs 2002; 21(4): 99
    13. 13. % Finding Difficulty in Receiving Care More than 1 in 4 in the population finds accessing care difficult in the United States. 30 28 % finding it difficult to get care 25 21 20 15 15 15 15 10 5 0 U.S. Canada New Zealand Australia U.K. Commonwealth Fund Survey, 1998
    14. 14. Trends in Health Care – Chronic Disease • By 2025, nearly 49% of U.S. population will have one chronic disease • Those with chronic diseases account for 81% of hospital admissions; 91% of all prescriptions filled; and 76% of all physician visits • CDC estimates that chronic disease management represents 75% of all healthcare spending and responsible for 70% of deaths Sources: CDC, fightchronicdisease.org
    15. 15. Limitation of Standard Drug Treatment Drugs prescribed for patients are effective in fewer than Reate of Efficacy with Standard Therapy (%) 60% of treated patients 100 90 80 70 60 60 62 60 57 48 50 50 40 30 30 25 20 10 0 e s s ) as s ia i ti es on es a si hr m hm se yp ro si et t th ar di s po lt b st y re ia al rh d 's A eo ep D oi r( er ar st at D ce m ac O um ei an di h he C ar lz A R C The rape utic Are a Source: Brian B. Spear, Margo Heath-Chiozzi, and Jeffrey Huff, “Clinical Application of Pharmacogenetics,” Trends in Molecular Medicine (May 2001).
    16. 16. Summary: The need for transformation • Total health care spending was $2.5 trillion in 2008, representing 16% of the GDP, like to reach $4 trillion by 2016 • 75-90% were spent on managing and treating chronic illnesses that are preventable and effectively managed • On a per-person basis, our health care costs are 50% higher than the second most costly nation • USA outspent other developed countries in health care but quality of care does not follow. • The U.S. healthcare ranked by the WHO 37/191 countries in performance • Drugs prescribed for patients are effective in fewer than 60% of treated patients but costs of development is skyrocketed.
    17. 17. What Makes Each One of Us Unique and What Defines Health?
    18. 18. Patient Phenotype home.honolulu.hawaii.edu/~pine/variation3.jpg
    19. 19. http://genomics.energy.gov/
    20. 20. The Human Genome Project • A 13-year project coordinated by the U.S. Department of Energy and the NIH • The total number of genes estimated at 30,000 • 99.9% nucleotide bases are exactly the same in all people • Functions unknown for over 50% of discovered genes Source: Human Genome Project Information http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml
    21. 21. NY Times Magazine: My Genome, My Self Steven Pinker, Jan 7, 2009
    22. 22. Complex Relationships Determine Health and Disease • Complex interactions of genes and proteins explain differences between people • Complex Interactions of proteins in networks and our environment are critical in determining health and disease • What field has tools that we need to understand the organization of these complex interactions?
    23. 23. Systems Biology • Emergent field that aims at systems understanding of biological systems. – Systems view focuses at understanding: • The complexity of the system • The networks activated in the system • The control methods of the system www.sysbio.de/figs/sysbio8.gif • Key nodes in the system
    24. 24. Systems Biology Opportunity in Clinical Medicine Identify Networks and Key Regulatory Nodes Controlling Networks http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html
    25. 25. PLoS One
    26. 26. How Will Personalized Medicine Look in the Future?
    27. 27. The Future
    28. 28. What Does the COM Contribute to Research at Ohio State?
    29. 29. • $34.1 M over 5 years • CTSA is an outcome of the Roadmap for Research from NIH
    30. 30. NIHIdeas People Resources Leadership
    31. 31. NIH Roadmap for Medical Research New Pathways to Discovery NIH Research Teams Re-engineering the of the Future Clinical Research Enterprise Source: NIH Roadmap Project
    32. 32. NIH Roadmap Strategy Interdisciplinary Research Pioneer Award Nanomedicine Training Public Private National Clinical Research Partnerships Associates Bench Bedside Practice Building Blocks Clinical Integrated Research Pathways Research Networks Molecular Libraries Informatics Clinical outcomes Bioinformatics and Translational Computational Research Biology Structural Biology Initiatives Source: NIH Roadmap Project Nanomedicine
    33. 33. Molecular Libraries Building Blocks, Re-engineering the and Imaging Biological Pathways Clinical Research and Networks Enterprise Clinical Enterprise Structural Public-Private Biology Partnerships Implementation Groups Bioinformatics and Computational Biology High-risk Research Interdisciplinary Research Nanomedicine New Pathways Research Teams to Discovery Source: NIH Roadmap Project
    34. 34. How Has the Stimulus Package Affected Research in the COM and Medical Center?
    35. 35. American Recovery and Reinvestment Act 2009
    36. 36. ARRA Stimulus Funding Proposal by Type OSUMC As of 6/2/09 $4,949,092 $11,923,253 Challenge Supplement $74,640,044 Aut ism Shared Inst r $63,091,300 APRC * RC2 GO Grant P30 Core Ct r $450,812 Revision $5,734,402 $33,199,437 $2,911,697 Source: COM Office of Total $200M Research
    37. 37. How Does Personalized Medicine Align with the Research Mission?
    38. 38. Personalized Health Care DISEASE TO WELLNESS Translation Application/ Dissemination Implementation Practice to Experimental Health Care Population Health Therapeutics and Delivery; Health Impact; Social Devices; Preclinical Care Effectiveness Networking Tools to Clinical (T2) (T3) and Solutions (T4) DISCOVERY Systems Biology/Systems Medicine Genomics/Proteomics; Genetics; Informatics; Modeling (T1)
    39. 39. BHAG for Personalized Health Care planning at Ohio State • We will develop and execute a demonstration project in personalized health care by 2010 to deliver care in a cost-effective, convenient, high quality and precision-based approach starting with our health plan and create the social epidemic to lead to its acceptance and desirability. • We will develop a personalized health care model that will meet our blue ocean strategy and… – Create Precision Medicine to improve quality – Lower the cost of health care – Increase patient access and customer satisfaction – Move health care from the doctor’s office to the patient’s home on demand
    40. 40. Tools
    41. 41. Applied Research and Systems Biology • Emergent field that aims at systems understanding of biological systems. – Systems view focuses at understanding: • The complexity of the system • The networks activated in the system • The control methods of the system www.sysbio.de/figs/sysbio8.gif • Key nodes in the system
    42. 42. PHR and Portability Microsoft HealthVault
    43. 43. Telemedicine
    44. 44. Social Networking
    45. 45. Systems and Process Focus Make your car last 200,000 miles GOOD BETS BAD BETS Honda Civic BMW 7-Series Honda CR-V Infiniti QX56 Honda Element Jaguar S-Type Lexus ES Jaguar X-Type Lexus LS Mercedes-Benz M- Class (V8) Toyota 4Runner Mercedes-Benz SL Toyota Nissan Armada Highlander Toyota Land Nissan Titan Cruiser Toyota Prius Volkswagen Touareg Toyota RAV4 Volvo XC90 (6-cyl.) Decoding the DNA of the Toyota Production System, Harvard Business Review, 1999 October 2007
    46. 46. FROM TO *Number of ICU beds is subject to change
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