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

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

Create the
Future of
Medicine to
Improve
People’s
Lives Through
Personalized
Health Care
Harvard
Business
Review |
October 2007 |
hbr.org

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 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

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,
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

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.

USA outspent other developed countries in
health care

Higher Spending Does Not Necessarily
Lead to Higher Quality
Source: Baicker and Chandra (Health Affairs 2004)

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

% 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

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

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
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s
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as
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es
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oi
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er
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at
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um
ei
an
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ar
lz
A
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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).

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.

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 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

NY Times Magazine:
My Genome, My Self
Steven Pinker, Jan 7, 2009

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?

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

Systems Biology Opportunity in Clinical Medicine
Identify Networks and Key Regulatory Nodes Controlling Networks
http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html

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
NIH
Research Teams Re-engineering the
of the Future Clinical Research Enterprise
Source: NIH
Roadmap Project

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

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

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
$4,949,092
$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

How Does Personalized Medicine
Align with the Research Mission?

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)

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

Tools

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

PHR and Portability
Microsoft HealthVault

Telemedicine

Social Networking

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

FROM
TO
*Number of ICU beds is subject to change