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  • 10/10/11
  • 10/10/11
  • 10/10/11
  • 10/10/11
  • 10/10/11
  • 10/10/11
  • 10/10/11
  • 10/10/11

Snyderman Snyderman Presentation Transcript

  • Personalized Health Care: The Key to Meaningful Health Care Reform
    • Ralph Snyderman, MD
    • Chancellor Emeritus, Duke University
    • Johanna and Ralph DeStefano Personalized Health Care Conference
    • Ohio State Medical Center
    • October 6, 2011
    ©2011 RALPH SNYDERMAN
  • Medicine Pre-1900 ©2011 RALPH SNYDERMAN
  • Science and Medicine 1900s Germ Theory Chemistry Physiology Pathology Physics 2000s Genomics Proteomics Metabolomics Systems Biology Informatics Micro/Nano Processing Find It Fix It Predict It Personalize It Understanding Disease Understanding Health, Disease and Complexity ©2011 RALPH SNYDERMAN
  • Concepts of Disease Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Preclinical Progression Disease Initiation Disease Progression Irreversible Damage Causative Factor Disease ©2011 RALPH SNYDERMAN
  • Concepts of Disease Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Causative Factor Disease Enhance Health and Well-Being ©2011 RALPH SNYDERMAN
  • Initiating Events Disease Burden Time Cost 1/reversibility Typical Current Intervention Earliest Clinical Detection Earliest Molecular Detection Baseline Risk Personalized, Predictive, Prevention Personalized Medicine Tools Development of Disease ©2011 RALPH SNYDERMAN Personalized Health Planning
    • Health Risk Assessments
    • Genomic Predictors (e.g.)
      • SNPs
      • Gene Sequencing
      • Haplotype Mapping
    • Biomarkers
    • Gene Expression Tests
    • Proteomics Tests
    • Metabolic Profiles
    • Clinical Risk Models
    • Clinical Decision Support
    • Adverse Outcome Models
    • Drug Metabolism Indicators
    • Companion Diagnostics
    • Targeted Therapies
    Emerging Medical Capabilities Personalized Medicine Tools Applications
    • Quantify Health Risks
    • Monitor Disease Progression
    • Define Disease Mechanisms
    • Select Therapies
    ©2011 RALPH SNYDERMAN
  • Shift to Personalized Health Planning Traditional Medical Evaluation and Record Chief Complaint History of Illness Past Medical History Family History Social History Physical Exam Diagnostic Tests Assessment and Plan Personalized Wellness Plan Current Health Status Clinical Risk Assessment Tracking Wellness and Pathogenesis Clinical Event Prediction Wellness Plans Patient Engagement Personalized Treatment Plan Mechanistically Defined Pathology Level of Disease Activity Best Therapeutic Intervention Tracking Factors Therapeutic Timeline and Plan Patient Engagement ©2011 RALPH SNYDERMAN
  • Hallmarks of Cancer
    • Self sufficiency of growth signals
    • Insensitivity to growth inhibition
    • Evasion of programmed cell death
    • Limitless replication potential
    • Sustained angiogenesis
    • Invasion/metastasis potential
    • Immune evasion
    • Stress response phenotype
    ©2011 RALPH SNYDERMAN
  • Targeted Cancer Therapies
    • Block Oncogene Addiction Inhibitors of BCR–ABL, c-KIT, HER, B-RAF
    • Enhance Tumor Suppressors Inhibitors of DNA methyl transferase, HDAC
    • Promote Apoptosis Inhibitors of Bcl-2; IAPs antisenses
    • Inhibit Angiogenesis Inhibitors of VEGF, EGFR, Notch
    • Abrogating Limitless Replication Inhibitors of CDK, CHK, MTK
    • Inhibit Invasion and Metastasis Inhibitors of TGFb, IGF-1R, FAK
    • Enhance Immune Surveillance Immunomodulatory drugs
    Examples ©2011 RALPH SNYDERMAN
  • Personalized Diagnostics Diagnostic Testing Overview Source: Company websites, L.E.K. analysis ©2011 RALPH SNYDERMAN
  • Consider a 28 year-old man with a mass in his neck Personalizing Cancer Care ©2011 RALPH SNYDERMAN
  • ©2011 RALPH SNYDERMAN
  • ©2011 RALPH SNYDERMAN
  • Personalized Cancer Care Plan Advanced Clinical Decision Support Personalized Diagnosis Risk Models Companion Diagnostics Targeted Therapies Adverse Reaction Indicators Disease Activity Indicators Dx Evaluation Rx Selection Onset Remission Tracking and Refining Therapies ©2011 RALPH SNYDERMAN
  • New Model Validation Biocausality Engine Clinical Decision Support Diagnostics Selectors Clinical Risk Predictors Therapeutic Predictors Payer Adjudication CPOE CDS TM PDx TM Personalized Cancer Care Plan EHR Clinical Decision Support at the Point of Care ©2011 RALPH SNYDERMAN
    • Personal Care Plan
    • Risks
      • Clinical
      • Therapy
      • Individual
    • Tracking Tools
    • Therapeutic Plan
    Patient Physician
    • Advanced Clinical Decision Support
    • Clinical Workflow and Guidelines
    • Risk Models
    • Molecular Diagnostics
    • Coordinated Care
    • Patient Centered Medical Home
    • Accountable Care Organization
    • Disease Management
    Personalized Data Base Personalized Health Care ©2011 RALPH SNYDERMAN
    • Coordination of Care
      • Patient Centered Medical Home
      • Accountable Care Organizations
      • Disease Management Programs
      • Health Care Innovation Zones
    • Reimbursement for Performance
      • Pay for Performance
      • Best Practice Pricing
      • Bundled Payments
    • Personalized Health Planning
    PPACA – Elements of Health Care Reform ©2011 RALPH SNYDERMAN