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2009: The Year of Bespoke Medicine

Technology, science, medicine, and business are converging to deliver more information than ever about you and your body. Individually tailored medical care is coming.

Two roads diverged in a wood, and I,

I took the one less traveled by,
And that has made all the difference.
-Robert Frost

When Robert Frost wrote "The Road Not Taken" almost a century ago, few choices existed for personal health care. Without antibiotics, an infection took its course. Diabetes was largely untreatable. X-ray images were new. And remedies for many diseases were little changed from the Renaissance.

Virtually no one talked about preventive or predictive medicine beyond mothers insisting that their children down a tablespoon of wretched-tasting cod liver oil.

A century later, physicians have vast arsenals of drugs, procedures, therapies, and data to deploy if one gets sick.

Until now, however, major health-care decisions have tended to be made or guided by doctors. In the coming year, one of the big stories in life sciences will be the explosion of information that will become available to individuals about their current health and what may happen to their health in coming years.

This gives new meaning to Frost's poem about which road we will want to travel as data proliferates about our genes, the impact of the environment on our bodies, and the health and function of our brains.

Integrating all of this-everything from how a person's diet interacts with his or her unique genetic profile to how mercury and other pollutants affect cognitive function in the brain-is in its infancy, but the process will begin to significantly change health care for a growing number of people in 2009 and beyond.

Outgoing Secretary of Health Michael Leavitt recently issued a 300-page report: Personalized Health Care: Pioneers, Partnerships, Progress that offers one of many blueprints that have recently emerged from government and industry that insist the long-awaited era of individualized medicine is on the cusp.

"We are at an early stage in our ability to differentiate between variations in the biology of individual patients and provide effective treatment for different diseases," the report says.

"Even our definitions of diseases remain rooted in 18th- and 19th-century terms. We refer to asthma, but there are many varieties of asthma," Leavitt continues. "From a treatment perspective, they are actually different diseases, yet we are barely at the cusp of being able to identify them accurately and provide the right treatment at the first encounter."

Other proselytizers of individualized health care include Lee Hood of the Institute for Systems Biology in Seattle and George Church of Harvard. They've long called for redirecting medicine and medical research toward personalized medicine to focus on the well rather than the sick. This has begun and will accelerate in 2009.

New online companies-led by 23andme, deCODEme, Navigenics, and DNA Direct-are offering individual customers access to their own genes. Genetic sequencing companies such as Illumina, Affymetrix, and Applied Biosciences are being joined by new firms such as Complete Genomics and Knome to mine individuals' genomes, and are rapidly reducing costs.

Much of the genetic data available direct to consumers is incomplete and preliminary, but in coming years, it will be tested and validated.

A few genetic tests are well validated and already a part of the standard of care. Genentech's breast cancer drug Herceptin, for instance, is indicated only for patients who test positive for an over-expression of the HER2 gene.

Other companies, mostly in stealth mode, are plotting to tease out details of people's protein signatures and the impact of environmental influences.

A host of books documenting the personalized medicine revolution are already in the works. Tom Goetz of Wired and Misha Angrist of the Duke Institute for Genome Sciences and Policy are writing about their own experiences of being genetically screened for diseases and other traits, and what these tests will mean for people in the future.

Geneticist Francis Collins, one of the architects of the human genome project and until recently the director of the National Human Genome Research Institute, is writing a book on personalized medicine.

My own book on being genetically screened for health and environmental influences-Experimental Man: What One Man's Body Reveals About His Future, Your Health, and Our Toxic World-will be out this spring.

(I've also written a series of columns on this subject for Portfolio.com.)

New groups are forming, including the Quantified Self, founded by technology guru and Wired magazine's "senior maverick" Kevin Kelly and Wired contributing editor Gary Wolf. Members share their experiences in gathering data about themselves-from diet to sleep patterns and beyond-in monthly meetings held in the San Francisco Bay Area.

A raft of new technologies will help make this new age happen, creating a world where one day a doctor's exam will include a quick scan of our bodies that tells us hundreds or thousands of bits of data seamlessly integrated by a computer into a health score card. Think of the sickbay on the starship Enterprise.

Or maybe we'll have our own handheld device-let's call it an iHealth (with apologies, or perhaps a suggestion, to Apple)-that will keep track of our genomes, incorporate the most recent scans of our brain and body, and record real-time environmental data about what we are exposed to as we walk around, eat, and work. This could include levels of mercury and benzene, say, as well as exposure to ultraviolet rays.

This information will be synched up at home with sophisticated biomonitors that daily record levels of thousands of chemicals, proteins, and other substances inside us.

Our iHealth could download the data, assess our current health, and determine up-to-the-minute probabilities for acquiring various diseases and exposures. At the same time, it could assess risks for everything from eating a steaming piece of swordfish to walking in an environment teeming with hidden chemicals.

While we're waiting for all of the data to sync we can play a game, check emails, or watch a video on a futuristic version of YouTube.

The impact of such a device and the intimate information it will provide is hard to fathom, much as people in Robert Frost's day had no idea what antibiotics would mean to future generations.

The poet who contemplated which road to take in a wood couldn't have imagined that tuberculosis, whooping cough, and other diseases that terrified his era and cut lives short would largely disappear in the West, and that millions of people would remain alive and vibrant into their 70s and 80s.

I suspect that some people will obsessively check their iHealths and will be terrified to go outside, and others will love having the information.

Everyone will worry about privacy, health-hackers, and new forms of identity theft that will make today's fears seem quaint.

Yet this era is coming, and 2009 may well be the year people remember as the moment when we stepped onto a path never before traveled.

I for one can't wait to see what difference this will make.

Visit Portfolio.com for the latest business news and opinion, executive profiles and careers. Portfolio.com© 2007 Condé Nast Inc. All rights reserved.
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