Dr. Hossein Fakhrai-Rad's blog post was featured
Patient Data-Driven Personalization Key to Fixing Today's Broken Health Assessments
On average, we live 8 years longer than we did in 1970. The problem is, even though we’re living longer than we ever have before, we are not necessarily living healthier. In fact, we are living sicker in the last 10-15 years of life.Modern medicine and medical treatments are prolonging our lives, even helping us live with diseases that were otherwise fatal.But we’re also in the habit of reacting to and medicating diseases that are preventable: diabetes, heart disease, hypertension, sleep apnea, certain cancers among other common complex diseases. Quality of life has suffered in this paradigm.It’s regrettable, but it’s changing. We’re becoming increasingly curious and increasingly motivated. We want to know our personal health risks so that we can prevent them. We want to live longer and healthier, and we want to know exactly how to do it.Health assessments are a popular way to bring preventive care to patients at large. Typically, they are survey-style tests that triangulate a patient’s individual risk for developing certain diseases based on lifestyle choices, medical and family history. For example: WebMD’s Better Health Evaluator, the American Heart Association’s Heart Attack Risk Assessment, or Heartage.me.These tests -- you’ve probably taken them before yourself -- will tell you that if you smoke, you’re 15-30 more times likely to develop lung cancer. If your BMI is above normal, you’re far more likely to develop sleep apnea or Type 2 Diabetes. If you are a female and have a close family member who had breast cancer, you’re twice as likely to develop the disease yourself.While this type of eye-opening information is meant to be a catalyst for behavior change, early detection and treatment, in reality, the results are too general to be of actual use to patients and physicians.Furthermore, patients rarely adopt the behaviors that will help them lower their risks after reviewing their assessment because the results aren’t personalized and actionable. In fact, the best catalyst for behavior change is the right education about complex issues like risk prevention and genetic predisposition.Here are three ways we can improve these assessments to make them actual drivers of behavior change and successful preventive care.Health Assessments Compare You to the AverageMost health assessments take portions of your family history, clinical data, and some lifestyle factors into consideration, and then compare those against population averages.For example, most health assessments today give me the risk of all other moderately active 35-45 year old males with high blood pressure, instead of giving me my personal risk of developing heart disease.The problem is, you are not the average. The way that disease symptoms, like high blood pressure; risk factors like smoking and family medical history affect an individual depend on a whole host of factors including your unique DNA, your environment and lifestyle, as well as your complete medical history.Hospitals and medical schools are starting to use genomics to provide an added level of personalization to the care they provide. Stanford University Medical School has started a training program for their Pathology Residency in personal genomics in order to better serve their patients. Cancer clinics are considering how to implement personalized treatments based on genomic technologies with cancer patients with approaches that span risk stratification, prevention, therapy and survivorship programs.For health assessments to serve patients better, they need to take into account the unique way that my risk factors interact with me, not the aggregate. Emergingresearch suggests that patients are more likely to adhere to behavior change if they discuss personal risk factors during a counseling session. This means physicians need a comprehensive view of the patient’s data to be able to present him or her with their individual risk for disease.Health Assessments Are Non-ContextualImagine that I do an online health assessment and find out that I have a 10% increased risk of Type 2 Diabetes over the average. Is that a risk I’m born with or is attributable to my lifestyle and environmental factors?One common misconception of health assessments, is that many times people mistake having a genetic predisposition for a common complex disease (like Type 2 Diabetes) to mean that there is nothing they can do to reduce their risk of developing that disease.In reality, it’s a mix of both. There is a certain amount of risk that I can’t do anything to change, because it lives in my genome. But there are a variety of risk factors that I have control over -- such as BMI, level of exercise, or whether or not I smoke or drink among other modifiable risk factors.Health assessments need additional context to make the results personal to the patient. Interventions that provide real-time continuous feedback may be more likely to motivate risk-reducing lifestyle behaviors. For example, personal monitoring devices like the Nike+ or FitBit that can track exercise metrics, or devices that can track calories consumed or other aspects of diet can be integrated into visualizations of an individual’s risk over time, detailed explanation of the results, or a consultation with a healthcare professional.One example is AliveCor, a heart monitor and companion app that helps patients and physicians learn about and characterize their heart rates and rhythms through real-time tracking of their ECG using a smartphone.Most importantly, a patient’s doctor must be involved to explain the data in detail, to provide context for the patient, answer questions, untangle recommendations, and map out an action plan for lowering risk. This is a critical and often overlooked step.Patients Need Detailed Attack PlansWhen we get more health data than we know what to do with, we shut down. We don’t know what to do with it. In some cases we even misinterpret the results. As much as we like to be informed, we aren’t doctors and don’t know how to make use of this new information.Health assessments are very rarely accompanied by steps to reduce an individual’s risk. Patients need to know how their risk of developing diseases translates into real, everyday actions.Of course, there are things that nearly everyone should be doing to lower their risk of heart disease, diabetes, etc., like eating healthier foods, exercising more, getting better sleep, and drinking plenty of water. But “eating better” looks different for me than it does for my wife, than it does for my colleagues. Even someone with the same basic profile -- male, 35-45, increased risk of heart disease -- will have different needs than I do.We know that specific action plans and concrete goal setting between a clinician are a useful strategy to encourage behavior change. Health assessments need to be accompanied by specific action plans, tailored to the individual. Specificity is the key here -- because I’m far more likely to adhere to an action plan that is tailored to my unique needs. Generic advice about diet and exercise is far too easy to ignore.This keeps patients engaged with their health. If I know that 20 minutes of rowing 4 days/week will improve my potential for preventing diabetes, I’m much more likely to routinize these recommendations, especially if I can see a chart of how my actions lowered my risk over time.Prevention Is PersonalWhen health assessments are highly individualized, and take into account the unique way risk factors interact for each person, we’ll see more engaged patients, lowered cost of long-term healthcare, and most importantly, individuals who live longer, and healthier lives.That’s the real promise of personalized medicine and preventive care. It’s not just a matter of prescribing a custom drug to deal with a disease -- it’s about improving the odds that you’ll improve your quality of life today and in the long run.Dr. Hossein Fakhrai-Rad is a scientific and entrepreneurial visionary in the fields of molecular biology, genetics, genomics, and personalized medicine.See More