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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
7.2%8.1%
9.1%
10.4%
12.3%
13.7% 13.8%
15.9%16.0%
$-
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
1970 1975 1980 1985 1990 1995 2000 2005 2006
In B
illi
on
s ($
)
0.0%
5.0%
10.0%
15.0%
20.0%
Per
cen
t
National health exp. GDP Health Exp as % of DGP
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.
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)
Source: OECD, 2004 & Health Affairs 2002; 21(4): 99
Life Expectancy
78.1 78.579.4 79.7 79.9
81.5
77.1
70
75
80
U.S. U.K. Germany France Canada Italy Japan
Ag
eWhile much higher than developing countries, US life expectancy is lower than most developed countries.
% Finding Difficulty in Receiving Care
21
15 15 15
28
0
5
10
15
20
25
30
U.S. Canada New Zealand Australia U.K.
% f
ind
ing
it d
iffi
cu
lt t
o g
et
ca
re
Commonwealth Fund Survey, 1998
More than 1 in 4 in the population finds accessing care difficult in the United States.
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 TreatmentDrugs prescribed for patients are effective in fewer than
60% of treated patients
2530
48 50
5760 60 62
0
10
20
30
40
50
60
70
80
90
100
Therapeutic Area
Re
ate
of
Eff
ica
cy
wit
h S
tan
da
rd T
he
rap
y (
%)
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
• 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
The Human Genome Project
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?
www.sysbio.de/figs/sysbio8.gif
• 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• Key nodes in the system
Systems Biology
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
IdeasPeople
ResourcesLeadership
NIH
NIH Roadmap for Medical Research
New Pathwaysto Discovery
Re-engineering theClinical Research Enterprise
Research Teamsof the Future
NIH
Source: NIH Roadmap Project
Bench Bedside Practice
Building Blocks PathwaysMolecular LibrariesBioinformatics and Computational BiologyStructural BiologyNanomedicine
TranslationalResearchInitiatives
Clinical ResearchInformatics
Integrated ResearchNetworksClinical outcomes
TrainingNational Clinical Research Associates
Interdisciplinary ResearchPioneer Award Nanomedicine
Public PrivatePartnerships
NIH Roadmap Strategy
Source: NIH Roadmap Project
Re-engineering the Clinical Research
Enterprise
Public-PrivatePartnerships
High-riskResearch
Interdisciplinary Research Nanomedicine
Bioinformatics and Computational Biology
StructuralBiology
Building Blocks, Biological Pathways
and Networks
Molecular Libraries
and Imaging
ImplementationImplementationGroupsGroups
New Pathways to DiscoveryResearch Teams
ClinicalEnterprise
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 OSUMCAs of 6/2/09
$450,812$5,734,402
$2,911,697
$33,199,437
$74,640,044
$63,091,300
$4,949,092
$11,923,253 ChallengeSupplementAutismShared InstrAPRC *RC2 GO GrantP30 Core CtrRevision
Total $200M Source: COM Office of Research
How Does Personalized Medicine Align with the Research Mission?
DISCOVERYSystems Biology/Systems Medicine
Genomics/Proteomics; Genetics; Informatics; Modeling (T1)
Personalized Health CarePersonalized Health Care
Translation
Experimental Therapeutics and
Devices; Preclinical to Clinical (T2)
Application/ Implementation
Health Care Delivery; Health
Care Effectiveness (T3)
DisseminationPractice to
Population Health Impact; Social
Networking Tools and Solutions (T4)
DISEASE TO WELLNESS
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
www.sysbio.de/figs/sysbio8.gif
• 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• Key nodes in the system
Applied Research and Systems Biology
PHR and Portability
Microsoft HealthVault
Telemedicine
Social Networking
Systems and Process Focus
Decoding the DNA of the Toyota Production System, Harvard Business Review, 1999
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 Highlander
Nissan Armada
Toyota Land Cruiser
Nissan Titan
Toyota Prius Volkswagen Touareg
Toyota RAV4 Volvo XC90 (6-cyl.)
Copyright © 2004-2009 Consumers Union of U.S., Inc. No reproduction, in whole or in part, without written permission.
October 2007
*Number of ICU beds is subject to change
FROM
TO