Will Systems Biology Survive Healthcare Reform?

If you ever find yourself munching a sandwich at your desk and want to enliven your lunch break with a fascinating lecture about the future of medicine, tune in to a talk titled "Systems Biology, Systems Medicine, and Transformational Technologies" by Dr. Leroy Hood of the Institute for Systems Biology.

Pitching a lay audience at one of Yahoo! Labs "Big Thinker" events, Dr. Hood does a masterful job describing the possibilities that lie ahead for what he calls the new age of P4 medicine. The four "P"s are predictive, personalized, preventative, and participatory.

Add one more P. Pity that it will never be allowed to happen here.

While big science will undoubtedly continue winning government grants to conduct research - increased funding for the perennial War on Cancer is a guaranteed applause line for politicians - turning science into medicine is going to become an increasingly rare event. Not just because clearing regulatory and reimbursement hurdles is going to get ever more difficult, though it surely will. Rather, the objectives of P4 medicine run counter to the fundamental tenets of redistributive justice and communitarian economics that lie at the heart of healthcare "reform".

Let's start with the first P - predictive. Dr. Hood looks forward to the day when routine blood tests will be tuned to each individual's blood chemistry such that an increase in a patient's chances of developing a particular ailment can be statistically anticipated well in advance of symptoms. Patients identified as being at higher risk could then be tracked more closely while being put on maintenance dosages of preventative medicines.

Right. Imagine the economics of both the increased medical resource utilization by at-risk populations seeking more frequent monitoring as well as the cost of keeping these groups on preventative medicines for the rest of their lives. Compare that to the cost of treating only those unfortunate few who actually come down with a dire disease. While you're at it, imagine what it will take to strong-arm what's going to be left of the private insurance industry into covering preventative treatments for asymptomatic individuals. Now recall the recent brouhaha over something as simple as recommending regular mammograms for women under 50.

Well, how about personalized? One of Dr. Hood's key insights is the fact that designing medical systems to deal with averages and aggregates runs counter to the complex diversity of human life. Why can some people smoke two packs a day and live into their nineties while others die in their fifties after exposure to second hand smoke? By personalizing everything from test result interpretations to treatment regimes, tuned to each individual's genotype and phenotype, ineffective treatments can be avoided, expensive interventions can be better targeted, incurable cases can be triaged, and the doctor-patient relationship can evolve into a tight and durable partnership.

Uh-huh. And how is this extraordinary degree of personalization going to square with uniform national standards imposed by one-size-fits-all Congressional mandates? Are you watching the trend to ban trans fats from restaurants? Do individual diners get an exception if they have high levels of protective "good" cholesterol? Will my harried doctor get increased reimbursement for the extra time he has to spend customizing my care? To get some idea of what will happen when the trend toward personalized medicine collides with healthcare reform imagine how access to personal computers would have played out if Congress were in charge of distributing them. PCs would cost $10,000, Macs would be illegal, and half the country would be receiving government subsidies to assure equality of "access".

That brings us to preventative, a virtue that doesn't take Systems Biology to achieve. Try these on for size. Don't smoke. Wear your seatbelt. Put on a condom. Go easy on the booze. Skip the fries. Get off your butt and walk. How much would the nation's healthcare bill be cut if every American did these simple things? Why can't we grab this low hanging fruit? Could it have anything to do with the fact that making people bear the consequences of their own choices is anathema to communitarians? If there is no penalty for abusing your own body because Congress demands that someone else pays the repair bills, why bother?

That leaves us with participative. Making P4 medicine work requires educated consumers, engaged healthcare workers, and adaptive price mechanisms under which cost benefit decisions can be made based on personal wellness outcomes. This is one thing you certainly won't see as part of healthcare reform. Despite the sturm and drang, Washington is determined to make sure we remain mired in a system that pays for procedures ordered up by doctors terrified of malpractice lawyers priced by politicized bureaucrats all paid for by our unborn grandchildren.

So dream on, Dr. Hood. May the real world catch up with you one day. Perhaps in China.