Ralph Snyderman Challenges the Status-Quo 100 Years After Flexner.

Posted on | January 2, 2017 | Comments Off on Ralph Snyderman Challenges the Status-Quo 100 Years After Flexner.

Credit: NEJM Catalyst

Mike Magee

In Hcom’s most read post of 2016, we challenged the notion of “personalized medicine” as often an empty “branding exercise”, and subsequently noted a seeming disconnect between NIH supported scientific medical progress and human progress.

At around the same time, Ralph Snyderman and his team at Duke published an important paper in the NEJM titled, “To Adopt Precision Medicine, Redesign Clinical Care.” In it, he states, “the path from a scientific breakthrough to transforming health care is not straight”, and declares that “the basic approach to clinical care has to be re-envisioned to fulfill the promise of personalized medicine.”

In a series of accompanying illustrations, we see him peal back the onion toward prevention. He goes from “sporadic treatment of episodic disease” to “predicting disease” to “prevent and mitigate” disease. But to gain access to this new approach, policy makers must force us to enter the health care world through a different door. The new chamber, according to Snyderman, is “out of reach until the health care delivery system is designed for health promotion, comprehensive disease prevention, and efficient adoption of personalized and precision medicine (PPM) capabilities”.

The Duke team is optimistic professing that “with available and emerging tools, risk for disease can be quantified and prevention measures initiated before pathology develops”. One of the most interesting elements of the article is the illustration above focused on the “inflection curve” which demonstrates how late we come to the game of health delivery, and how this gives rise to unacceptable cost and irreversible human carnage. It also suggests the type of promise I described some years back with the Lifespan Planning Record.

LPR Video

If you follow the curve backward, you see limitless potential, if only we are prepared to no longer accept the status quo. But with the changing of the guard in Washington, that now seems a long way off. Clearly, Snyderman’s view is revolutionary, and it recognizes not only fundamental changes in the way we deliver care , but also the way we capture and advantage a range of personal, environmental and scientific data in real-time. As he says, “It aims to reorient front-line care so that health risks are identified and stratified early, healthful behaviors are promoted, and disease is either prevented or precisely treated.” And he admits that won’t be easy.

But the Chancellor Emeritus at Duke, and former President of the AAMC, comes at this with a deep historical perspective. He says, “The 1910 Flexner Report shocked the medical establishment into incorporating scientific advances to transform how disease is defined, diagnosed, and treated. More than a century later and a decade since the genomic revolution, it’s again time to redesign clinical care to also enhance health and prevent disease.”