According to the World Economic Forum, chronic diseases will cost the global economy $47 trillion over the next 20 years. The situation in the U.S. is especially dire: America has worse health care outcomes and lower life expectancy than almost every other developed nation. The CDC states that chronic diseases affect one in two Americans and account for 80 percent of the nation’s health care costs.
Conventional disease paradigms generally define disease by manifestations of a dysfunctional organ system and overlook underlying pathobiological mechanisms. Disease, however, is rarely a simple consequence of an abnormality in a single gene product. Our biological forms and functions cannot be simply determined by a genetic blueprint; they are emergent properties of the entire epigenetic network. But modern medicine’s definition of diseases include such an excessive multitude of symptoms that it begs the question whether two people are actually experiencing the same disease or whether the umbrella term should be disregarded. Dr. Jeffrey Bland—the founder of functional medicine, which focuses on the underlying causes of disease from a system biology perspective—asserts in his book, The Disease Delusion, “Diseases don’t exist.” For example, Type ll Diabetes is an umbrella term for a variety of underlying problems of glucose metabolism such as insulin resistance, islet cell problems, defective insulin transporters, and defective ion channels.
And because of the general lack of understanding of the true nature of disease, as Dr. Lawrence Cheng explained during his speech last weekend at the annual Integrative Healthcare Symposium, medications aren’t working. Dr. Cheng pointed out that at least one-third of the money spent on prescription drugs is wasted, because many patients are prescribed medications that are either ineffective or dangerous.
Although we treat diseases separately, most are not independent of each other. Therefore, we must address medicine by cause and mechanism rather than through symptoms and diagnostic labels. Human biochemistry is so unique that diseases are caused and exhibited in a broad array of ways. Doctors must shift their focus to care more for the individual patient than for the particular manifestation of the disease. As Hippocrates once said, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
The essential underlying problem is that we have rejected the wisdom of ancient medicine and failed to recognize the connection of the mind, body and spirit and the interplay between the individual, community and planet. Instead of recognizing that health is the result of efficient interplay of all parts of the body, we visit separate specialists and wind up with three different diagnoses and medications. It’s time for a new approach in which health professionals work alongside one another in order to understand each patient’s unique landscape.
What the Future Holds
Medicine is moving from a disease-centric approach to a systems biology that addresses the individual as a whole. The medicine model of tomorrow will be predictive, preventative, personalized and participatory. Predictive means it will incorporate genomics to determine the probability of disease. Preventative means people will know their individual risk profile, which will motivate them to make changes before they get sick. These will be personalized recommendations, namely targeted and specific interventions and treatment. There will also be empowered engagement in personal choices that is participatory, meaning patients will discuss how to improve their general health with their doctor and find out what led them to become sick in the first place.
The relatively new discovery of epigenetics offers tremendous hope; genes are no longer a kind of predetermined destiny. Said Dr. Jeffrey Bland at the Integrative Healthcare Symposium, “Our health and disease patterns… are not hardwired deterministically by our genes, but rather consequences of the interaction of genetic uniqueness with environmental factors.”
We can no longer be defined in terms of individuals with specific medical conditions. We are all unique ecosystems; no one part of the body is truly independent of another. Complicating the matter, there are 10 times more bacterial cells in our bodies than human cells. The gut microbiota includes trillions of bacteria and other microorganisms. Our individual microbiomes are sometimes called our genetic footprints, since they help determine our unique DNA, predisposition to diseases, body type and much more. The functional medicine community believes the microbiome and its activities are involved in most, if not all, of the biological processes that contribute to human health and disease. Further, bacterial species contain more than 100 times more genes as our own human genome. We are quite literally walking super-organisms.
It is possible now to utilize genome sequencing to understand the molecular diagnosis of an unknown condition. There are, however, limitations in genome sequencing. We are, after all, mosaics, as our 37 trillion cells do not have the same DNA. So far, most commercial tests are not nearly as conclusive or exhaustive as they will eventually be. Regardless, we need to address the microbiome, considering exome sequencing (a technique for sequencing all the protein of the body that offers a look into the genome) accounts for only 1.5 percent of our entire DNA. The rest is not deterministic. In addition, most variants of DNA will be of unknown significance.
Those in the field of functional medicine are already intercepting diseases by noticing anomalies in people’s genomic sequencing. In the future, people will be able to adapt a specific healthy lifestyle regimen that suits them on a genomic level. Already, patients are bringing in print outs of their DNA profiles and instructing doctors about how they would like to be treated. Eventually, this will be welcomed and automatic. Records will be shared with patients, which will increase patients’ control and understanding of their medical conditions. Drugs and vitamins will no longer be generic; rather, they will be especially tailored for the individual.
With all of this new technology, doctors’ offices may cease to exist. Virtual visits and computer-automated diagnoses will be in practice. Imagine taking a photo of a skin ailment and simply sending it to whatever dermatologist is on the other end of the app you choose. Smartphone doctors and home visits could become the norm, and they would be more effective and convenient than spending hours in a waiting room.
Of course, there will be new concerns as well. Will our society become one of cyberchondriacs? What new ethical dilemmas will arise? Will there be proper security of our genetic data? How will we ensure that there is no genetic discrimination by insurance and employers? What will be gained and lost with the advent of less face-to-face interaction with one another? Though these questions remain, medicine is moving in the right direction. Whether we are ready or not, a medical revolution is taking hold. Welcome to the future of medicine.
Kristy Rao is a certified health and nutrition coach.