Not a Freudian Slip: Personalized Health Is Often Not Personalized or Health – Part 1

Column Editor: Connie Mester, MPH
To learn more about Connie, click here.

 

There is quite a bit of confusion and misconception about personalized health.  Many times, “personalized” health doesn’t consider the whole person, the realities of life, or a person’s emotional state or mental ability to recover, heal, or change. And even though a clinical lens provides insight into significant advancements in treating injuries and illnesses, we are missing a major part of the equation related to making an impact on health outcomes.

What is personalized health and how is it different from similar terms like personalized medicine, precision medicine, and personalized healthcare?  And why is it important to bring clarity around these terms that are used interchangeably?  Could confusion over these different terms cloud a critical component, and have us missing what people define as personalized health? In this two-part series, we will distinguish the differences between these often confused terms and reveal how limiting the view to diseases, physical and biological measures, and treatment recommendations may hinder one’s ability to make healthy choices and experience whole health.

Distinguishing Differences
Personalized medicine, also called precision medicine, is defined by the National Institutes of Health (NIH) as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”1

Personalized medicine came out of an effort to shift away from reactive, disease-focused healthcare to a more individualized approach focused on prevention using genomic and non-genomic data to predict disease.  Personalized medicine, a medical delivery segmentation model of sorts, uses a person’s unique molecular and genetic profile to direct treatment. However, “[personalized medicine] is sometimes misinterpreted as implying that unique treatments can be designed for each individual.”2

Personalized healthcare is a broader, more strategic approach that uses personalized medicine tools and health assessments to predict health risks and form a targeted treatment plan.  The clinician and patient partner together to plan, set goals, and monitor progress to strengthen care coordination and patient engagement.3

We know that people’s genetic make-up differs. By matching a person’s DNA to the most appropriate clinical procedures and medication, new clinical recommendations can reduce negative impacts like side effects or even augment disease susceptibility. With precision medicine advancements, clinicians will continue to more accurately pinpoint treatment recommendations, strengthening positive health impacts.

Much of the press around precision medicine holds promise for improving healthcare while also lowering costs, but what is the reality?  Precision medicine aims to find the best medication and treatment for a person, which should lead to better outcomes. But does this mammoth undertaking really matter, especially when we look at the top ten causes of death?  Can a person’s genotype direct an approach that produces better outcomes than the traditional clinical measures [gender, age, weight, etc.] used to prescribe treatments? And would the cost versus benefit of this complex, personalized approach make more of an impact than healthy lifestyle modifications on overall health outcomes for chronic conditions?

NIH’s landmark $1.5 billion precision medicine All of Us Research Program opened nationwide enrollment May 6th.  This extraordinary project will collect and analyze terabytes of genetic, biological, environmental, health, and lifestyle data from 1,000,000+ people to “accelerate health research and medical breakthroughs, enabling individualized prevention, treatment, and care for all of us.”4  Through this endeavor, we will soon know the impact of personalized medicine on cost and outcomes.

Don’t get me wrong, I am one who loves to identify trends across data to uncover nuances and similarities to strengthen existing solutions.  However, since we know behavior impacts a large portion of our health [40%] and our behavior is directed by our decisions, I propose we focus on helping people make smarter decisions around lifestyle factors like diet, activity level, stress, sleep patterns, risky behaviors, etc.  Besides, focusing on increasing knowledge and truly supporting change and skill development are less expensive ways to impact health outcomes for more people.

Making It Personal
How is personalized health different? When most people define health, statements like feeling good or having the strength and stamina to do the things in life that are important to them are typical.  In the medical arena, however, health is more traditionally defined as the absence of disease.  Of course, people want to be free from disease and reduce their likelihood of injury or illness.  But this is more biological and functional, an objective view that takes the stance that the healthcare “system” is working to “fix” or “treat” or “prevent” these negative diagnosis or conditions.  

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individual_focus.jpgEven though medical research and terms like “real world evidence” are getting closer to tapping into the realities of a person’s daily life, these encounters are still seen from a clinical eye with a focus on adherence and compliance with evidence-based treatment recommendations.  This lens is necessary, and I appreciate the significant advancements that have allowed people to live longer, more fulfilling lives.  However, including the missing element of human emotions and the realities of everyday life, by looking deeper into personal dynamics and idiosyncrasies of behaviors, might prove more impactful. As previous insight reveals, autonomy, along with motivation and intention, are the factors that drive, predict, and influence behavior change.

mind_body_connetion.jpgHealth interventions should go beyond individual preference for communication channels and consider the person’s knowledge, feelings, and fears, as well as the cultural differences and societal dynamics that influence habits.  However, the negative stigma surrounding emotions and mental health is limiting our ability to provide the type of health support that can be the most beneficial.

In Part 2 we will expand the scope of health beyond medical procedures and clinical diagnosis and look at how our thoughts, feelings, and behaviors impact the bigger picture of whole health. By doing so, I am hopeful we can bridge the mind – body gap in our health “care” approach and align with an individual’s definition of personalized health to have a greater chance of making a positive impact.

 

Contact Connie at: connie.mester@gmail.com 

 

 

References

  1. “Precision Medicine” (2016). Lister Hill National Center for Biomedical Communications U.S. National Library of Medicine National Institutes of Health Department of Health & Human Services. Retrieved April 2018.  https://ghr.nlm.nih.gov/primer/precisionmedicine/definition
  2. “What is the difference between precision medicine and personalized medicine?” (2016). Lister Hill National Center for Biomedical Communications U.S. National Library of Medicine National Institutes of Health Department of Health & Human Services. Retrieved April 2018. https://ghr.nlm.nih.gov/primer/precisionmedicine/precisionvspersonalized 
  3. Snyderman R. (2012). Personalized Health Care from Theory to Practice. Biotechnology Journal, 7(8), 973-979. https://doi.org/10.1002/biot.201100297 
  4. All of Us Research Program, National Institutes of Health. Retrieved April 2018. https://allofus.nih.gov/