Predictive Health

July 2, 2012
In the new health care paradigm emerging in 21st-century America, “it is disease, not death, that will be the medical failure,” say Brigham and Johns, who pioneered the Emory Georgia Tech Predictive Health Institute to develop their concept of preserving patient health over a lifetime. Although most of their musings seem highly theoretical, some bordering on science fiction, the impetus they cite for urgently needed change—billions of health-care dollars spent to keep barely functioning patients alive—has caused a major breakdown of the system. From genomics, proteomics, and metabolomics to nanotechnology, bio banks, and cyberhealth, the authors cover many scientific and technologic advances that might lead to achieving their vision of mapping a baby’s future health through blood and genetic testing; following the child into adulthood to factor environment and lifestyle into the genetic mix; and creating treatment plans that prevent disease or minimize its impact on quality of life. The authors are literate and engaging, framing the biological drama as a grand opera and citing the likes of Epicurus, Sun Tzu, Albert Einstein, Marcel Proust, Bette Midler, and Dr. Seuss. Much of the book’s appeal will be to medical professionals, students, and scientifically minded general readers, but a final chapter brings the discourse down to earth with a moving expression of what it means to live and die well.

Starred review from August 1, 2012
Two doctors envision a future in which many illnesses could be prevented, where "disease, not death...will be the medical failure." Brigham (Medicine/Emory Univ.) and Johns, Emory University's chancellor for health affairs, open their debut with a case study. In 1966, Carleton Hensley was admitted to Johns Hopkins Hospital suffering a systemic infection brought on by diabetes and a drinking habit. Despite the best efforts of the unnamed doctor, Hensley, just over the age of 60, died. From here, the authors advance a theory: What if diseases, like Hensley's diabetes, could be treated before they even began? With researchers constantly discovering more links between our genetic code and the predisposition to specific diseases, the authors describe a possible future in which patients like Hensley have a blood sample drawn at birth. They make it clear, however, that biology is not destiny, and they describe at length the specifics of how this future health care system would work. The main idea would be to guide people toward healthier living based on their genetic makeup, freeing up doctors to "once again become the caretaker of an individual person's health and well-being." Brigham and Johns also look at the potential overall savings to the health care system and examine the links between environment and health. Perhaps the biggest surprise in the book is the well-written prose. The authors discuss their main points in accessible terms, with a mix of thorough research and real-life evidence, without getting bogged down in technical jargon. They acknowledge that these changes, if they happen, will be a long time coming, but they effectively show how "[t]he promise is real and the voyage is underway." A clear, insightful vision of a health care system that could bring about a better, healthier world.

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October 1, 2012

Brigham (health, Emory Univ.) and Johns (chancellor, Emory Univ.) argue that the staggering amount of available data on health should by now be helping people avoid illness, not just fight it. This is a thoughtful, detailed account of the promise of a dizzying array of technologies and disciplines geared to prevent disease. The authors' writing can be less dynamic than David Agus's in his recent preventive medicine book, The End of Illness, but this is largely because this title wisely prescribes few shortcuts. (Agus controversially boosts the use of statins for many indications, even in the healthy, whereas Brigham and Johns briefly note the benefits for the heart of statins--then carefully talk side effects.) They recommend that providers and insurers continue to help patients avoid harmful fat, smoking, and stress, but they also embrace proven mind/body practices and health partners trained to coach patients in preventive health practices as additional methods to avoid illness. VERDICT The authors, both founders of Emory's predictive medicine school, are ultimately compelling in their argument for both openness to new ideas and critical thinking for the vigorous pursuit of evidence-based health measures, though they rely too much on buzzwords. An absorbing look at an exciting potential health-care revolution.--Cynthia Fox, Brooklyn, NY

Copyright 2012 Library Journal, LLC Used with permission.