Third Annual Prospective Health Care Conference

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• Third AnnualProspective Health Care Conference
• "Where are We Now?"
• Ralph Snyderman, MD
• Chancellor Emeritus, Duke University
• November 1, 2007

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Contemporary Practice of Medicine

• Disease oriented
• Find it, fix it
• Reactive
• Sporadic intervention
• Physician-directed
• Not Standardized
• Not Personalized

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The Inflection and Opportunities for Intervention
Health Care Cost vs. Disease Progression
Cost 1/reversibility
Disease Burden
Time
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Factors Impacting Medicine Today

• Genomics
• Proteomics
• Metabolomics
• Medical technologies
• Informatics
• Risk Prediction

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Tools Needed for Prediction and Personalized Care
Monitor Progression Predict Events Inform
Therapeutics
Decision Support Tools
Predict/Diagnose
Assess Risk
Refine Assessment
Cost 1/reversibility
Disease Burden
Time
Baseline Risk
Preclinical Progression
Disease Initiation and Progression
Dynamic Genomics

Gene
Expression Proteomics


Metabolomics


Molecular Imaging
Therapeutic Decision Support
Sources of New Biomarkers
Stable Genomics Single Nucleotide
Polymorphisms (SNPs) Haplotype
Mapping Gene Sequencing
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Prospective Health Care
Participating Population
Risk Assessment and Decision Support Tools
Late Chronic
Cost 1/reversibility
Disease Burden
Early Chronic
Low Risk
High Risk
Time
Personalized Health Plan
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Needs for Prospective Health Care

• Health risk assessment tools
• Therapeutic evaluation tools
• Aligned health care providers
• Aligned reimbursement systems
• Motivated consumers

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So, Where Are We Now?

• Research
• Clinical Models
• Personalized Medical Records
• Payers
• Advocacy Groups
• Medical Education