Source: Institute for Systems Biology

Leroy Hood, president of the Institute for Systems Biology (ISB) in Seattle, Washington, likes to talk about what he calls P4 medicine: health care that is predictive, preventive, personalized and participatory. Medicine today is a string of infrequent interventions prompted mainly by symptoms of illness. Hood argues instead for continuous management of health, making full use of whole-genome sequencing and biomarkers to correct disease before it gains a foothold.

In March, Hood will embark on the first big test of his ideas: a nine-month pilot study, dubbed the Hundred Person Wellness Project, in which 100 healthy individuals will be intensively monitored (see An examined life), offered regular feedback and counselled on lifestyle changes such as shifts in their dietary or sleep habits. The effects of these behavioural changes on their health will, in turn, be tracked using a battery of diagnostic tests.

The study violates many rules of trial design: it dispenses with blinding and randomization, and will not even have a control group. But Hood is confident in its power to disrupt the conventional practice of medicine. We hope to develop a whole series of stories about how actionable opportunities have changed the wellness of individuals, or have made them aware of how they can avoid disease, he says.

If the pilot study works as hoped, it will expand in several phases until it encompasses 100,000 subjects monitored over 25 years. The ISB is paying for the first hundred people through private donations and has budgeted around US$10,000 per person. Hood expects those costs to drop drastically in a larger study, thanks to economies of scale and rapidly evolving diagnostic technologies. But he acknowledges the challenge of securing the hundreds of millions of dollars that a generation-long trial would require.

Even in its pilot phase, the project is unusually thorough. The ISB will sequence the whole genome of each participant at the outset. And in later phases, Hood says, the study team will also examine epigenetics: methylation and other modifications to DNA that can reflect environmental exposures. But that is just the tip of the data-collection iceberg.

Institute for Systems Biology

Leroy Hood: We hope to develop a whole series of stories about how actionable opportunities have changed the wellness of individuals.

Participants will be asked to wear digital devices that will continuously record their physical activity, heart rate and sleep patterns; subjects will periodically upload those data to the institutes systems. Every three months, researchers will gather samples of participants blood, urine, saliva and stool. They will measure five biochemicals in saliva and urine, and sequence the stool samples to track the ecology of major microbial species in the gut. Blood-chemistry screens will extend well beyond the usual tests for cholesterol and glucose to include 20less-commonly monitored variables, such as C-reactive protein which signals inflammation at high levels. Hoods teams will also monitor about 100 organ-specific proteins that, he says, are sensitive markers for transitions from health to disease in mouse and cell models.

The point of the study and of P4 medicine in general is to detect those transitions and respond to them before symptoms appear. To that end, participants (mostly residents of the Seattle area, invited through social media) will have full access to their personal cloud of data points. Some will have enough scientific training to dive into the literature and interpret their data themselves. But Hood expects most to rely on ISB-provided wellness coaches and their own physicians to interpret the results and recommend medical treatment or changes in diet or behaviour.

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Medicine gets up close and personal