Letter from the Dean

Be proactive

Let's look beyond biology to socioeconomics and the environment

In modern health care, we’re always playing catch-up. Once a disease occurs, we rush to intervene — curing the illness when we can, treating it when we can’t. Then we wait for another disease to pop up.

At Stanford Medicine, we know there’s a better way. Our vision for precision health is based on the simple idea that health care should be proactive and preventive, promoting health as much as it defeats disease. It starts with realizing that medical care plays only a small role in determining our health outcomes. It’s our genes, behaviors, social status and environment that play the leading role in determining when, whether and how we get sick.

Yet the focus of medicine today is on the clinical signs and symptoms that we can easily see and measure, like an elevated blood-pressure reading or a patient’s reports of fatigue. Rarely addressed are the factors that matter most and would yield rich insights into why the disease occurred in the first place. And the more we know about why, the more we will be able to tailor treatment for that disease and, best of all, predict and prevent other diseases altogether.

Creating a more proactive and preventive health-care system is a complex challenge that will require a whole new approach and level of innovation for the global medical community, but precision health is an idea whose time has come. In recent years, new tools and technologies have revolutionized our lives, from the way we work to how we play. Now it’s time that we put these advances to work in promoting health and wellness.

Using data from electronic medical records, genomic sequences, biospecimen repositories, insurance records and wearable sensors, we are increasingly able to quantify the factors that affect our health and untangle the relationships among these factors. We can now answer such questions as: How does our behavior affect our genes? How do our genes affect our social status? How does our social status affect our behavior?

Understanding the complex interplay among the determinants of health is one of our precision health strategic priorities. To help us do this is a new $11.5 million grant from the National Institutes of Health to establish the Stanford Precision Health for Ethnic and Racial Equity Center, or SPHERE. One of the center’s initial projects, led by Professor Thomas Robinson, is to better understand how various factors — from genetics and behavior to socioeconomics and the environment — contribute to obesity in low-income Latino children in a nearby neighborhood.

Through quantifying the metabolic and biomolecular differences of these children and combining these findings with existing physical data, lifestyle surveys, family history and health information, the study will provide valuable insights into how best to prevent excessive weight gain for this vulnerable group. More broadly, we hope that this and other SPHERE projects will contribute to the elimination of pervasive health disparities.

By considering all the factors that determine health outcomes, precision health will allow us to spend less time treating disease as it appears and more time preventing that disease in the first place, giving us lives that are not only free of sickness but also long, happy and full. That’s the future of health care.

Sincerely,

Lloyd Minor, MD

Carl and Elizabeth Naumann Dean of the School of Medicine

Professor of Otolaryngology — Head & Neck Surgery

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