The tool shop

A closer look at the implements for doing precision health

When it’s time to prep for surgery, the medical team lays out all the tools, so everything is at hand and it’s easy to see if anything is missing. Precision health has its own set of gleaming new tools, including “omic” data, activity and other monitors, and electronic medical records.

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Ome sweet ome

The body operates by means of vast arrays of molecules that work together every moment of your life. Decoding how those molecules function is a critical part of improving health care. Professor of genetics Mike Snyder, PhD, and his team recently began studying 14 different “omes” in 100 people, including each participant’s complete set of genes, or genome; all of their RNA, or “transcriptome”; all the proteins produced by their cells, or “proteome”; all of their metabolites, or “metabolome”; their immune cells; and five microbiomes, the communities of bacteria living in the gut, the sinuses or other parts of the body.

Among the first to participate in the Stanford omes project are twin astronauts Scott and Mark Kelly. While Scott spends a year in space providing data, Mark will supply all the same data while firmly on the ground. Snyder’s team will compare the two sets of data to see how life in space affects health and what problems a traveler to Mars might expect.

Snyder is an old hand at tracking such data: For six years, he has been tracking omic data for just one patient — himself. He’s been teased for exploring the “narcissome.” But his genome revealed that he was at risk for Type 2 diabetes, and when he discovered that he was in fact developing diabetes, he took steps to reverse it. He’s tracked his body’s responses in sickness and in health, through mild colds and more serious illness.

Snyder’s team is also watching what happens to the microbiome when people change their diet or become infected with a pathogen. “In my case,” he says, “I got Lyme disease and we profiled me through that. I took antibiotics, so we’re seeing what happens with that.”

Truths from trackers

Another major source of precision health data is the plethora of new bio-sensors. Suppose you wear a Fitbit that tells you how many steps you take each day. At the end of the day, it can be a reminder that you never went for that lunchtime walk and maybe you should go after dinner.

If you choose, you could automatically share that information with your doctor, and if she gets a notice that your walking dropped, she might check in with you. Maybe you developed mild hip pain; she has you see a physical therapist and a month later, you are back on track.

Now, suppose a million people share their Fitbit data and health records. Health researchers could have a field day digging through the numbers to find out what happens to people over time if they walk, say, 7,000 steps a day versus 17,000, or what happens if people walk 3,500 steps on weekdays and 20,000 on the weekend. Does that variation change your cholesterol numbers? Does it affect your risk for hip or knee problems?

Devices that monitor our health and daily activities can go well beyond a Fitbit, including thermometers, electrodes that detect changes in skin conductance, chemical sensors that detect changes in our blood or breath, and mechanical sensors that respond to pressure, impact or stretch.

Ideally, say researchers, millions of us will share the data in some form that is anonymous, or “de-identified.” When Stanford launched the Apple ResearchKit app MyHeart Counts last year, more than 50,000 people signed up to use their iPhones to monitor and share data about their activity levels, sleep, sense of well-being, diet and overall cardiovascular health.

Mining patient records

Some of the richest data comes from patient medical records. Such data includes doctors’ notes, X-ray images and MRIs; self-reporting of mood or pain; data from tissue samples and other tests; and records of medical visits and procedures.

Electronic medical records can tell researchers how millions of patients were diagnosed and treated and which approaches worked and which didn’t. EMR data is the backbone of patients-like-you programs that propose to identify groups of patients with similar sets of symptoms.

Patient records are also a gold mine of answers to specific medical questions. For example, by scouring the medical records of 17,000 prostate cancer patients at two major hospitals, associate professor of medicine Nigam Shah, MD, PhD, demonstrated that prostate cancer patients treated with androgen blockers were at nearly double the risk of later being diagnosed with Alzheimer’s disease compared with similar prostate cancer patients who didn’t receive androgen blockers.

Omics, activity trackers and medical records are just a few of the tools available in the precision health tool shop. Sophisticated sensors can evaluate your health based on the chemical makeup of your sweat, and algorithms can create order from the data in medical records or reconstruct genomic information. As in any good shop, you can find ever more tools hanging on the walls or tucked away in special drawers.

Jennie Dusheck is a science writer for the medical school's Office of Communication & Public Affairs. Email her at dusheck@stanford.edu.

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