The P4 Health Spectrum – A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan

https://doi.org/10.1016/j.pcad.2016.08.002Get rights and content

Abstract

Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often ‘silent’ chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as “P4” holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a ‘P4 Health Continuum’ model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.

Section snippets

The P4H continuum model

There is broad agreement that the current framework used to guide healthcare and chronic disease management is largely ineffective. As such, there is a need to re-conceptualize the paradigm to focus on wellness and the prevention of chronic disease and associated risk factors first and foremost. The concept of wellness, an optimal state of health, is a paradigm-changing concept for transforming healthcare. In the future, healthcare must shift its focus to promoting a state of wellness, from the

P4 principles throughout

Clearly the reactive health care model that currently exists is suboptimal, requiring a paradigm shift to improve global to individual health and address the current challenges we face with chronic disease and associated risk factors. We need a new approach, focusing on care that is preventive, predictive, personalized and participatory (P4) as core principles of the P4H continuum model. Table 1 lists key factors to consider in delivering P4 medicine and subsequent sections describe key

Leveraging technology

The use of technology to continually engage individuals in preventive medicine and healthy lifestyle messaging, information and interventions is vital moving forward.37., 38., 130. Health-focused platforms continue to emerge and evidence demonstrating the meaningful impact of technology-based healthy lifestyle interventions is continually growing.131., 132., 133., 134. There is particular value potential in utilizing the smartphone platform for continual engagement centered on preventive

Systems medicine and the complexity of chronic diseases

An old Indian story talks about a group of blind men coming across an elephant. Each of the blind men touched a different part of the elephant and gave a description of what he believed an elephant was. The first person touched the elephant's trunk and claimed the elephant to be a snake. The second person touched the elephant's leg and declared the elephant to be a tree trunk. Then the last person came forward, touched the elephant's ear and positively identified the elephant to be a sail.

Convergence of principles from Eastern and Western medicine

Eastern medicine, like P4 medicine and systems medicine, considers human biological systems as a cohesive whole. Eastern medicine also considers the human body as a holistic entity of harmonious organs and approaches health from this framework. Eastern medicine principles are mainly derived from Chinese and Indian cultures, with long-term practical experience in the prevention, diagnosis and treatment of chronic diseases.

Principles of Chinese medicine and its role in the P4H continuum

Traditional Chinese medicine has evolved over thousands of years and represents one of the oldest paradigms of translational medicine in the world.137 Chinese traditional medicine considers the human body as an open organism operating in a continuous biological and mental exchange process with the outside environment; human health is maintained by the balance between Yin and Yang that respectively represents two opposing factors in nature.138 The diagnosis and stages of health (i.e., Stage A),

Principles of Indian medicine (Ayurveda) and its role in the P4H continuum

Ayurveda basically means “knowledge (Veda)” of “life (Ayur).” Ayurveda is an ancient system of personalized medicine documented and practiced in India since 1500 B. C.140 Today, Ayurveda not only plays a key role in Asian health care systems but is also increasingly recognized in the European and North American model.141

A unique aspect of Ayurveda is the comprehensive understanding of the biological basis of human individuality through Prakriti (literally meaning basic nature or the healthy

The P4H continuum: Impacts from population to cellular health

The key benefits of the P4H continuum model, from the population to cellular level, include the following examples: 1) prevent the occurrence of chronic diseases and associated risk factors by implementing effective interventions at all levels; 2) detect and predict disease at an early stage, when it can be controlled and reversed effectively; 3) stratify individuals into refined specific disease phenotypes, enabling the selection of optimal therapies; 4) reduce adverse drug reactions through

Conclusion

To address chronic diseases globally and in their totality, and in order to reduce their burden and societal impact, medicine has to evolve from a reactive to a proactive system, the latter of which is committed to a healthy aging process (i.e., lengthening the healthspan). It is proposed that chronic diseases should be viewed as a single expression (i.e., chronic diseaseome) with common risk factors and themes. Efforts to make healthcare more predictive, preventive, personalized and

Statement of conflict of interest

None of the authors have any conflicts of interests with regard to this publication.

References (146)

  • C Ling et al.

    Epigenetic adaptation to regular exercise in humans

    Drug Discov Today

    (2014)
  • MD Peterson et al.

    Low muscle strength thresholds for the detection of cardiometabolic risk in adolescents

    Am J Prev Med

    (2016)
  • D.P. Leong et al.

    Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study

    Lancet

    (2015)
  • SS Anand et al.

    Stemming the global tsunami of cardiovascular disease

    Lancet

    (2011)
  • C Trefois et al.

    Critical transitions in chronic disease: transferring concepts from ecology to systems medicine

    Curr Opin Biotechnol

    (2015)
  • S Yusuf et al.

    Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study

    Lancet

    (2004)
  • Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease study 2013

    Lancet

    (2015)
  • BB Kelly et al.

    Recognizing global burden of cardiovascular disease and related chronic diseases

    Mt Sinai J Med

    (2012)
  • YH Khang

    Burden of noncommunicable diseases and national strategies to control them in Korea

    J Prev Med Public Health

    (2013)
  • Organization WH

    Global action plan for the prevention and control of NCDs 2013–2020

    (2013)
  • D Mozaffarian et al.

    Heart disease and stroke statistics – 2016 update: a report from the American Heart Association

    Circulation

    (2016)
  • L Jaspers et al.

    The global impact of non-communicable diseases on households and impoverishment: a systematic review

    Eur J Epidemiol

    (2015)
  • DM Lloyd-Jones et al.

    Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic impact goal through 2020 and beyond

    Circulation

    (2010)
  • SC Larsson et al.

    Primary prevention of stroke by a healthy lifestyle in a high-risk group

    Neurology

    (2015)
  • DW Belsky et al.

    Quantification of biological aging in young adults

    Proc Natl Acad Sci U S A

    (2015)
  • Increasing healthspan: prosper and live long

    EBioMedicine

    (2015)
  • T Rankinen et al.

    Are there genetic paths common to obesity, cardiovascular disease outcomes, and cardiovascular risk factors?

    Circ Res

    (2015)
  • N Halfon et al.

    Life course health development: an integrated framework for developing health, policy, and research

    Milbank Q

    (2002)
  • JP Shonkoff et al.

    Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention

    JAMA

    (2009)
  • H Vogt et al.

    The new holism: P4 systems medicine and the medicalization of health and life itself

    Med Health Care Philos

    (2016)
  • C Auffray et al.

    Predictive, preventive, personalized and participatory medicine: back to the future

    Genome Med

    (2010)
  • L Hood et al.

    Participatory medicine: a driving force for revolutionizing healthcare

    Genome Med

    (2013)
  • L Hood et al.

    Revolutionizing medicine in the 21st century through systems approaches

    Biotechnol J

    (2012)
  • L Hood et al.

    Systems biology and new technologies enable predictive and preventative medicine

    Science (New York, NY)

    (2004)
  • L Hood et al.

    Predictive, personalized, preventive, participatory (P 4) cancer medicine

    Nat Rev Clin Oncol

    (2011)
  • M Flores et al.

    P4 medicine: how systems medicine will transform the healthcare sector and society

    Pers Med

    (2013)
  • L Hood

    Systems biology and p4 medicine: past, present, and future

    Rambam Maimonides Med J

    (2013)
  • AD Auerbach et al.

    Preventability and causes of readmissions in a National Cohort of general medicine patients

    JAMA Intern Med

    (2016)
  • CH Yam et al.

    Avoidable readmission in Hong Kong – system, clinician, patient or social factor?

    BMC Health Serv Res

    (2010)
  • L. Hood et al.

    A vision for 21st century healthcare

  • Improving chronic care illness program

  • S Melov

    Geroscience approaches to increase healthspan and slow aging

    F1000Res

    (2016)
  • BS McEwen et al.

    Stress and the individual: mechanisms leading to disease

    Arch Intern Med

    (1993)
  • R Arena et al.

    Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

    Eur Heart J

    (2015)
  • J Bousquet et al.

    Systems medicine and integrated care to combat chronic noncommunicable diseases

    Genome Med

    (2011)
  • BS McEwen

    Protective and damaging effects of stress mediators

    New Engl J Med

    (1998)
  • SH Shah et al.

    Opportunities for the cardiovascular Community in the Precision Medicine Initiative

    Circulation

    (2016)
  • L Hood et al.

    Promoting wellness and demystifying disease: the 100K project

    Clin Omics

    (2014)
  • L Hood et al.

    Demystifying disease, democratizing health care

    Sci Transl Med

    (2014)
  • Biology IfS. 100 K wellness project

  • Cited by (163)

    View all citing articles on Scopus

    Statement of Conflict of Interest: see page 517.

    Disclosure: None.

    Officially Endorsed by:

    • -

      The European Society of Preventive Medicine, United Kingdom.

    • -

      European Institute for Systems Biology and Medicine, France.

    • -

      Luxembourg Center for Systems Biomedicine, Luxembourg.

    • -

      Institute for Systems Biology, USA.

    • -

      Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, China.

    View full text