Personalized Health Care Through Basic, Translational and

Applied Research

A Case for Improved Care, Lower Costs and Transformation from Disease to Wellness

Clay Marsh, MD

Vision for Ohio State University

• It is Ohio State's time to be the university of the American dream, an institution worthy of the public trust and the front door to the future.

– Gordon Gee, President, The Ohio State University

Create the Future of

Medicine to Improve People’s

Lives Through Personalized Health Care

Harvard Business Review | October 2007 | hbr.org

What is the goal of Personalized Health Care at Ohio State

University?

Improve People’s Lives by Transforming Disease-Based Care to Wellness

P4 Medicine• Predictive:

– Probabilistic health history--DNA sequence

• Personalized:– Unique individual

human genetic variation mandates individual treatment

• Preventive:– Focus on wellness

• Participatory:– Patient understands

and participates in medical choices

• Precise:– Deep understanding

of health and disease

Wellness and Risk Management

What is the Compelling Argument to Change the Way Health Care is

Delivered to You?

National Health Care Trends

• Health Care - one of the top three issues of American concern along with Iraq war, economy/jobs in 2008

• In 2005, total health care spending represented 16% ($2.5 Trillion) of the GDP and is projected to increase to 20% ($4 Trillion) of the GDP by 2015

• Chronic Diseases like heart disease, asthma, cancer, diabetes are primarily responsible for the rise in health care spending

Sources: pollingreport.com, National Coalition on Health Care, CDC

Health Care Expenditures as % of GDP

7.2%8.1%

9.1%

10.4%

12.3%

13.7% 13.8%

15.9%16.0%

$-

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

1970 1975 1980 1985 1990 1995 2000 2005 2006

In B

illi

on

s ($

)

0.0%

5.0%

10.0%

15.0%

20.0%

Per

cen

t

National health exp. GDP Health Exp as % of DGP

Between 2001 and 2016, health spending is projected to grow 2.5% per year faster than GDP, so that by 2016 it may constitute 20% of GDP.

SOURCE: CMS, Office of the Actuary, National Health Statistics Group.

USA outspent other developed countries in health care

Higher Spending Does Not Necessarily Lead to Higher Quality

Source: Baicker and Chandra (Health Affairs 2004)

Source: OECD, 2004 & Health Affairs 2002; 21(4): 99

Life Expectancy

78.1 78.579.4 79.7 79.9

81.5

77.1

70

75

80

U.S. U.K. Germany France Canada Italy Japan

Ag

eWhile much higher than developing countries, US life expectancy is lower than most developed countries.

% Finding Difficulty in Receiving Care

21

15 15 15

28

0

5

10

15

20

25

30

U.S. Canada New Zealand Australia U.K.

% f

ind

ing

it d

iffi

cu

lt t

o g

et

ca

re

Commonwealth Fund Survey, 1998

More than 1 in 4 in the population finds accessing care difficult in the United States.

Trends in Health Care – Chronic Disease

• By 2025, nearly 49% of U.S. population will have one chronic disease

• Those with chronic diseases account for 81% of hospital admissions; 91% of all prescriptions filled; and 76% of all physician visits

• CDC estimates that chronic disease management represents 75% of all healthcare spending and responsible for 70% of deaths

Sources: CDC, fightchronicdisease.org

Limitation of Standard Drug TreatmentDrugs prescribed for patients are effective in fewer than

60% of treated patients

2530

48 50

5760 60 62

0

10

20

30

40

50

60

70

80

90

100

Therapeutic Area

Re

ate

of

Eff

ica

cy

wit

h S

tan

da

rd T

he

rap

y (

%)

Source: Brian B. Spear, Margo Heath-Chiozzi, and Jeffrey Huff, “Clinical Application of Pharmacogenetics,” Trends in Molecular Medicine (May 2001).

Summary:The need for transformation

• Total health care spending was $2.5 trillion in 2008, representing 16% of the GDP, like to reach $4 trillion by 2016

• 75-90% were spent on managing and treating chronic illnesses that are preventable and effectively managed

• On a per-person basis, our health care costs are 50% higher than the second most costly nation

• USA outspent other developed countries in health care but quality of care does not follow.

• The U.S. healthcare ranked by the WHO 37/191 countries in performance

• Drugs prescribed for patients are effective in fewer than 60% of treated patients but costs of development is skyrocketed.

What Makes Each One of Us Unique and What Defines Health?

Patient Phenotype

home.honolulu.hawaii.edu/~pine/variation3.jpg

http://genomics.energy.gov/

• A 13-year project coordinated by the U.S. Department of Energy and the NIH

• The total number of genes estimated at 30,000

• 99.9% nucleotide bases are exactly the same in all people

• Functions unknown for over 50% of discovered genes

Source: Human Genome Project Information http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml

The Human Genome Project

NY Times Magazine: My Genome, My Self

Steven Pinker, Jan 7, 2009

Complex Relationships Determine Health and Disease

• Complex interactions of genes and proteins explain differences between people

• Complex Interactions of proteins in networks and our environment are critical in determining health and disease

• What field has tools that we need to understand the organization of these complex interactions?

www.sysbio.de/figs/sysbio8.gif

• Emergent field that aims at systems understanding of biological systems.– Systems view focuses at

understanding:• The complexity of the

system• The networks activated in

the system• The control methods of

the system• Key nodes in the system

Systems Biology

Systems Biology Opportunity in Clinical Medicine

Identify Networks and Key Regulatory Nodes Controlling Networks

http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html

PLoS One

How Will Personalized Medicine Look in the Future?

The Future

What Does the COM Contribute to Research at Ohio State?

• $34.1 M over 5 years• CTSA is an outcome

of the Roadmap for Research from NIH

IdeasPeople

ResourcesLeadership

NIH

NIH Roadmap for Medical Research

New Pathwaysto Discovery

Re-engineering theClinical Research Enterprise

Research Teamsof the Future

NIH

Source: NIH Roadmap Project

Bench Bedside Practice

Building Blocks PathwaysMolecular LibrariesBioinformatics and Computational BiologyStructural BiologyNanomedicine

TranslationalResearchInitiatives

Clinical ResearchInformatics

Integrated ResearchNetworksClinical outcomes

TrainingNational Clinical Research Associates

Interdisciplinary ResearchPioneer Award Nanomedicine

Public PrivatePartnerships

NIH Roadmap Strategy

Source: NIH Roadmap Project

Re-engineering the Clinical Research

Enterprise

Public-PrivatePartnerships

High-riskResearch

Interdisciplinary Research Nanomedicine

Bioinformatics and Computational Biology

StructuralBiology

Building Blocks, Biological Pathways

and Networks

Molecular Libraries

and Imaging

ImplementationImplementationGroupsGroups

New Pathways to DiscoveryResearch Teams

ClinicalEnterprise

Source: NIH Roadmap Project

How Has the Stimulus Package Affected Research in the COM and

Medical Center?

American Recovery and Reinvestment Act 2009

ARRA Stimulus Funding Proposal by Type OSUMCAs of 6/2/09

$450,812$5,734,402

$2,911,697

$33,199,437

$74,640,044

$63,091,300

$4,949,092

$11,923,253 ChallengeSupplementAutismShared InstrAPRC *RC2 GO GrantP30 Core CtrRevision

Total $200M Source: COM Office of Research

How Does Personalized Medicine Align with the Research Mission?

DISCOVERYSystems Biology/Systems Medicine

Genomics/Proteomics; Genetics; Informatics; Modeling (T1)

Personalized Health CarePersonalized Health Care

Translation

Experimental Therapeutics and

Devices; Preclinical to Clinical (T2)

Application/ Implementation

Health Care Delivery; Health

Care Effectiveness (T3)

DisseminationPractice to

Population Health Impact; Social

Networking Tools and Solutions (T4)

DISEASE TO WELLNESS

BHAG for Personalized Health Care planning at Ohio State

• We will develop and execute a demonstration project in personalized health care by 2010 to deliver care in a cost-effective, convenient, high quality and precision-based approach starting with our health plan and create the social epidemic to lead to its acceptance and desirability.

• We will develop a personalized health care model that will meet our blue ocean strategy and…– Create Precision Medicine to improve quality– Lower the cost of health care– Increase patient access and customer satisfaction – Move health care from the doctor’s office to the patient’s

home on demand

Tools

www.sysbio.de/figs/sysbio8.gif

• Emergent field that aims at systems understanding of biological systems.– Systems view focuses at

understanding:• The complexity of the

system• The networks activated in

the system• The control methods of

the system• Key nodes in the system

Applied Research and Systems Biology

PHR and Portability

Microsoft HealthVault

Telemedicine

Social Networking

Systems and Process Focus

Decoding the DNA of the Toyota Production System, Harvard Business Review, 1999

Make your car last 200,000 miles

GOOD BETS BAD BETS

Honda Civic BMW 7-Series

Honda CR-V Infiniti QX56

Honda Element Jaguar S-Type

Lexus ES Jaguar X-Type

Lexus LS Mercedes-Benz M-Class (V8)

Toyota 4Runner Mercedes-Benz SL

Toyota Highlander

Nissan Armada

Toyota Land Cruiser

Nissan Titan

Toyota Prius Volkswagen Touareg

Toyota RAV4 Volvo XC90 (6-cyl.)

Copyright © 2004-2009 Consumers Union of U.S., Inc. No reproduction, in whole or in part, without written permission.

October 2007

*Number of ICU beds is subject to change

FROM

TO