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P4 Medicine or O4 Medicine? Hippocrates Provides the Answer
Clare Fiala1, Jennifer Taher2,3, Eleftherios P Diamandis4,2,3
1Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Insights
P4 medicine (predictive, preventative, personalized, participatory) aims to prevent disease through extensive testing and monitoring. This analysis explores its benefits and introduces O4 medicine (overtesting, overdiagnosis, overtreatment, overcharging) as a critical counterpoint.
Area of Science:
- Biomedical research
- Systems biology
- Preventive medicine
Background:
- P4 medicine, coined by Dr. Leroy Hood, focuses on disease detection and prevention.
- It utilizes extensive biomarker testing, monitoring, statistical analysis, and health coaching.
Purpose of the Study:
- Analyze the Hippocratic origins of P4 medicine.
- Evaluate the advantages and disadvantages of P4 medicine.
- Introduce O4 medicine as a counterpoint to P4 medicine.
Main Methods:
- Analysis based on the "100 Person Wellness Project" findings.
- Examined whole genome sequencing, clinical laboratory tests, metabolite and protein measurements.
- Included microbiome analysis, exercise monitoring, and lifestyle/supplement counseling.
Main Results:
- P4 medicine framework involves comprehensive health assessments and interventions.
- O4 medicine (overtesting, overdiagnosis, overtreatment, overcharging) is presented as a potential drawback.
- Highlighted possible harms and costs associated with extensive medical interventions.
Conclusions:
- The study provides a critical analysis of P4 medicine's practical implications.
- It emphasizes the need to consider potential drawbacks and resource allocation.
- Aims to contribute to discussions on optimizing healthcare resource utilization for maximum patient benefit.
Background:
The term P4 medicine (predictive, preventative, personalized, participatory) was coined by Dr. Leroy Hood of the Institute for Systems Biology to demonstrate his framework to detect and prevent disease through extensive biomarker testing, close monitoring, deep statistical analysis, and patient health coaching.
Methods:
In 2017, this group published the results of their "100 Person Wellness Project." They performed whole genome sequencing and 218 clinical laboratory tests, measured 643 metabolites and 262 proteins, quantified 4616 operational taxonomic units in the microbiome, and monitored exercise in 108 participants for 9 months. The study was also interventional, as members were paired with a coach who gave lifestyle and supplement counseling to improve biomarker levels between each sampling period.
Results:
Using this study as a basis, we here analyze the Hippocratic roots and the advantages and disadvantages of P4 medicine. We introduce O4 medicine (overtesting, overdiagnosis, overtreatment, overcharging) as a counterpoint to P4 medicine to highlight the drawbacks, including possible harms and cost.
Conclusions:
We hope this analysis will contribute to the discussion about the best use of limited health-care resources to produce maximum benefit for all patients.
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