The future of medicine

Medicine is a collaborative partnership with patients, said Lawrence Cheng, MD, CCFP (EM), MPH today at the 2018 Integrative Healthcare Symposium annual conference in New York City.

Patients are more savvy and educated than ever when it comes to their health, said Cheng. They have ready access to medical journals, studies, and even at-home genetic testing, which means practitioners have to be prepared.

"We're truly living in extraordinary times, said Cheng. "There's a major transformation in how we work with patients."

There is an epidemic of chronic disease, and the future of medicine must address that. The current system doesn't focus on preventing disease, but rather treating disease, oftentimes when it is too late. Despite all of the money poured into healthcare, the majority of funding goes to drugs, unnecessary intervention, and treating disease too late, said Cheng.

In a world of molecular medicine, the focus will shift to an etiology of disease. The new paradigm is going to be systems biology, said Cheng. We have to move from a field of simple associations, the pill for every ill mentality, and understand that medicine is about networks and systems.

Cheng described 4 P's, which he says describes where medicine is heading:

• Predictive—using genomics to determine the probability of a disease
• Preventative—knowing your individual risk profile motivates you to make changes
• Personalized—targeted and specific interventions and treatment
• Participatory—Empowered engagement in personal choice

This concept of "Network Medicine" aims to look at the whole person—disease networks, rather than treating diseases separately. Further, disease treatment must address the both the mechanism and the cause. Practitioners cannot prescribe pills without completely understanding both the disease and the individual they are working with.

In an era of what Cheng describes as "high definition medicine," treatments can be data-driven and treatments can incorporate technology for a preventative treatment program, which highlights complete wellness for patients.

"The convergence of technology will fuel the next medicine revolution," said Cheng.

The human genome can now be sequenced in a couple of hours, said Cheng. Combined with wearable technology and other ways that allow patients to take ownership of their health and wellbeing, precision medicine is more feasible than ever before.

Practitioners need to stay on top of emerging fields, including epigenetics, genomics, and the microbiome, which Cheng reviewed in detail during his talk. The revolution of data and information, and how consumers have ready access to data and information, is going to change how practitioners care for patients. Personalized therapeutics based on these very precise tests and biomarkers is the way, said Cheng.

"The future of medicine is going to be more precise, preventative, personalized,  and my hope is more integrative."