P4 Medicine or O4 Medicine? Hippocrates Provides the Answer

Published on Apr 17, 2019
· DOI :10.1373/jalm.2018.028613
Clare Fiala3
Estimated H-index: 3
(MSH: Mount Sinai Hospital, Toronto),
Jennifer Taher6
Estimated H-index: 6
(U of T: University of Toronto),
Eleftherios P. Diamandis97
Estimated H-index: 97
(U of T: University of Toronto)
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.
  • References (66)
  • Citations (1)
Published on Aug 1, 2018in JAMA Oncology22.42
John Marquart2
Estimated H-index: 2
(OHSU: Oregon Health & Science University),
Emerson Y. Chen2
Estimated H-index: 2
(OHSU: Oregon Health & Science University),
Vinayak Prasad24
Estimated H-index: 24
(OHSU: Oregon Health & Science University)
Importance To date, the benefit of genome-driven cancer therapy has not been quantified. Objective We sought to estimate the annual percentage of patients in the United States with advanced or metastatic cancer who could be eligible for and benefit from US Food and Drug Administration (FDA)-approved genome-driven therapy from 2006 to 2018. Design, Setting, and Participants Retrospective cross-sectional study using publically available data of (1) demographic characteristics of patients with adva...
Published on May 24, 2018in The New England Journal of Medicine70.67
Shekinah N. Elmore4
Estimated H-index: 4
(Harvard University)
p53 and Me Just before beginning medical school, a woman who’s survived a childhood rhabdomyosarcoma and is facing breast and lung cancers discovers she has Li–Fraumeni syndrome. Though her p53 mutation won’t alter her medical care much, the changes to her psyche are profound.
Published on May 16, 2018in Journal of the National Cancer Institute10.21
Hilary A. Tindle25
Estimated H-index: 25
(VUMC: Vanderbilt University Medical Center),
Meredith S. Duncan4
Estimated H-index: 4
(BU: Boston University)
+ 3 AuthorsMatthew S. Freiberg28
Estimated H-index: 28
(VUMC: Vanderbilt University Medical Center)
Published on Apr 27, 2018in Science41.04
Jocelyn Kaiser32
Estimated H-index: 32
For people with advanced cancer who are running out of options, many cancer centers now offer this hope: Have your tumor9s genome sequenced, and doctors will match you with a drug that targets its weak spot. But this booming area of cancer treatment has critics, who say its promise has been oversold. Last week, two prominent voices in the field faced off in a sometimes-tense debate on what9s often called precision oncology at the annual meeting of the American Association for Cancer Research in ...
Published on Apr 1, 2018in Nature43.07
Ajay Aggarwal1
Estimated H-index: 1
Drug regulators and trial designs should assess benefits that actually matter to people with cancer, says Ajay Aggarwal. Drug regulators and trial designs should assess benefits that actually matter to people with cancer, says Ajay Aggarwal.
Published on Mar 6, 2018in JAMA51.27
Michael J. Barry90
Estimated H-index: 90
(Harvard University)
Published on Mar 6, 2018in JAMA51.27
Richard M. Martin99
Estimated H-index: 99
(UoB: University of Bristol),
Jenny Donovan79
Estimated H-index: 79
(NIHR: National Institute for Health Research)
+ 23 AuthorsSimon Evans13
Estimated H-index: 13
(RUH: Royal United Hospital)
Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer–specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years ...
Published on Dec 14, 2017in The New England Journal of Medicine70.67
Lisa Rosenbaum18
Estimated H-index: 18
Although reducing unnecessary care is important, the missionary waste-hunting zeal of the “less is more” movement can obscure a complex evidence base, perpetuating an oversimplified narrative about waste’s magnitude, causes, and solutions.
Published on Oct 4, 2017in Annali dell'Istituto Superiore di Sanità2.17
Simonetta Pulciani6
Estimated H-index: 6
(ISS: Istituto Superiore di Sanità),
Anna Di Lonardo2
Estimated H-index: 2
(ISS: Istituto Superiore di Sanità)
+ 1 AuthorsDomenica Taruscio24
Estimated H-index: 24
(ISS: Istituto Superiore di Sanità)
Hippocrates was the first to raise awareness of medicine as a science. He asserted the body being a unified whole and emphasized the importance of preventive and predictive medicine, spurring physicians to foster patient collaboration. Recent achievements today have permitted a new approach - ‛P4 medicine’ - Predictive, Preventive, Personalized and Participatory – with the aim of depicting an individual’s health history and molecular profile in determining the best medical intervention in mainta...
Published on Sep 1, 2017in Vaccine3.27
Ashish A. Deshmukh8
Estimated H-index: 8
(UF: University of Florida),
Scott B. Cantor39
Estimated H-index: 39
+ 6 AuthorsJagpreet Chhatwal21
Estimated H-index: 21
(Harvard University)
Abstract Importance Outcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected ...
Cited By1
Published on Apr 29, 2019
Geoffrey S. Baird22
Estimated H-index: 22
(UW: University of Washington),
Geoffrey S. Baird
The contrasts could not be starker. One is a world-renowned scientist with graduate degrees from Johns Hopkins and Caltech, an august record of scientific and academic achievement recognized by countless international accolades and awards, and who, importantly, invented DNA and protein synthesizers and sequencers that started the genomic and proteomic revolutions. The other is a college dropout with a scant history of any meaningful scientific contributions and who has been indicted for hoodwink...