Dr. Michael Snyder, Stanford Ascherman Professor and Chair of Genetics and the Director of the Center of Genomics and Personalized Medicine & Track 5 Chair:
“…the entire health care system seems totally broken. Nobody pays to keep people healthy, rather the current philosophy is only to pay to fix them, and we have to change that. We need to transform healthcare at all levels–patient, physician, insurance, and regulatory.”

Ahead of next week’s PMWC 2020 in Santa Clara, we had a discussion with Dr. Mike Snyder, Stanford University Professor, about what in precision medicine will have the biggest impact on value-based healthcare. Following are some excerpts from the interview.

“Value-based healthcare is employing the power of really understanding what is going on, which results in putting the right drugs in the right people where they can be most effective.”
That is a huge problem. Right now, we treat people based on population-based measurements. This is especially true for chronic diseases, which are usually not just one single disease but rather a combination of many different diseases. Diabetes is a good example. Diabetes is a disease that in reality has 50 or more underlying diseases all lumped together by high glucose. As a result, we don’t treat diabetes patients properly at all. Whether one should be treated with Metformin or Prandin – both anti-diabetic medications – needs to be understood at the molecular level, which helps explain the details of the underlying cause of the disease. Value-based healthcare is employing the power of really understanding what is going on, which then results in the ability to prescribe the right drugs to the right people where they can be most effective. In the case of diabetes, this is what I would call precision diabetes. Treating the diabetes subtype properly so you can have effective results.

“Longitudinal profiles are very valuable for the understanding of personal disease states.”
Individualized medicine is about longitudinal profiles with various measurements that highlight deviations from a personal baseline. This can only be done if one understands what a longitudinal, healthy baseline looks like. With the right tools, we will be able to extract these key findings. We are right now in the process of building smart watch tools that let individuals know when one is getting sick because there is an observation that your heart rate goes up. This simple flag can alert a person that maybe something is wrong with his/her health, especially if the individual sees no reason for an increased heart rate because they are not doing anything that should affect the heart rate.

Physicians need to realize that these data are actually useful, which is not the case right now. Not too long ago, we still saw push back and heard comments such as “wearables are not very accurate.” In reality, though, wearables are more accurate compared to measurements taken in a physician’s office where only one data point is measured. Continuous wearable measurements are very consistent and much better compared to what is measured one time in a clinician’s office. Unfortunately, getting them to accept new technologies is a big deal.

“The biggest challenges are cost saving assessments and training healthcare providers to help individuals stay healthy – we will have to educate physicians!”
Physicians are more reactive and slower on the uptake. They want to see that these new approaches truly have value. The same is true for insurance companies. In fact, that is the biggest challenge, in addition to understanding who is paying. This is more important right now, as the entire health care system seems totally broken. Nobody pays to keep people healthy. Rather the current philosophy is only to pay to fix them, when they are ill, and we have to change that. Realistically, as a general rule – if you look at the economics of these things – usually when you start adding in data to better manage people’s health – data gathering mechanisms like MRI and other platforms don’t seem to reduce costs. But what they do, they implement much, much better healthcare. They are not inexpensive, but they do keep people healthier. When people do get ill, that is when we see most of the cost. And most of our health care costs are due to chronic diseases, especially in the last years of life. If one can avoid a chronic disease, manage it in a more precise way, it should lead to some reduction in healthcare related costs. More than that, such a system is going to just manage people’s health better.

PMWC January 21-24, 2020 Silicon Valley has planned a three-day track on Health Data, Microbiome, and Patient Education (Track 5) that focuses on various aspects of health data, how the microbiome affects health, and physician and patient education.

Besides chairing Track 5, Dr. Snyder will chair the session “Health Data-Making Precision Medicine Mainstream”: New technologies let you measure thousands of health parameters that can be collected in a proactive healthcare system. Focusing on comprehensive health data early on can keep individuals healthy. To achieve this, we need to establish the baseline for each individual, which is a prerequisite for precision health. This session will focus on making precision medicine mainstream via managing and utilizing big data and genome sequence information.

Additional Track 5 sessions include:
• Opening Fireside Chat with Peter Thiel (Investor & Entrepreneur), and Jay Bhattacharya (Stanford University) discussing the prospect of future breakthroughs in precision medicine to solve fundamental medical problems associated with biological aging.
• Health data sessions:
o Health Data at Scale – chaired by Jessica Mega (Verily Life Sciences)
o The Physician & Patient Perspective – Making Precision Medicine Mainstream – chaired by Garry Chao (Q.bio)
o Workplace Genomics: How Employers are Adopting Genetics and Genomics for Their Members – chaired by Lisa Alderson (Genome Medical)
o Making Precision Medicine Mainstream With Health Data: Challenges to Acceleration – chaired by Marylyn Ritchie (University of Pennsylvania)
o Moving Genomics to Standard of Care: Scalable Return of Results – chaired by Justin Kao (Helix)
o Emerging Concepts in Precision Medicine in Racial/Ethnic Populations – chaired by Isabel Duron (The Latino Cancer Institute)
o The Medical Research Gender Gap – chaired by Anula Jayasuriya (EXXclaim Capital)
• Patient track sessions:
o Overview for Patients: The Latest Cancer Treatments – chaired by Jennifer Grandis (UCSF)
o Overview for Patients: Latest Tech in Oncology – chaired by Vikram Bajaj (Foresite Capital)
o How Patients Get What They Need – chaired by Eric Marton (Wavemaker 360)
o Summary for Patients: So What – Putting it Together – chaired by Marty Tenenbaum (Cancer Commons)
• Microbiome sessions:
o Microbiome Based Precision Medicine: State of the Science – chaired by Karim Dabbagh (Second Genome)
o The Microbiome: Keys to Unlocking it in the Clinic – chaired by Manoj Dadlani (CosmosID)
o A Fireside Chat with Keith Yamamoto (UCSF) and Margaret Peg Riley (University of Massachusetts Amherst) on how a precision medicine strategy can produce microbe-specific therapies or preventatives, and why pharma should be attentive to such an approach.
o Investment in the Microbiome – chaired by Manoj Dadlani (CosmosID)

In addition, PMWC 2020 Silicon Valley will have additional tracks:
o “Emerging Therapeutics” (Track 1),
o “AI & Data Sciences” (Track 2),
o “Diagnostics in Clinical Practice” (Track 3), and
o “Molecular Profiling – From Research to the Clinic” (Track 4).
Browse all seven PMWC 2020 SV tracks: 1.pmwcintl.com/program/

It is not too late to register for next week’s PMWC and to take advantage of the current favorable rate. Save by registering before the door!