What I Am Reading: Anticipatory Guidance

Oct 04 2012 Published by under General Health

Anticipatory guidance is a major part of outpatient pediatrics. In addition to the check-up and immunizations, various issues that may impact the child's health and well-being are proactively addressed. At a 6-month-old visit we would discuss impending mobility and the need to childproof the home. At 18 months of age the topic of toilet training comes up.

In Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years, the authors present an idea for a lifetime of such guidance. Kenneth Brigham, MD, and Michael M. E. Johns, MD, guided the creation of the Emory Georgia Tech Predictive Health Institute and its Center for Health Discovery and Well Being(R). They propose a future in which our genetic information, collected at birth, directs providers to keep us healthy. Rather than treating illness, they argue for centers that sustain health. Over time, data for our epigenetic and metabolomic profiles would be added to fine-tune our recommendations for health.

Throughout the book, the compare two patients. One, a mid-60s welder with type 2 diabetes, alcoholic liver disease, and sepsis, who dies "prematurely", and an alert woman with relatively good health into her 80s. They argue that eventually we will be able to live like her, with a good quality of life until we finally die of "natural causes."

Last time I checked, most diseases are pretty damn natural.

The book brings a lot of common ideas into a unified whole, and it provides coherent discussion of the current crisis in biomedical research that is necessary for their vision. Another chapter looks at the interaction of our environment and systems with our genetic predisposition. Some disorders simply cannot be prevented without changes in the world around us. Clean air and water, for example, can reduce a number of infectious illnesses and the severity of asthma. If you live in a polluted city, is your asthma due to your body or your environment?

I have a problem with the overall idea, though. Many disorders simply cannot be prevented at this point in time, especially in pediatrics. We may be able to identify susceptibility genes for some problems, but we cannot always stop the disease from occurring. Also, many of these preventative measures involve alterations in diet and exercise and other habits. Human beings can be ornery and often make bad choices about such matters. The 50th anniversary of the Surgeon General's Report on Tobacco is just a few years in the future, yet people still choose to smoke. I do not need my genotype sequence to tell me that I have genes predisposing me to obesity. Despite my best efforts at diet and exercise over the years, I sit here weighing well more than I should.

The goal of personalizing health recommendations, allowing us to live in relative health to a ripe old age sounds great, as does pie in the sky. Predictive Health provides a nice summary of this long-term vision for health. It's a noble goal, but I'm not holding my breath. I have to go to the gym.


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