Pointing the way to longer life
Researchers seek predictors that show up years before illness, but ethical questions arise on health strategy
BY KEN _FOSKETT Cox News Service
Can our bodies, healthy and diseasefree, tell us how we will die? Emory doctors believe they can.

PHOTOS BY LOUIE FAVORITE / COX NEWS SERVICE Researchers think so-called "biomarkers" can foreshadow diseases years before they occur, pointing patients to drugs and lifestyle changes that could help them stay healthy. At the Center for Health Discovery and Well Being in Atlanta, Chesley Lewis demonstrates a device that measures blood flow.

The Atlanta university has launched a $50 million research initiative in "predictive" medicine that it hopes will fundamentally change the nation's struggling health care system.

At an Atlanta clinic, Emory researchers plan to screen healthy patients for biological and genetic clues to future illness.

Researchers believe so-called "biomarkers" can foreshadow diseases years before they occur, pointing patients to drugs and lifestyle changes that could help them stay healthy. And, by studying fit patients, rather than sick ones, researchers think they can learn more about the internal mechanisms that ward off disease.

"We don't do much health care," says Dr. Kenneth L. Brigham, who is leading the initiative. "We do disease care. The research is focused on what went wrong, not what went right."

Emory doctors believe the strategy can cut health care spending dramatically, allowing patients to be treated long before they need costly, crisis intervention.

But the approach also presents new ethical dilemmas, from what information doctors should disclose to patients, to how medical data could be used against them.

How, for example, will the information be kept from insurers and employers? Will greater risk of disease mean less insurance coverage or fewer job opportunities?

"It's not only about health and health insurance," says Eric Meslin, director of the Center for Bioethics at Indiana University, who is studying the ethical questions. "It's about life insurance. It's about employment. ... It's pick anything where society is making judgments about who is fit to ... get entitlements."

Personal health plans

Think of Chesley Lewis as a personal assistant for health care. The 25-year-old Carrollton, Ga., native is a "health partner" at the Center for Health Discovery and Well Being, Emory's new predictive health clinic at Crawford Long Hospital in downtown Atlanta.

Greeting visitors at the 18th floor, Lewis guides them through a battery of tests and helps them formulate their own "personal health plan," which might include losing weight or changing diets.

With muted greens and grays, the clinic resembles a day spa more than a doctor's office. Those who come to the clinic, open only to Emory's 13,000 employees, are healthy, not sick.

Participants provide researchers hundreds of bits of information, from diet and religion, to when they sleep or whether they are depressed.

Blood samples are broken down for 50 distinct substances. Scanners calculate body fat and bone density. More sophisticated equipment measures the thickness of blood vessels.

The data are encrypted, stripped of personal identifying information and fed into a sophisticated processing warehouse managed by Georgia Tech, a partner in the project.

Curing what ails you

For years, doctors have had rudimentary methods of determining disease risk, beginning with a patient's waistline. Simple blood tests for cholesterol, combined with blood-pressure readings and body weight, can show a person's risk for heart disease and heart attack.

But advances in genetics and biology have suddenly allowed doctors to look inside the human body with a degree of precision never imagined. Tests can pinpoint mutated genes, or even those that are missing.

Biologists now understand how genes regulate the body's chemistry. And they also can spot when the body's chemistry begins to break down.

Researchers studying rheumatoid arthritis, a painful joint disease, have learned that many sufferers begin producing a distinct antibody years before they ever get sick.

Diabetics can begin developing diabetes 10 years before it strikes, at which point their kidneys already are damaged and they need costly drugs.

Dr. Lawrence Phillips, who will mine patient data at the center, is developing a new test that can recognize pre-diabetics in an hour. Those testing positive could arrest the disease through diet changes and exercise.

"If you find pre-diabetes, you can stay healthy," says Phillips, who estimates 30 million to 50 million Americans already are in this phase of the disease but don't know it.

Dr. Roberd Bostick, a cancer epidemiologist at Emory, has isolated chemical biomarkers for colon and prostate cancer and is studying how common vitamins might delay or even prevent tumors from growing.

Dr. Kimberly Rask, an internist in public health, will be sifting through the data for clues about how lifestyle and economic well-being influence health.

"What is it that improves your likelihood of staying healthy?" she asks. "How do those pieces fit together to tell you how long you will live?"

Questions arise

Brigham, tapped by Emory to lead the predictive health initiative, already talks about the U.S. health care system in the past tense. Geared toward curing the sickest, the system has become too costly, covers fewer and fewer people and, by some yardsticks, is failing patients, he says.

Detecting diseases before they do harm could dramatically cut health care costs, while alleviating pain and suffering for millions of Americans, he argues.

But predicting health also opens new challenges. The $5,000 to $7,000 per person cost of testing, covered by research funding for Emory participants, isn't economical for most. Brigham thinks costs will drop as researchers cut tests that aren't meaningful.

Trickier, perhaps, are the ethical dilemmas.

Will insurance companies turn to genetic testing for determining a person's insurability?

"That's a huge risk," Brigham says. "I believe society is going to have to come to a consensus agreement that you can't hold a person's biology against them."

Meslin, the ethicist, believes Americans will reject obvious genetic discrimination. But he notes the gray areas.

What if a person has a risk for seizures? he asks. Should that person fly a 747 jet?

There are implications for the doctor-patient relationship as well. What obligation does the doctor have to tell a patient he or she has a risk for an incurable disease? What if the doctor isn't sure about the degree of risk?

Will the patient even want to know? Meslin asks.

"The better we get at predictive health," he says, "the more profound these ethical dilemmas will be."