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Biomedicine

How to Save a Trillion Dollars

America needs a Human Genome Project for personalized health care.

Recently, I discovered that my heart-attack risk is frighteningly high over the next 10 to 20 years. This alarming prognosis was achieved using technology that could potentially be good news for the health-care reform effort being attempted in Washington. Amid bailouts and numbing deficits, this kind of personalized medicine might even help save billions or possibly trillions of dollars over the next decade or two.

My heart, the nation’s economy, and health-care reform are connected through an experimental test that I took last year that delivered my dire forecast. Created by Entelos, a company that performs computer simulations to make predictions about a person’s health, the test gathered data on my cholesterol levels, a heart CT scan, a genetic profile, and more, and fed the results into a powerful computer.

What popped out is a prediction that the company claims is not only customized to my own genes and physiology, but also factors in far more variables than traditional heart-risk tests.

Entelos was on track to raise money to refine and launch its test commercially within a year or two. But in the current economic climate, sources of funding have become more difficult, delaying the final development and launch of the test.

The company is hardly alone. Other potentially promising discoveries almost ready for prime time include protein markers that can target and trace therapies for cancer, and new discoveries in fields ranging from neurological disorders to diabetes. Likewise, thousands of gene markers associated with diseases have been identified by researchers. Companies such as 23andme, deCODEme, and Navigenics offer tests for some of them, although the approach has yet to be validated by clinical testing.

What’s missing is a comprehensive plan to push these efforts to the next stage, not only in terms of science and medicine, but also in terms of patent law, regulation, ethics, and finance. What’s needed is a Human Genome Project level of focus on personalized and preventive medicine for major diseases. Let’s call it the Personalized Health Project.

The Human Genome Project cost $2.7 billion and took more than a decade to complete. A Personalized Health Project would similarly cost in the low billions and take between 10 and 20 years, although unlike the genome project, which was completed only at the end of a long process, the personalized project could begin producing results almost from the start.

The endeavor would link up genetics with promising research on the impact of environmental factors affecting disease. The Entelos model is one example of how scientists are attempting to combine these different disciplines in order to provide personalized profiles of an individual’s health future–not only risk factors for disease, but also alternative scenarios based on diet and lifestyle that can increase or decrease the likelihood of cancer, diabetes, or heart disease.

In my case, the heart-attack model provided me with three distinct scenarios over the next 20 years. First was a heart-stopping risk factor of 40 percent in 10 years that I will have a heart attack and a nearly 70 percent risk factor in 20 years. But this dire forecast only happens if I gain a modest amount of weight: about a pound a year, the average weight gain for a man over age 40. If my weight flatlines, the risk falls to only about 2 percent. If I take cholesterol-lowering statins, my risk falls to zero.

I took the Entelos test seriously enough that I dropped 10 pounds, having gained a pound a year since turning 40 (I’m now 51).

Whether my new leanness will actually save me from a heart attack has yet to be determined. Nor can I be sure that the Entelos model is accurate, because the company hasn’t run the extensive clinical trials with the thousands of patients needed to validate the test.

Once funded, Entelos would like to offer its test for less than $1,000 as volume increases. This price tag might seem high, but not if it substantially delays or prevents the need for, say, a diagnostic cardiac catheterization that costs $25,322 or a heart bypass operation that runs $85,633. The cost also has to be weighed against the $448 billion spent last year in direct and indirect costs for heart disease among the 80 million Americans who suffer from this malady.

Would a $1,000 test given to, say, people over 50 with borderline high cholesterol put off or eliminate debilitating and costly treatments?

No one knows. Nor will we know for sure unless we provide the organized push needed to find out.

David Ewing Duncan is the author of Experimental Man: What one man’s body reveals about his future, your health, and our toxic world.

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