Lifestyle Medicine is the evidence-based practice of helping individuals adopt and sustain healthy behaviors that affect health and quality of life. Examples of target patient behaviors include, but are not limited to, eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption.
Lifestyle Medicine is based on the concept that chronic diseases and conditions such as obesity, diabetes, high blood pressure and high cholesterol are caused in large part by lifestyle choices: What people eat, how they move, and what they think.
Most medical treatments are designed for the average patient. Precision Medicine, on the other hand, matches each patient with the treatment that will work best for them. Also called personalized medicine or individualized medicine, precision medicine takes individual variation into account: variation in our genes, environment, lifestyle, and even in the microscopic organisms that are living inside of us.
At the center of precision medicine are efforts to understand how variations in our genes influence our health. Just like genetic variations contribute to physical characteristics like height and hair color, they also influence our likelihood of getting certain diseases. Some genetic variations protect us from disease, and some make us more susceptible.
Genetic variations also influence how we respond to medications and other interventions. For instance, it is crucial to know a person’s blood type before giving them a transfusion. And understanding individual variations in the enzymes that process drugs can help Dr. Mahl and his staff prescribe the right dose of the right medication.
Beyond treating disease, precision medicine includes approaches to diagnostics, prevention, and screening:
- Methods for identifying those who are at risk before disease strikes;
- Analytical tools for predicting which prevention strategies will work best for which patients;
- Screening methods that can identify early signs of disease before symptoms emerge;
- Diagnostic methods for identifying subtypes of disease that may look the same on the surface but respond very differently to treatment;
- Tests that can identify disease carrier status for prospective parents;
- Devices for managing diseases and for tracking and guiding recovery
- Finding the proper dose of the proper drug
Doctors have known for as long as they’ve been prescribing medicines that no drug affects every patient in the same way. Yet for decades, the standard way of figuring out which drug would work was trial and error.
But the old ways are changing. The field of pharmacogenomics aims to understand how genetic variations influence individual responses to medications. Genetic tests for guiding treatment decisions are becoming increasingly available across diverse areas of medical care. These tests get more-effective drugs to patients earlier in their treatment and with fewer negative side effects, and some even reduce costs.
GENOMICS & CANCER
Cancer is the target of some of the most promising precision medicine approaches available today. Cancer usually comes about through the gradual accumulation of genetic changes (often called mutations) in genes that control cell growth. In this way, cancer is very much a disorder of the genome. Depending on where in the body the cancer arises and the types of genetic changes the cells accumulate, different types of cancer can have very different genetic profiles. These genetic profiles can be used in a number of ways to help doctors choose the best treatments for each individual patient.
Rather than targeting the cancer cells themselves, immunotherapy treatments target the patient’s immune system, enhancing its cancer-fighting ability. Immunotherapy has been remarkably successful in some patients, in some cases eliminating all visible signs of metastatic cancer in a period of weeks. Science magazine named cancer immunotherapy the 2013 breakthrough of the year.
GROWING REPLACEMENT TISSUE
Basic research into stem cells has expanded the field of regenerative medicine well beyond tried and true bone marrow transplants. Today, a patient’s own stem cells can be isolated, grown in culture, coaxed to differentiate into any one of a variety of cell types, and returned to the patient. By manipulating stem cells, we can help patients repair and re-grow tissue that the body cannot fix on its own.
When a patient is treated with their own cells, there is no risk of rejection by the immune system, as with donor organs and tissues. And there’s no waiting on a list until a matched donor can be found.
Just like individuals vary in their responses to medications, people also respond differently to the same foods. It turns out that a food’s “glycemic index” does not always predict how that food will affect an individual’s blood-sugar level. For some diabetic patients, rice may cause a dramatic rise of blood sugar levels; for others, it may be tomatoes.