P4 medicine - moving towards a more effective approach to treating disease
Treatment of disease needs to move towards more personalised, predictive, preventive and participatory healthcare (P4), but leadership is required to accelerate the uptake of P4 medicine within the NHS and internationally.
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Models of healthcare are changing. An ageing population and pressure on health budgets means treatment of disease needs to move towards more personalised, predictive, preventive and participatory healthcare.
Such ‘P4’ medicine represents a move away from models of reacting to illness to maintaining health.
It would mean that data collected through diagnostic tests, health ‘apps’, and other tools can help people to understand risk factors and counteract them.
The Academy of Medical Sciences, Medical Research Council, Science Europe and University of Southampton see P4 medicine as an important area for research and development, and have identified positive steps and barriers to progress in this area.
Moving to a P4 model will involve patients and stakeholders from across the healthcare sector working together.
Take late-onset dementia as an example. It is not currently possible to predict who will develop the disease, and while there are treatments that can temporarily alleviate symptoms and slow down progression, they do not work for everyone.
Under a possible P4 model, genetic testing would be undertaken to identify those with genetic susceptibility to dementia. Environmental risk factors that are triggers for the susceptibility genes could then be modified through lifestyle changes.
Individuals would record a range of measurements using healthcare apps on their smartphones. A monthly finger-prick test could measure markers of disease progression and alert the individual to visit their GP when the markers reach a pre-determined level.
To delay the onset of symptoms, the GP would discuss the treatment options available, tailored to the individual’s personal characteristics.
And it’s not just dementia that such an approach could work for. Progress has already been seen in cancer treatment where more drugs that specifically target a patient’s individual tumour are providing much more effective treatments.
Preventive healthcare could also benefit. For example, providing vitamin D supplements to pregnant women at greatest risk of vitamin D deficiency could help prevent poor bone health in their child’s later life.
The opportunities offered by P4 medicine are clear.
But leadership is required to accelerate the uptake of the P4 approach both within the NHS and internationally.
Medical professionals themselves can take greater responsibility for driving the adoption of P4 approaches.
Patients and the public also have an important role to play by participating in the maintenance of their own health.
The integration of ‘big data’ will be central to the success of P4 healthcare, requiring organisational, technological and cultural changes.
Healthcare systems can be better organised to support adoption and provide adequate training for clinicians.
Pricing and reimbursement models for new medicines, and their accompanying diagnostics, may need to be reconfigured to better support ongoing development in this area.
The Academy and partner organisations will work together to support work in this area.