©2007 RALPH SNYDERMAN

Third AnnualProspective Health Care Conference

"Where are We Now?"

Ralph Snyderman, MDChancellor Emeritus, Duke University

November 1, 2007

©2007 RALPH SNYDERMAN

Contemporary Practice of Medicine

• Disease oriented

• Find it, fix it

• Reactive

• Sporadic intervention

• Physician-directed

• Not Standardized

• Not Personalized

©2007 RALPH SNYDERMAN

The Inflection and Opportunities for Intervention

Dis

ease

Bur

den

Time

Cos

t

1/re

vers

ibili

ty

Health Care Cost vs. Disease Progression

Typical Current Intervention

Earliest Clinical

Detection

Earliest Molecular Detection

Initiating EventsBaseline Risk

©2007 RALPH SNYDERMAN

Factors Impacting Medicine Today

• Genomics

• Proteomics

• Metabolomics

• Medical technologies

• Informatics

• Risk Prediction

©2007 RALPH SNYDERMAN

Tools Needed for Prediction and Personalized Care

Dis

ease

Bur

den

Time

Cos

t

1/re

vers

ibili

ty

Typical Current Intervention

Earliest Clinical

Detection

Earliest Molecular Detection

Initiating EventsBaseline Risk

Decision Support Tools:

Baseline Risk Preclinical Progression

Disease Initiation and Progression

Assess Risk Refine Assessment Predict/Diagnose Monitor Progression

Predict Events

Inform Therapeutics

Sources of New Biomarkers:

Stable Genomics: Single Nucleotide Polymorphisms (SNPs) Haplotype Mapping Gene Sequencing

Dynamic Genomics: Gene ExpressionProteomics Metabolomics Molecular Imaging

Therapeutic Decision Support

©2007 RALPH SNYDERMAN

Prospective Health Care

Risk Assessment and Decision Support Tools

Dis

ease

Bur

den

Time

Low Risk High Risk

Early Chronic Cos

t

1/re

vers

ibili

ty

Personal Lifestyle Plan

Disease Management

Risk Modification

Personalized Health Plan

Late Chronic

Participating Population

©2007 RALPH SNYDERMAN

Needs for Prospective Health Care

• Health risk assessment tools

• Therapeutic evaluation tools

• Aligned health care providers

• Aligned reimbursement systems

• Motivated consumers

©2007 RALPH SNYDERMAN

So, Where Are We Now?

• Research

• Clinical Models

• Personalized Medical Records

• Payers

• Advocacy Groups

• Medical Education