13 June 2022

‘Disease management’ has failed – it’s time for health systems to embrace proactive wellness


As a doctor I am often struck by how differently our society treats the care of the human body from that of nearly anything else. The same people who customise and optimise everything – from work schedules to workouts to weekend socialising – seem content with a one-size-fits-all approach to health that has remained largely unchanged for generations.

Advances in understanding the differing physiognomy of individual patients could – and should – drive tailored, proactive, healthcare and wellness programmes. But the health sector has instead remained wedded to a complacent ‘disease-management’ approach – waiting for things to go wrong, by which time it is often too late.

This became painfully clear during the Covid-19 pandemic. Many who succumbed to the disease did so because of so-called ‘co-morbidities’ – already-present conditions which rendered Covid fatal when it might not have been otherwise. Across huge swathes of the Western population, the sophisticated defences our bodies have developed over millennia are compromised or running sub-optimally.

This is evidenced not only by ‘freak’ occurrences like the pandemic but by the everyday drivers of life expectancy. In four of the past five years, US life-expectancy has declined – and not due to new or incurable diseases but rather preventable conditions. An astonishing 50% of the US population suffers from at least one lifestyle-related, chronic condition – while 70% of all deaths in that country are attributable to chronic disease. A massive 90% of all US healthcare spending is devoted to treating patients who already have chronic physical and mental health conditions.

The result is the first declines in life expectancy recorded in over a century. Decades of advances in medicine and science are being surrendered. Why? Because the basic principles of wellness itself has been neglected in favour of disease-management. This is a like buying a new car and refusing to have it serviced until it breaks down.

A life largely free of illness may seem like a vaunting ambition, given how comfortable we have become with chronic disease. Yet advances in understanding each person’s unique genetic make-up – along with epigenetic factors, blood analytes, microbiomes, environmental toxins, diet, and lifestyle – can help achieve just this. These elements work in complex and interrelated ways but aligning with them can indeed reduce susceptibility to disease.

I have seen first-hand the vast potential of this new approach to wellness – including a project to sequence the genomes of 5,000 medical patients while also cataloguing their overall health over five years.

Early findings have been remarkable. Take the gut microbiome. This consists of trillions of bacteria of multiple species, which have myriad responsibilities: they regulate metabolism, bolster immune response, and even promote healthy cognition. The biodiversity of this microbiome is essential to human health – yet is all-but-ignored in traditional medical care. In one recent experiment, colleagues studied the gut microbiomes of 9,000 individuals across the entire adult human lifespan. The project demonstrated that gut microbiomes in healthy people change markedly as they age. It transpires that healthy gut biomes differentiate themselves and maintain species diversity over their lifetime. Those of healthy older subjects had even successfully deleted major bacterial species common in young people.

Indeed, subjects in their 80s with less-significant microbiome changes were four times more likely to die than those who showed marked changes. This is an area of ongoing research but its value is self-evident. Fuller answer so these questions will increase our understanding of the ageing process, leading to powerful new strategies for promoting lifelong health.

Another similar area is Vitamin D levels. Deficiency here likely increases susceptibility to cancer, Alzheimer’s, Covid-19, and other diseases. Our study showed that a daily dose of 1,000 international units of vitamin D was enough to restore heathy levels in many patients – but that many others required doses 15 times greater. It turned out that many of those who were unresponsive to the lower dosages had genetic variants that blocked the uptake of vitamin D.

These type of enquiries are the essence of a more personalised medicine. Using individual data-driven analyses from genome, blood, and lifestyle reports reveals that we call have unique traits – which in turn allow for the design of bespoke preventative health support.

The implications of this approach allow us to consider strategies quite alien to ‘traditional’ medical practice. For example, scientists have found diagnostically significant signals in blood samples that indicate disease long before symptoms can be detected by traditional means. Again, such research offers exciting opportunities to pursue interventions that delay or prevent the onset of serious diseases.

The question now is whether we’ll finally do something about it. If the Covid pandemic showed one thing, it’s that proactive wellness in mind and body could offer huge gains in the health resilience of our societies – and lower costs to our economies. It’s time to give it the urgency, scientific rigour, and attention it deserves.

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Dr. Michael Sagner is Director of the European Society for Preventive Medicine

Columns are the author's own opinion and do not necessarily reflect the views of CapX.