By Rob Califf, M.D., M.A.C.C., Verily Advisor and Advisory Board Member
Rob Califf, recently sat down with Dennis Ausiello, M.D., and discussed wellness and healthcare.
Dennis A. Ausiello, M.D., is the Jackson Distinguished Professor of Clinical Medicine and director emeritus of the MD/PhD Program at Harvard Medical School. He served on the Broad Institute's first Board of Directors. He is also chairman of Medicine emeritus and director of the Center for Assessment Technology and Continuous Health (CATCH) at the Massachusetts General Hospital (MGH). This center is a partnership among MGH, MIT, and Harvard University whose mission is to develop real-time assessment of human traits in wellness and disease. A graduate of Harvard and the University of Pennsylvania, Dennis is a nationally recognized leader in academic medicine who understands the needs for partnerships between the academy and industry.
Q.What areas of research and medicine currently captivate your interest?
There are three areas that come to mind that I’m thinking heavily about at the moment. One is developing continuous health measurement tools to better understand wellness and disease in the human condition. Historically, medicine has been episodic and symptomatic. Essentially, you go to the doctor with a headache or a backache and he or she takes a narrow, static snapshot of your health through tests and an exam. We have to move to an approach that is more systematic and continuous for the measurement of wellness and pre-symptomatic biomarkers. At CATCH, we quantitate the human phenotype, which fits very nicely with Verily and its focus on the measurement of health and the transition to illness.
I’m also deeply interested in understanding the impact of inflammation. Every disease has an inflammatory component. People understand that inflammatory bowel disease and Lupus have an inflammatory component, but they don’t realize that inflammation is also a critical component of heart disease, diabetes and cancer. Inflammation in the body is meant to defend us from cold viruses and bacteria, but when the immune system attacks organs or blood vessels, it leads to disease. Studying the early immune system/immunology is one of the most important areas of research, in my opinion.
Another matter is the microbiome. The microbiome is an organ. Ninety percent of physicians were taught that the microbiome was an artifact of a body being born sterile into a dirty world. They were taught it was an inert symbiotic relationship—which couldn’t be farther from the truth! It’s involved in half to two-thirds of our immune responses. Dysbiosis, the abnormalities that occur in our microbiome, are primal in many of our chronic illnesses. In the next 25 years, I predict that 35% of all drugs will be formulated based on the microbiome.
Q.Are there any particular projects that you believe hold a lot of promise?
Medicine is the only field that doesn’t know its ‘Gold Standard’. We know disease states and how they progress to death, but we don’t know about the wellness state and how it progresses to disease. Medicine must move from symptomatic, episodic care to presymptomatic, continuous care. I think Verily’s Project Baseline and One Brave Idea are on the right track for changing the field’s approach.
Q.How might academia and industry work together to move from episodic to more continuous care?
Medicine is no longer solely in the hands of the physician, for example some tech companies are bringing assistive health care goals into their businesses and missions. Science and technology can energize and inspire our understanding of wellness and disease in the human condition. Verily is working on tool sets and skill sets to enlighten us. What are the disruptive factors of illness? We’ve had an episodic approach to medicine, but 99% of health exists outside the hospital and clinic walls. We need to change our approach so that healthcare extends into the home and the workplace, involves teams working with the patient beyond the traditional physician model and incorporates sensors and direct feedback using digital technology. It is our most significant challenge and greatest opportunity.
Q. What challenges do we need to overcome to unlock Big Data’s potential to impact healthcare?
Big Data has been around for about 25 years. What is missing is annotated data that we can assess in real-time. For example, today’s electronic health records are so chaotic. They offer an exchange of information on a given individual and offer safety information such as drug allergies. However, if we could annotate and interrogate health data, that would be useful.
Q. What are your hopes for Verily’s contribution to the biomedical world in the near term?
The thing I like a lot about Verily is it can be agnostic in its development of tool kits and wellness measurements. It has a blank slate that allows it to use its scientists, clinicians, and resources in data analysis and tool development. I’ve worked in arguably one of the greatest medical communities all my career, but it was very hard to be disruptive in that environment. Verily can help the world by making disruptive tools and approaches to measuring health. In my opinion, Verily is best in class and really attuned to measuring how we determine the human condition. Are we sad, happy, anxious, and what does that do to our health? If we actively measure the blood pressure of every person, for example, we would know more about the health and condition of people in this country than ever before. We might begin to understand blood pressure and hypertension.
Looking forward, the future of health assessment will depend on partnerships among tech savvy companies like Verily with other industries, hospitals, and doctors to engage the public in everyday life. Only then will we develop an understanding of wellness and how to maintain it.