How Otolaryngologists Can Apply Predictive Medicine to Patient Care

The phrase “health and wellness” seems to be everywhere. Essentially, it’s based on the belief that healthy behaviors—such as proper diet and exercise, avoiding alcohol and tobacco use and good stress management—and early detection of disease are the best way to stay well. And yet, our medical system is set up to be reactive: We wait for illness to occur, and then we run to our doctors.

Michael M.E. Johns, MD, an otolaryngologist who recently stepped down as chancellor of Emory University in Atlanta and co-authored the book Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years (Basic Books, 2012), has been working toward reversing that dynamic. At the Emory-Georgia Tech Predictive Health Institute, researchers are following healthy volunteers and tracking a variety of biomarkers they believe will monitor different aspects of health. At the clinic, volunteer subjects also meet with health coaches to improve their lifestyle habits.

If you look at the human body as a collection of metabolic processes, said Dr. Johns, “We see regeneration of cells in tissues such as the skin and the gut. There are inflammatory processes and immune processes. When these systems go haywire, we get disease.”

For instance, arthritis is defined as inflamed joints, but coronary artery disease and diabetes can also be considered problems of inflammation. So, by focusing on these metabolic processes, rather than single organs or somatic symptoms, physicians might have a more holistic way to detect and diagnose disease, perhaps even before it occurs.

“It’s a great concept, to prevent disease. It’s the holy grail,” said Bert O’Malley, Jr., MD, Gabriel Tucker Professor of otorhinolaryngology at the University of Pennsylvania in Philadelphia. “It’s also extremely challenging, especially in terms of understanding how to intervene.”

As predictive health researchers collect data and identify telling biomarkers, however, doctors must still address health and disease in their practices. What does predictive health mean for the practice of otolaryngology today? Sometimes it means early screening for common otolaryngology issues, and sometimes it means identifying characteristics of early disease to personalize treatment.

Hearing Loss

One of the most obvious ways to screen for otolaryngological health is testing the hearing of newborn babies. The tests themselves are not new, but their impact is profound, said Howard Francis, MD, associate professor and director of the Listening Center, the cochlear implant program at the Johns Hopkins Hospital in Baltimore. “These babies are at risk for poor language development because of their hearing impairment,” he said.