Chapter 23 - Systems Medicine and the Emergence ofProactive P4 Medicine: Predictive, Preventive, Personalized and Participatory

Medicine is undergoing a revolution that will transform the practice of healthcare in virtually every way. This revolution is emerging from the convergence of systems biology e a holistic approach to biology (and medicine) e and the digital revolution. Systems biology is opening what has historically been the black box of our individual biological systems as they change over time. The digital revolution is vastly expanding our capacity to generate and analyze ‘big data’ sets, deploy this information in business and social networks and create digital consumer devices to measuring personal information. Both of these new capabilities will be deployed in systems medicine (see below). Systems biology emerged at least partly in response to the incredible complexity of biological systems, both normal and diseased [1,2]. This complexity arises from the natural process of Darwinian evolution e random mutations followed by natural selection generated in large part by the environment. Darwinian evolution is a random and chaotic process e building new complexities on top of previously evolved complexities. Indeed, biological systems resemble RubeeGoldberg devices. Consider a RubeeGoldberg device that attaches 14 different gadgets EL SE together to cool the temperature of soup. Deciphering the complexity of this ‘soup-cooling system’ requires (1) defining the components of the soup-cooling system, (2) determining how these components interact with one another, and (3) delineating the dynamics of these components in space and time that are necessary for carrying out their function of soup cooling. These are precisely the elements that systems biology attempts to define when deciphering the complexity of biological systems. To achieve actionable understandings of biological complexity, the analyses must be global (comprehensive), integrative and dynamic. Systems medicine, the healthcare-focused derivative of systems biology, is beginning to alter the face of healthcare through (1) a systems approach to disease, (2) driving the emergence of technologies that permit the exploration of new dimensions of patient data space (e.g., sequencing the individual human genome), (3) the analyses of the quantized units of biological information (single genes, single molecules, single cells, single organs to provide diseaserelevant information on health or disease for the individual), and (4) the resulting explosion of patient data that is transforming traditional biology and medicine into an information science [1e11].