Wednesday, September 26, 2012

Predictive Health and Health Coaches

About a year ago, in a post entitled “Let’s Rediscover Preventive Health Care,” I wrote about how health coaches could play an important role in helping to create a health care system that would be more effective, better suited to individual needs, and less expensive.  I recently read a review of a new book, Predictive Health: How We Can Reinvent Medicine to Extend Our Best Years by Kenneth Brigham and Michael M. E. Johns.The authors are the founders of the Emory-Georgia Tech Predictive Health Institute which practices “personalized medicine, combining genomics with the study of how proteins and other molecules act in the body. “

The Institute, financed by private foundations, uses “the latest biological tests, including measures of body fat, bone density, circulatory function, physical fitness, and brain function.”  Four ‘biomarkers’ are thought to be especially significant in predicting future health:  inflammation, oxidative stress, immunity, and regenerative capacity.  After data on each patient has been collected she or he works with a health coach on an individualized plan that involves diet, exercise, and medical care.

I wanted to know more about the program so I went into the Emory website and found an interview with Kenneth Brigham, director of the Institute.  Brigham describes America as having a “disease care non-system” with a vertical relationship between doctor and patient that doesn’t work.  He cites studies showing that “half of the people who see doctors don’t do what the doctors tell them to do.”  At the Institute, health partners (health coaches) engage in a horizontal relationship with patients;   they seek to inform patients and to encourage them as they work toward their individual goals.  Of course, the bottom line is money.  We all know that the present system is unsustainable, but will the PHI program save money in the long run? The Institute hopes to collect data to show that the approach is cost effective so that it can be adopted on a larger scale.

Health coaches could play an important role in enhancing quality of life and preventing illness.  Under our current system doctors see so many patients per day that it is impossible for them to know each person well.  The emphasis now is on ordering tests and prescribing medications rather than attaining a holistic view of the individual.  By contrast, health coaches could get to know patients personally and follow their progress on a regular basis.  Doctors primarily seek to identify and treat disease.  Health coaches could observe characteristics like balance, posture, muscle tone, and flexibility that can contribute to later health problems.  They could then pass along valuable insights to doctors in order give them a more complete picture of each patient.  They could also help patients understand more about their own bodies and participate directly in their own health care.

Here in Indiana we currently have an ideal opportunity to try out this new approach.  Indiana University is about to establish two Schools of Public Health, one in Bloomington, the other in Indianapolis.  The Bloomington School will be the successor to the current School of Health, Physical Education, and Recreation, which has a well-regarded program in kinesiology.  Why not use this occasion to try a cooperative program between the Department of Kinesiology and the IU Med School to train health coaches?

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