In This Doctor’s Office, a Physical Exam Like No Other

I offer you a uniqueperception supported by research: The primary decline in insulin secretion results from a reduction in the number of β-cells, https://www.sciencedaily.com/releases/2016/12/161213130607.htm Understanding how the microbiota affects the development of beta cells, which are lost in patients with Type 1 diabetes, eventually could lead to new diagnostic, preventative and therapeutic approaches for this disease, Hampton Hill said. "We're realizing that the microbiome is a rich source for discovering new biomolecules that have enormous potential for manipulating and promoting our health," "This is a new idea that the microbiome could be a source for signals for the development of the pancreas," Guillemin said. "This is the first time that anyone has made a connection between the microbiome and the development of beta cells."

Scientist Prove DNA Can Be Reprogrammed by Words and Frequencies In the Beginning is the WORD finally validated by Science!! Guess what viruses and bacteria contain inside themselves….DNA !!! Thus, they too are Responding [not invading, or hijacking] to the Frequencies being generated to them from our Body, our choice of words and self-talk. which collectively create Our Body’s Frequency Matrix ! Each has been vibrating at a Signature Frequency since the Beginning of Time manifesting as "The Body’s Adaptation System". [bacteria and viruses have been adapting since the beginning of time,] Bacteria and viruses resonating to the older paradigm [life ends in death] vibrate/resonate at a different frequency matrix, than that of bacteria and viruses that resonate with the Newer Paradigm of Self-Healing, Adaptation and Integration. Changing your Root Belief System of Material- Based labeling/Wording” to a Belief system where the “Wording” supports an Energy-Based Perception will jump-start this process. Example… Our “Immune system” is not a killing defensive system….It is actually an Interactive, Adaptation System, that uses Nature’s “Adapters” [i.e. Bacteria and viruses of resonating frequency] to help our bodies encode the upgraded perception. and the frequency matrix Forming the New paradigm is the Template which sends signals out to activate the adapters. Expanding thoughts create new beta cells Just thought I would offer a parallel perception to be considered.

We absolutely need data collection on large populations all the way to phenotype. This is how we’ll be able to understand health - what’s healthy and what’s not. Quite a few of the current “normal” values were established using biased data - gender, race, economic etc. We’re mostly in the Stone Age of medicine except for a few specialities, trying protocols established using a few thousands of patients in millions and billions. Eventually this kind of data will also help us develop cheaper proxy measurements - using mobile phones and cheap sensors - that can revolutionize preventive care.

Agree with the sentiments expressing how this tech can be put to ill use (pardon the pun) by both insurers and eugenicists but that that shouldn't stop the progress of medicine. I'm also impressed that this hyper-testing did turn up numerous health problems that conventional exams would've missed. But put me in the I-won't-be-signing-up camp for numerous reasons. One that I haven't seen so far in my quick perusal of comments is that old concern voiced with genetic testing that turns into a personal and philosophical question: if it's discovered with certainty that a patient will develop a disease for which there is no known cure, how will that affect the quality of life before any symptoms have manifested? I know people have come down strongly on both sides of wanting to know or not. However, practicing medicine as described in this article will have society going down the slippery slope of giving up the right not to know.

Really, not interested in having a physician who wants to track everything in me. Privacy issues, boundary issues and exhaustion make me rme at the thought.

Re insurance coverage, I think the most frightening thing about all of this is that one day soon, insurance companies will not cover you unless you agree to undergo similar invasive testing. As it is, our insurance company for state and gov employees offers significant savings if we participate in a health enhancement program. I know it has saved our state a lot of money, more than expected, by encouraging people to get screenings that often catch conditions early enough to treat for way less than treating a costly disease with complications later on. Undoubtedly it is probably good for some people who might not otherwise follow up on some problem areas. It reminds me of some car insurance carriers that track customer driving with those monitors. Sure, it's an option, and we can always opt out and pay a higher premium. But one day we will not be able to opt out of these devices, programs, or procedures that gather and use our personal data in exchange for needed services. We should enjoy our freedoms while we still have them.

"Five years after his second diagnosis, he still has diabetes. For now, he is trying long walks after eating instead of new drugs." Hmmm. How many physicians would be OK prescribing that for diabetes? Tens of thousands of dollars in high-tech diagnostics and this is the prescriptive result? Hmmm.

This might be great if one has no insurance worries. For any 'gapper' -- age (fill-in-the-blank) to 65, and with current state of ACA (i.e., the R's and this admin. continuing to jerk people around year after year after year) ... no WAY would one get such a comprehensive test. All those disqualifying items in one's history? Nope. Sadly, it's become both ignorance is bliss and bliss might mean death.

I have been a regular patient for probably 3 physicians in my life but seen a host of others over time (simply put, I have moved quite a bit for various reasons, e.g., education, work). What I can say is that most old-school GPs took the time to monitor me via blood work and other normal, mostly yearly, types of testing, and in doing so, established a baseline for me. This is the kind of professional approach, which feels quite personal, that gives me some faith in healthcare when, bluntly put, I don't see much reason to have faith in a system that has shifted from a foundation of caring for the individual to a foundation of For Profit. My point is, establishing a baseline per individual is not new; this is old-school proper medicine, as is the attitude that life-long medications are a last resort because a daily pill for life is not a cure, it is maintenance of a problem. What would be helpful, though, is a national medical database. Many issues to be discussed about that, but it is something the USA should seriously consider.

While I agree with the previous comments that the funding for these experiments should have been more transparently reported, it seems the assumption here is that, over time, the costs of these tests will drop precipitously - as it has for many medical procedures over time. I’m more curious about how the approach is a change from the status quo. Biogenetics has already been paving the way for treatment. E.g. medical students are taught early on that patients who are slow acetylators have increased side effects from drugs like procainamide. Where is the niche in medicine in which these tools will be most useful?

doubtful this type of medical care will be available to the poor.

Great. For those that are made of money. Me, I am continuing to see as few doctors as possible. Middle people of a corrupt health system.

Interesting that the penultimate paragraph suggests the lowest possible tech form of a health intervention known to man: "a long walk". Perhaps in some cases a discrete modern medicine biological intervention can have a dramatic impact on a hitherto unknown condition, but in most cases not much can be done about it other then the obvious "do's and dont's" we all know already: eat a little, sleep a lot , exercise regularly , calm down and engage socially and, of course, avoid those "fun" things like smoking, drinking, speeding and wingsuit flying etc.

The worst part of the rabbit hole opened decades ago, when insurers first starting to drop people because of blood tests and access to medical records. My minor lesson, from about 1990, was a result of the blood-test chain offering a wide spectrum blood test for cheap. Bunch of tests my doctor wouldn’t have ordered routinely. Next thing, my insurer dropped me, and kept me dropped despite two letters, one from my doctor and another from the head of hematology at the hospital. And no, the ‘disqualifying issue’ never developed. The news was that the insurance industry had a hook into, not only my physician’s records, but those of testing services. Imagine how much more selective your insurer could be if it had genomic data. Attractive also to employers, pension plans, Social Security. Job injury? No, your profile indicates bad balance, so when you fell into the machine, it was your fault. The new rabbit hole is immensely wider and deeper. Cheers.

From the abstract: "We explored the ability of deep longitudinal profiling to make health-related discoveries, identify clinically relevant molecular pathways and affect behavior in a prospective longitudinal cohort (n = 109) enriched for risk of type 2 diabetes mellitus." So these volunteers were already at risk for type 2 diabetes, that's a crucial detail the NYT article fails to mention.

Medicine advances with new knowledge, but not all new knowledge yields benefits. The diabetes example given is unpersuasive on every level: 1. There are no convincing data that treating "pre-diabetes" benefits the patient in the long run or in the short run. We may be able to read the handwriting on the wall but that doesn't mean we can do anything with the message. 2. Before Dr. Snyder did his genomic review, the genetic differences between type 1 and 2 diabetes were well known and more inexpensive technology provides the same data and information. Screening tests have always been problematic. Bone densities for osteoporosis are seriously flawed tests which often result in preemptive treatment for an event which may never happen (fracture) and in doing so the rudimentary therapies we have may wreak more havoc than they prevent. We all love the new in medicine, but like older approaches the new has to be critically assessed. Dr. Snyder offers more enthusiasm than reality.

Ooh! It's a new medical advancement that can save a lot of lives. So let's all be afraid of it, because we don't understand it; and let's discourage others from possibly benefiting from it as well, without taking any responsibility for the illnesses we indirectly incur on them. Luddite much, people?

No doubt precision medicine could one day be a great boon for assessing health and treating disease, but doctors may have to learn much more in order to use it effectively. One issue is the false positive problem. All tests can make errors, including medical tests, and even an accurate test might result in a healthy person falsely having a positive test. If such a test erred 10% of the time, and 1000 health people took the test, then 100 of them would test positive, even though they had no disease. If many healthy people chose to take a "carpet bombing" number of genetic tests, then that could result in a very large number of false positives, which in turn would lead to even more testing and a lot of anxious patients and unnecessary treatment.

As someone who has been in therapy for health anxiety (once called hypochondria), this kind of constant monitoring would’ve driven me over a mental cliff. I’ve had to learn how to NOT obsessively monitor every tiny symptom and to accept my doctors’ diagnoses. I wonder the potential for care like this to cause others to become similarly unduly obsessed with their health.

This is kind of funny, considering that so many people still have to fight to get even a minimal physical exam and follow-up. And I am not talking about unemployed, underinsured people, or those living in poverty. I’m talking about people with adequate insurance but inadequate care (full blame goes to the insurance companies). This is putting the cart before the horse, don’t you think? I’m also thinking about the bills patients may face for follow-up testing, some of which will be unnecessary. For example, I have had anomalies found in imaging (incidental findings) that have led to multiple, further tests and more precise imaging sessions. My doctors were obligated to follow through, even knowing that it was probably nothing. I spent a lot of money and time complying with a course of diagnostics that was more about protecting my doctor and her medical group than it was about me. Finally, you can tell a patient that she is early-stage pre-diabetic, but it’s still up to her to change her lifestyle. The diagnosis is just the beginning. I have seen this in my own family, where the counseling and monitoring — the real treatment — was not provided after the diagnosis. Knowing and acting are very different things. You still need that basic care, which does not exist for many in this country. Of course, the wealthy body hackers of Silicon Valley will love this! But I am skeptical. This sounds a lot like the full-body CT scans that were popular a while back.

I don't see the downside to this because if the individual can't or won't tolerate the constant monitoring, or if they can't afford it, they don't have to be obligated to participate it. It also should not be discarded just because it may not be immediately available to poor people. The more people that start to use this successfully the more it will be perfected and cost could come down.

Are the critics from the insurance industry? Certainly they should want to screen to prevent costly chronic diseases, but the issue is whether they would pay for expensive procedures to prevent serious and painful illness for a given individual. Now that an early diagnosis is out in the open for many diseases, what are we as a society (and insurers who are in this for the money) willing to do to prevent illness?

as someone whose Dr was a little more curious than most (and at 76 still practicing so an old dog can learn new tricks), some additional traditional testing showed I have a genetic condition that kills people all the time. Now know what to look for , I see it all the time. Its happened to maybe a dozen or so celebrities, and b/c of who they are, we get details allowing me to see their outcomes, how they were treated etc.Its probably at least extended if not saved, my life. I had a 33% chance of dying in first 3 years. I've now made it past that interval and do what few lifestyle I can to help the situation. Now maybe I'll be around to see my youngest graduate college. Thanks Dr!

I support the advancement of science and research, particularly where human health and well being are concerned. That said... can people not see the dark side of this emerging technology????? The way costs will be managed over the long term will be by genetic screening WITH exclusionary practices. Employers would want your genetic profile before agreeing to hire you... because an employee is always a cost to them and they want to control those costs and limit them. And lets not forget that eugenics is never very far from extreme politics and social factionalism... and this technology will empower eugenics. Not to mention.... use of genetic profiles to actually create methods to harm someone...... it could become the newest form of assassination or debilitation of people someone in power does not like or approve of. My point here is that there must be extremely rigorous civil and criminal statutes and process BEFORE this stuff become mainstream... because if there is one constant in humanity, it is the willingness to turn the best and most positive aspects of science into a form of harm through weaponization (either litterally, or simply administratively.

This is the future. Think about it. Why do we take cholesterol tests long before we get heart disease? This is the same principle on overdrive.

I am disillusioned with what modern medicine has to offer. We seem to get plenty of what we don’t need and little of what we do need. For example they go all out for testing blood fats and cholesterol but leave out the most important and damaging factor,..trans fat. I have never had a doctor mention it. I have asked time and again for my doctors to measure my zinc because I have had a deficiency with symptoms in the past and have lab work to prove it. Not interested. My mother (was perfectly well nourished) was diagnosed with chronic b6 deficiency. None of my doctors seemed interested in the heritability of this defect. My GP does not measure my B12 though this vitamin is well known to be deficient in seniors. I am not impressed with any of the fabulous medical advances as long this lack of common sense persists.

This sounds like innovative and important research. Complaints about it's eventual relative worth are misguided.

I got to know about machine learning 14 years back by doing a small research project and now I am simply astounded by the popularity of algorithms across wide range of domains. This research looks promising as an early warning system. Many fatal diseases can be avoided through preventive cures, which is far less taxing on human health.

“It turns out 53 out of 109 people learned something really, really important from doing these deep profiles,” How many of these would have been discovered with a PROPER history and physical exam? What about follow-up when meds aren't working? In the "business" of medicine today I see shocking shortcuts in these fundamentals.

I wish the article had mentioned how much the Stanford study cost. Likely several million dollars worth of grants and lab support. This would have given a better idea of whether this approach is even feasible considering the massive amounts of money the country already spends on healthcare. Did it cost $100,000.00 per patient to find out that they have early diabetes? Perhaps it is better to spend $80 with the standard lab test and use all that money for something else. It’s also interesting to realize that knowledge and information (even early on) do not necessarily produce change in behaviour or outcome. After all that money spent on his genes and data, the lead researcher still has active diabetes.

As someone with a rare chronic illness, I wonder what my life would like now if it could have been caught before it manifested.

The prophecy of “Gattaca” has been fully realized.

At 68, I want this info NOW. I want healthspan, we all do. The people working on this medicine are heroes. I volunteer.

This looks very interesting, they are learning a lot about diseases and how they start as well as helping several individuals. The costs should come down as the processes are refined, just as DNA sequencing has become cheaper over the past decades. I think poor people may benefit most, since it uses much less of their time.

This is another example of medicine gone amok. Personally I accept the frailties we have and understand that being human is not risk free. I don't want horrible diseases but I also don't want to be micro-managed and to become the property of the massive medical industrial complex. Part of what makes life interesting is that we don't know what is in store for us. The medical business is just turning us into machines, like an automobile, swapping parts in and out, tweaking and re-engineering things. We are losing our humanness to them.

"Along with his genome (all his genes), Dr. Snyder published his transcriptome (the molecular signature of which of his genes were active), his proteome (all the new proteins his body produced), and his metabolome (all the molecules involved in his metabolism)." It is important to note that there is not just one transcriptome, one metabolome, and one proteome per person. These all vary tremendously among tissues and even cell types within a tissue. They also vary tremendously over time, including circadian (daily) rhythms and other temporal changes. Which tissues and cells were monitored? When?