What if the first medication prescribed for a health problem always worked — without side effects?
What if chronic pain could be relieved without so many painkillers?
What if patient outcomes could be improved if health care professionals simply brought more “heart” to work?
These provocative questions, posed by three experts at Vanderbilt University Medical Center (VUMC), were among the highlights last Friday at TEDx Nashville 2016, an exposition of “ideas worth sharing” at Nashville’s War Memorial Auditorium.
Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine, opened the session with two grim statistics: 100,000 Americans die every year from adverse drug effects, and the first drugs given to treat or prevent disease don’t work half the time.
It doesn’t have to be that way. Physician-scientists at VUMC are pioneering a transformative approach to health care they call “pre-emptive genomics.”
Patients at VUMC have their DNA sequenced and a record made of genetic variations that may affect how they respond to six commonly prescribed medications. Doctors are warned electronically if their patients have one of the variations, so they can adjust their prescriptions accordingly.
If pre-emptive genomics was applied to every drug known to have a genetically-based variable response, and to every patient nationwide, “imagine the cost savings,” Balser said. “Imagine the safety.”
Truly personalized health care will only happen, he said, when physicians prescribe medications based on knowing everything there is to know about their patients — not only their genetic and medical histories, but their socioeconomic circumstances and lifestyle behaviors as well.
As serious as adverse drug effects are, so is the treatment of chronic pain, said the next VUMC speaker, Tracy Jackson, M.D., assistant professor of Anesthesiology in the Division of Pain Medicine.
Americans spend an estimated $630 billion a year to treat chronic pain. They consume 80 percent of the world’s supply of opioids and 99 percent of the world’s hydrocodone.
Yet chronic pain is the No. 1 reason why they can’t work.
Many chronic pain patients fear their doctors will tell them “it’s all in your head.” Actually, most would get better, faster, if that’s what they heard, Jackson said. When it comes to treating chronic pain, lifestyle changes and “functional rehabilitation” have better long-term outcomes.
“If we do nothing but change the way we think, breathe and move … we can change the very structure of our brain and prevent and reverse the changes associated with chronic pain,” she said.
In her talk, Susan Carter, administrative director at the Osher Center for Integrative Medicine at Vanderbilt, advocated a similar approach to improve health care delivery.
Stress and pressure are well-known impediments to creativity, energy and efficiency in any human endeavor, Carter said, yet they are ubiquitous characteristics of most health care systems.
If, instead, employees were encouraged to bring the best of themselves to their work and if they felt more fulfilled and valued, they would likely be more effective, too. “We can bring meaningful change to health care,” she said, “just by using our heads but following our hearts.”
This is the seventh year TEDx Nashville has brought together leaders in technology, entertainment, design, education, public policy and other areas to share ideas for creating positive social change.
The second day of this year’s event, held at the Tennessee Performing Arts Center, featured Kelly Holley-Bockelmann, Ph.D., associate professor of Physics and Astronomy at Vanderbilt.
