Leroy Hood, MD, PhD

Doctor Hood spoke of his mission to bring “P4 medicine” to our healthcare system - medicine that is predictive, preventative, personalized and participatory. Through this systems approach and with assistance from biotech companies Dr. Hood co-founded, such as Arivale,disease care will attune to the unique needs of each individual patient while also being extremely cost effective.

Does participatory healthcare involve the participation of patients or organizations?

It includes every member of the healthcare system so that's families, leaders, pharma companies, and regulators like the FDA. Part of the reason drugs cost a lot is because of the hoops regulators jump through With data driven health, much of the steps taken now will be unnecessary.

You helped found the first interdisciplinary department at UW, ISB, and now Phenome Health. Have you found the general climate to be more welcoming of systems thinking over time?

I think it's getting more and more popular as people realize how complicated healthcare is. There are these major components people are starting to argue about including individualized medicine and preventative medicine. There’s a general term called precision medicine that’s very vague and gets used often but doesn't mean much. [Precision medicine addresses patients' differences in genetics and environment while individualized medicine utilizes in depth information to form a comprehensive patient profile through means of genomic testing.]

How has the Arivale dataset been analyzed for recent research?

It’s been analyzed using the most sophisticated techniques of data analysis. We’re just beginning to analyze it in terms of things like knowledge graphs, digital twins, and large language models like ChatGPT4. We can use big data to create precision medicine that allows us to deal with disease but our preference is to keep people well and prevent disease transitions from occurring. Again, this is how we think we’re going to be able to eliminate a significant fraction of chronic diseases and lead to trillions of dollars in healthcare savings. We’ll be able to focus principally on wellness and dealing with disease transitions.

More recently, Phenome Health has collaborated with another company, Posit, to actually develop forty digital measurements which could assess 25 different cognitive features in healthy and diseased individuals. What is really remarkable is with these measurements, with normal individuals, cognitive abilities rise to a maximum in one’s mid thirties and almost everybody fades away, slowly losing all their cognitive abilities. What is demonstrated is that you can take a thousand eighty year olds and most of them can be reconstituted back to their optimal function.

The Arivale data has allowed us to publish almost thirty different papers in many different journals. Each of those papers gives us a story in a window of some aspect of either wellness or prevention. The measurements that we’ve used were the whole genome sequence of these individuals and blood tests that looked at protein metabolites, the gut microbiome, and digital tracking with a Fitbit where we can assess physiology features. These data points lead to hundreds of actionable possibilities which are specific to individuals to either improve wellness or to avoid disease. The actionable possibilities came from statistical correlations from large data sets. Then, when we saw interesting correlations we went to the literature and validated them. We also had coaches who delivered the actionable possibilities to patients on a monthly basis.

How was bias kept out of the Arivale dataset? For example, it is known that the gut microbiome can vary depending on geography and socioeconomic class.

We just characterized whatever existed in individuals and saw to what extent the environment influenced the gut microbiome. What really influenced the gut microbiome was diet and that's why it's good to eat fibrous foods (lots of vegetables and fruits). One of the really interesting things about red meat is that the gut microbiome can convert it to toxins that can cause certain kinds of cancers in certain people. We were able to distinguish those who had the dangerous gut microbiome and really insist they eat fish and stay away from red meat.

How was the cognitive loss of the 80 year olds in the Arivale study reversed?

It's basically reversed by playing digital games. For example, one cognitive feature is reaction time so you can play games where you have to hit the key. After you’ve played the games, you can get very good and shorten your reaction time. There’s another game in which you look at a picture of thirty birds. All of a sudden they fly out to the peripheries and only one of the birds is different. You have a shorter and shorter amount of time to identify in which quadrant the different bird is. That increases your depth capability. There are also tests you can play for memory. The key point about the brain is that it should be exercised exactly how your heart is exercised - on a daily basis. It's called BrainHQ. They have daily brain exercises of 15 to 20 min that can keep your cognitive levels very high.

From your perspective, how should we go about eliminating the hesitancy that is going to come forward as health data becomes bigger and is shared across institutions?

What we did with the Arivale patients, and 95% of them agreed to this, is we de-identified their data. We hired 3 special companies to try and de-construct their data and they all failed; we got certifications. The argument we made about whether we should do this is that you’re inventing the future of health for your kids and your grandkids; that's an important contribution you can make. I think the real problem we haven't solved is discrimination. For health insurance, we have good anti-discriminatory laws in Obamacare and in a law called GINA but if you get something like long term disability insurance, it's not protected. An insurance company can come and demand that you tell them anything you learned in connection with that kind of data. What we want is anti-discrimination laws that are absolutely general and comprehensive.

In terms of extending wellness to a whole population, would that mean targeting children, people whose brains are still developing?

We ought to start at fertilization and follow the mother very carefully through pregnancy. We can learn alot about the fetus from the mother. When the infant is born, they should have the same kind of analysis. There are a number of infants that go to ICUs for unknown causes and more and more, it's turning out to be a major genetic defect. If you’ve done the whole genetic sequence or if you’ve looked at their blood metabolites, you can begin to identify them. We ought to diagnose as early as possible and correct any of the errors or deficiencies that people have as soon as we can. Now, there are people who would argue against that but many of these kids will be sick for 10 or 15 years before a physician finally figures out what’s wrong. Maybe it's too late to do something or maybe you can start to correct at least a part of it; why not get it at the very beginning.

Have you done a study on pregnant women yet?

Yes. We’re collaborating with an obstetrician at the University of Pittsburgh and together, we’re following a total of 350 women. We’ve already followed 250 of them through their pregnancy. We’ve taken blood, gut microbiome, and digital health samples throughout the gestation periods. With this data driven approach, we’re going to learn more in that one study than we’ve known in the entire history of studying pregnancy. There are really interesting areas where there are data deserts - we know very little about what the data looks like. One is early childhood development. We know almost nothing about how that really works. A second area was pregnancy but we’re changing that. The third area is menstruation which we know almost nothing about. A lot of the advice that women have been given in the past about being careful with hormones is absolutely wrong and I think it's going to be definitely reconstituted in a short period of time.