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From Sick Care to Well Care

From Sick Care to Well Care

How healthcare is primed for disruption

July22nd,2019
Clinical Lab Manager
Aaron Hudson, PhD

Aaron Hudson is the vice president and general manager of global marketing and strategy at SCIEX, leading the company’s various marketing efforts, including digital marketing, branding, content development, and public relations.

Aaron joined SCIEX UK in 2002 as a senior sales representative focusing on proteomics and in 2005 became proteomics marketing manager for Europe. In 2006, Aaron moved to the United States, and over the next 11 years, was promoted several times to various leadership roles, each with increasing responsibility. Most recently, he held the role of senior director and general manager, SCIEX Diagnostics. Under his leadership, SCIEX launched its first fully integrated in vitro diagnostic LC-MS system.

Prior to joining SCIEX, Aaron spent seven years at Waters in both technical and sales roles.

Aaron holds a bachelor of science (BSc) in biochemistry and a PhD in molecular genetics and protein chemistry, both from the University of Sheffield, UK.

Q: What is your vision of the future of healthcare?

A: The future that I see is that when you are born, you’ll get your DNA sequenced, and from that you’ll know you’ve got the propensity for five or six diseases during your lifetime. Some of those will be hereditary, some of those will be just point mutations that arise as mutations do. Once you know that, you will be monitored for traditional wellness markers, whatever they become—vitamins would be a good example, but steroids as well, and probably a number of proteins that are related to a healthy human being. The markers will be different from men to women and they will be different from Caucasians to Africans to Asians, but there will be a set of markers for this wellness. On top of that, there will be a set of markers that will be based on the diseases that it is expected that you might or might not get during your lifetime. But really, once you sequence your DNA, it is largely not going to change from the day that you’re born to the day that you die in every cell in your body (aside from epigenetic changes).

Then you’ll have to measure these metabolites, lipids, and proteins monthly most likely. You’ll do that in your home from a drop of blood on a little tube. You’ll snap it off, put it in the post, and send it to a reference lab or a biotech lab. The results you will get back will be a screen—not a diagnostic, but a screen against your baseline that shows how your baseline is changing all the time.

Since you’ll then have anonymized populations of these tests, there will be some artificial intelligence or machine learning that says, “Hey, we’ve noticed that people have started changing in this way, started to get these diseases.” Over time, the body of data will get more indicative of smaller changes as you slip from wellness into illness.

Then when you slip into illness, maybe you’ll start feeling a bit unwell, or you won’t know and a red flag will come up on your mobile phone that says you’ve got to go to the doctor because something’s about to happen. When you go to the doctor, you will not just use the diagnostic tests that exist at the moment, which are not as precise and accurate as they could be. You’ll have precision tests using mass spectrometry that identify the disease that you’ve got.

Once you know what you’ve got, there will be options of therapies. At the moment, those tend to be small-molecule drugs, though there’s been a shift from small molecules to monoclonal antibodies and newer modalities like oligos that can knock down RNA to effect change within your cells, and cell and gene therapies—CRISPR-Cas9 gene editing, for instance, has great potential. Precision therapy will start to make you well again.

Compendium of Clinical Diagnostic Notes Volume 2  

Q: How would people know they’re getting well if they never get to the point where they feel sick?

A: You need to measure that in some way; you need a marker. That is roughly translated as companion diagnostics. At the moment, companion diagnostics really stratify patients to say whether they should take a certain treatment or not. HER2 breast cancer is a good example of this; if a companion diagnostic reveals you have the HER2 gene, you can take Herceptin. But that really just stratifies patients; it doesn’t monitor whether the treatment is improving or not. So you’ve got to have a number of markers that are really more around treatment efficacy—not necessarily companion diagnostics, which are a slightly different subclass—and then to measure those markers until you return to wellness.

Q: What hurdles must be overcome before we can move from a system of sick care to well care?

A: If you think about how you would meaningfully deploy a program like that, even if you had wellness, even if we could measure all of those things in your body, would you be willing to go once a month and give blood? You need a process; you need to make it more accessible to the consumer. So that’s one thing—accessibility. I think it’s acknowledged whilst you may go once a year to give an armful of blood, most people will not go once a month to do that, and you need to be able to take a pinprick of blood, you need to be able to do that in the comfort of your own home just like you do with the genetic tests at the moment, like Ancestry DNA—spit in a tube and send it off.

The second thing is that you need the technology to do it. We’ve already established that chemistry and immunoassay systems are good at measuring analytes, but you can only measure one thing at a time. You aren’t going to know whether you’re slipping from wellness into illness by just measuring one marker—it’s got to be hundreds of markers. It’s got to be some kind of multiplexing. So the technology is not existent. It’s also that sensitivity and specificity to be able to measure multiple things in small volumes of blood as well, so the technology has not really been there to do that.

And I think the last thing is that the markers are not there. We don’t know what they are just yet. We can guess, we do a little bit of that, we look at vitamins and endocrinology, we look at cholesterol, do some blood pressure testing, Fitbit and things, but it’s going to be a combination of things.

Q: What role will mass spectrometry play in the transition to well care?

Compendium of Clinical Diagnostic Notes Volume 2  

A: Mass spectrometry is becoming increasingly foundational in all of this because the ability to accurately quantify molecules is the basis of well care. If you can’t precisely quantify molecules, you don’t get precision diagnostics. It’s a kind of cascade.

Q: How long will it be before well care becomes a reality?

A: This is not happening tomorrow, but it’s coming like a freight train. China are putting 9 billion dollars in the next 10 years into something called health 2030, into precision medicine or wellness testing. I think there is a shift now to disruption in healthcare, just as we’ve seen other industries get disrupted.