4P-medicine of the future: preventive, personalized, predictive, patient-centered

Світлана Бурмей
17 hours ago
5 min read

Біговий захід GoMove в Ужгороді за підтримки Ediens

Introduction: The Crisis of Classical Medicine and the Paradigm Shift

The first decades of the twenty-first century are characterized by an unprecedented epidemic of noncommunicable (noncommunicable) diseases (NCDs). Cardiovascular diseases, type 2 diabetes, neurodegenerative disorders (Alzheimer's, Parkinson's), aggressive forms of cancer and depressive states increasingly affect young people. Current health outcomes are considered inadequate, since classical medicine is mostly reactive: it begins to treat severe chronic pathologies after their occurrence, often in the late stages.

To avoid a global economic and demographic crisis, the scientific and medical community initiated a paradigm shift - a transition from delayed interventional treatment to medicine focused on health maintenance. This new integrative concept was called 4P medicine (or 3P medicine), which stands for: Predictive, Preventive, Personalized and Patient-centered or Participatory. The European Medical Association (EPMA) has defined this approach as the medicine of the future, which allows to contain the spread of diseases through individual algorithms and evidence-based science.

Fundamental principles of 4P medicine

1. Predictive Medicine: The Power of Biomarkers

Prognosis means the ability to predict the development of a disease before its clinical manifestation and to determine the exact response of the body to a specific treatment. The basis of predictive medicine are biomarkers - the first signaling molecules or indicators of changes that can be detected long before the onset of the disease itself.

Unlike classical analyses that state the fact of the presence of a disease, individual biomarkers (microbial, biochemical, immune) allow to calculate risks mathematically. For example, using machine learning (Data Science) and analysis of the concentration of certain microorganisms, predictive models are created, such as the "STOP-stroke formula", which allows to assess the risk of atherosclerosis development and the need for intervention in points. In addition, predictive medicine rejects the "trial and error" treatment method (when drugs are prescribed at random); instead, it guarantees the proven individual effect of drugs even before they are taken.

2. Preventive medicine:

Treatment before the onset of illness The goal of preventive medicine is to maintain the health of the entire population, not just provide services to those who are already sick. Traditionally, prevention is perceived by the population as banal advice (for example, "do not drink cold water"), which has nothing to do with true prevention.

Real preventive medicine works with a state of "suboptimal health" - the reverse borderline state between optimal health and clinically pronounced pathology. A doctor should examine a healthy person and inform him that a certain lifestyle or diet will inevitably lead to a malfunction in the system. For example, preventive diagnostics of the microbiome can detect early markers of disorders that will eventually lead to autoimmune diseases, obesity or depression, which allows stopping this process in the bud.

3. Personalized Medicine: Moving Away from Universal Protocols

Classical medicine is often called protocol medicine: patients with the same diagnosis are treated according to the same regimen, ignoring their physiological characteristics or drug intolerance. Personalized medicine is based on creating a so-called "omics-profile" of a person, which takes into account genetics, epigenetics, stress level, age, birth conditions and place of residence.

Today, it has been proven that although genetics play a role, epigenetic factors (nutrition, stress level, physical activity) are dominant in shaping health. The most important individual indicator and epigenetic factor is the microbiome. Only a deep understanding of the unique microbiota of a particular person (through sequencing of microbial genes, metabolomic analysis) allows us to develop individual nutrition plans and select personalized pharmabiotics (new generation biologics) that act selectively without suppressing one's own beneficial flora.

4. Patient-centered (Participatory) medicine: The patient as a partner

This principle involves the patient's active participation in the process of their own healing. Patient-centeredness means that the doctor does not simply write a prescription, but explains to the person the need to take care of their health in advance, collect data about their body, and change eating or behavioral habits.

Without openness and activity of the patient, personalization is impossible. For example, hiding details during the collection of anamnesis (eating habits, harmful addictions) makes predictive models invalid. A big problem of our time is the search by patients for a "magic pill" (for example, drugs for weight loss without changing the diet), the desire for instant results without effort and shifting full responsibility to the doctor. Patient-centered medicine teaches a person to maintain an individual physiological balance and adhere to selected recommendations.

The microbiome as the biological foundation of 4P medicine

A revolutionary discovery in modern medicine is that the microbiome is the key to personalization. About 75% of the body's immune response is supported by gut microbes. Microorganisms control mental health by producing neurotransmitters, including serotonin, which critically affects mood and helps treat PTSD and depression.

Any drug, before giving a systemic effect, gets on the microbiota and interacts with it. Therefore, the creation of individual correction agents, such as pharmabiotics, and the development of personalized diets based on the metabolomic activity of intestinal bacteria (which are calculated by artificial intelligence or complex algorithms) is the most effective way to influence health. The pinnacle of the preventive approach is the creation of an "Individual Microbiota Bank" - cryopreservation of the patient's own healthy bacteria for future use, for example, to restore immunity after heavy antibiotic therapy, stress or chemotherapy.

Conclusions 4P medicine is not just a change in terminology, but a fundamental shift in thinking. The rejection of the pathoanatomical approach in favor of health management allows us to stop the development of serious diseases before their clinical manifestation. In-depth study of individual biomarkers, microbiome and metabolic pathways in combination with IT algorithms creates conditions under which each person receives not a "general protocol", but precise biological instructions for their own body. However, the success of this medicine of the future lies in the plane of responsibility of the patient himself: without a conscious attitude to lifestyle and nutrition, no innovation will give a lasting result.

Short questions and answers on the topic (Q&A)

1. What is the main difference between 4P medicine and classical medicine?

protocol? Answer: Classical medicine is reactive and works according to general protocols: it prescribes the same drugs to all patients with the same symptoms after the onset of the disease, often acting by the "trial and error" method. 4P medicine is proactive: it identifies risks before the onset of the disease (preventiveness), selects treatment strictly according to the physiology and microbiome of a particular person (personalization) and mathematically guarantees the effectiveness of drugs even before they are taken (predictability).

2. Why is the microbiome considered the foundation of personalized medicine? Answer: The microbiome is unique to each person and responds to epigenetic factors (food, stress, environment) more quickly than genetics. It controls 75% of our immunity, synthesizes mood neurotransmitters (serotonin) and manages metabolism. Since all drugs or foods initially interact with the microbiota, its analysis allows you to accurately select a diet or pharmabiotics that will work for a particular patient.

3. What are biomarkers and what role do they play in predictive medicine? Answer: Biomarkers are the earliest signaling molecules or individual indicators (microorganism composition, biochemical or immune data) that signal changes in the body long before the appearance of physical symptoms of the disease. Their detection using modern algorithms allows mathematically calculating the risk (for example, stroke or autoimmune disorders) and making early adjustments to the person's condition.

4. Why does 4P medicine require "patient-centeredness" (participation) and why are doctors against "magic pills"? Answer: No personalized regimen or perfect drug will work if the patient remains passive. People often look for a "magic pill" for instant weight loss or recovery, refusing to change habits or nutrition. Patient-centeredness requires absolute honesty during diagnosis and the patient's willingness to cooperate with the doctor, following individual recommendations and nutrition plans to maintain their health.