to keep it in remission through these behavior changes, without taking any drugs. That doesn’t mean he’s completely in the clear. He knows his risk will go up again as he gets older. He also knows from his genome that if he gets diabetes, and needs to take the generic drug metformin, he should take a lower-than-usual dose. But most importantly, because he’s a scientist willing to make himself a laboratory subject, he’s more likely to catch diabetes or some other ailment at an early and treatable stage.
After giving 50 samples to his research team over the past 34 months, Snyder says he expects much more interesting data to come. This wasn’t just a case of a single paper which generates some buzz, maybe a few new research ideas, and then fades into the ether. It’s really just the first step in a long-range study of Snyder at the molecular level, and what that means for his health. “I’m sure I’ll be doing this the rest of my life,” Snyder says.
No question, this is all still very much at a research stage. This kind of hard-core data-gathering approach is many years away from being reduced to practical use, or lending itself to new products for diagnosis or treatment. The Stanford team used a next-generation gene sequencing machine, and two different mass spectrometers, which are expensive pieces of equipment. The first study of Snyder’s ‘omics profile generated 50 terabytes of data, and he says the next phase of research will probably double the amount of data. It cost tens of thousands of dollars, and he doesn’t really have a full accounting that includes computer analysis and staff time. And the costs keep recurring. While the team only had to sequence his genome once—because his unique DNA signature doesn’t change over time—the battery of other ‘omic tests will probably cost at least $2,000 each time he gives blood, just for the chemical reagents required, not counting costs for analysis and staff time.
Still, every day as the costs come down, more research ideas become feasible. Snyder’s story, which got a fair bit of media attention in the spring, has inspired a number of volunteers who want to help. The Stanford team is broadening the scope of their personalized medicine vision by looking to analyze the microbes in Snyder’s gut—the microbiome—and his epigenome, which will show how his genes get expressed. Those extra analyses will add cost, but Snyder says he believes it will be soon be possible to capture a simple version of the molecular analysis for maybe $600 each time he gives blood. Once the costs get down into that range, it will be feasible to do one continuous study of 10 volunteers like Snyder, who are willing to subject themselves to all these regular blood draws, when they’re feeling well and when they’re not.
Beyond that study, Snyder says he and his team are exploring a 250-person study of people at high risk for diabetes, or who are pre-diabetic. The idea will be to take these regular personal ‘omic snapshots, connect it with a detailed picture of the person’s environmental stimuli (particularly their diet/exercise habits), and watch over a 5-year period to see whether certain biochemical pathways are truly predictive of whether a person will get diabetes. That kind of study would be clearly more informative to the practice of medicine than just one man’s experience, which could be a fluke.
Certainly, there are going to be experiments that fail, or just give us vague ideas of where an individual’s health is headed. People, being human, won’t always follow their doctor’s advice, even if they know they can stop themselves from getting diabetes. Insurance companies may use this data to their own advantage, and to the disadvantage of the individual. (In fact, Snyder says his life insurance premiums went up once he told his insurer about his diabetes diagnosis. That action is perfectly legal, he notes, because life insurance firms aren’t subject to the Genetic Information Non-Discrimination Act of 2008.)
The whole march of science, the business implications, and the ethics of this movement will surely lurch along in fits and starts over the coming decades. It will be messy. It won’t happen overnight.
But I do believe we’re going to learn amazing things that will change our behavior. And I think that within the next decade, a whole lot more people in the U.S. will have the same kind of visibility Snyder got into his individual health, because it really ought to save the whole system money if it scares people into leading healthier lives. The 99 percent of patients will no longer say “Personalized Medicine? What’s that?” People will want this information, they’ll demand it, and many will act on it. Some of today’s skeptics will turn into believers, and they’ll find ways to profit from this movement, by helping people prevent bad things from happening. As Snyder puts it, “This is what personalized medicine is all about. You can look at your altered biochemical state, and you can change things when you catch them early. It’s the name of the game.”
