Feature Article: April 2020 – The 5 Ps of Age Management Medicine

The 5 Ps of Age Management Medicine

Isabela M. B. David, M.D.

Historically, the expression “4 Ps” came from marketing. In the mid-20th century, marketing experts promoted an approach to their business with four variables: product, price, place and promotion. With the digital revolution, the “4 Ps” were also used to describe a new form of public action in Medicine – from treatment to prevention – which would respond to four major principles(1): Preventive, Predictive, Personalised and Participatory(1,2). Along with it, Age Management Medicine has developed itself, sharing with it the same principles.

Notwithstanding, if we go deeper into this issue, we come across a 5th P, but one that is not always the same. Pertinence(1), platform(2), promotive(3) and pluri-expert(4) have been proposed. However, in the context of Age Management Medicine, we would like to draw attention to a much more appropriate one: Proactive.

In this article, we would like to make some commentaries on the 5 Ps of Age Management Medicine.

Why more Preventive?

Because we have moved the focus from prevention of diseases to health maintenance. Make the picture: if we act in a way to deter, delay or even reverse the molecular “damage” associated with aging which is related to inflammation, oxidation and glycation, we are also working to reduce the risk of diabetes mellitus and Alzheimer’s Disease, both closely associated with the three biochemical processes mentioned above(5). Therefore, we don’t have to be concerned about the diseases themselves. Just working on health optimization and maintenance, we are doing our best for the patient, being able to prevent the majority of disorders.

On the other hand, the field of Epigenetics has shown how our environment and our choices (what we eat, where we live, who we interact with, when we sleep, how we exercise, how we age and so on) can influence our genetic code and that of our kids(3). In this context, the patients have become the main actors. We, as physicians, mostly have to guide them through.

As far as diet and nutrition are concerned, in the last 10-15 years a real “revolution” has been taking place related to our dietary options. Now we understand how our genes influence our diet (Nutrigenetics) and how our diet and some bioactive chemicals in foods and supplements influence our genes (Nutrigenomics)(4). Words and expressions such as healthy foods, healthy diet, heathy eating, healthy-friendly foods, nutri foods, weight-loss-friendly foods and superfoods are becoming ever so familiar to us in a way that people, in general, are more and more aware of the importance of what they choose to eat if they want to live healthier and longer.

Why more Predictive and Personalised?

Predictive and Personalised Medicine are closely connected. Therefore I will describe them together.

Predictive medicine is a branch of medicine that aims to identify patients at risk of developing a disease, thereby enabling either prevention or early treatment. Single or, more commonly, multiple analyses are used to identify markers of future disposition to a disease(9).

Predictive and Personalised Medicine are also embraced under the name of Precision Medicine. While there are many definitions of Precision Medicine, they share the fundamental idea that the health and medical services for each individual must be personalised using unique information about this person, such as the genetic information encoded by their genome sequence. In fact, with decreases in cost and increasing availability, genome sequencing is no longer a technique of the future, but a test available to most clinicians(10).

It is worth mentioning that this “new era” started after the conclusion of the Human Genome Project in 2003. Evaluation of genetic predispositions have become more and more available. Now we can say that we are not “hostages” of your genes any longer. In fact, it was on the cover of Time Magazine on 18th January, 2010: Why your DNA is not your destiny.

As far as food choices are concerned, there’s a very important saying in this context: Not every healthy food is healthy for you. That’s the reason why each one’s diet should be personalised. Yet, new tools and models, including stem cell-based approaches and genome editing, have huge potential to transform nutrition research(7).

Being able to identify our genetic predispositions, we can find the best way to nourish ourselves, know which physical exercises are recommended for us, what to do to have a balanced microbiome, how to help our immune system react based on gene expressions, that is, to interfere more objectively on heath optimization and maintenance.

Why more Participatory?

Because there are many different professionals all over the world working to make possible a better and longer life for us all. Some scientists are concentrated on the development of therapies to enhance regenerative processes and possibly replace whole organs or tissues(11). Some digital programmers are working to optimize software developments to delight clients with breakthrough solutions. Physicists, matematitions, chemical workers, digital technicians, dentists, physiotherapists, psychologists, sport coaches, you know, all professionals can give some contribution to the possibility of reaching a healthier and prolonged life.

It is a very complex “puzzle”, because we can’t deny that we need technology, but we have got to use it only in our favor. That’s why simplicity is now part of a health optimization program(12). We have got to find some balance between the ever-growing technology available and the choices related to a “simple life”, maintaining connection to nature, having respect and being concerned about environmental policies and putting into practice the whole idea of Age Management Medicine.

Finally, why more Proactive?

Proactive perfectly suits Age Management Medicine. Because to maintain health during our lives, we have got to be a hell of a lot more proactive than we used to be. The idea of balance between body, mind and soul has to be worked on a daily basis. Meditation, for instance, a well-known stress-reduced technique, is ever so popular and its benefits have been proved scientifically(13,14).

Other issues which can not be postponed are those related to an organic life. When we become adepts at Age Management Medicine, our best options are to choose organic foods(15), organic beverages, reduce trash and litter production, avoid all types of environmental toxins, including plastic(16) and heavy metals(17), protect ourselves from radiation exposure in excess(18) and etc. That is to save the planet and ourselves.

In conclusion: The 5 Ps of Age Management Medicine is a relatively new philosophy in healthcare aimed at application of innovative technologies in the prediction of human pathologies, the development of timely prevention, individualised use of supplements and, if necessary, therapy-planning. The advantages of predictive diagnostics and personalised advice include prevention of the majority of disorders and substantial improvement of life-quality. This kind of progress can be achieved by highly professional application of currently available technological approaches(19).

Last, but not least, evolution of mankind is a continuous process. Sometimes we seem to go “too far” somehow in one direction. Then we realize that it is time to change. That unexpected or, maybe, some expected problems came about too seriously and we’ve got to move direction to survive. Age Management Medicine is growing to make known all this knowledge: that it is possible to work on health optimization and maintenance. We, as Age Management Medicine practitioners, shall do our best to make it succeed and always reinforce the possibility of living healthier and longer.

References:

  1. The digital revolution and the 5 Ps of Medicine. Paris innovation review. http://parisinnovationreview.com/articles-en/the-digital-revolution-and-the-5-ps-of-medicine Acessed at 24th December, 2019.
  2. Hu, C. S., & Tkebuchava, T. (2016). New “P” in Medical Model. Chinese medical journal129(4), 492–493.
  3. Fang, F., Jie, Z. Y., Xia, L. X., Ming, L., Zhan, M., Fen, G. S., & Cheuk-Man, Y. (2015). Cardiac Resynchronisation Therapy and Heart Failure: Persepctive from 5P Medicine. Cardiac failure review1(1), 35–37.
  4. Gardes, J., Maldivi, C., Boisset, D., Aubourg, T., Vuillerme, N., & Demongeot, J. (2019). Maxwell®: An Unsupervised Learning Approach for 5P Medicine. Studies in Health Technology and Informatics, 264, 1464–1465.
  5. Pugazhenthi, S., Qin, L., & Reddy, P. H. (2016). Common Neurodegenerative Pathways in Obesity, Diabetes, and Alzheimer’s Disease. Biochimica et Biophysica Acta (BBA) – Molecular Basis of Disease, 1863.
  6. What is Epigenetics? A Super Brief and Basic Explanation of Epigenetics for Total Beginners. Site: https://www.whatisepigenetics.com/what-is-epigenetics/. Accessed at: 24th Dec 2019.
  7. Mathers, J. (2017). Nutrigenomics in the modern era. Proceedings of the Nutrition Society,76(3), 265-275.
  8. Fenech, M., El-Sohemy, A., Cahill, L., Ferguson, L., French, T.-A., Tai, E.-S., … Head, R. (2011). Nutrigenetics and Nutrigenomics: Viewpoints on the Current Status and Applications in Nutrition Research and Practice. Journal of Nutrigenetics and Nutrigenomics, 4, 69–89.
  9. Predictive Medicine. Nature. https://www.nature.com/subjects/predictive-medicine Accessed at: 24th Dec 2019.
  10. Ashley EA. Towards precision medicine. Nat Rev Genet. 2016 Aug 16;17(9):507–22. A comprehensive review of fundament precepts of precision medicine and challenges to achieving the these goals.
  11. Larrick, J., & Mendelsohn, A. (2010). Applied Healthspan Engineering. Rejuvenation Research, 13, 265–280.
  12. Health Optimization Program. http://www.healthoptimizationprogram.com/ Accessed at 24th December, 2019.
  13. Goyal, M., Singh, S., Sibinga, E., Gould, N., Rowland-Seymour, A., Sharma, R., … Haythornthwaite, J. (2014). Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis. JAMA Internal Medicine, 174.
  14. Luders, E., Kurth, F., Mayer, E., Toga, A., Narr, K., & Gaser, C. (2012). The Unique Brain Anatomy of Meditation Practitioners: Alterations in Cortical Gyrification. Frontiers in Human Neuroscience, 6, 34.
  15. Hurtado, S., Tresserra-Rimbau, A., Vallverdú-Queralt, A., & Lamuela-Raventós, R. M. (2017). Organic food and the impact on human health. Critical Reviews in Food Science and Nutrition, 59, 1–11.
  16. Wu, P., Huang, J., Zheng, Y. P., Yang, Y., Zhang, Y., He, F., … Gao, B. (2019). Environmental occurrences, fate, and impacts of microplastics. Ecotoxicology and Environmental Safety, 184.
  17. Liu, A., Ma, Y., Gunawardena, J., Egodawatta, P., Ayoko, G., & Goonetilleke, A. (2018). Heavy metals transport pathways: The importance of atmospheric pollution contributing to stormwater pollution. Ecotoxicology and Environmental Safety, 164, 696–703.
  18. Krutmann, J., Schikowski, T., Hüls, A., Vierkötter, A., & Grether-Beck, S. (2016). [Environmentally induced (extrinsic) skin aging]. Der Hautarzt, 67.
  19. Golubnitschaja O. (2010). Time for new guidelines in advanced diabetes care: Paradigm change from delayed interventional approach to predictive, preventive & personalized medicine. The EPMA journal1(1), 3–12.

Isabela M. B. David, M.D. is a Clinical Nutrition Practitioner in the Post-Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina. Av. Pedra Branca, 25. Palhoça SC, 88137-270, Brazil. (2017)

Contact: contato.isabeladavid@gmail.com
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