Precision Creativity (Episode 21)

Interview with Dr. Bernard Esquivel, International Chief Medical Officer at OneOme.

How do you decide which idea to develop? Many would go with gut-feeling, passion or “what feels right”, but there is a case to be made for picking our ideas with precision.

I got to learn about Precision Creativity in a conversation with Dr. Bernard Esquivel, International Chief Medical Officer at OneOme. OneOme was recently ranked as the 22nd most innovative company by Fast Company for its disruption of the health industry with its focus on personalized medicine.

OneOme, which is co-developed and exclusively licensed from Mayo Clinic, is a healthcare technology company whose genetic test helps doctors predict how a person may respond to hundreds of medications and enables healthcare providers to better optimize medications for their patients. Their RightMed test covers 27 genes, with indications for hundreds of medications.

The company is founded on the idea that giving medicine to individuals based on how a general test group reacted to a drug doesn’t always work well for an individual patient. For decades our way of treating diseases has been very blunt and quite inefficient. Enter pharmacogenomics (PGx), which studies how DNA may affect the way patients respond to certain medications.

Dr. Esquivel shared a mind-blowing statistic with me about how adverse drug reactions are the 4th (!) most common cause of death in the USA – or as Dr. Esquivel summarized it: “It’s a problem”. It sure is. And it is a problem that PGx can help providers solve. 

With modern gene technology, we can now identify how an individual patient may respond to a specific medication based on that patient’s DNA. It’s like going from trying to hit something blindfolded in the dark, to seeing exactly what you should hit.

Historically we could not imagine basing a medicine on one specific person. It was just 20 years ago that we were able to sequence the human genome for the first time, and then that cost more than 3.1 billion dollars to do. Today you can sequence the DNA of yourself for about 1000 USD. And suddenly we can now find out what drug will work on specifically your DNA.

Dr. Esquivel gave two examples of how precision medicine changed how we treat patients, by putting more focus on testing.

Example A: Historically we have been thinking in “diseases”. But it turns out that some people who have the disease “breast cancer,” may not all respond to the same treatment the same way. One patient may respond well, while another due to her specific DNA, may respond better to a medicine traditionally used for colon, or other types of, cancer. Pharmacogenomics helps providers give the right drug at the right dose at the right time for the right patient; considerably decreasing the risk of adverse drug reaction in anticancer treatments.

Example B: In the guidelines for what to prescribe to a patient who comes in with breathing problems due to Asthma it might say that you should give X or Y, but breathing problems can be caused by so many other things, like a patient being stressed from going through a divorce, or having issues at work etc etc. Finding out as much as possible about the patient can help to identify that the best solution is to prescribe meditation or counseling – and a lower dose of X, for example.

“Know more”, is the mantra of making precision decisions.

Precision decisions are, of course, not new. We could argue that mankind in all industries, and in all times, has tried to get more precise data and information in order to be able to make better decisions. And we see it everywhere: From advertising having to guess how well their advertising worked on TV and billboards to precise ad-tracking on Google and Facebook. From guesswork on how people traveled in a pandemic to real-time tracking of movements through mobile data. The more precise the data the higher the quality of the decisions.

As a matter of fact, it turns out that the words “precision” and “decision” have the same root meaning in Latin – meaning “to cut off”. When we decide to do something we actually “cut off” all the other things we are choosing not to do. And when we are precise we cut off all the things that are not essential for what we are trying to say or do. For both words we are cutting off something to focus on something specific.

So it could be argued that the more we focus on precision the easier the decision becomes – we know exactly where to cut.

I asked Dr. Bernard Esquivel how working in Precision Medicine had changed his thinking and he explained he was now more focused on finding unique solutions.

I then asked him to give a simple example on how I could use Precision Thinking for buying a gift for my wife for mother’s day. He said things like: “Do not just think “What does she like?” but think “What is she feeling right now?”, “What has she indicated that she might want to become?”, “What has she been buying recently?”, “What has she mentioned that her friends have been buying?”.” As he was digging deeper and deeper into this hypothetical Mother”s Day example I saw the power of using precision to improve your decisions – and for having better ideas.

The world of medicine is being transformed as we now can take precise decisions down to the individual patient’s DNA and current health metrics (thanks to real-time health tracking through things like Apple Watch etc). And it is highly likely that something similar is happening in your industry. What are the latest developments in tracking, measuring, capturing, collecting and understanding data that is now available in your industry that did not exist one year ago? How could they drastically improve the precision of your decisions? And how would that increase the quality of your ideas?




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