2. Medicine Pre-1900 ©2011 RALPH SNYDERMAN

3. Science and Medicine 1900s Germ Theory Chemistry Physiology Pathology Physics 2000s Genomics Proteomics Metabolomics Systems Biology Informatics Micro/Nano Processing Find It Fix It Predict It Personalize It Understanding Disease Understanding Health, Disease and Complexity ©2011 RALPH SNYDERMAN

4. Concepts of Disease Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Preclinical Progression Disease Initiation Disease Progression Irreversible Damage Causative Factor Disease ©2011 RALPH SNYDERMAN

5. Concepts of Disease Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Causative Factor Disease Enhance Health and Well-Being ©2011 RALPH SNYDERMAN

6. Initiating Events Disease Burden Time Cost 1/reversibility Typical Current Intervention Earliest Clinical Detection Earliest Molecular Detection Baseline Risk Personalized, Predictive, Prevention Personalized Medicine Tools Development of Disease ©2011 RALPH SNYDERMAN Personalized Health Planning

8. Shift to Personalized Health Planning Traditional Medical Evaluation and Record Chief Complaint History of Illness Past Medical History Family History Social History Physical Exam Diagnostic Tests Assessment and Plan Personalized Wellness Plan Current Health Status Clinical Risk Assessment Tracking Wellness and Pathogenesis Clinical Event Prediction Wellness Plans Patient Engagement Personalized Treatment Plan Mechanistically Defined Pathology Level of Disease Activity Best Therapeutic Intervention Tracking Factors Therapeutic Timeline and Plan Patient Engagement ©2011 RALPH SNYDERMAN

11. Personalized Diagnostics Diagnostic Testing Overview Source: Company websites, L.E.K. analysis ©2011 RALPH SNYDERMAN

12. Consider a 28 year-old man with a mass in his neck Personalizing Cancer Care ©2011 RALPH SNYDERMAN

13. ©2011 RALPH SNYDERMAN

14. ©2011 RALPH SNYDERMAN

15. Personalized Cancer Care Plan Advanced Clinical Decision Support Personalized Diagnosis Risk Models Companion Diagnostics Targeted Therapies Adverse Reaction Indicators Disease Activity Indicators Dx Evaluation Rx Selection Onset Remission Tracking and Refining Therapies ©2011 RALPH SNYDERMAN

16. New Model Validation Biocausality Engine Clinical Decision Support Diagnostics Selectors Clinical Risk Predictors Therapeutic Predictors Payer Adjudication CPOE CDS TM PDx TM Personalized Cancer Care Plan EHR Clinical Decision Support at the Point of Care ©2011 RALPH SNYDERMAN