Page 105 - Journal of Special Operations Medicine - Spring 2017

counterproductive. We present several examples where issues), the Genome Aggregation Database (http://gno
individual differences have historically presented chal- mad.broadinstitute.org/), the government’s new Cancer
lenges to HPO research and application, but where, Moonshot initiative (https://www.cancer.gov/research
with a P2 approach, such differences might be leveraged key-initiatives/moonshot-cancer-initiative), the Human
to enable new opportunities to approach the goal of in- Behaviour Change Project (https://www.ucl.ac.uk/health
dividually optimized human performance. -psychology/research/HBCP), and other equally ambi-
tious projects.
Finally, we end with a few questions likely to be of
increasing importance if the notion of P2 continues In this new digital ecology, significant advances, if suc-
to evolve and mature. Acknowledging that P2 is still cessfully leveraged, could enable exciting advances to-
mainly conceptual, it will necessarily have to tackle ward P2 to accelerate discovery of new HPO tools and
many technical and cultural challenges to realize its po- methods as well as to tailor current approaches for
tential, much like the PMI. In particular, a key question individuals to truly realize their optimal performance
is how do we conduct rigorous, sufficiently powered, for different missions and contexts. Today, most HPO
but still practical HPO research that can lead to action- tactics have had to rely generally on a “one size fits
able P2 recommendations for individual warfighters all” approach to identifying best nutrition practices,
while avoiding being driven by trends or fads and be- conducting mental skills training, dealing with envi-
coming “HPO by anecdote”? ronmental exposures, guiding physical training, and
other efforts to improve or sustain performance. This
is particularly true within the military, where numbers
From Precision Medicine to Precision of people and sizes of organizations have traditionally
Performance? made truly optimizing an individual’s performance an
impractical task at best. Acknowledging those few ex-
“We must stop making the measurable ceptions, such as with elite athletes in training for the
important, and start making the important Olympics and within Special Operations, it is generally
measurable.” still true that recommendations are not necessarily tai-
—Former US Secretary of Defense lored to an individual’s particular, and important, dif-
Robert McNamara ferences, including their genome sequence, RNA and
protein expression, microbiome composition, health
According to many researchers involved with the PMI, history, lifestyle behaviors, diet, and/or social support
the path to developing truly individualized care will be and environment. Naturally, one has to ask how im-
realized by collecting, analyzing, and, most importantly portant each of these differences may be for optimizing
perhaps, integrating data from a wide range of sources: an individual’s performance. However, it is increasingly
genomics, proteomics, metabolomics, the microbiome, clear that we might, perhaps for the first time, really
environmental and social backgrounds, personal and begin to answer that question, enabled, like the PMI, by
family behaviors, as well as more traditional clinical technological advances in genetic and microbiome se-
and medical tests and records. By developing models quencing, an explosion of wearable and social sensors
based on an integrated approach, PMI’s goal is to iden- that capture many different kinds of performance data,
tify and deliver the most effective therapeutic treatment and new capabilities for storing, sharing, and analyzing
for an individual with a specific disease at a specific these data across many different levels (“from genes to
time. Notably, although the PMI emphasizes a role for groups”). This willl help guide HPO approaches that
basic scientific discovery to inform the development of may truly incorporate and fully exploit the most impor-
individualized care, much of the PMI’s approach is only tant individual performance differences.
now possible because of advances in technology—in
particular, enormous increases in computational power,
new data storage and collaborative tools, as well as Why Might Precision Performance Matter?
the ability to capture multiple kinds of individual and
group data at higher frequencies and with greater fidel- “Remember Orgel’s Third Law: Biology
ity. These are the same sorts of technological advances is always more complicated than you can
that have led to the launch of large-scale efforts to col- imagine, even after accounting for Orgel’s
lect and integrate different data to make new progress Third Law.”
on old problems. These include the Kavli HUMAN —Patricia Churchland
Study (http://kavlihumanproject.org), the Social Science
Genetic Association Consortium (http://www.thessgac. We have all seen differences among individuals—from
org), the International HapMap Program (a genetics the natural athlete who seamlessly masters any sport to
program taken down in June 2016 because of security the natural linguist who picks up multiple languages in

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