You can't get more personal care than this
Dr. Bradley Bale is the Medical Director of the Heart Attack Prevention Clinic in Spokane, Washington, and practices medicine with the Advanced Center for the Prevention of Heart Attack at the Covenant Heart and Vascular Institute in Lubbock, Texas.
The whole future of medicine rests with prevention.
With his Bale Method approach to preventing heart attacks, Dr. Bradley Bale has been breaking ground in what looks to be the future of medicine – preventive care.
As he puts it: “After 20 years of practice I looked back and realized a lot of patients over this time were not just patients, they had become friends. And more than I care to think of had suffered a heart attack or a stroke or actually perished from a heart attack or stroke, so I wanted to look into ways to try to prevent that in-stage disease.”The plain-spoken Medical Director of the Heart Attack Prevention Clinic had immediate success. By simply applying the current information on heart attacks from medical journals like Lancet, New England Journal of Medicine, and JAMA, he came up with what would be known as the Bale Method. Focusing on individual patient’s lifestyles and particular risks, Bale looked back on his first six years in preventive medicine and realized that, of his 3500 patients, not one had suffered a heart attack.
Prevention worked. He made up his mind that “the whole future of medicine rests with prevention and not treating in-stage disease.”
The more personal we can be for that one patient, the better off we’re going to be.
Dr. Bale explains where contemporary medicine often goes amiss: “What most practices are still doing is chasing numbers, so to speak. Oh, your cholesterol is too high, and our data tells us that some of those people are going to have a heart attack. So we’ve got to start treating your cholesterol.”
But these basic approaches are far from efficient, as Dr. Bale explains, “The reality is we know half the people with high cholesterol don’t have the disease. And half the people with good cholesterol, they’ve got horrible disease. So when you chase numbers, you’re forced to treat a patient as the average of a huge study population. The more you can actually get at the individual patient’s genetic makeup, the actual disease, do they have it or not, the better compliance you’re going to get with that patient, and the better care you can provide.”
Genetic data, especially, is a key tool in Dr. Bale’s practice. Beginning with the Apolipoprotein E, or APOE, gene, the doctor has used genetic information to shape specific treatment. The use of this information is straight forward, but it also demonstrates how specific information is essential in preventive medicine. Dr. Bale sums up the difficulty: “All the studies show alcohol reduces the risk of heart attacks. But in fact if you carry the APOE IV genotype, you can’t metabolize alcohol very well at all. It actually is not helpful in reducing the risk of heart attack and can actually be harmful. So we advise patients who carry that genotype to limit their alcohol intake, and preferably not take in any alcohol at all. Why do all the studies show that alcohol is beneficial? APOE IV genotypes are only about 20-percent of the population. So you do a big study with 30,000 people, guess what, they get diluted out. So they say `Oh, alcohol is beneficial,’ and that’s aimed at everybody.”
According to Dr. Bale, “Genetic knowledge is at the core of trying to personalize medicine. The more personal we can be for an individual patient in terms of advice and treatment the better off we’re going to be. And you can’t get any more personal than knowing a patient’s genetic makeup.”
In speaking with us, Dr. Bale comments on coming in contact with deCODE research: “The first big signal I saw that put my radar up was in 2006 in the journal Nature. It was published that they’d found one gene that was thought to account for 21 percent of adult diabetes. And the people who became diabetic who had that gene were generally younger, and leaner, and not overweight individuals.”The publication of research results on type-2 diabetes from deCODE genetics caught Dr. Bale’s interest some years ago and when it was announced in 2007 that it was possible to actually measure that gene in a real patient, he admits to becoming “very excited” about it.
Dr. Bale continued: “I had my nurse get hold of the company and figure out how can we get this done. And we started testing individual patients. It’s exciting to be one of the pioneers who will clinically discover what are the best treatments to help people with the type-2 diabetic gene disposition.”
The power of genetic testing.
We asked Dr. Bale to explain how he uses deCODE profiles in a specific case. He presented a case that demonstrated, he felt, “the power of genetic testing”:
“I have an actual patient. He’s a male. We know he’s having this atherosclerotic disease and he carries some risk for heart attack and stroke, and his genetic testing shows that he’s also predisposed to become a type-2 diabetic (which actually is the biggest cause of this atherosclerotic disease). He’s a healthy farmer. He eats very well. He’s not overweight. He gets exercise every day. But yet we can tell from his laboratory testing, his blood tests, that he’s still moving toward diabetes despite his best lifestyle efforts. So we discussed all this with the patient.
“We had the genetic test telling us he’s twice as likely as the average person to become a type-2 diabetic. He’s genetically predisposed. And we gave him the option of assistance with pharmacological treatment in addition to his excellent lifestyle, to try and halt the progression toward type-2 diabetes. This individual patient was in favor of doing that, so we now have him on treatment with the medication to see if we can offset this move towards type-2 diabetes with pharmacological treatment in addition to the lifestyle.
“It’s exciting from a personal standpoint being in preventive medicine to be on the cutting edge with this genetic testing, and to be one of the pioneers who will clinically discover what are the best treatments to help people with the type-2 diabetic gene disposition. Our patients certainly understand this is cutting edge, and they’re excited about it as well.”
From this specific case, Dr. Bale extrapolates on future uses of genetic testing in preventive medicine: “In my opinion, it’s information that everybody should have. And you could argue that the younger you are when you get that information, the more potentially beneficial it is.”
“The future, in my opinion, will rest heavily in genetic testing. And knowing, as much as possible, about the individual’s genetic makeup, and the earlier you know that the better.”