Do the difficult things while they are easy and do the great things while they are small.
Accurate knowledge and understanding of a person (assessment, risk prediction) precede and lay the foundation for improvement and targeted intervention (prevention and treatment). Objective testing could reveal earlier and better (more precisely) a person’s state (how a person is doing), and trait (what mental health abnormalities a person is at low risk or high risk for).
Biomarkers (biological markers) such as gene expression RNA levels (or protein or metabolite levels) are a sweet spot between accuracy and early detection (assessing state severity and predicting future risk). The interaction of genes and environment leads to gene expression, and underlies the subsequent ultimate manifestation of the symptomatic clinical illness. Thus, gene expression (RNA) is orders of magnitude more powerful and informative than genetics (DNA). As such, with biomarkers, one could detect things fairly precisely and specifically in terms of relationship to phenotype, and fairly early (allowing for early intervention or prevention efforts). Panels of gene expression biomarkers are more precise and specific than individual biomarkers. They can also inform what medications somebody is likely to respond to, based on biology (pharmacodynamics).
Single time-point testing of biomarkers for an individual can provide primarily information related to state and clinical severity levels. Repeated measures over time of biomarkers can provide better information related to trait and response to treatment. Watermark extreme states of a person, i.e. maximum levels, are particularly informative- if a river is prone to flooding, it will flood again in the future unless re-engineering and building occur. The past trajectory of a person coming into the present, and specifically the slope of change between time points, are informative as well: the most recent slope, and the maximum slope ever.
We propose the use of blood biomarker tests as part of routine annual exams, and whenever medications are changed. Comprehensive approaches, integrating biomarker testing as well as tracking feelings, thoughts and behaviors with apps, show the highest yield in terms of combining earlier detection with better precision of assessments. Most importantly, the blood biomarker tests can match patients to nutraceuticals and pharmaceuticals that fit their biology, in a precise and personalized fashion.
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