We stand at the brink of a fundamental change in how medicine will be practiced. Over the next 5-20 years medicine will move from being largely reactive to being predictive, personalized, preventive and participatory (P4). Technology and new scientific strategies have always been the drivers of revolutions and this is certainly the case for P4 medicine, where a systems approach to disease, new and emerging technologies and powerful computational tools will open new windows for the investigation of disease. Systems approaches are driving the emergence of fascinating new technologies that will permit billions of measurements on each individual patient. The challenge for health information technology will be how to reduce this enormous amount of data to simple hypotheses about health and disease. We predict that emerging technologies, together with the systems approaches to diagnosis, therapy and prevention will lead to a down turn in the escalating costs of healthcare. In time we will be able to export P4 medicine to the developing world and it will become the foundation of global medicine. The "democratization" of healthcare will come from P4 medicine. Its first real emergence will require the unprecedented integration of biology, medicine, technology and computation. as well as societal issues of major importance: ethical, regulatory, public policy, economic, and others. In order to effectively move the P4 scientific agenda forward new strategic partnerships are now being created with the large-scale integration of complementary skills, technologies, computational tools, patient records and samples and analysis of societal issues. It is evident that the business plans of every sector of the healthcare industry will need to be entirely transformed over the next 10 years.and the extent to which this will be done by existing companies as opposed to newly created companies is a fascinating question.