A recent article* appearing in Scientific American magazine points to several developments coming together to transform the practice of medicine as we know it. I cover a few of the key points here and comment on their implications for both the practice of medicine and longevity.
At some point in time, perhaps starting around 2025 certain key practices will be in place including:
· The practice of medicine will focus much more on prevention, anticipation of disease susceptibilities and taking early actions for disease avoidance by utilizing a wealth of information about an individual’s genetic makeup and health state at the moment in a systems context. Specifically:
o It will economical and practical for individuals to have their entire genomes sequenced and kept on file. Cost may be less than a few hundred dollars and virtually everybody will do this.
o It will be economical and practical to take snapshots at any given time of up to hundreds of thousands of protein and mRNA (messengerRNA) molecules that are characteristic of the absence, presence or emergence of most major known disease conditions in most organs. No matter where the problem may be, much information as to disease states flows freely in the blood as mRNA and protein molecules and a single droplet of blood is all that are needed for testing.
· Sophisticated computer models will exist that relate both an individual’s SNP gene variations and critical observed mRNA and protein-level patterns to disease susceptibilities, the state of health of an individual, the possible emergence of any disease condition, or the early-stage existence of a disease that is not yet overtly manifest. Medicine will become a systems science where diseases and disease susceptibilities are observable as signature molecular patterns. The entire process of blood analysis and disease condition analyses and predictions will be automated and cheap.
· The most important medical interventions will be preventative ones, taking actions early before serious diseases become manifest rather than trying to repair a situation where much of the damage is already done. Costs for prevention will be vastly lower than later costs for treatment.
· The result will be a much healthier longer-living population and much lower average health care cost. What is needed to get there? Several things:
· Great reduction in the cost of sequencing entire individual genomes. The cost of sequencing has been following a version of Moore’s law (every year, cost of a given sequencing task drops by half), and if this trend continues sequencing an entire genome for a few hundred dollars will be practical in less than 10 years.
· Technologies that allow massive scale mRNA and protein screening at very low cost. It is likely that microfluidic chips will play a major role here, and these also are showing price-performance improvements according to a version of Moore’s law. Critical to this path in evolution of medicine is “the extreme miniaturization of technologies for making diagnostic measurements from minuscule amounts of blood or even single cells taken from diseased tissues. These emerging tools, constructed at the scale of microns and nanometers (billionths of a meter), can manipulate and measure large numbers of biological molecules rapidly, precisely and, eventually, at a cost of pennies or less per measurement. That combination of cost and performance opens up new avenues for studying and treating disease by permitting the human body to be viewed as a dynamic system of molecular interactions(ref).”
· Much additional research and computer modeling relating SNPs, critical protein and MRNA levels to disease susceptibilities, pre-disease and disease conditions and embodiment of this research into sophisticated predictive models. Therapeutic models are needed as well. It may take over a century for this task to be completed but I expect work should be well along in by 2025.
· Much more personal participation in health related activities.
· A context of proactivity for taking actions to protect against disease conditions before they are manifest.
· A change in the model of practice of medicine will occur to focus on the five Ps, personalization, prediction, prevention, participation and proactivity It may take over a century for this task to be completed but the shift should be well underway in 15 years. It is interesting that those of us concerned with extending our lives in a context of health are already there with most of these Ps. What we are missing are good tools for prediction and personalization.
An analogy can be made between maintaining health and keeping an automobile running well. In 1952 you brought your car into a garage when it had a serious problem and tried to get it repaired. That is what most medicine is like today. A three year-old car with 50,000 miles was an old car headed soon for the junkyard. If your brakes fail on the highway – well, too bad! Now you bring in your car for scheduled maintenance and the mechanic with the aid of inboard computers checks for hundreds of possible problems. You fix them before they become manifest. If your brakes have recently been checked out with care, there is much less a chance they will fail on the highway. That is like what medicine is becoming. As to longevity, a three year-old Toyota or Honda with 50,000 miles today still has most of the value of a new car and is only a third of the way through its lifetime. The age of 65 was once old; it is becoming mid-life and, if I am right about life extension, at some point will be seen as young. You have to bring a car into a garage for an unforeseen problem rarely until the car gets very old. The same should become true for hospital stays. (Of course, improved quality of auto construction has a lot to do with the changed auto picture too, but the analogy still stands.)
* The Feb 2009 Scientific American article is entitled Nanomedicine–Revolutionizing the Fight against Cancer, by James R Heath, Mark E Davis and Leroy Hood. It was interesting to me in that it brings forward the points covered above.