We have seen the future of medicine-and it is tough on the eyes. The secret to radically improved health care lies at the cellular level, ground zero for disease, where everything is roughly 1,000 times as small as the period at the end of this sentence. Go ahead a decade or so, and doctors will wield molecular tools to switch genes on and off, taming diabetes and obesity, among many ills.
Researchers will harness tiny proteins to ward off any strain of influenza.
Precision-guided cancer killers will lay waste to tumors without so much as grazing the surrounding healthy tissue. No more chemotherapy side effects.
From a nano-sewing kit that mends severed nerves to a genetic switch that turns off fat genes, the future of molecular medicine looks bright. And that's no small thing.
This is what the not-so-distant future of medicine will look like. Over the next two decades, medicine will change from its current reactive mode, in which doctors wait for people to get sick, to a mode that is far more preventive and rational. People call it P4 medicine—predictive, personalized, preventive and participatory. What's driving this change are powerful new measurement technologies and the so-called systems approach to medicine. Whereas medical researchers in the past studied disease by analyzing the effects of one gene at a time, the systems approach will give them the ability to analyze all your genes at once. The average doctor's office visit today might involve blood work and a few measurements, such as blood pressure and temperature; in the near future physicians will collect billions of bytes of information about each individual—genes, blood proteins, cells and historical data. They will use this data to assess whether your cell's biological information-handling circuits have become perturbed by disease, whether from defective genes, exposure to bad things in the environment or both.
Several emerging technologies are making this holistic, molecular approach to disease possible. Nano-size devices will measure thousands of blood elements, and DNA sequencers will decode individual human genomes rapidly, accurately and inexpensively. New computers will sort through huge amounts of data gathered annually on each individual and boil down this information to clear results about health and disease.
Medicine will begin to get more predictive and personalized (the first two aspects of P4 medicine) over the next five to 10 years. First, doctors will be able to sequence the genome of each patient, which together with other data will yield useful predictions about his or her future health; it will be able to tell you, for example, that you have a 30 percent chance of developing ovarian cancer before age 30. Second, a biannual assessment of your blood will make it possible to get an update on the current state of your health for each of your 50 or so organ systems. These steps will place the focus of medicine on individual patients and on assessing the impact that genes and their interactions with the environment have in determining health or disease.
In preventive medicine (the third P), researchers will use systems medicine to develop drugs that help prevent disease. If, say, you have a 50 percent chance of developing prostate cancer by the time you're 50, you may be able to start taking a drug when you're 30 that would reduce substantially reduce that probability. In the next 10 to 20 years the focus of health care will shift from dealing with disease to maintaining wellness.
Participatory medicine acknowledges the unparalleled opportunities that patients will have to take control of their health care. To participate effectively, though, they will have to be educated as to the basic principles of P4 medicine. New companies that can analyze human genome variation, like 23andMe and Navigenics, are already planning to provide patients with genetic information that may be useful in modifying their behavior to avoid future health problems. In the future, patients will need not just genetic data but insight into how the environment is turning genes on and off to cause disease—just as smoking often causes lung cancer and exposure to sunlight can cause skin cancer.
P4 medicine will have a big impact on many industries, including pharmaceuticals, food and insurance, as well as health care. The interesting question is whether preexisting businesses and entrenched bureaucracies will be able to respond to these winds of change, or whether a host of new companies will emerge to replace them—focused precisely on these new opportunities.
Research will also have to change. Because most important diseases such as diabetes, cancer, heart disease, obesity and Alzheimer's are so complex, the traditional approaches to studying them have had only marginal results. Powerful new systems approaches, individual measurements and computational technologies will transform our ability to deal with complexity and fashion new drugs and approaches for therapy and prevention.
Medical education will also need to be transformed. Although today's medical students will be practicing P4 medicine within the next five to 20 years, their training is still focused on a classification of disease based on observation of relatively few measurements of health parameters. Tomorrow's physicians will need to be familiar with the complexity of the human biological system as never before, and they'll have to be handy with computer-based tools. Physicians will need to deal with patients who have an enormous amount of information at their disposal. And doctors will need to deal with maintaining wellness more than with disease.
The key benefits of P4 medicine, to the system and mostimportantly the patient, include innovative techniques to:
• Disease detection at an earlier stage, thus not only making the treatment more effective but also reducing the cost
• Stratify patients into groups that enable the selection of optimal therapy
• Reduce adverse drug reactions by more effective early assessment of individual drug responses
• Improve the selection of new biochemical targets for drug discovery
• Reduce the time, cost, and failure rate of clinical trials for new therapies
• Shift the emphasis in medicine from reaction to prevention and from disease to wellness
The digitization of medicine—that is, our ability to extract and store disease-relevant information from DNA and molecules in the blood of each individual—together with the revolutionary changes in diagnosis, therapy and prevention will allow those of us in the developed world to export P4 medicine to the developing world and thus transform the quality of its health care. The new P4 medicine will eventually lead to a universal democratization of health care, bringing to billions the fundamental right of health, unimaginable even a few years ago.
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