Future of medicine – the critical path forward
I saw a presentation yesterday by Carolyn Compton, the new head of C-PATH, the critical path institute located in Tucson, AZ. This group has the goal of accelerating the development of new medicines by working at the interface between pharmaceutical companies, academic researchers and clinicians, the FDA, and the public.
Dr. Compton spoke especially on utilization of sequenced genomes of individuals could impact medical diagnostics. The cost and time has dramatically decreased to the point where it is now feasible to sequence an individual’s genome in less than 24 hours at a cost of less than $US 1,000. This information could be used to select patient-specific interventions. For example, breast cancers that are HER2+ should be treated with Herceptin® since this intervention is truly a life saving approach; but if the cancer is HER2- (not having the HER2 mutation), the treatment is not likely to be effective and essentially $US 100k per year for treatment is poorly spent. In this example, having the knowledge of a disease’s genetic fingerprint is crucial in selecting a treatment.
Dr. Compton spoke on identifying many more paths by which a diagnostic physician’s judgement could be better replicated by detailed heuristics based on better diagnostic tools. She referenced the long repeated concept that individuals can consider only 5 inputs when making a decision. What is to be done when there are >5 relevant pieces of information?
We are moving toward greater utilization of computerized expert systems to guide medical diagnostics. How quickly these are implemented depends not only on the development of technology but also on the public acceptance and acceptance by the medical community. Biological engineers are developing tools for rapid detection of SNP’s, of certain microbial components of disease, and in physiological function. Many of these use lab-on-a chip approaches, microfluidics, nanotech, etc. Will we every get to the point where medical diagnostics do not require human intervention?
I think that medicine will eventually become fully automated in which an individual who is not feeling well would be able to self collect a relevant sample (perhaps a finger stick) which is inputted to equipment which quickly reports back not only what is the problem but also provides a list of recommended interventions. Certainly many diseases are not driven by host genome but include infections, environment-gene interactions, and physical trauma. My assumption is that deep diagnostic techniques will follow for each of these in the wake of utilizing personalized genetic medicine.
Do we need to rely on the judgement of a physician? Many (most, but certainly not all) have excellent judgement and can see connections and use intuition. Could we some day be able to replicate this intuition (especially an intuition which is developed through varied training and experiences – a sequence which could be replicated digitally)? If such a path is feasible for medicine, it should also be feasible to address environmental challenges, personalized nutrition, and the like. I do have faith in technology, although we must be cautious to not over hype the coming developments which would raise the public’s expectations unrealistically and too quickly.






