A look into the future
What do our doctors think about the medicine of the future
LenaZhernova, Leader-ID company blog, Habr
If you ask scientists about the future, you will almost never get a normal answer. They try to be objective, so it is difficult for them to talk about what is still only at some early stages of verification. And even if they have ready-made samples or the results of successful experiments on their hands, they still know that it may never reach everyday use. Or, when it comes, everything around will change so much that the epoch-making discovery will no longer be relevant.
But this does not stop anyone, and populist questions are asked to scientists all the time. For example, is eternal youth waiting for us? Is there a chance to find cures for incurable diseases? What will medicine be like in 30 years? What will happen to transplantation and genetic engineering? When will a mechanical heart start pounding in a person's chest for a long time and artificial or printed organs start working? And so my colleagues interrupted several scientists from their work and asked all this. They answered with understanding.
Below is a squeeze from the round table, where several of our scientists made reports about the medicine of the future, in which they themselves believe, and about what problems there may be with it. Yes, and this time – without the topic of coronavirus.
We met in an online format. My colleagues from NTI initiated the meeting as part of the HealthNet initiative. The moderator was Yaroslav Ashikhmin, cardiologist, Advisor to the Director General of the International Medical Cluster Foundation, PhD, and Andrey Lomonosov, Deputy Head of the Biomedicine direction of the HealthNet working group.
In the interlocutors and speakers they had:
- Dmitry Sychev, Rector of the Russian Academy of Sciences, Corresponding Member of the Russian Academy of Sciences, Professor, MD;
- Simon Matskeplishvili, Deputy Director for Scientific Work of the Moscow State University Medical Center, Cardiologist, Corresponding Member of the Russian Academy of Sciences, Professor, MD;
- Mikhail Samsonov, Director of the Medical Department, CFR, RFarm;
- Ilya Yasny, Head of Scientific Expertise, Partner at Inbio Ventures;
- Dmitry Fadin, Director of Strategic Development and Innovation of INVITRO, Director of Development of the 3D Bioprinting Solutions laboratory.
Some of them are quite public people. Periodically I come across numerous reposts of their notes on Facebook concerning the pandemic, coronavirus research and other things. They write adequately and interestingly.
As a result, after the conversation, I got a thematic squeeze in different directions. I specifically chose the format of detailed quotes to convey the main thoughts and remove all the water. So, let's go.
There will be no full-fledged personalized medicine, there will be predictive
There is a lot of talk about personalized medicine today, but this direction cannot be the dominant approach, since it is impossible to create a million treatments for a million people. Medicine will be more preventive, predictive.
The future is not about how we will treat diseases, but about how we will prevent their occurrence.
Treatment in the future will identify and affect specific risk groups. As a result, the accuracy of identifying risk groups for each disease will increase.
Machine learning will be used to prevent serious diseases. He will also be entrusted with the selection of methods of treatment. Prototypes of these systems are already being tested with might and main. It will be a tool that simplifies the work of a doctor – diagnosis and treatment selection. But even after a hundred years, artificial intelligence will not be able to replace live communication with a person. In addition, for many patients, communication with a doctor itself gives a positive psychotherapeutic effect, so people in white coats will not go anywhere.
In addition to the paradigm shift associated with the transition from curative (treating) medicine to preventive medicine, we will have to face another big problem – financing. Today, companies that produce drugs, devices, operating and diagnostic machines have a direct impact on the development of medicine in general. If technology allows to prevent the occurrence of diseases, a number of medicines may be unclaimed. In addition, manufacturers of all kinds of "fuflomycins" will come under attack. As a result, the conflict of business interests, medicine as a science and society will worsen.
They will cure oncopathology and diabetes
In thirty years, Simon Matskeplishvili is deeply convinced that oncological diseases will prevail. This does not mean that they will not develop, but doctors will know how to treat all types of cancer.
In the predicted period of time, the problem of diabetes mellitus, including type I diabetes mellitus, will also be solved. The reason for such optimism is the success that doctors have achieved in the field of transplantation of pancreatic islet cells.
After transplantation, islet cells begin to produce insulin, actively regulating the level of glucose in the blood.
This still experimental method is considered the most likely direction of diabetes treatment.
Big bets on transplantation and mechanical organs
Russia is the first country to offer open organ transplantation, including heart transplantation, which was first performed on dogs by Vladimir Petrovich Demikhov. After Demikhov's student Christian Barnard transplanted a human heart at the University of Cape Town, orthotopic transplantation (from one donor to another) became the gold standard in the treatment of severe heart failure.
But the number of donors is not infinite, and it is obvious that artificial mechanical heart technologies will be actively developed in the coming decades. Moreover, the heart, if compared with organs such as the kidney or liver, is a relatively simple organ for transplantation.
In fact, it is just a pump that can be easily replaced by a mechanical device. Such technologies have been around for a long time. An artificial heart can be fully implantable or operated by external pumps. But to give an unambiguous answer to the questions "Will an artificial heart be the result of regenerative medicine?" and "Will cyborg people appear?" is not yet possible.
Today, mechanical devices that simulate the work of the heart have a number of significant drawbacks that will need to be eliminated in the future: they cause problems with blood clotting, thrombosis, bleeding, destruction of red blood cells.
Mechanical devices based on the principle of levitation partially solve these problems: in devices the size of a palm, the rotor is suspended in a magnetic field, so that there are no touching parts, and the turbine operates at a speed of 10 thousand revolutions per minute.
Definitely, such devices are the future, they will be improved and used everywhere until the level of regenerative medicine allows to obtain biological replacement of organs. In any case, in a hundred years, anyone will be able to order a new heart.
This is how, for example, the rotor of the domestic "Satellite" looks like (lvad.ru ), designed to replace the functions of the left ventricle of the heart.
Regenerative medicine: growing and printing organs on the way
Another promising technology is bioprinting, with the help of which it is theoretically possible to recreate the heart from the cells of the patient himself. Autologous transplantation solves a lot of problems associated with the rejection of organs by their own immune system – in particular, patients will not need immunosuppressive therapy.
Scientists have made significant progress in the regeneration of individual organs and tissues, including the heart muscle.
Here it is worth recalling the recent success of scientists from Tel Aviv, who have already managed to print a rabbit-sized heart from living tissues grown in a test tube on a 3D bioprinter.
It is important that this is not just a myocardium (cardiac-type muscle tissue), but a tissue with already imprinted blood vessels. They were reproduced on the basis of a separate mathematical algorithm.
This achievement in the field of bioprinting proves that in the future we will be able to print both heart valves, and various cavities, coronary arteries. Regeneration of the heart can also be realized with the help of cellular and gene technologies.
There will be precision medicine
Today, the reactive model of medicine prevails in the world – this is when there is an approved set of instructions and prescriptions that doctors are required to strictly follow when treating a disease. In accordance with them, for example, a patient is "individually" selected one medicine from several prescribed ones, acting by trial and error.
In contrast to the reactive model, precision medicine provides tools – biomarkers. Biomarkers are a broad concept, they can include everything from pulse rate to DNA composition. In this case, we are talking about substances that are formed or accumulate in the body and signal characteristic processes or structural features. Biomarkers allow the doctor to choose a drug with high clinical efficacy that will not cause adverse reactions.
Comparison of approaches of the reactive model of medicine and precision. In the first case, after the diagnosis, there is a choice of drugs and their multiple changes, if they do not work. In the second diagnosis, together with an assessment of predispositions and features, immediately indicates the correct drug.
Aspirin will remain in service
The old time-tested drugs are not going anywhere. For example, colchicine has already found use in the fight against COVID-19. Recent studies have shown that colchicine not only has a favorable safety profile for the cardiovascular system, but also reduces the risk of ischemic complications.
Additional studies will be conducted on old drugs, during which they will look for biomarkers of maximum efficacy and safety with the prediction of individual pharmacogenetics.
According to Dmitry Sychev, the study and comparison of biomarkers for a number of old drugs has been conducted for a long time by scientists of the Russian Medical Academy of Continuing Professional Education (RMANPO). They do it in stages. First, there is an association of biomarkers with a poor response (when the drug did not give a therapeutic result), then clinical validation of the algorithm (evaluation of effectiveness in a test group of patients), and finally, implementation into the healthcare system with mandatory consideration of the profitability of the project.
The old drugs will be tested according to the new schemes described above.
Genetics in terms of predicting outcomes or efficacy and safety does not play a primary role, it is much more important to look at clinical indicators. Genetics only helps to increase the accuracy of this forecast.
Technologies for detecting biomarkers based on PCR will become cheaper and more accessible. Therefore, in a hundred years, every inhabitant of the Earth will be sequenced and fully decoded by DNA. In a few decades, medicines of a fundamentally new type will appear.
A biomarker will correspond to each drug, ensuring that this particular person is effectively treated with this drug.
Cell and gene therapy, CRISPR-Cas – this is more difficult
The production of cellular and gene therapies is still very expensive. For example, the cost of gene therapy for hemophilia is over 150 thousand dollars for one dose of the drug. Over time, the situation should change. Automation technologies, fluid technologies – all this will help to reduce the price of drugs of this kind. By the way, there is an opinion that medicines are growing in price all the time. It is rather political populism, the purpose of which is to mislead the inhabitants.
New developments are protected by patents for only 20 years. After that, they become public domain and any specialized institution can engage in their production, generating competition.
If we look into the distant future, then gene editing, for example, with CRISPR-Cas techniques is a promising direction of modern genetic engineering. Today, the accuracy of the CRISPR-Cas system is insufficient to apply it in vivo, it is relevant only for individual cases when only those cells that will not harm the body due to their erroneous side editing can be selected from people for modification. There is no doubt that in a hundred years the accuracy of the methods will increase.
An example of DNA editing by CRISPR/Cas9.
These technologies make it possible to influence at the gene level at all stages of the development of the organism, including embryonic. It is unknown how these and other bioethical issues will be resolved. Medicine of the next hundred years will change dramatically, and how it will look depends solely on how these problems will be solved.
A separate fundamental area that will begin to bear fruit very soon is technologies at the level of individual cells, when their genome is sequenced and they look at the dynamics of proteins. While there is a stage of accumulation of knowledge in this area, but in the end it should cause a qualitative breakthrough in a certain area, for example, to help in the study of the brain.
Scientists expect that nanorobotic technologies will develop in the next hundred years. There will be complex molecular complexes that can be launched into the human body for monitoring and treatment. Perhaps they will be implemented on the basis of genetically engineered cells. Nanomechanisms moving in the body will appear, which will collect information about undesirable deviations of a given parameter.
Medicine will become invisible, and aging will remain questionable
The desire for comfort is inherent in human nature. Therefore, it is not surprising that the more complex the technology and the greater the progress in science, the stronger people's desire to forget about health–related problems. In the future, this "lazy" position will have a direct impact on trends in medicine. The advantage will be on the side of non-invasive technologies, as well as technologies that will provide an opportunity to take care of human health unnoticed by him.
On the one hand, this will cause a boom in wearable devices that will monitor key human biomarkers and monitor their indicators, on the other hand, it will become an incentive for the emergence of new non–invasive technologies.
The speed of development of directions in medicine will be very high. So, in 2011, it was possible to quickly hold a consultation on bioprinting with two dozen leading specialists. In 2021, there are already hundreds of groups and a huge number of collaborations. Their number is growing every day, and this has a positive effect on the overall progress in research.
During the discussion, Dmitry Fadin expressed doubt about the correctness of the directions that hinder such fundamental processes as aging. In his opinion, this mechanism has a deep meaning and its destruction can lead to unpredictable consequences. Perhaps much more severe than the natural withering of the body.
As a detached example, he cited the question of an 80-year-old friend who was given a series of tests and predicted that she would live to 120 years. She planned to travel all over the world and painted her life up to 105 years old, but she does not know what to do next. And the question of meanings here should come first.
Although these are no longer medical issues.
There will be problems that we don't know anything about right now
We will live longer and think less about health, as disease prevention will become a service. But there will be a lot of new problems ahead that we don't know about yet. Their emergence will be facilitated by new circumstances and environment: the climate is changing, the human diet is replenished with new products, the stress level is increasing. There will be new pandemics. The current pandemic is respiratory–systemic, perhaps not the most dangerous and certainly not the last.
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