The near future of medicine: an optimistic scenario
A person who is being liberatedGalina Kostina, Expert Magazine
In the next 20-30 years, a person will resort to cyborgization and genetic modification to increase life expectancy and improve its quality.
However, the real victory over age, according to some scientists, will be the ability to control the biological clock that triggers the mechanisms of aging.
My friend broke his leg at a party. Reclining in the forced pose of a Roman patrician, he fantasized about the future of orthopedics: "Here, so that once, I put something to my leg and went. Or he took a pill and went again. Or in general – he replaced his broken leg with a spare tire. Although no, it's kind of creepy." Meanwhile, on his foot was an ugly plaster boot – a product of technology from the creation of the world.
About the spare tire – this is, of course, too much. But as for the pill or injection, it is quite the foreseeable future. The medicine is likely to be either stem cells or drugs that stimulate their own stem cells or progenitor cells in the right direction - so that the bone quickly fuses.
Relatively recently, such an assumption would have been considered, if not a complete fantasy, then more than a vague prospect. However, very often scientific predictions come true much earlier than the date set by experts. Here they predicted the reading of the genome only at the end of the XXI century, but they read it at the beginning, they were already a hundred years wrong. Today, experts tend to assume that the biggest technological breakthroughs of humanity will be associated with the life sciences. According to Outlook Report 2009, the race of biomedical and genetic technologies will become one of the most acute and expensive in the world economy and will be comparable in scale to the space race of the last century. Having created a spaceship, a nuclear power plant, the Internet and a mobile phone, a person realized that technological progress mainly affected his environment, but not his life and health. He himself grows old, gets sick and dies, although, according to scientists, theoretically he could still live and live – much more than 100 years.
New knowledge about genes and cells obtained at the end of the XX – beginning of the XXI century, and new technical capabilities will finally allow a person to live longer and live better. Experts believe that in the next 20-30 years, breakthrough technologies will be used in those areas for which there are already groundwork. Telemedicine and robotics in healthcare will become the most widespread. The technology of replacing human organs with artificial ones will be introduced. They will be able to effectively treat cancer and neurodegenerative diseases. Personalized therapy will be actively developed. Genes, small ribonucleic acids (RNA), and stem cells will be widely used as therapeutic agents. The average life expectancy as a result of their use can reach 100-120 years. But this is not the limit, scientists believe, suggesting that aging is a program that allows the Genome of all living things to "cross out" bad individuals. An individual may be smart enough to resist such a dictatorship.
A surgeon in Moscow, a patient on SakhalinRecently, a story was shown on TV: in the Pirogov medical and surgical center, an operation is performed with the help of the famous Da Vinci robot.
The patient is surrounded by all the necessary specialists, except the surgeon. He generally sits far away and looks more like a child wielding a joystick in front of a computer. The movements of his hands are repeated by two thin robot arms, as if stuck into the body through small holes (with a traditional surgical intervention in such a situation, half of the animal would be cut). Two more robot arms help – illuminate the place of operation and transmit the picture to the screen. The robot, even the best surgeons admit, performs operations jewelry – more subtly, accurately, and therefore almost bloodlessly and without complications. After such an operation, the patient recovers much faster. The use of robot surgeons will make it possible to perform remote operations: a doctor can sit in Moscow, and a patient can lie in a clinic on Sakhalin. Robots in healthcare are used not only for operations, but, for example, for the care of bedridden patients. Nurses and loved ones know how hard it is to lift such a patient, to carry him somewhere; robots have learned to do it with ease and tenderness.
Experts predict that in ten years almost all operations will be performed with the help of robot surgeons. Moreover, these robots will be able to assemble themselves in the body, receiving parts that the patient will send inside himself, like dumplings. Such a robot Ares is already being developed in Italy. While, however, it is not reported how he will travel inside the body and how to get out after surgery. Maybe by self-disassembling and directing to a natural exit. Nanorobots capable of moving inside vessels are being tested in several laboratories around the world. In the future, they can become excellent diagnosticians and doctors.
Experts state that medicine is still one of the least computerized industries in the world. But this gap will be quickly eliminated. Powerful IT systems will help to significantly reduce the costs of treatment and patient care. At one of the international exhibitions, Philips demonstrated the wonders of technology in the ward of a cardiological patient. On the wall-screen, data constantly appeared about all the body systems that the attending physician needed to monitor online. The three-dimensional image of the heart rotated on the screen, allowing you to see all the smallest details. Some of the sensors were in the... blanket that the patient was covered with.
Remote treatment, consultations in the presence of test results transmitted via the Internet, X-rays, computed tomograms, electrocardiograms and other research data will become common practice, especially for remote areas.
Upgrade with scalpel and soldering ironA resident of California, Linda Morfut, experienced the real luxury of life only at the age of 64, when she was able to see her grandson playing in the yard, how huge the Statue of Liberty is in New York and how amazing the lights of Paris are from the height of the Eiffel Tower.
At the age of 21, she was diagnosed with retinitis pigmentosa, her vision was constantly deteriorating, and by the age of fifty she was almost completely blind. In 2004, she underwent surgery by installing an implant with 16 electrodes on her retina. In 2008, surgeons had already implanted a plate with 60 electrodes to several blind people, restoring their vision. A miniature video camera mounted in the glasses directs the captured images to the electrodes, which in turn, with the help of the optic nerve, forward the images to the brain.
Bionic hands are already very similar to real ones. There are veins-wrinkles on the silicone surface, and the hand itself moves, receiving signals from living nerve endings on the sensors embedded in it. So far, the names of those who became the owner of such a hand are printed in the press, but in a dozen years the operation will become ordinary.
The creator of the bionic ear Graham Clark from Melbourne has been working on his brainchild for more than 30 years. And already several tens of thousands of people, having such implants, can hear sounds that have long been forgotten.
There are already technologies in which brain signals control the cursor of a computer or allow a patient with paralysis after a stroke to pronounce sounds through a computer and a speech synthesizer. Scientists have taken a swing at entire parts of the brain. The University of Southern California has created the first prosthesis of one of the most studied areas of the brain – the hippocampus. It is believed that the main function of the hippocampus is the so-called short-term memory. If this part of the brain is damaged by stroke or Alzheimer's disease, the new hippocampus can significantly help people. Experts managed to create a chip instead of the hippocampus, which communicates with the brain with two bundles of electrodes. One signal goes from the brain, the other – to the brain. The chip should not be implanted under the skull, it is attached to the skull. While the hippocampus is being tested on rats. The success of these tests allows you to dream about how to expand the capabilities of human memory and easily upload into it not only the instructions for driving a helicopter, as in the Matrix, but also textbooks of foreign languages, philosophical treatises or economic statistics, in general, what anyone needs. However, while scientists call such a download dreams – it will take a lot of time to comprehend the fundamental foundations of brain functioning. And it is difficult even to predict to what extent it will be possible to improve the brain-computer interface.
Bionics scientists once came up with an emblem for themselves – a scalpel and a soldering iron connected by an integral sign. New technologies involve other symbols in bionics. Now the device "Artificial kidney" occupies almost an entire room. Scientists are working on compact models. Stem cells with directed differentiation can be used in technologies for creating organs that are quite simple in function, but very complex in structure, such as the kidney or liver. Since it is not yet possible to create whole organs from these cells, it is possible to combine them with artificial materials, they will be mainly an architectural part of the organ, and implanted cells will be the content.
According to TechCast Project estimates, the mass introduction of technologies for replacing many human organs with artificial ones should be expected in 2022 (plus or minus five years).
Drug EvolutionHowever, while we wait for a wonderful future, people will die from incurable diseases today.
However, progress here has gained quite a good speed in recent decades. So, according to oncologists, cancer has already ceased to be a symbol of inevitable death. New knowledge of genomics and proteomics made it possible to design so-called targeted (targeted, selective) drugs that act on a specific target of a cancer cell. "Look at how pharmaceutical approaches have evolved over the past hundred years," comments Andrey Ivashchenko, head of the HimRar High Technology Center. – At first, the effectiveness of the drug was simply tested on an animal: it will work – it will not work. Then animal organs were compared with and without treatment. In the second half of the XX century, they learned to see the effect of the drug at the level of tissue, and then cells. And only at the end of the XX – beginning of the XXI century there was a modern understanding of the biomishen – a specific protein that needs to be affected. Understanding such a target and the technical capabilities of experimentation make it possible to select very selective substances much faster. Such targeted drugs are much more effective and less toxic." For example, a modern anti-cancer drug does not just bombard cells, but blocks a well-defined protein receptor on a tumor cell that transmits a signal for unrestrained cell division.
If until relatively recently almost nothing was known about many proteins – neither about their structure nor about their functions, massive research accumulates more and more information, which becomes the object of modeling for pharmaceuticals. However, in the case of such a multifactorial disease as cancer, new knowledge also brought new sadness. «…We have seen a variety of factors and mechanisms that induce it (cancer), and this weakens the hope for universal methods of therapy," Roman Khesin, a well–known Russian molecular biologist, wrote at the time. But scientists do not despair, continuing the search for "multifactorial" approaches.
Of course, there is a great temptation to solve the problem radically – to fix the pieces of DNA damaged by mutations. And serious research and experimental work is being carried out in this direction. "In gene therapy, the key problems have not yet been solved – the effective and accurate delivery of such structures to the right place, into tumor cells," comments Sergey Lukyanov, head of the Laboratory of Molecular Technologies at the Institute of Bioorganic Chemistry named after M. M. Shemyakin and Yu. A. Ovchinnikov. "Attempts are being made very actively, but, unfortunately, success has not yet been achieved."
Despite some pessimism, many scientists still believe in victory. "Two of the world's first gene therapy drugs against cancer have already been released to the market in China," says Sergey Kiselyov, head of the Laboratory of Genetic Foundations of Cell Technologies at the Vavilov Institute of General Genetics of the Russian Academy of Sciences. – Our laboratory, together with the Bakulev Center, conducted clinical trials of a gene-therapeutic drug created by us that stimulates vascular growth in patients with coronary heart disease. And it is not necessary now to be able to direct the right gene to the right place in the DNA, it can hang out in the right cell for some time and produce the necessary protein. I am sure that in the next decade there will be gene therapy drugs for the treatment of certain oncological, cardiovascular, immunodeficiency diseases."
Stem cell-based drugs are also being developed in the same laboratory. In many ways, the hype raised by the press around the miracles with stem cells, when the earliest works were given out as a sure victory, spoiled the reputation of the cell industry. However, it is already known that favorable results of therapy with cells of varying degrees of stemness have been obtained during clinical trials for more than 60 diseases. And the fact that at the end of the XX century, large pharmaceutical companies that avoided any ties with stem cells at the beginning of this century began vying to announce serious budgets for stem cell projects speaks for itself.
Scientists place more hope on working with small RNAs, for which the Nobel Prize was awarded not so long ago. As always, small, seemingly worthless, practically garbage RNAs were ignored for a long time. And only recently it became clear that they are able to do what researchers are trying to do for the treatment of a number of diseases – selectively turn off genes. If in some cancers a gene produces a defective protein, with the help of artificially synthesized small RNA, this gene can simply be plugged. This smallest RNA is also an excellent tool for research: by turning off genes, scientists understand their functions better, and there are more chances to find ways to treat various diseases associated with mutations in DNA.
Mass diagnosis, individual treatment"The US National Institutes of Health has set researchers the task of determining the sequence of the human genome for $ 1,000, which will be comparable to the cost of a trivial analysis," says Professor Sergey Mirkin of Tufts University (USA).
– Apparently, this task will be solved in the very next few years. It will be possible to determine the sequence of the genome of each newborn, and in the foreseeable future – genotyping of all mankind."
According to Sergey Lukyanov, a few years ago there were revolutionary changes in DNA sequencing technology: "Fundamentally new highly efficient sequencers were created, allowing to obtain information in the amount of up to 100 billion nucleotides per reaction. For comparison, the most effective sequencers of the previous generation, based on capillary electrophoresis, helped to obtain information about the structure of up to one million nucleotides in one production cycle. This allows us to count on the emergence of a new era in medical genetics, an era based on the analysis of individual genomes of millions of people. In my opinion, this will lead to a new level of our understanding of the causes and mechanisms of diseases in the next decade, will allow us to develop individual recommendations on the living conditions of different people and ultimately on the development of individual medicines and treatment programs. That is, we will finally be able to realize the millennial dream of physicians – to move from treating the disease to treating the patient!"
Continuing the topic, Lukyanov says: "So far we don't know much about the links of genes with diseases. The more genomes are sequenced, the greater will be the basis for research and discovery of the causes of many diseases."
This is especially true of multifactorial diseases. "The genetic foundations of diseases such as cancer, Alzheimer's disease, schizophrenia will be established," Mirkin believes. – Every person from the moment of birth will have information about diseases that may occur over the years. And understanding the causes of many diseases will lead to the creation of new drugs aimed at specific components of cells responsible for these diseases. The most important consequence of mass genotyping will be the development of so-called individual medicine: the patient's treatment will be linked to his genotypic features."
It is already clear that the treatment of many oncological diseases requires an individual approach. The grueling fight against cancer has shown that, it would seem, the same oncological disease can respond to therapy or not. It turned out that there are no identical tumors. In particular, it was found that in about 25% of breast cancer cases, a large number of HER2 receptors are observed on the tumor cell, and a special drug blocking this receptor was selected for the treatment of this type of cancer.
The purpose of individual or personalized medicine is to find the right medicine for a particular person, optimize the treatment regimen and control this process. Personalized medicine is also one of the leading trends in the global pharmaceutical industry: companies are developing both the latest diagnostic systems and precisely hitting the target drugs. According to Outlook Report 2009, the widespread introduction of "individual" medicines will also begin around 2030.
The individual will rise up against the speciesThe latest technologies that will help to recognize diseases in the bud and correct errors in the functioning of the body by various methods will naturally allow a person to live longer.
According to the estimates of TechCast Project experts, by 2030, life expectancy will reach an average level of 100 years. "Genetics can help, but it cannot solve the problem in principle," Sergey Mirkin believes. – There are quite a lot of super-old people living in the world now, and their genotyping can give clues to which genes are conducive to longevity. However, even with an ideal genotype and an impeccable lifestyle, the biological limit of human life can hardly exceed 120 years."
However, there is no consensus about such a limit, since there are several different concepts describing the key causes of aging. Scientists, who believe that aging is a program and can be turned off altogether, do not even risk naming life expectancy figures in order not to be considered science fiction. "Darwin, Wallace and Weisman suggested in the XIX century that the death of an individual could be altruistic for a family or community," says Academician Vladimir Skulachev, director of the Belozersky Institute of Physico–Chemical Biology. – In the last century, Hamilton suggested that the main unit of selection is not an individual, but a gene. In essence, we can talk about the dictatorship of the genome, the only self-reproducing biological structure, the preservation, development and expansion of which has acquired priority over the well-being of the individual. Within the framework of this concept, an individual is just a device, a machine that ensures the interests of the genome."
Skulachev believes that the dictatorship of the genome is supported by the samurai principle "it is better to die than to make a mistake": any critical condition of the organism in which it is unable to guarantee the safety of its genome and in case of recovery can reproduce offspring with a corrupted genome should be a signal for self-destruction. By analogy with the program of cell self-destruction called apoptosis, Skulachev calls the self-destruction of the organism phenoptosis. And aging is slow phenoptosis.
"You know, in our situation, the life of an individual is not worth a penny," says Vladimir Skulachev. – There is a ruthless dictatorship of the genome – terror. It should capture as much space in the biosphere as possible. Any genome of creatures has been formed for billions of years. If it is lost, it will never be reproduced. And the fact that this is not happening means that there are many programs. And one of them is self–destruction: a black sheep should not spoil the genome of the species." Skulachev gives such an example. The man caught a severe infection. His temperature rises, because of this he weakens, lies down, does not go anywhere. That's right, he shouldn't infect other individuals. Then – cured or died. But he died with all the bacteria. From the point of view of the genome – everything is fine, from the point of view of the individual – not very much. For him, self–destruction as a result of acute illness or slow in the form of old age is a counterproductive program.
"We are machines that carry out the orders of the genome. But we can stop this outrage – arrange an uprising of machines," says Skulachev. "And I think the future of medicine is saving humanity from itself."
If a person reveals the mechanisms of counterproductive programs, he will win this uprising. In a good way, he needs to get to and study the so-called biological clock, which launches a human development program, starting with two cells, and then an aging program. In the meantime, Skulachev is developing a new generation of drugs that act on the aging process as an antioxidant. If his assumption is that the program of slow phenoptosis, or aging, uses toxic oxygen forms in mitochondria, then the means developed by the scientist will delay aging. "The abolition of counterproductive programs will be the greatest achievement of medicine of the XXI century," says Skulachev, "and will symbolize the transformation of homo sapiens, a reasonable person, into homo discatenatus, a liberated person."
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28.09.2009