Waiting for flashing
The boom of medical innovations can give a person immortality, but it threatens with unpredictable consequences
Ivan Dmitrienko, "Profile"
Scientists at the Massachusetts Institute of Technology (MIT) reprogrammed the brains of mice, in the UK decided to create a single DNA database of the country's inhabitants, in Skoltech created a robot assistant for genomic research. These are just three June news items that flashed among hundreds of news about new developments in bioengineering and medicine. A whole range of technologies is being developed in these areas, which together will radically change the approach to health protection.
In the digital medicine of the future, there will be no treatment of diseases, nor hospitals themselves: the doctor will be able to monitor the patient's condition online, and the main task will be to bring the organism given by nature to perfection. But in addition to promising prospects, the "upgrade" of a person is fraught with dangers, the scale of which is difficult to predict now. "Profile" tells about the leading medical trends and possible risks.
Creative approach to life
This decade will go down in history as a time of breakthroughs in genetics. Back in the 20th century, genome sequencing and GMO cultivation were available to scientists. But only recently have genetic methods been successfully used in the treatment of diseases. In November 2017, the first genome editing operation was performed in California in the body of an adult: by cutting the DNA of Brian Mado's patient using zinc finger technology and adding the missing gene there, doctors saved him from an incurable disease – Hunter syndrome.
CRISPR/Cas9 technology, which allows to correct the DNA of embryos, looks even more promising. The first experiments with it took place in 2015 in China and were criticized by the West for ethical flawlessness. However, in 2016, the United Kingdom and the United States allowed similar experiments to their scientists, and in 2017, the first successes were noted: a team from the United States and South Korea edited the DNA of embryos with mutant blood genes.
While we are talking about experimental embryos, which are then destroyed. The practical application of CRISPR is hindered by doubts about the accuracy of the incision – if something goes wrong, a mutant child will be born. But recent work has encouraged scientists: almost no non-target mutations have been detected after CRISPR intervention. At this rate, the technology will enter the market in the coming years: the startup Editas Medicine that has taken up it attracts hundreds of millions of dollars of investment.
In parallel, gene therapy is developing – the treatment of diseases by "repairing" genes without changing the overall structure of DNA. This is how patients with hemophilia, "butterfly people" without an upper layer of skin, cancer patients are treated. The leading technology is CAR‑T, developed since the 1990s: the patient's lymphocytes in a special incubator are taught to recognize malignant cells, after which they are returned to the body, and they rebuild the immune system, gradually eliminating the disease. An illustrative case occurred this spring in Canada: thanks to CAR-T, doctors cured a patient with breast cancer in the last stage.
In gene therapy, legislative restrictions are also removed, which creates the ground for the development of the market. In Europe, in 2015, the drug Glybera from UniQure was approved – a course of treatment costs 1.1 million euros. In the USA, in 2017, gene procedures for blood cancer were allowed (Kumriah, Yescarta). Now the pharmaceutical company Novartis intends to introduce them in dozens of hospitals, the treatment will cost the patient $ 500 thousand. "Today's medicine is aimed at the speedy introduction of innovations, what used to take 25-30 years now fits into 5-10," futurologist, ambassador of Singularity University Evgeny Kuznetsov notes in an interview with Profile. – So it is with genetics: a quarter of a century ago, the idea of genome editing caused rejection among doctors. But 10 years have passed, and it surfaced in academic research, another 10 – clinical practice began. Now there is a massive search for low–hanging fruits - diagnoses that can be completely defeated by reconfiguring immunity. The pinnacle of hope is the correction of the genome to slow down the aging process, the point "shutdown" of genes. It will be a medical revolution more than penicillin. It is possible to ensure that the body synthesizes vitamins better, produces the "right" metabolites, is faster, higher, stronger… Now such procedures are expensive, but genome sequencing is becoming simpler and cheaper. In 10-15 years, genetic surgery will become commonplace."
Diagnosis from the computer
Meanwhile, medicine is being transformed under the influence of computer technology. The most trivial use of them is electronic document management: what was previously processed into multi–volume medical records is now stored on the servers of clinics and insurance companies. Remote services (telemedicine) are also developing: the Internet allows you to send by e‑mail the results of tests and conclusions of doctors, arrange consultations and consultations by video link.
Telemedicine itself is not an achievement, but a basic condition for it: it standardizes the process, promotes the accumulation of large amounts of data (big data). The next step is their processing by artificial intelligence (AI), identification of patterns (data science). The main example is the use of computer vision algorithms to analyze X–ray, CT, and MRI images.
By training the AI on a sample of images with different diagnoses, it is possible to ensure that the machine distinguishes graphic information and builds conclusions. In some cases, a "trained" AI understands the situation even better than a doctor – for example, it can reveal an unexpected pathology in the image that a person would not even think to look for. To distinguish a mole from skin cancer, to recognize a myocardial infarction by ECG, to diagnose retinal lesions in diabetes – the computer copes with such tasks effortlessly, accuracy is above 90%.
In most cases, AI is still considered a doctor's assistant – a "decision support system". To make a final diagnosis, prescribe appointments is still a job for a specialist, because he needs to focus on a lot of factors, up to the psychology of the patient and the size of his wallet.
But gradually there are computers that take over the full cycle of medical care. The main one is the IBM Watson supercar, presented in 2013. "Iron" Watson is able to recognize human language: for two years of training, he analyzed 605 thousand medical documents, recorded millions of medical histories in his memory. No doctor in the world has such "baggage": it has been established that IBM Watson takes 10 minutes to study a cancer patient and prescribe treatment for him, while an entire team of professors takes 160 hours to do this.
Following IBM, other companies took up computer diagnostics: Babylon Health, Ada Health, in Russia – DOC+, Unim. The simplest version of an AI doctor is chatbots, which can take over the routine part of communication between the patient and the medical staff.
Such developments are hindered for various reasons: there is a certain closeness of medical institutions that do not want to share research data with each other, and the disunity of the medical community, and the banal resistance of doctors who refuse to delegate their powers to the machine.
Nevertheless, the global AI medicine market is growing: according to Global Market Insights, in 2016 its volume was $750 million, and in 2025 it will reach $10 billion, an annual growth of 40%. About 43% of the global market is held by the United States, where the introduction of digital medicine is supported at the state level, and thousands of clinics are connected to the use of IBM Watson. Japan last year announced plans to introduce AI due to a shortage of medical staff: the first stage of the project is the compilation of a national database of ultrasound and tomography images from 320 thousand images.
In Russia, on January 1, 2018, the law on telemedicine came into force, suggesting that it should be made available to patients of the CHI system. The document has not produced a real effect: by-laws have not been adopted yet (expected by the end of the year), and the digitization of medical archives in the country is just beginning.
According to Kuznetsov, the future of computational medicine is already visible: humanity will come to create a global DNA database – this will allow doctors to automatically take into account the factor of a patient's genetic predisposition when making a diagnosis. And later, each person will receive his virtual double. "Medicine is moving towards the fact that we need not drugs, but the right effect on cells so that they regulate the processes in the body themselves. But this requires a different level of understanding of his work. A complete digital model of a person will be required, on which it is possible to work out scenarios of the course of diseases," the interlocutor believes.
Organ Factory
Another achievement of the medicine of the future should be the transplantation of body parts and organs. Despite the development of donor practices, they are still not enough: according to media estimates, 37 thousand organs were available for transplantation in the USA in 2016, while 117 thousand people felt the need for them.
Genetic engineering offers its own solution to the problem: to transplant the biological material of animals to a person, of which pigs are most suitable. There are already examples of such operations: pig pancreatic cells cure diabetes, pig skin helps with burns. A person has not yet carried the whole liver or heart from an animal: they contain the genes of dangerous viruses. But there are plans to "edit" pigs using CRISPR technology – one of the startups, eGenesis, raised $40 million to grow modified pigs.
Scientists from The Salk Institute for Biological Research (USA), which announced a year ago the creation of a kind of pig-human "chimera" (human stem cells were added to the animal's DNA). While the human share in the "chimera" does not exceed 0.001% of cells, but having increased it to 0.1–1%, geneticists expect to grow organs in pigs for transplantation.
Another way of producing "spare parts" for humans is 3D printing. The first experiments have been going on for two decades: in 1999, a bladder operation was performed using a printer. But so far, not all the "components" of a person have been printed. 3D printing has proven itself well in prosthetics (titanium and ceramic bones and joints), dentistry (bite correction caps, crowns), prototyping in preparation for operations.
With internal organs, there is still a problem, research is just beginning. Last year, the American company Advanced Solutions developed a bioprinter for printing lungs and hearts, and Organovo Holdings from Australia announced a project to create an artificial kidney. Startups promise to enter the market in about five years. There are also players on it Russia: 3D Printing Solutions company wants to grow bionic cartilage and vascular tissue in orbit.
According to Evgeny Kuznetsov's forecast, a person will master organ replication no earlier than in 20 years. In any case, it will not come to the printing of a "whole" person and the appearance of androids from flesh and blood, as in science fiction films, in reality. This is difficult to implement, because 3D organs do not work well together, and most importantly, it makes no sense: it is much easier to build a mechanical robot assistant.
Speaking of 3D printing, do not forget about pharmaceuticals: the manufacture of medicines on a printer will radically change this industry. The doctor, instead of a prescription, issues a file with instructions, which the pharmacist turns into a command for the printer: the tablet is made taking into account the individual characteristics of the patient (precision medicine), its shape and size are regulated. This is how the popular fantasy about the 3D future looks like. And it is gradually becoming a reality: in 2015, the American authorities registered the first 3D medicine - Spritam levetiracetam for epilepsy.
However, changes for the pharmaceutical industry can happen for the worse: Gartner predicts losses of up to $ 100 billion a year to the market due to piracy and clandestine drug manufacturing.
From Biohacker to Cyborg
Another level of upgrade is offered by a variety of "smart" gadgets – portable, wearable and invasive (implantable): in their person, a person no longer acquires a mechanical "detail", but a whole system that exercises intellectual control over his vital activity (biohacking).
In a simple embodiment, this is by no means fantastic: activity, nutrition and sleep trackers can be loaded into each iPhone. And if that's not enough, try on a fitness bracelet or ring. Wearable devices serve as an aid in medicine: for example, the mPERS alert system is designed for lonely elderly people and notifies the doctor in case of cardiac arrhythmia or pressure surge, and Shirley Ryan AbilityLab devices monitor the health of stroke survivors.
Subcutaneous chips and sensors provide tighter integration with the technology. They are also used in medicine (pacemakers, implantable systems for diabetics) or in professional needs (the Pentagon plans to equip US military personnel with chips to transmit data about their condition on the battlefield). But for now, such devices are more associated with biohackers-enthusiasts who are obsessed with universal cyborgization.
According to various estimates, there are up to 100 thousand "chipped" in the world. Some of them have become real stars. For example, Kevin Warwick in the 90s was the first to implant a beacon for automatically opening doors, and then installed Braingate implants for telepathic communication for himself and his wife. Rob Spencer has inserted a camera with a transmitter instead of his right eye and shoots documentaries with it. Neil Harbisson implanted an antenna into his skull, and then launched a startup Cyborg Nest to produce similar sensors. With their help, the company's customers should develop a "sixth sense" – the feeling of the Earth's geomagnetic field, overcoming the sense of time or hearing threshold.
"While these are just experiments, adequate invasive systems will appear in ten years," says Kuznetsov. – But the mass distribution of wearable systems is already underway, and in most cases they are enough. A striking example is helmets for drivers that control that a person does not fall asleep on the road at the wheel."
In the distant future, it will be the turn of computers directly connected to the human brain – neural interfaces. Futurologists call the onset of this milestone a "singularity" – a complete fusion of a human with a robot.
There are different concepts of a hybrid brain: "internal", with implanted electrodes, and "external" – hats that record brain activity using an encephalogram. Startups are already working on such devices (their "ancestors" can be considered today's VR helmets and AR glasses) - for example, Elon Musk's Neuralink.
"Your phone, your computer have become an extension of you, only finger movements or speech are used as an interface, and they are very slow," says Musk.
No matter how strange such projects sound, they can become a real discovery for medicine. Experiments show that patients with amyotrophic lateral sclerosis (astrophysicist Stephen Hawking suffered from it) with the help of a neurointerface will be able to re-control their body, as well as serve themselves in everyday life with the help of mind-controlled drones.
But while all this is a distant future, Kuznetsov notes: "I would not expect the appearance of neural chips in the next 10-20 years. Brain waves and vibrations are still a subject of fundamental science, where there is a lot of unknown. Even further, the ultimate dream of transhumanists is to transplant human consciousness onto a digital medium so that it can exist regardless of the body. But now fundamental work is already underway – in several laboratories they perform a complete mapping of the brain, with all neural connections. This is a necessary stage, just as genome sequencing was necessary at the time."
Live long and watchfully
Due to the acceleration of various technologies, medical companies have become one of the pioneers of progress. According to the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), in 2015 they invested about 110 billion euros in the development of new products (for comparison: automakers – less than 100 billion, IT companies - 60 billion). And the global turnover of the medical market will grow from $7 trillion in 2012 to $12 trillion in 2022 (data from Business Monitor International).
What does this give a person? "The trend of the century will be the transition from "fire" medicine to preventive medicine – not to fight already developed diseases, but to prevent their occurrence," Evgeny Kuznetsov believes. – Not only breakthroughs in genetics are important here, but also attention to your health. The twentieth century also had its own leap. Wash your hands before eating – it would seem a simple thing, but it has saved the lives of millions of people more effectively than penicillin. As a result, the achievement of the last century was the reduction of child mortality, and in the current century, everyone is waiting for the prolongation of youth. It is believed that today's Americans under the age of 30 have every chance to live up to 120, and keep a cheerful state up to 100. But absolute immortality is still a fantasy."
At the same time, many people associate medical innovations with threats: they say that genetic engineering methods are well suited for creating biological weapons, and wearable devices will put a person under the supervision of a "Big Brother", allowing manipulating his behavior. There are grounds for these fears, admits Kuznetsov.
"The invasion of the patrimony of evolution can have serious consequences, artificial viruses are a real and dangerous story," the expert argues. "American experts from the special services insist on the need to introduce the concept of "genetic weapons" and include non–proliferation regimes of genetic technologies. But the competitor of the USA is China, which you cannot control. The lifting of the ban on gene editing using CRISPR technology is indicative. At first, the West tried to persuade China to abandon it, and when the futility of efforts became apparent, the Americans and the British themselves followed this path, not wanting to lag behind. Most likely, people who are concerned about what is happening have no chance to keep progress."
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