Mainstream medicine will be transformed in the coming years by increasingly diverse research studies, new molecular technologies, innovative approaches to treatment, and more. The result will be that we can better predict disease outbreaks, identify them when they occur, and more effectively treat patients who get sick. That was the main takeaway from several public health officials at a recent scientific conference. Here, we highlight several examples they shared to support their predictions.
According to National Institutes of Health Director Francis Collins, diversifying who participates in large-scale research studies will improve the delivery of precision medicine to people from a wider variety of ethnic and racial groups. Today, the benefits of more personalized medicine fall mainly to people of European descent. That’s because this population has been studied more extensively than any other. NIH’s “All of Us” program, an effort launched in 2018, aims to study 1 million Americans. It was specifically designed to recruit participants from groups that have previously been underrepresented in biomedical research. Collins, speaking at the recent Advances in Genome Biology & Technology meeting, an annual scientific conference held this year in Marco Island, Florida, says that more than 80% of the 260,000 people who have completed the study protocol so far come from previously-underrepresented groups. That means that insights from this study will benefit a far larger proportion of the general U.S. population.
This spring, scientists will get beta access to data from the All of Us program so they can begin to mine it for new biomedical discoveries. Many other large-scale studies are also underway around the world, adding to researchers’ understanding of how clinical outcomes can be shaped by a person’s ethnicity, socioeconomic status, environment, and more.
Collins also cited the need for studies that incorporate and combine advanced technologies to learn more from each participant. Genomic technologies, for instance, can be paired with single-cell analysis tools or spatial biology tools for a deeper understanding of health and disease.
New approaches to medication — such as gene therapies that can be used to treat or even cure genetic diseases — are another promising source of clinical progress. While today’s gene therapies are typically used on cells outside the body, which are then infused back into the patient, Collins says that there’s a pressing need to find ways to deliver these treatments directly into people to tackle a broader range of conditions. In his lab, scientists are working with mice to test a potential treatment for progeria, a rare disorder that causes drastic premature aging. By using a new type of gene editing delivered in a single dose, the researchers have been able to extend the lifespan of these mice by 77 percent.
Another major healthcare innovation will be intervening much earlier, potentially even before a person gets sick. Lee Hood, chief science officer at the national healthcare system Providence St. Joseph Health, envisions that in the not-distant future, each person would be tracked for life, starting even before conception, to establish a baseline and then understand the functional effect of health changes that occur. Almost all institutions are practicing what Hood calls 20th century medicine: focusing on patients with advanced stages of disease that typically cannot be entirely reversed. He says that 21st century medicine will allow for much earlier intervention, making it possible to restore health in ways that cannot be done now. Spotting signs of disease through careful analysis — possibly even before any symptoms manifest — would give doctors the best chance of intervening when there is still a possibility of reversing the disease.
Another crucial element for improving community healthcare will come from spotting the potential for problems before they arise. Matthew Keller, a scientist with the U.S. Centers for Disease Control and Prevention, is helping develop an influenza surveillance initiative that’s being rolled out to places where there is increased opportunity for a virus to jump into humans from an animal host, such as, for instance, live animal markets. (It was in a market like that in Wuhan, China, where scientists believe the coronavirus COVID-19 may have first jumped from small mammals to humans.) Keller’s team has set up shop in the U.S. at swine exhibitions — large, county fair-style events with petting zoos and other human-pig interactions. In one case the team found that 75 percent of pigs they tested had influenza. That’s a huge community of viruses primed to make the leap into humans, potentially leading to a new outbreak.
At one exhibition, Keller and his team detected a new flu strain, analyzed its genome, and emailed the DNA sequence back to CDC investigators, who were able to begin vaccine synthesis even as the outbreak was just getting started. This kind of portable, field-ready surveillance system could be a critical tool to prevent or arrest outbreaks not just of flu, but of any kind of virus that starts out in animal hosts — including a coronavirus like COVID-19.
With new technologies, new approaches to treatment, and the ability to intervene long before a disease has caused irreversible damage, medicine should become more effective and more preventive than it is today. This shift from reactive healthcare to proactive healthcare could fundamentally change how we think about wellness and what’s possible in our lives.
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