Monday, August 29, 2016

The Future of Medicine

I was asked recently what I thought the next breakthroughs in medicine would be. I have no idea. Although I like to read about where science is going and although I used to participate in research, now my career has greatly diverged from that. Nevertheless, sometimes you get asked a question and you just have to hypothesize.

We've been talking about personalized medicine for (it seems like) forever, but I think it's going to happen. President Obama launched the Precision Medicine Initiative and that helps funnel NIH funding to those areas of research. We are definitely getting more knowledgeable about how all the "omics" (genomics, proteomics,, metabolomics, gut microbiomics) affect disease and health. Despite this, it hasn't translated to everyday clinical application. For example, though whole genome sequencing has become cheaper and more readily available, genetic testing is not widely used by physicians to make clinical decisions. Only a few tests are standard of care (such as testing for an HLA gene before starting someone on the HIV medication abacavir). I believe physicians are just late adapters of technology. Once genetic testing becomes a more commonplace clinical tool, I think personalized medicine will really hit its stride. This will almost certainly increase costs. We just await to see if that translates to better outcomes.

To me, personalized medicine comes in flavors beyond the interaction of genetics and diseases. One form of personalized medicine is the use of feedback loops and technology to achieve our health goals. For example, insulin pumps for type I diabetics can almost work on autopilot. They can test a person's sugar, adjust the dose of insulin, and check to see if it worked in an entirely automated algorithm. Will anesthesia move in that direction? Will we end up having machines that can detect the level of anesthesia for a patient and automatically adjust the medications to achieve a target? (This was attempted with a robotic sedation system which never caught on; it's now off the market). To me, these individualized therapies also represent a kind of personalized medicine.

With regard to areas of medicine that will blossom, I think immunotherapies and treatments for neurodegenerative diseases will become a big focus in the coming decades. We must focus our resources on diseases like Alzheimer's which currently doesn't have effective treatments but will become a growing burden on society and our health care system. These are, at least, my predictions; who knows where things will go in the next few decades.

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