The Future of Medicine

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According to Professor Michael Bess, we are on the brink of a medical revolution and about to enter the age of “bio-enhancement,” in which not only will we heal the body but even alter and improve it. After millennia of useless herbs and potions, of savage, bungling operations, human beings are finally developing effective medicine.

Where We Are and How We Got Here

It is often said that we live in an age of “miracle cures” and “medical wonders,” and yet in every street, even in the wealthiest countries, you will find people tormented by physical and mental illness. Whether it is depression, cancer, Parkinson’s, MS, ME, Motor Neurone Disease, or simple anxiety and insomnia, swift, painless cures still elude us. We can treat such things, but that is different. Of course, modern medicine is still impressive, certainly compared to what passed for medicine before the 20th century. Indeed, in the early nineteenth century, an American physician famously wrote that if all the world’s pills, potions and other medicines were collected together and thrown into the sea, only the fish would suffer!

Medicine as we know it today is the result of a profound revolution in human thought, one that began with the birth of science in 17th century Europe. Gradually, as the 17th century gave way to the Enlightenment, a shift occurred: instead of a Universe inhabited by supernatural beings, it was increasingly believed that the material world is all there is; and that through patient observation, the world of matter (which includes the human body) could be understood and mastered.

The Genetic Revolution

First, there is the genetic revolution. In 2003, the Human Genome Project, which sought to map our complete genes, was completed. Initially, there was great excitement. People assumed that every disease and disorder would soon be linked to a specific gene, which could then be interfered with. When things inevitably proved complicated, the opposite idea took hold – that the genetic revolution was a failure. In fact, it is only getting started.

In the developed world, the vast majority of people die from non-infectious diseases, such as diabetes, cancer, and heart disease. And your risk of suffering from one of these is influenced by your genes. Genomics is the field concerned with understanding these links. Once we can associate a certain gene with a certain disease, we can advise those at risk of the steps they might take to avoid it. For example, if a woman has a particular mutation in a gene known as BRCA 1, her risk of developing breast cancer goes up to between sixty and ninety per cent. Such links will no doubt be found for all sorts of diseases, allowing doctors to intervene before illness even occurs.

Nanotechnology

Nanotechnology is arguably the single most exciting and extraordinary area of scientific development. Indeed, the British journalist Mark Stevenson writes in An Optimist’s Tour of the Future that nanotech is “perhaps the most powerful technology ever created, and will play a game-changing role in everything from A.I. to medicine.” The extraordinary thing about nanotech is that it will enable us to interfere with the body at the molecular level, using machines smaller than the eye of a needle. In other words, we will tackle illness at the most basic level, making current medicines seem crude in comparison.

And the possible applications are almost limitless. For example, viral infections could be checked with nanoparticles that bind to the virus and stop it spreading. Blood clots and arterial plaque could literally be destroyed by tiny robots injected into the body with a hypodermic needle and then guided through the bloodstream. These could also be used to break down fat deposits before they cause heart disease. Even the walls within the heart could be repaired using nanoparticles coated in a sticky protein that carries therapeutic drugs to the precise spot.

Indeed, there seems hardly an area of the human body that nanotech can’t treat! Bones, for example, could be regenerated with nanostructures that act like scaffolding to support bone repair. Or take glaucoma. This may one day be treated through nanoparticles inside the patient’s contact lenses! Once in contact with the eyes, they would release healing drugs.

Even something as complicated as the nervous system will be amenable to these new technologies. The nervous system is composed of neurons organized into networks of information. When the neurons are damaged and the circuit broken, problems arise. Researchers are now looking to repair such damage with carbon nanotubes. Again, these will act as a kind of scaffolding, allowing the neurons to re-connect. In the future, neurological disorders such as Parkinson’s may be treated in this way.

More generally, nanotechnology will revolutionize drug delivery. The human body is a complicated organism, and ensuring that drugs are both safe and effective is not easy. Some do not reach their target, others are denied entry by the cells. In the near future, nanoparticles called liposomes will surround the drug particles and guide them to their destination.

Cancer

It would not be an exaggeration to say that the dread of cancer haunts almost everyone. And our treatment record is poor at best: between 1950 and 2005, the death rate dropped by a feeble five per cent! Today, your chances of developing the disease are higher than ever, due mainly to longer lifespans. Quite simply, the longer you live, the more time there is to develop it. No overview would be complete without asking the question people have asked for generations: will there ever be a cure? In the early 1970s, President Nixon famously declared war on the disease, signing the National Cancer Act in 1971 to increase spending and research. And yet, over 40 years (and 200 billion dollars) later, with the 2020s looming, cancer remains a mass killer.

But there are grounds for hope. For a start, researchers now know their enemy. As Michio Kaku writes in Physics of the Future, “Back in 1971, before the revolution in genetic engineering, the causes of cancer were a total mystery. Now scientists recognize that cancer is basically a disease of our genes.” Ask the average oncologist if there will ever be a cure, however, and they’ll probably reply “not in the foreseeable future.” But it does seem certain that we will get better at treating it. Cancer may not be cured, at least not in the first half of the 21st century, but it will almost certainly be tamed. Instead of a killer, it will become a nasty, chronic, but manageable disease.

As a general rule, prevention is better than cure. And this is especially true of cancer. The key is to catch it early, something we will also become better at. Indeed, Kaku hopes we will become so good that the word “tumor” will disappear from the English language. For example, people may have gadgets in their lavatory to detect strange DNA sequences (Kaku describes them as “DNA chips scattered throughout our environment”). When cancer cells are detected, an alarm will sound. Imagine it is 2040 and this has happened to a young woman. She visits her local test center and a blood sample is taken, confirming breast cancer. That afternoon, robotic imaging and destruction is carried out by her oncologist. A follow-up vaccine is recommended, and by the next morning she’s back at work.

Because we now have a better understanding of the disease, we will be able to attack it at its molecular and genetic roots. Presently, there are three main ways of treating cancer: surgery, chemotherapy, and radiotherapy. Over the last few years, however, researchers have been working on a new, “fourth pillar,” known as Immunotherapy. This means using drugs, cells, and even viruses to turn the patient’s immune system into a weapon.

Nanotech also opens up exciting possibilities. For example, nanoparticles will be used to smuggle a sequence of DNA into cancer cells, producing a toxic compound that then kills them. Such treatments have already been successfully tried in rats, destroying brain cancer cells and shrinking tumors. Oncologists will continue to use Radiotherapy to destroy rogue cells, but it will be combined with 3D reconstructions to maximize accuracy. They will also continue to use drugs, but these will be personalized, tailored to the exact molecular abnormalities that caused its development in the first place.

Longevity

Some, notably Aubrey de Grey, argue that instead of researching specific illnesses like Alzheimer’s and cancer, we should instead focus on their most common cause – the ageing process itself. And this is indeed happening. The Harvard Professor David Sinclair even claims to have invented a pill that can slow the process down and to have given it to his ageing father – with positive results.

Whether or not Sinclair’s pill really does work, longer lifespans seem almost certain. Research is being conducted not only into ways of slowing the process down but even reversing it. And the subject of extended lifespans is no longer treated as a sci-fi fantasy, as it once was. Professor Michael Bess, for example, a serious and respected authority on the history of science, takes it for granted in his 2017 book, Make Way for the Super Humans, that it will happen, even devoting a whole chapter to “the implications of extremely long health spans.”

Obviously, we cannot predict the future. Some breakthroughs will fail to materialize, and some medicines and technologies will prove ineffective when they do. And of course, some will take a lot longer than expected to reach the average person. Others, however, will surpass our highest hopes or arrive sooner than expected. And even the most sceptical would have to concede that it is unlikely all these treatments, from immunotherapy to stem cells, nanotech to genomics, will lead nowhere.

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