Anyone debating the future of health care and medicine should keep in mind how rapidly this field is changing. We are experiencing an explosion in medical and biological research that will revolutionize health care at least as dramatically as computers and communications in the latter half of the 20th Century. Yet, while these changes offer the potential to significantly improve our lives, they also come with ethical, moral, and philosophical challenges that humanity has never encountered before.
There are two primary reasons why medicine and health management are changing so radically. First, we are entering the first truly scientific era of medical research. In the past, medical advances have come from accidents – such as the discovery of radiation and X-rays – or from what might be called “voodoo research.” Many medical advances came from studying what medicine men and wise women in primitive societies did that seemed to work, and then trying to find the rational explanation for it. This is how digitalis, the basis of a family of drugs used for heart disease, was discovered, for instance. Today, though, we know enough about how cells and molecular biology work that we can say things like, “We know we can stop this disease from spreading if we can find a molecule with this kind of structure to plug into the receptors on the outside of human cells.” Then we use computers to screen different kinds of molecules to find those that have the right geometry, and hence are likely to be successful at fighting a given disease, vastly improving the odds of finding a useful new drug.
The second reason for today’s rapid advances in health research is that we are using computers instead of laboratory trial-and-error, which is speeding up the pace of research by several orders of magnitude. The Human Genome Project was completed about eight years ahead of the original schedule, cost significantly less than expected, and is yielding more results than originally projected in large part because computers were used to perform gene sequencing – the grunt work of the project.
But computers are not only letting us do much of the heavy lifting in research, they’re allowing us to perform new kinds of research that have never existed before. One computer software technique, for example, called “genetic programming” lets researchers identify new drugs and diagnostics several orders of magnitude faster than traditional techniques by harnessing the kind of evolutionary process involved in life itself to come up with progressively better and better solutions to a given problem. Hence, this software will look at which genes seem to be implicated in a given genetically-liked disease, for instance, and suggest a range of possible combinations of gene interactions involved. It will then fit these proposed explanations to experimental data, discard those that provide the worst fit, and re-combine those that remain. By repeating this process at computer speeds, solutions evolve into explanations that are novel, and might never have occurred to human researchers, because the software has no preconceptions about what the right answer is. This is one technique from a broad, new field called bioinformatics.
And where will all this lead us? Into a revolution in human health. We will, for instance, be able to cure diseases that seem to be linked to individual genetic flaws, possibly by re-writing the genetic code of the cells involved. This will let us cure such diseases as Cystic Fibrosis, Multiple Sclerosis, and certain kinds of diabetes and cancer. It may be that in 20 years, a young woman may go in for a check-up, find that she has breast cancer, and have it completely cured without surgery in a matter of days. Far from being life-threatening, it will be no big deal.
We may develop artificial “anti-bodies” in the form of nano-bots, microscopic robots, that fight specific diseases, or that hunt for cancerous cells in our body, or that float through our blood stream looking for problems to report. Our health may be guarded by our wearable computers, which will monitor our health, heartbeat-by-heartbeat, and alert us to a problem or even call for an ambulance in an emergency.
We will develop new pharmaceutical drugs and new diagnostic tests that allow us to identify diseases more quickly, and treat them more precisely. Today, a highly effective new drug works between 50% and 70% of the time. This means that it does not work between 30% and 50% of the time, and may actually produce harmful side effects. We are now starting to suspect this is because of SNPs (pronounced “snips”, and standing for Single Nucleotide-Polymorphisms), which are the minute genetic differences between one person and another. We are learning that individual differences may be the reason why one person responds well to a drug, while another reacts badly, and why diet can work wonders for one person’s cholesterol count, yet do nothing for someone else.
The net result of all these changes, and the many more I haven’t discussed, is that we are, one by one, going to pick off the diseases and conditions that kill us and destroy our health. This will naturally lead to longer and healthier lives – but what if we could cure old age itself? There are researchers who think that there is no natural life span, and that we die essentially because our body’s machinery breaks down. If we can fix the break-downs, say with new organs grown from our own genetic code, and stop the clock of aging, which researchers are contemplating, then we may live as long as we can afford to. Indeed, cost is a significant factor, both in paying for such treatments, and in living that long beyond the traditional retirement age of 65. And when I ask audiences whether they’d like to live to 200, for instance, most people say no. When I rephrase it and ask if they’d like to live to 200, but with the body of a 30 year old, I get a much more positive – or at least more thoughtful – response.
Which leads us into the realms of philosophy: what is the purpose of our lives? At present, we think of our lives in three stages: childhood, adult or worker, and retired. Does this model make sense if you stretch it out over 200 years? How long is childhood? How long is retirement? What would you do with your time?
Indeed, the whole realm of health care is fraught with questions we’ve never encountered before. If we can select the genetic qualities of our children, are we morally justified in doing so? If we can tell, when someone’s 40, that they’re likely to suffer from Alzheimer’s disease by the time they’re 60, should we tell them? To whom does your genetic pattern belong if, say, you have a particularly disease-resistant genome? And to whom does information about your genetic defects belong? Should the government be privy to it? How about your banker or insurance agent? What about ethical questions, such as: if we can ensure that the child of deaf parents can hear normally, should the parents be allowed to choose to have their child born deaf so she can share in her parent’s culture?
These, and many other difficult questions await us. Perhaps we’ll need the longer, healthier lives we’ll live in order to start dealing with the answers.
by futurist Richard Worzel
© Copyright, IF Research, November 2003.
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