The future fields that will dominate health will include early detection of disease and delivery of medicines or genes in more efficient ways.
Look at how far we have advanced in even two hundred years. Health has progressed in stages.
The first big advance came in sanitation. Doctors began washing their hands and sterilizing surgical equipment. Sewage systems were set up; clean water was created. (Yes, it is true that in China water was boiled before it was used even in Marco Polo’s Day, but clean water has not been a priority in developed countries until after WWII).
The Romans and Aztecs removed waste from their cities, but in “modern times” this was not done. Civilization needed to start at scratch. Many parts of the world do not have clean water or basic sanitation yet.
During the American Civil War more soldiers succumbed from disease than injures on the battlefield. This was true in other wars as well as with other disasters.
Sanitation was followed with pasteurization of milk and inoculations against such diseases as small pox and measles.
Like these diseases, polio has for the most part been eliminated, although non-inoculation is causing a comeback.
These advances are preventive.
Much illness is man- made: agent orange, DDT, forever chemicals, plastics, and asbestos. Here the guilty party is government, but often they are the identifiers.
Penicillin was used, however, to cure diseases, such as infections caused by war as well as syphilis and gonorrhea. This cured people after they were infected.
Covid 19 was tackled by using MRNA to teach our cells how to make protein, a new way to have one’s body attack the disease. While we lost millions of lives, mostly older, vulnerable folks, or folks who did not take shots, advances came quickly, in part because the Chinese identified the sequence of the disease and then a new approach was used. This shows that we do not live in a void and that we can gain by listening to others.
Studies have been made on cancer, heart and lung disease, TB and malaria. The goal is to find cures.
Now we are transitioning to wellness. Here early detection will allow us to take steps to save lives.
Leroy Hood & Nathan Price put together an excellent book on wellness (The Age of Scientific Wellness.) It discusses how to make people well by identifying illnesses early, rather than curing people after their illnesses have advanced.
They believe that we can improve our chances for health and long life by better diet, exercise and regular check-ups. In theory they are correct, but humans being who they are, this will not occur in the short term.
The Economist reflected on the nature of health in a discussion of Great Britain’s National Health System (NHS). They said that “The NHS must stop mainly treating people who are manifestly very sick and get them when they, still, ostensibly, seem well. Not being dead is the not the same as being healthy alive.”
Bravo! Medicine. Sanitation. Exercise and moderation of bad habits like smoking, drinking and overeating are good starts to making people healthy.
Saying that, I was amused last July (2023) when I read the Obit of Louise Levy who died at 112. She was part of a study of 700 people who were over 90 years old. The goal was to study the genetic reasons why some folks lived long and healthy lives.
Ms. Levy was in excellent health until a short time before she died.
Did exercise, diet, sleep and social connectivity help? The study showed that less than 50% even did household chores or exercise. 50% were overweight or obese. 60% smoked. Only 3% were vegetarians.
The premise of the study was that it is gene mutations that are responsible for slowing the impact of aging. (Suggestion. Select your parents & their genes. It can be a great pathway to health.)
This study was made by the Institute of Aging Research at the Albert Einstein School of Medicine (Bronx)
Three companies that are on the forefront of the two trends I discussed above are ADmdx, Galeata Bio and Xeris Pharma (XERS). Two are private (ADmdx & Galeata Bio) and Xeris Pharma is public. (In full disclosure, I have positions in each company).
ADmdx uses advanced imaging biomarkers (PET & MRI scan) to diagnose and treat brain disorders. They look at Alzheimer’s progression, Atypical Alzheimer’s, frontal temporal dementia variants, traumatic brain injuries, Down Syndrome and Parkinson’s disease. They have been able to identify successfully the early start of these diseases where treatment could be successful. For many of the diseases they study, early detection can provide relief.
Galeata Bio studies the human genome of populations that are not represented. The vast majority of these past studies are from populations from Northern Europe. Galeata Bio is working with underserved Latin American populations.
Why is this important? It is because science gains much by looking at what is different and what is the same with genetics from diverse populations. Galeata Bio believes that studying novel genetic associations that occur in ethnic minority groups can help to develop drugs for the whole.
Xeris Pharma (XERS) is a public company with three FDA approved drugs:
Gvoke Hypo pen (ready to use rescue pen for severe hypoglycemia), Recorlev (for Cushing syndrome) and Keveyis (for primary periodic paralysis). They hold 174 patents and 109 patents, mostly creating a stable form of a drug that can be easily injected.)
In my opinion, the secret sauce for Xeris Pharma is the delivery of drugs in a specific, targeted manner.
Other trends center on the effective and targeted delivery. Currently, most gene therapies rely on viruses engineered to deliver “cargos” to safer locations and that cause less of an immune response.
In the future, we will use in vivo editing. This will be safer, cheaper and more effective than the current systems.
Not to state the obvious, but the delivery of gene therapy (drugs & meds) is the challenge with this treatment.
Science News profiled “scientists to watch.” One is Deblina Sarkar. She is a nanotechnologist who has created ultra tiny electronic devices to enter the brain. She believes that her work can help with Parkinsons and Alzheimer’s.
Another future-like advance is from Quinton Smith, a chemical engineer, who is developing lab-made organs. He has adapted the tools used in fabricating tiny electronics to craft miniature, lab-grown organs that mimic their real-life counterparts.
There are few quick fixes to better health, but the future will be dominated by how we identify disease early and how we will better target and deliver cures.
