What Can Isaac Asimov Tell Us About the Future of Medicine
“…they will be appalled that we waited for people’s brains to degenerate before we treated them.”
One of the predictions shared by clinical and venture capital experts in the “Future of Medicine 2054” panel at the 2019 World Medical Innovation Forum.
In 1984, biochemistry professor and science fiction author Isaac Asimov was asked to predict life in 2019. Many of his insights were prescient and have since become reality, including the rise in the use of computers in work and at home, the expanded role of robotics in the workplace, and the increasing impact of overpopulation and pollution on the world’s resources.
The panel discussion at the 2019 World Medical Innovation Forum sought to extend Asimov’s original vision another 35 years to 2054.
Moderated by Keith Flaherty, MD, director of Clinical Research for the Mass General Cancer Center, the panel included thought leaders in the fields of venture capital, cardiac care, neurology, and cancer immunotherapy.
Individual disease disciplines: Future anachronism?
In a wide-ranging discussion, the panelists envisioned a health care system transformed by scientific advancements, data sharing, mobile technology, and key philosophical shifts in the diagnosis, treatment, and monitoring of disease that will emphasize early detection, active prevention, and team-based care.
“I think there are lots of examples where simple metrics, like how you live your life, are a much better predictor of your risk of any downstream disease than any of the features that a physician or biomedical enterprise would measure,” said Calum MacRae, MD, PhD, vice chair for Scientific Innovation in the Brigham and Women's Hospital Department of Medicine.
“I think individual disease-based divisions are already close to being an anachronism,” MacRae added. “We need to start thinking about how we’re using the tools that we all have in each of our disciplines to cross disciplines.”
Other panelists discussed advancements that could play a key role in transforming health care in the next 35 years to include improved biomarkers for cardiac and neurodegenerative diseases, active health monitoring that can drive new insights into the relationship between lifestyle factors and disease, collaborative data sharing, and cutting-edge treatment strategies, such as cell-based therapies and CRISPR gene editing.
Defining the model for cell therapies
Marcela Maus, MD, PhD, director of the cellular immunotherapy program at the Mass General Cancer Center, discussed the potential for cell-based therapies to treat cardiovascular and neurodegenerative diseases, restore damaged organs and tissue, and reduce chronic inflammation.
She also talked about some of the hurdles involved in deploying this technology more broadly in the clinic.
“I think one of the challenges in cell therapy—and we’re going to see how it evolves in the next 35 years—is what’s the model going to be,” Maus said. “Now, we’re seeing cells perturbed with one gene as therapeutics. People are starting to introduce two genes, three genes — gene editing technologies where there are one or two or more gene knockouts. How many changes can you make to a particular cell type and still know how it’s going to behave?”
In one sense, if Asimov’s answer to the “next 35 years” of his time was the “emergence of ubiquitous computing and growth of robotics” Maus’ insights lead to a paraphrase for the next 35 years as “emergence of cell-based therapies and cures for genetic diseases.”
Active monitoring, early detection, more timely intervention
Panel members agreed there is an opportunity for clinicians to more actively monitor patient health using remote or mobile sensors technology and to use the insights gained from these data to develop new strategies for early disease intervention.
“What we’re really looking for is to change the culture, to engage and make patients active participants, have the system be surveilling rather than expectant and to move to continuous rather than episodic monitoring and intervention,” said MacRae.
“If we start to take those attitudes, you begin to see barriers breaking down, because, in reality, the information we’re collecting in behavioral health informs our risk of cancer, our risk of cardiovascular disease, and vice versa.”
The theme of early detection was echoed by Rudy Tanzi, PhD, director of the genetics and aging research unit at Massachusetts General Hospital. “When it comes to neurodegenerative disease, the answer will be a mantra of early prediction—meaning knowing your family history and your genetics in terms of what risks you face just coming into this world for a neurodegenerative disease like Alzheimer’s—and that will guide at what point you do early detection.”
“I think in 2054, they will look back and not just be surprised, but appalled, that we waited for people’s brains to degenerate before we treated them,” Tanzi added. “It will seem pretty silly by then.”
Shifting the mindset from attacking disease to protecting the body
“There is also an opportunity to shift the overall mindset of health care from one of attacking diseases with drugs and surgery to one of protecting the body through prevention and early intervention,” said Noubar Afeyan, PhD, CEO of Flagship Pioneering.
“If we start thinking about [health care] from a security standpoint, such that drugs or surgery are the lifeline of defense, not the first thing we do, I think that the future will look different, and prevention and detection will be the most profitable things, just like they are in the world of human defense.”
It will also be important for scientists and entrepreneurs to take chances on high-risk, high-reward ideas, Afeyan added.
In 1983, 35 years after George Orwell penned “1984,” Asimov was invited by the Toronto Star to predict the answer to a specific question: “What will the world look like in 2019?” Asimov was more or less correct in many of his predictions on the future of computerization, including: “Computerization will undoubtedly continue onward inevitably…mobile computerized object will penetrate the home…the increasing complexity of society will make it impossible to live without this technology. Computers will disrupt work habits and replace old jobs with ones that are radically different.” Much of this has already been implemented in digital health.
“A lot of what was said on this panel would seem unreasonable to people today. That’s why we think it can only happen in 35 years, because even as scientists we’re allowed to project unreasonable things as long as it’s far enough out. I think the job of entrepreneurs and Innovators is to pull that timeframe and be willing to look foolish saying unreasonable things long enough that you can get resources to do it,“ Afeyan concluded.