Humanity is on the precipice of something rather special. Information technology – once the preserve of silicon valley – is now branching out to all fields of human endeavor We’ve discovered that the base pairs in our DNA are, at root, exactly the same thing as the electrons buzzing around in our computers. A store of information. Now the base-pair has in a sense graduated to join the bit and the byte as a bonafide carrier of information.
Previously, we had only been able to read DNA sequences. We couldn’t edit a genome, and we certainly couldn’t write one. But now that is all changing. Just like it’s possible to write information onto a microchip, it’s also possible to write new genetic information and insert it into DNA. Powerful new techniques like CRISPR-Cas9 are allowing scientists to literally rewrite genetic code. It seems like every month we get a story on the news about a new treatment for a genetic disease made possible by gene editing.
Clearly, the ramifications of this technology for our health are profound. But more profound is the fact that biotechnologies are themselves becoming an information technology.
Let’s step back and think for a moment about what happened in traditional information technology. Back in the 1970s, when the first microprocessors went into production, a man called Gordon Moore noticed a pattern. Every two years or so the number of transistors on a microchip doubled. After a few years, this became a predictable pattern. Moore noted the pattern and predicted the biannual doubling might last another decade. By the mid-1980s his own law was supposed to have puttered out. But that didn’t happen. Moore’s law continued and is still going strong today.
You’ve seen the incredible impact of Moore’s law in computing. Your computer processor has become more powerful with each passing year for the last forty years. It’s now a thousand times smaller and a million times faster than the computers that sent humans to the moon.
Moore noticed something unique about information technologies. Whereas most technological progress followed a predictable, linear trajectory, information technologies did not. They were, in a sense, a totally different animal.
Now that biotechnology has crossed the threshold into an information technology I believe we can expect to see the same effect. We will likely see a doubling in the power of this technology every two years or so.
Of course, measuring progress rate of progress depends on which metric you choose. For computers, we might choose the number of transistors on a chip or the cost of a single gigabyte. In biotechnology, we might look at the number of genomes sequenced or the cost of sequencing a base pair.
When we look at these measures we already have evidence that biotechnology is experiencing its own Moore’s law. In other words, biotech is improving exponentially, just like computers are.
The cost of sequencing a human genome, for instance, has collapsed since the first genome was sequenced back in 2001. Back then it cost something like $100 million to sequence one human genome. By 2008 it had fallen to $1 million. And by last year, the price was hovering around $1000. If you do the maths, the fall in the price of sequencing the genome is exponential. And more remarkably, is actually proceeding faster than Moore’s law.
These staggering improvements in biotechnology are going to have profound ramifications on medicine.
Shifts The Emphasis From Reaction To Prevention
At the moment health care is setup to react to disease, rather than to prevent it. That’s because we really don’t have a good way of knowing whether a particular person is likely to develop a particular disease.
We know that, in general, certain lifestyle factors are associated with certain diseases. But we don’t know which individuals exposed to them will actually develop diseases. Now, though, personalized medicine is allowing people to take specific measures to prevent disease. And it’s all based on their unique set of genetic risk markers.
Companies interested in preventing illness are already designing highly personalized interventions. These are designed to stop problems in their tracks before they have a chance to develop. Kingsway Compounding Pharmacy, for example, has begun developing drugs tailored to individual need. And what’s the result? Better patient experience and a higher chance of returning to, and staying in, health.
As these technologies improve, each individual will be able to have their genetic code sequenced. And once it is sequenced, it will be read and understood. Say, for example, you’re a woman with a history of breast cancer in the family. You’ll want to know whether you’ve got the BRCA1 or BRCA2 gene mutations which are associated with higher risk of breast cancer. With that information you can make a decision about your lifestyle and whether to take preventive action now.
But in the future, you’ll probably be able to have your own genes edited like you’d edit a bad program on a computer. With the new genes inserted you’ll return to having the same risk of breast cancer as everyone else.
And it’s not just breast cancer that advances in biotech can potentially solve. There are already some 15,000 tests for 2,800 problem genes. These problem genes are related to all sorts of conditions, from heart disease to hearing loss.
Direct Optimal Therapy And Reduce Trial And Error
What’s abundantly clear from the data is that when it comes to pharmaceuticals, one size does not fit all. In fact, it is quite remarkable how ineffective many leading drugs are. Take SSRIs for example for treating depression. Something like 62 percent of people do not react to these drugs at all. And when you combine them with their side-effects, including suicidality, you have a very bleak picture indeed. Common asthma drugs are ineffective in about 60 percent of people. Common diabetes drugs are ineffective in about 57 percent of people and so on.
This is because traditional approaches to pharmacy often prescribe a generic drug and wait and see if it has any effect. Today, the best pharmacies offer personalised medicine, designed to meet the patient’s needs. They also offer preventive medicine to minimise the chances of disease developing.
One commendable way they’re doing this is by combining their own tailored solutions with better nutrition. They recognise that their pharmaceuticals work best in conjunction with a supportive lifestyle.
In the future, it looks likely that trial and error can be partially avoided. Drugs will be directed right to the source of the problem: bad genes. In fact, there are already options available for women with breast cancer. Genetic testing can already help physicians chart the best course for treatment to take. Tests can now indicate whether women are likely to benefit from chemotherapy. Others can tell whether women are likely to suffer a recurrence of cancer after surgery.
Improve Adherence
Non-compliance with standard treatment regimens is a big problem. Patients often suffer negative health effects, and overall health costs rise.
But personalised medicine offers some important advantages. The first is that there are fewer side-effects. This means that patients are going to be more willing to stick with a programme of treatment. Today, for example, statins are prescribed to lower cholesterol in patients at risk of a heart attack. Some people can suffer debilitating side-effects, like muscle pain and a loss of libido which cause them to give up treatment.
But in the future, people at risk of heart disease will have the option to make lifestyle changes in advance. In this way they’ll be able to avoid an unpleasant lifelong drug regimen.
Improve Quality Of Life
Finally, nothing consumes more medical resources than randomized controlled trials designed to find out if a drug does more good than harm. But when you think about the concept of a randomised controlled trial, you realise how wasteful a practice it is.
It’s essentially a question of averages. On average, is life expectancy better on the drug than off the drug? But within that average is a lot of individual variation. Some people might fare well on a new drug. Others might do very badly. Some will even die prematurely.
But unfortunately, this is the only tool we have when we don’t have personalised medicine. All we can say is that, on average, the drug worked. Using the old methods, we can never say that a drug helped everyone. In fact, the opposite is usually true.
Personalised medicine, on the other hand, is not invasive at all. And it looks to have far fewer side effects. Once we know how to write human DNA as well as we know how to write computer programs it looks as if we will probably avoid side effects entirely. And that’s what makes all this so exciting.
What matters most is the quality of a patient’s life. And these already-emerging techniques are non-disruptive and non-invasive. As medicine transitions to an information technology, painful and outdated procedures will be replaced by a click of the mouse. Already today, we’re seeing innovative companies personalising their approach to medicine. Long may it continue.
