Science Special Edition: Frontiers of Medical Technology 2021
I just received a special issue from Science, and it deserves its own nutrition notes so it won’t be too long.
SHORT NOTES: Google’s CEO says “artificial intelligence is more profound than electricity or fire!” It is not yet built into the modern health care environment; the concept of a learning health system seems stuck in a time warp, missed time and again;Transformational change of methodologies used generations ago has not occurred; causing cognitive overload when taught incorrectly in medical school; Cancer mortality rates have decreased by nearly one-third since 1971; most women with the most common type of breast cancer can be spared adjuvant chemotherapy after surgery; Sleep is strongly associated with heart health; Atherosclerosis starts early in life, from birth to age 25; The 20th-century concept of nature vs nurture must be tossed aside. Genetics and environment do not compete, the new field combining both is exposomics; a 1-million fold reduction in the cost of genome sequencing and data analysis is being used at a massive scale in clinical settings; adults over 75 with serious illness make up only 5 to 10% of our population, but account for over 2/3rds of health care spending; One in 4 over age 80 has Alzheimer’s, and this will triple over the next 30 years (consider Mito-C); Protective immune defenses against cancer and infection are critical for survival (take 2,000IU vitamin D and Triumph); Single gene disorders affect 5% of live births and account for 30% of pediatric hospitalizations; a human brain has 100 billion neurons, an equal number of glia, and about 100 trillion synapses. Brain disorders (depression, psychosis, dementia, stroke, and addiction) are 5 of the top 10 disabilities worldwide (try Mito-C); the exorbitant cost of developing a new drug is $2.6 billion in 2021; there are dramatic changes in how surgery is performed; Research is now uncovering unique gender-based attributes thanks to NIH’s 2016 mandate to include sex as a variable in all funded research.
LONG NOTES:
Google’s CEO says “artificial intelligence is more profound than electricity or fire!” It is not yet built into the modern health care environment. AI will guide patients toward disease prevention, resulting in enhanced well-being. (pg 4)
While research and clinical practice have leaped to new heights, the concept of a learning health system seems stuck in a time warp, missed time and again. (pg 5)
Transformational change of methodologies used generations ago has not occurred, despite the flood of new scientific information and data. The wealth of scientific information produced by genomic, biochemical, and biophysical technologies is causing cognitive overload if taught using classic faculty-driven, classroom-based teaching modalities. (pg 7)
Cancer mortality rates have decreased by nearly one-third since 1971. Clinical trials have played a pivotal role, the result of basic science discoveries including antibody-drug conjugates, immune checkpoint inhibitors, bispecific T-cell engaging antibodies, and engineered cellular therapy. (pg 9)
Though most clinical trials are driven by the pharmaceutical industry developing expensive new drugs, two NCI-sponsored trials in early stage breast cancer determined that the majority of women with the most common type of breast cancer can be spared adjuvant chemotherapy after surgery, reducing medical expenses and pharma income. (pg 10)
Sleep is strongly associated with heart health. Atherosclerosis starts early in life, from birth to age 25, before manifesting debilitating or fatal heart disease at age 50 to 100. (pg 12)
Exposomics is a field encompassing all factors that predict health, including genetics and environment. The 20th-century concept of nature vs nurture must be tossed aside. Genetics and environment do not compete, they work together. Yet there is no systematic plan to integrate exposomics into precision medicine. The inflection point will come when he commercial, public health, and medical value is realized. (pg 14)
Spurred by the over 1-million fold reduction in the cost of genome sequencing and data analysis, the link between genetic variants and health is being used at a massive scale in clinical settings. Genetically engineered T cells have been established as a highly effective treatment for aggressive blood cancers, and mRNA vaccines have altered the course of the COVID pandemic (pg 16).
Over the past century, improved living conditions, advances in public health, and modern medical care have nearly doubled human life expectancy and brought with it the gifts of longer life, space to pursue our passions, and more time for deepening relationships with loved ones. But these added years after age 75 are often accompanied by one or more serious chronic illnesses with which we live for many years. Older adults with serious illness make up only 5 to 10% of our population, but account for over 2/3rds of health care spending. New models of care focus on quality of life, maintaining independence, and staying at home with dementia and Alzheimer’s. One in 4 over age 80 is afflicted, and this will triple over the next 30 years. (pg 19)
Protective immune defenses against cancer and infection are critical for survival. But overactive immunity can drive detrimental inflammation and autoimmune disease like MS. Data generated by AI can solve questions about immune responses, like a recent machine learning model that predicts how cancer patients will respond to immune checkpoint inhibitors (pg 21)
Single gene disorders affect 5% of live births and account for 30% of pediatric hospitalizations. Gene sequencing of exomes and genomes is practical and disease-causing sequences treated or repaired. (pg 24)
The human brain is uniquely complex, with 100 billion neurons, an equal number of glia, and about 100 trillion synapses. While computers are faster and more accurate, a human brain still outperforms computers in abstract thinking, planning, social intuition, and emotion. Brain disorders (depression, psychosis, dementia, stroke, and addiction) are 5 of the top 10 disabilities worldwide. The brain exhibits so called emergent properties, consciousness and “the mind”, that cannot be understood based on molecular-cellular interactions alone. Even the most basic properties like interpreting a visual image, throwing a baseball, solving an equation, remembering the past, or emoting in response to good or bad news, cannot be explained today by simply measuring cell and circuit activity.(pg 27)
Each person carries several million common genetic variants, 10 to 100,000 less common ones, and about 100 de novo exclusive to the individual. How these interact with the environment helps explain why some of us are more susceptible to certain diseases and why the same drug may be beneficial to some and harmful to others. A major hurdle impeding progress is the exorbitant cost of developing new drugs, estimated at $2.6 billion in 2021. Learning about how environmental factors interact iteratively with an individual’s genome to determine disease risk will catalyze new classes of prophylactic drugs, fundamentally different than those for after the disease is established. (pg 31)
Advances in microscopy, miniaturization, implantable materials, imaging techniques, and our understanding of biology and brain function, together with computing, robotics, and AI have led to dramatic changes in how surgery is performed. Percutaneous fracture repair and new ingrowth materials for joint replacement have been developed. (pg 35)
Research is now uncovering unique gender-based attributes, including many characteristics of women of diverse racial and ethnic backgrounds. This coincides with NIH’s 2016 mandate to include sex as a variable in all funded research. (pg 39).