Medicine of the XXI century

Seven main trends

Marianna Ivanova, Slon.ruWhat will healthcare be like in 50 years?

All attempts to imagine this today seem like science fiction and immediately evoke associations with genetic engineering, cloning, cryogenic and other futuristic technologies. However, two things about the medicine of the future can be said firmly: it will become personalized, and medical care for each person will be based on a colossal – compared to today – mass of statistics and other objective data.

Today, medicine is able to truly take up its eternal task: to know the full mechanism of the development of the disease, the exact scheme of its prevention and to master the methods that allow it to stop. And this fundamentally changes a person's attitude to health, and the business models of biotechnological, pharmacological and insurance companies. We will talk about all these changes – about the main trends in healthcare of the XXI century - today.

Incurable diseases? What is it?Each new era in the development of medicine changes the very idea of diseases and the medical norm.

Personalized medicine and genetic treatment technologies will bring no less profound changes. For example, the previously incurable disease adrenoleukodystrophy, which leads to an early death, can now be completely stopped in some cases with the help of a genetic engineering method that restores the work of a damaged gene. To do this, using an intravenous injection, a person is injected with his own blood cells, but modified: a well-functioning section of the gene, which was originally damaged in a person, is introduced into them.

Injuries and defects that were previously considered a sentence become curable. There are already cases when blind people (due to early retinal dystrophy) were able to see and read the first three rows of the vision check table: they were cured by repairing the retinal pigment epithelium gene (PRE65).

Genetic treatment is a universal technology applicable to many types of diseases. Viruses harmless to humans (adenoviruses, lentiviruses and others) can be used as directional vectors. The desired section of DNA or RNA is inserted into the genome of the virus, and this genetic information is embedded in the nucleus of a human cell, getting into the body together with the virus. There, thanks to her, a new, correct protein begins to be synthesized. Instead of viruses, you can use membrane bubbles, inside which you can put a lot of pieces of DNA. In short, the technology of production of viral vectors and liposomal particles has already been worked out. Now the task in the treatment will be to find out which of the genes is damaged (a person has about 25 thousand genes in total), synthesize the correct gene and send it to the human body.

Finally, we are approaching the frontier of knowledge, when a change in one link of the biological process, for example, the replacement of one nucleotide in a gene, can be calculated at the level of the whole organism, that is, we will be able to assess what effect this will lead to. And this is just the beginning of a long journey.

Diagnosis instead of treatmentA real boom is unfolding in the diagnostic market.

In the XVIII century, a stethoscope, examination and urine analysis were enough to make a diagnosis and prescribe treatment. In the XXI century, an incredible number of technologies and devices are used to study the body. If at the beginning of the XX century the turnover of the world diagnostic market in medicine was about 10% of the market of medicines and surgical treatment, then at the beginning of the XXI century this share is approaching 40%.

In other words, we are learning more and more about the processes taking place in the human body. In some cases, this allows you to reduce the cost of treatment, as it makes it possible to more accurately diagnose and not prescribe ineffective drugs, intervene in the disease at a much earlier stage, increase the likelihood of a more drastic recovery. And this, in turn, gives a significant economic effect, at least by increasing a person's ability to work.

Medicine for one person Until recently, pharmaceutical companies were developing "universal medicines for everyone."

The larger the target audience, the larger the batch of production of the drug, the greater the turnover and the cheaper it costs. Now the approach to the development and production of medicines is changing: medicines are becoming more effective, but the circle of patients for whom they are designed is narrowing.

For example, the drugs "Ushstat" (UshStat) or "Ataluren" (Ataluren) are used only for patients with Usher syndrome, when a person has congenital deafness and blindness progresses, this disease occurs in 3% of people. The gene therapy drug "Glybera" (Glybera) was approved in 2012 for the treatment of one of the rare forms of pancreatitis with lipase deficiency, this drug shows a very good effect in 1% of patients with pancreatitis.

The final postulate of personalized medicine is a full cycle of drug development for one end user. To implement such a scheme, it is necessary to reduce the cost of drug development billions of times, and with genetic methods of treatment, this does not seem so impossible.

Medical crowdfunding How to raise money for the creation of new medicines?

If financial investments in the creation of a product are distributed among millions of interested participants, then we can not just raise funds for development, but immediately understand who needs this development, who is ready to support the production of the product.

We are still facing crowdfunding in the medical field today. Beggars in the subway with photos and medical statements, letters and mailings on social networks asking to help the girl Masha with leukemia and many other ways to raise funds from the world on a string – this is crowdfunding. This scheme will also be effective in the search for new treatments, especially in the treatment of diseases such as diabetes mellitus, cardiomyopathy, myasthenia gravis, ocular, endocrine and mitochondrial diseases.

On the website www.medstartr.com you can find prototypes of those ideas for which it will be possible to raise funds from their final recipients: digital mammography; a service offering to send thoughtful gifts to patients instead of flowers that will help them recover faster; a portable medical iPod that gives the right information at the right time; organization of meetings and events for patients and their doctors and so on.

And in the future, whole communities of people with common needs for medical care will probably begin to appear; it's like homeowners' associations with a common goal – to live in one house with comfort. A person responsible for the result is appointed, a team of performers gathers, fundraising takes place among those who are interested in this result, for example, in creating a new drug or a new device for rehabilitation.

Data, data, and more dataAn individual, personalized approach in medicine gives birth to a whole wave of new generation businesses.

Moreover, only a small part of them is directly related to medicine. Communications, the organization of patient flows, the speed of information exchange and money will play a very important role in medicine. Therefore, new medical technologies will lead to the rapid development of acquiring technologies, protection and transfer of large amounts of medical data. There will be new services and applications that help manage patient flows using social networks, new mobile applications that allow patients to optimize their treatment.

Insurance medicine will become more accurate when the issue of the morality of using medical data in calculating the cost of insurance is resolved. And as for entrepreneurs who provide services directly in the field of "personal medicine", many companies of narrow specialization will appear. They will develop and improve the treatment of strictly defined diseases. The team of such companies will include bioinformatics specialists, programmers, clinical specialists, analysts and managers. And these companies can be truly transnational, not limited to the walls of one building or the borders of one state.

Medicine as a lifestyleThe lines between businesses providing beauty services, lifestyle services and medical services are increasingly blurring.

For example, the number of beds in hospitals will decrease, and boarding houses or comfortable hotels will be able to act as medical hospitals. The total area of medical institutions may even be reduced, because many of the services that were previously carried out in inpatient conditions can now be carried out at home or in an outpatient clinic.

The importance of psychophysiology is also increasing: by influencing the human body with medical methods, we change its sense of self and spirit; and in the future, by influencing the feelings and mood of a person, we will be able to significantly change the physiological processes in the body. Why take medicines if you can get rid of the disease without resorting to chemistry at all?

The patient's health is the responsibility of the patient himselfEveryone will be increasingly responsible for maintaining their health and the health of their family.

Partly because trust in traditional institutes of medicine has been declining in recent decades, and trust in the recommendations of close people and social networks is growing. And partly because the attitude to health itself will change, people will lead a more conscious and rich life, turn into experts in matters of their own health.

And new technological solutions will help them in this. For example, toilets that have already appeared in Japan, whose sensors allow you to do an automatic analysis of urine and feces, give recommendations on diet, send data to the attending physician for monitoring. We will have at our disposal a lot of devices that collect data on physical activity, the amount of food eaten and the quality of calories, medications used, the state of the air around, etc. As a result, we will accumulate large amounts of objective, statistically reliable information about which factors most affect human health in general and a particular individual in particular. This will allow you to issue individual recommendations on workload, professional activity, sports activities, etc. Even in kindergartens, meals, walks and upbringing will be organized taking into account the characteristics of each child's body.

Portal "Eternal youth" http://vechnayamolodost.ru10.01.2013