Part 4: Precision Medicine — Not Just for Oncology

Saving Human Civilization

Cancer. Infectious disease. Common multi-genic disease. Medication safety and efficacy. Could genomic medicine benefit yet more areas of health?  You bet.  Genomic medicine could save human civilization.

Epidemics can end civilizations. Hernan Cortez’s 500 “conquistadors” subdued Mexico in the 1500s not with gunpowder, but with smallpox that ultimately killed 95 percent of the indigenous 20 million Aztecs. Historians debate the precise numbers, but an eye-witnesses was clear: “They died in heaps, like bedbugs.”

Detecting Epidemics Early

Bio-surveillance is the field that detects epidemics … quickly, one hopes, so the response can start as soon as possible. Bio-surveillance has existed for decades as a poor step-child of public health, but the 2001 anthrax attacks in the United States, plus Zika, Ebola, SARS, West Nile, and other recent epidemics have put it on the map at the highest levels of governments and non-governmental organizations.  President Obama stated just months ago: “What I spend a lot of time worrying about are things like pandemics.”

Detecting epidemics early is not easy. Many dangerous epidemic diseases start with the same set of flu-like symptoms we all know so well, delaying the true diagnosis for days and weeks and giving the epidemic time to take root in the community. The problem is compounded if the public health infrastructure is weak, i.e. if high quality confirmatory data from individual patients are not collected and sent to regional health officials for analysis and action.

Low-cost Genomics is Essential

Low-cost genomics will enable constant, vigilant, bio-surveillance at scale.  Imagine a hospital filled with patients. To answer the questions “Do any have Ebola?” or “Do any have SARS?” genomics could let us skip the time-consuming clinical examination of these patients. Instead we could check what DNA is in their blood or what DNA is being coughed into their handkerchiefs -- looking for matches with Ebola virus, SARS virus, or whatever. Hospital laboratories invariably have gallons of leftover blood from the routine tests that doctors order every day, so it would not even be necessary to draw blood anew for this purpose. Identifying individual patients is not necessary in this first level of bio-surveillance.

We could perform such bio-surveillance screening every day, and have the DNA machines automatically send results over the internet to regional health officials.  Sending only the non-human DNA results would preserve patient privacy. Although it has been said for centuries that “one swallow does not spring make,” detecting one blood sample containing Ebola would spring the epidemic-containment team into action.

This plan is not yet feasible in all respects: DNA sequencing is still too expensive.  (For now, proteomics beats it.) But there are technical developments on the horizon that could make it feasible soon. Nor should the expense of the information processing and connectivity requirements be ignored. Those geographic regions where a strong bio-surveillance capability is most required are also the regions with the least supporting infrastructure. That infrastructure will have to be built.

Recent advancements in genetic understanding have been nothing short of breathtaking. The convergence between genetic technology and silicon technology will produce inventions that future generations will find indispensable… so indispensable that, without the convergence, future generations may not exist.

 

This is the final in a four part series co-written by physicians at both Oracle Health Sciences and Intel Health & Life Sciences. Previous articles include:

Precision Medicine - Not Just for Oncology (Part 1) by Summer Kahlon, M.D. | Oracle Health Sciences

Part 2: Precision Medicine – Not Just for Oncology | John Sotos, M.D. | Intel Health & Life Sciences

Precision Medicine -- Not Just for Oncology (Part 3) by Summer Kahlon, M.D. | Oracle Health Sciences