A Crystal Ball for the Decade Ahead
With a new decade dawning, Duke Today asked several Duke professors to hypothetically gaze into their crystal balls to tell us what they see happening in the years ahead. MEDx director Geoff Ginsburg and MEDx Investigator Shyni Varghese gave their perspectives on what medicine will look like in a decade.
HEALTH CARE -- CIRCA 2030
By Geoffrey Ginsburg
Following his heart attack, Jeff had his genome sequenced as part of a new employee health benefit. His wife and children were also sequenced as part of their participation in the All of Us Research Program (joinallofus.org).
The genome sequencing of Jeff’s wife revealed a number of gene variants that protected her from cancer. But Jeff’s history of heart disease and his genome data showed he had genetic variants for familial high cholesterol, which affects 1 in 250 people in our population and is what caused his heart attack.
Two of his children carry the same genetic variant, which is why his son Jack sent a stem cell sample to a company to develop a personalized physiologic model -- “Jack-on-a-chip” -- which was used to select the drug most likely to reduce Jack's cholesterol with the fewest side effects.
Jeff’s daughter, Jill, elected to undergo a new gene-editing procedure in which the genetic defect in the LDL receptor (responsible for removing cholesterol from the blood) is corrected and obviates the need for lifelong drug therapy.
Jeff has taken control of his risk for heart disease with genetically selected medications and a virtual health coach who helps him adhere to his lifestyle prescriptions. Smart phone and smart home devices help him and the coach monitor his physical activity, food and calorie/fat intake, sleep duration and stress.
One day Jeff awakens with a fever and sore throat and, after a conversation with a chat bot, is directed to swab his nose, place the swab on a biosensor attached to his phone and use the “I have a fever” app. The app indicates he is developing the flu, so does not need antibiotics and recommends he stay home from work to not infect coworkers. His GPS and sensor data are uploaded to the cloud where data analytics are used to model the potential for an emerging viral epidemic in his community. His data also alerts Amazon to drone-deliver Tamiflu and chicken soup to take care of his flu symptoms. A modern-day house call, you might say.
SPEAKING OF MEDICINE, “YOU-ON-A-CHIP”
By Shyni Varghese
Imagine a day when you can walk into a hospital and the health provider can prescribe the optimal drug based on a simple finger prick or a Q-Swab.
This should be possible in the not-too-distant future, thanks to Artificial Intelligence.
Say, for instance, you are a cancer patient. The oncologist draws blood from you that, along with the excised tumor, is sent to a research facility where the cells are converted to stem cells. Using the patient-derived stem cells, the facility can develop a patient-specific “you-on-a-chip” to identify the optimal drug with minimal side effects.
Going beyond, your doctor can now use the screening results to precisely advise you on potential side effects and suggest preventive measures. These emerging technologies make the conventional approach of “one size fits all” a thing of the past.
“You-on-chip” can also be used to predict -- and therefore prevent -- episodes of environment-driven diseases such as pneumonia and allergies, and help healthcare providers anticipate therapeutic outcomes based on an individual’s lifestyle, including diet, exercise or environmental exposure. This will revolutionize medicine by allowing us to personalize health care the same way we personalize our diets, wardrobes or Alexa.
On a related topic, aging is a key factor that leads to compromised organ function and impaired healing. For example, kids’ broken bone often heal without complications. However, the same injuries for an aging person not only don’t heal, but often introduce other complications.
But it may be possible in the next decade to go to the nearby pharmacy and buy an implantable medical device (e.g., functional biomaterials) that can deliver molecules at the injury site that assist with tissue healing or reverse the aging and associated complications.
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