Guest Contributor – Exponential Investor (Great Britain) –
Medicine just flipped.
Healthcare has worked in a simple way for over a century. Patients get sick, then the doctor tries to fix them.
Now, a revolution is starting – a fundamental shift in the way medicine operates.
At the heart of this change is a completely different understanding of disease. Presently, medics are labelling clusters of symptoms as “diseases”, and treating them in isolation. But these “diseases” may be the tip of a biological iceberg.
What we think of as diseases today may merely be symptoms of more fundamental biological processes – which are themselves failing.
Today, I’m going to illustrate that point, by talking you through several recent breakthroughs in health – all of which point to a real shift in the way we think about sickness.
Firstly, there are a couple of drugs (trazodone, DBM) that appear to be effective at blocking the underlying mechanisms for various neurodegenerative diseases. Instead of trying to alleviate the symptoms of Alzheimer’s, or Parkinson’s, this new approach means that a single treatment that could potentially prevent a wide range of neurodegenerative diseases. Under this way of understanding disease, both Alzheimer’s and Parkinson’s might be seen as a single new class of disorder – which can be treated with a single chemical regime.
This is a fundamental, seismic shift in medicine. It changes the whole way we think about disease and treatment. Recently, there has been an opposite move in medicine – towards highly-specific personalised medicine. This approach is based on creating ever-finer subdivisions in diseases, and treating them very precisely. Recent news on prostate cancer shows that this approach can still be successful – unlocking a DNA test for the effectiveness of abiraterone and enzalutamide in individual patients.
But now, things are moving back the other way – and we’re now looking at how differentiated diseases can be grouped, and treated, at a much more fundamental level. That’s particularly important in diseases like cancer – which can be divided to an almost infinitesimal extent. The more diverse this subdivision process is, the less useful it becomes. This is because you can’t economically create an unlimited range of drug treatments – even if you can identify a vast number of distinct diseases. Ultimately, personalised medicine becomes a victim of its own success – rendered entirely impractical, in terms of creating suitable treatments.
It’s time for a new approach – finding, and controlling, the master switches of entire groups of diseases.
In Exponential Investor before, we’ve looked at techniques that rely on interference with fundamental disease processes. For example, Jeff Bezos (Amazon) is currently backing Unity Biotechnology. This firm is engaged in the business of dealing with senescent (non-dividing) cells. It’s looking more and more like these cells underpin the ageing process – and recent research on mice has lent considerable weight to that view.
Comparably, there is new work on kidney disorders – which are associated with diabetes. Again, scientists researching this condition have found a fundamental molecular switch that appears to prevent the progress of the disease. This means that instead of merely treating the symptoms of kidney failure, doctors are now able to imagine a future where kidneys don’t fail in the first place, despite diabetes. It’s a fundamentally new way to think about managing disease. Even better, the hormone (Klotho) appears to have effects on a range of disorders beyond the kidneys.
Finally, there is yet more research that suggests that young blood is a potential “elixir of youth”. Experiments involving blood transplanted from human babies into adult mice showed a rejuvenating effect from this treatment. Unfortunately, bleeding babies is not a practical way of sustaining the health of billions of elderly people. Instead, the molecular mechanism behind this process is starting to be unlocked. Recent research has identified tissue inhibitor of metalloproteases 2 (TIMP2) as being important – and umbilical cord blood is a concentrated source. This builds on previous work, which has singled out growth differentiation factor 11 (GDF11) as another significant blood component, with potentially useful anti-ageing properties.
These are a couple of ways these blood proteins could potentially be used clinically. Firstly, it may be possible to trigger the to produce them “naturally”. This could be done using drugs, or perhaps even gene therapy. Alternatively, they could be manufactured outside the . This would likely be done using genetically-modified organisms, or a culture of human cells.
In summary, what looks like three entirely separate medical breakthroughs actually come together into a much bigger story – one that’s far more important. Our concept of disease, and how we treat and manage it, is changing fundamentally. The medicine of tomorrow will not be like the medicine of today – and it may concentrate far more on the “big picture”. You better make sure that you’re riding this new medical wave.
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