"Dr. Watson, what do you say?"

Genoma editing, personalized cancer treatment, diagnostics with a supercomputer - all this is a medicine of a completely visible future

Excellent health for all mankind, life up to 120 years, flowering offspring-the forecast of physics-theoretical and popularizer of science Stephen Hawking. The famous scientist predicts in the very near future the onset of the era of the planned evolution based on the successes of science and medicine.

Hawking, almost completely immobilized due to lateral amyotrophic sclerosis, is a hot supporter of genetic engineering. He is sure that the medicine of the future is much closer than it seems, because a lot that we recently read only in fantastic novels-bionic prostheses and organs printed on a 3D printer, operations that robots do, and a complete analysis of a person’s health made in seconds on super-powerful computers-has become real.

There are many obstacles on the way of the latest developments - from a lack of money to ethical problems. It never occurred to anyone to argue whether the use of antibiotics, inventions, which completely changed medicine around the world and saved millions of lives. However, conservatives, representatives of various religions and even the scientific community protest against the use of genetic engineering.

The day after tomorrow

“Supporters of traditionalist beliefs can simply come to families who grow children with genetic diseases, see how these children live, and ask-their parents would like to be able to adjust the“ wrong ”gene in time,” says Roman Ivanov, vice president of the development and research of the biopharmaceutical company Biocad. I ask him about the prospects of genetic medicine in our country - Ivanov replies that this is no doubt the future of not tomorrow, but after tomorrow's day. From the point of view of the scientist, our country can go on a par with the West, but only if the state supports this direction with money, and most importantly - a strong -willed decision.

In 2003, the cost of deciphering the genome was three billion dollars, and six largest countries, from the USA to China, participated in the project. In 2006, the price dropped to one million, last year - to one thousand dollars. Financial costs are not the biggest problem for the development of technology in genetics. As soon as scientists began to make the first successes, the scientific community, officials and the public of the whole world remembered ethics.

In 2015, in Nature, one of the most reputable general scientific journals in the world, an announcement of the American biochemist Edward Lanfire appeared. He talked about the possible ambulance publication of work on changes in embryos DNA by editing the human genome. On his behalf and on behalf of his team, the scientist called for the moratorium on such interventions before the development of the Ethics Code. A few months later, well -known scientists, among whom were one of the founders of genetic engineering David Baltimore and the Nobel Laureate Paul Berg, specially met in California to discuss the rumors of new studies of editing the human genome. The result was the publication in Science, warning against the development of this method.

The study on attempts to adapt the CRISPR/CAS9 editing system for manipulations with human DNA, which was opposed by the most authoritative scientific journals of the world, was published in the little -known Protein & Cell magazine - both Nature and Ssience refused to publish it from ideological reasons. The author of the study, Zyunju Juan, the head of the scientific group of geneticists from the University of Sun Yatsen in Guangzhou, in their interviews speaks of the reaction of the scientific community with resentment - Chinese genetics used “dead” human germs that were obtained with the consent of patients in such experiments. The experiments cannot be called successful: 28 out of 86 embryos have successfully survived the editing of the genome, and only four of them received the corrected version of the gene. The experiment was stopped, because, in addition to corrections in the desired part of the DNA, the structure of the genome in other areas changed.

Junzu Juan conducts experiments at the University of Sun Yatsen in Guangzhou Photo: LU Hanxin/Xinhua Via Zuma/Tass

“Yes, now in most countries, including in Russia, it is completely prohibited to use these technologies on embryonic cells, somewhere, as in the UK, it is only partially allowed,” says Roman Ivanov. “But you need to understand that there is no alternative to this technology, this is the only and, potentially, the most effective way to treat so many hereditary diseases.” According to Ivanov, thanks to the achievements of modern medicine, many carriers of genetic diseases can live a long life and have children - it was impossible before. “This is great in itself and exactly what our medicine has strove for,” adds Ivanov. “Here we have reached the goal-now we need to take the next step, because in the long run it is a path to nowhere, not a single healthcare system will be able to take out treatment with mega-expensive drugs of more and more people.”

90% of complete remission

The achievements of modern medicine are easiest to see on developments in oncology. The word “cancer” familiar to the layman, even with more or less detail - “breast cancer”, “blood cancer”, “leukemia” - in medicine and science have long lost its meaning. Hundreds and thousands of species of malignant tumors are known, each of which requires a special approach and treatment protocol. Standard chemotherapy is gradually replaced by targeted chemotherapy, blocking the growth of cancer cells with intervention in the mechanism of specific molecules necessary for the origin and development of the tumor.

“Targeted therapy as competition develops, the emergence of new, more effective methods of treatment, the expiration of patents, will become more accessible,” said Roman Ivanov. He gives an example the drug Imatinib. In the late 1990s, when the international group of scientists received this effective anti-mushroom targeted drug, it cost quite expensive. “Now, when the patent has expired, and the market is filled with cheap, but no less effective generics, the cost of treatment has fallen ten times,” says Ivanov.

The next step after targeted therapy is personalized therapy. In August 2011, in the United States, representatives of the Comonwealth Foundation For Cancer Research Cancer Foundation announced the opening of the Center for Personalized Medicine and the transfer of $ 30 million for its needs. The center is working on studying the genetic characteristics of patients who determine their sensitivity to one or another antitumor therapy. Specialists of the Center suggest that by 2020 this approach will be widespread around the world.

In July 2017, FDA, the main regulatory body in the field of healthcare, recommended that the method of treatment with cancer based on genetic editing. A medicine that allows to achieve complete remission is extracted from the patient's own blood. Scientists have received a huge array of information about the interaction of the immune system and a malignant tumor. On its basis, it was possible to develop a technique that allows you to make a “visible” tumor for the immune system. The body fights with the tumor itself, just as with banal pathogenic bacteria or viruses.

A medicine that allows to achieve complete remission is extracted from the patient's own blood

So far, the cost of a new method is high - several hundred thousand dollars per patient - and side effects are very serious. In some control groups, a third of the wards found serious neurological disorders. But everyone was more interested in another figure: 90% of patients on whom they experienced a new treatment methodology reached complete remission.

“This can completely change oncology,” says the oncgetologist and corresponding member of the Russian Academy of Sciences Alexei Maschan. “Cells with activated receptors that not only recognize the tumor, but also actively and constantly destroy them - a real breakthrough.” Maschan believes that the discovery comparable in value is the appearance of genetic drugs affecting cholesterol metabolism. “These are discoveries not local or significant only for certain areas of medicine,” says Maschan. “Despite the fact that universal discoveries at the level of antibiotics are not expected, new inventions will affect the life of millions of people.”

Diagnostician from the car

In February 2011, on the Jeopardy Textor! (an analogue in Russia - “its own game”) against the owner of the largest winning in the program of Brad Ratter and the record holder for the duration of the win -win series of Ken Jennings was played by Dr. Watson. The IBM supercoupter, named after the assistant Sherlock Holmes, contained two hundred million pages of structured and unstructured information, but was not connected to the Internet. IBM Watson won by receiving a million dollars, and its creators announced plans to use its capacities to help assessing insurance risks or energy consumption efficiency, and most importantly, to help in the diagnosis and treatment of patients.

The employee of the IBM research unit demonstrates his pulse using the application. The respiratory rate and body temperature are also measured. All data can be transmitted to other devices via a wireless network. This system can be used to monitor the health status of numerous employees photo: Matthias Balk/DPA/TASS

Two years later, the supercomputer has already been actively used in this direction. Statistics spoke in his favor - for example, after diagnosing lung cancer in US hospitals, in about half cases, doctors recommend not the most ideal course of treatment and drugs. IBM Watson brings the accuracy of prescribing optimal treatment to 90%. Quite often, a computer that analyzed hundreds of thousands of stories of the disease and a huge building of medical articles generally makes a different diagnosis. One of the indicative examples - at the Tokyo University, doctors after several months of unsuccessful treatment of sixty -year -old patients decided to check the accuracy of their appointments on a supercomputer. But, having analyzed the entire medical history of the patient and herself, comparing it with 20 million other stories of the disease in his base, IBM Watson determined a completely different form of leukemia, almost not diagnosed with traditional methods.

“Twenty years later, it is for self -learning systems that work on the principle of accumulation and analysis of big data, the main analysis of medical information will be entrusted,” Roman Ivanov says with confidence. The final decision still remains with the doctor, because the responsibility for the life and health of the patient cannot be assigned to the car, but the doctors will more and more rely on such “clues”. “The volume of scientific knowledge in medicine is growing in exposure,” Ivanov explains. - The human brain is simply not able to cope with this, the doctor cannot treat and constantly monitor the latest developments. But with the help of a system based on artificial intelligence technologies, a person can make a reasonable and correct decision. ”

Yuri Krestinsky, Director of the Center for Research of Economics and Management in Health Care, Skolkovo, the Director of the Skolkovo Business School, agrees with him: “Health digitalization can be considered predetermined today. In many ways, the competitiveness of national healthcare systems will be determined by the development of the digital competencies of states, governments and medical communities, leaving far behind all those who are not in touch with the times. ”

Krestinsky says that with all the undeniable advantages of new technologies - blockchain, artificial intelligence, machine learning - one must not forget about risks. What new medicine will look exactly when the emphasis from the competencies in the field of biological sciences will be shifted in the segment of information sciences and technologies, no one can predict for sure.
The Russian Ministry of Health plans to do without Western developments. In 2014, Elena Boyko, who heads the IT department and the department of the department said: “IBM Watson costs several hundred billion dollars. But we believe that we can create systems no worse and not pay outside our homeland. ” In reality, the Ministry plans to completely get rid of paper until 2020, introduce an integrated electronic medical card and establish the interaction of its main departments.

The price of life

“High technologies - bionic prostheses, regeneration management, biopharmaceuticals - promise us great prospects,” says Dmitry Shamenkov. “Only the effectiveness of the use of new technologies is directly dependent on the human ability to conscious management of his health.” Shamenkov - former director of the Center for Biomedical Studies of the First Moscow State Medical University named after I.M. Sechenova, specialist in cell therapy and member of the expert collegium of the development fund of the Skolkovo Innovation Center for Biomedical Projects. Now the sphere of his interests is primarily aimed at leading the social network created by him and the public movement “Community of Improving Health”. Shamenkov believes that the medicine of the future is primarily the medicine of communities. “We are already beginning to understand that problems with the physical and psychological health of a person are a consequence of social isolation, disunity and loneliness,” he says. “Restoring the connections in the family, communities, between communities, we help to heal the person himself.”

Bio -dentures of the upper extremities at the exhibition “10 artifacts of the future - promising Russian technologies” as part of the opening of the Center for Prototyping of high complexity “Misis” “Kinetics” photo: Valery Sharifulin/TASS

Roman Ivanov believes that, first of all, the responsibility for what the medicine of the future will be, lies with the state and this is an economic question. It cites the UK as an example, where issues about providing drugs are resolved on the basis of pharmaceutical data. “If the drug extends the patient's life, increases its quality, gives performance, if its cost is adequate to the added years, then the state covers it,” he says. “In Russia, this approach does not work for a number of reasons, the main of which is the lack of political will and determination to the state to admit that human life has a certain value.” In his opinion, Russian medicine awaits a good future only if the state will act decisively.

responsibility for what the medicine of the future will be on the state and this is an economic question

“Any discoveries, the address of which is a large population, should be industrialized, if not all over the world, then at least within the boundaries of the country,” said Alexei Maschan. “The road here is still long, because there is not enough infrastructure, there is no funding.” I ask how long it will take the path from the oncoimmunological laboratory in the United States to the oncology dispensary in Arkhangelsk. Maschan grins and says that most people in power simply do not understand how things are actually in medicine. “They are reported to them that everything is fine that the money that all allocates for this is enough,” he says. “But this is not true.” In order to integrate all the discoveries into everyday practice, and not to do them only dozens, or let hundreds of people need tremendous infrastructure efforts. ” The doctor believes that medicine development prospects are optimistic, because thanks to modern scientific platforms, you can get results and broadcast them very quickly. “But while our country and humanity as a whole will not stop constantly fighting, they will not begin to spend resources on a person, and not on his murder, nothing will change,” the doctor said.

Medicine of future technology