How systems medicine will transform the healthcare sector and society

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Abstract

Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine.

Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions.

Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA.

FULL TEXT: Personalized Medicine

Breath

Breath explores how the human species has lost the ability to breathe properly over the past several hundred thousand years and is now suffering from a laundry list of maladies — snoring, sleep apnea, asthma, autoimmune disease — because of it. Nestor travels the world to figure out what went wrong and how to fix it.

Aging clocks: AI-based biomarkers of aging

an alarm clock

Excerpt

First published in 2016, predictors of chronological and biological age developed using deep learning are rapidly gaining popularity in the aging research community. These deep aging clocks [that have been developed using artificial intelligence (AI)] can be used in a broad range of applications in the pharmaceutical industry, spanning target identification, drug discovery, data economics, and synthetic patient data generation.

Recent advances in machine learning, coupled with increases in computational power and availability of the large publicly available datasets, have led to a renaissance in AI. These advances have generated substantial investment and hype, and many data scientists and companies are exploiting the surge in AI hype for promotional purposes. This has sown confusion in the market and triggered criticism from scientists working in the pharmaceutical industry, where approval in clinical trials is the ultimate measure of success.

Most of the credible advances in the field have been in deep learning and reinforcement learning. Since 2013, deep learning systems have surpassed human performance in multiple applications, including strategy games as well as image and text recognition. In healthcare, deep learning systems outperformed human dermatologists, ophthalmologists, and radiologists in various tasks. Deep learning also demonstrated significant improvement over conventional machine learning methods in biomedical data analysis.

Biomarkers of aging

During this same period of deep learning progress, aging research has also experienced a renaissance, and new breakthroughs are rapidly emerging. Multiple data types can be used to predict age and associate the prediction with mortality, disease, general well-being, or other biological processes including methylation, gene expression, microbiome, and imaging data.

Since the publication of the first multitissue methylation aging clock by Steven Horvath in 2013, multiple methylation aging clocks and applications of these clocks in humans and mice were developed. Even though these clocks were developed using traditional machine learning approaches – notably linear regression with regularization and the use of a limited number of samples – the results suggest that gradual changes during aging can be tracked using various data types with reasonable accuracy.

FULL TEXT: Trends in Pharmacological Sciences

Ethics of regenerative medicine










Stem cells + regenerative medicine

Introduction

The possibility of regeneration fascinates us as much today as it did the ancient Greeks. In the story of Prometheus, an eagle was sent to peck his liver each day as punishment, while at night it regrew. Stem cells have a similar mythical character — part fact, part fantasy — that captures the imagination but also blurs reality.

[We published] the Lancet Commission: Stem Cells and Regenerative Medicine to assess advances in the field, including gene therapy, since our last Series on the topic in 2013, and how to plan future developments in a way that both promotes science and protects the public.

The commissioners emphasise the importance of well funded basic science that led to the insights and techniques that have made stem cell therapies possible. However, in vitro findings have not always been replicated in humans. To improve translation, they suggest wider collaboration with clinician-scientists.

The report notes that many regenerative therapies appeal to potentially vulnerable people, which raises concerns about ethics, safety (particularly for unregulated autologous cell use), and financial structures for development and marketing. At the same time, the enormous advantage of curative gene therapy for a disease like Duchenne muscular dystrophy, which can restore independence and reduce health-care costs, is clear.

To guide practice, the Commissioners propose a social contract that emphasises best science, equitable funding, strong governance, and transparent engagement with patients and the public. Prometheus was punished by Zeus for stealing fire and giving it to humans, which enabled civilisation. In other interpretations, Prometheus is associated with scientific enquiry.

Since our previous Series, the spark of regenerative medicine has become a flame that offers vast potential benefits, such as limbal stem cells licensed for corneal repair. But dangers persist that are incompletely understood, and the best way to harness stem cells and genes to alleviate true clinical need is unclear. The Commission provides a welcome mechanism to move past the smoke of hype and cultivate the flame of hope.

SERIES: The Lancet