Health and Fitness

Revolution ahead in prevention, treatment

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You’ll still get sick, still see a doctor and probably still dread hospital food.

But much else in medicine will look different 30 years from now, says Francis Collins, director of the National Institutes of Health. That includes "breathtaking" advances in understanding disease, improvements in technologies and in shifting medicine from treatment to prevention. The fundamental relationship between patient and doctor will evolve over the next three decades.

What else will we see? "Precision medicine, precise choices about prevention and treatment that are based on understanding of the individual patient," says Collins, 62, who now leads the federal biomedical research agency with its annual budget of $31 billion, the place where the science behind tomorrow’s medicine first appears. "We will have a strategy for this patient we know will work. And we will know how we are going to do it."

An Institute of Medicine report last year called for ending the century-old practice of doctors diagnosing disease primarily by signs and symptoms and instead retooling medicine into a practice based on genetic and biochemical specifics of ailments.

"That means for cancer patients, no more one-size-fits-all chemotherapy but a treatment targeted to the genetic characteristics of their tumors," Collins says. This is already happening for one type of lung cancer, in which a drug was shown to help the 10% of patients with the right genetic mutations that made their tumors receptive to treatment.

In his lab on NIH’s sprawling 322-acre campus, Collins holds up a computer-chip device the size of a quarter that fits into a gene-sequencing machine. It’s capable of mapping your genes, "for about $7,000." A decade ago, machines the size of refrigerators were yoked together to produce the first sequence of the human genome, or genetic blueprint, a project Collins headed that cost roughly $4.56 billion in today’s dollars. By 2042, he suggests, every baby’s genome probably will be recorded at birth, which will provide the starting point for lifelong medical treatment.

Even without gene sequencing, "technology will drive a lot of the advances," Collins says, including:

Stem cells. Doctors will grow replacement tissues from a patient’s own cells to treat diseases such as Parkinson’s or liver failure or diabetes. The newly grown cells might replace dying ones in a failing organ.

Brain implants and prostheses. Advances in connecting nerves and brain signals to bionic prostheses promise to help paralyzed patients. Implants that connect brain cells to electronic devices would let them control robotic arms and legs.

Health apps. Gadgets today can record calories, count footsteps and send heart rates to doctors. In 30 years, clothing-embedded sensors may track every breath or test your blood for genetic markers of cancer.

"I hope there will be a big shift in the direction of prevention," Collins says. "So much of what we are currently seeing as far as human suffering and misery comes from diseases that should have been preventable but were not."

To that end, Collins predicts that medical training will change, producing doctors who are better tuned in to the latest advances in research. A discipline of "preventionist" health providers may be the front-line physician for most people, helping you stay healthy before disease strikes.

"We will still need people to take responsibility for their own health," Collins says, pointing to the risks posed by smoking and obesity. "We will still age — I’m sorry if you thought we would have a fountain of youth by then. We’ll need to work on that."

(c) Copyright 2012 USA TODAY

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