Precision Medicine will need to get out of the pharma silo that is based on symptoms


Welcome to the digital era of biology (and to this modest blog I started in early 2005).

To cure many diseases, like cancer or cystic fibrosis, we will need to target genes (mutations, for ex.), not organs! I am convinced that the future of replacement medicine (organ transplant) is genomics (the science of the human genome). In 10 years we will be replacing (modifying) genes; not organs!


Anticipating the $100 genome era and the P4™ medicine revolution. P4 Medicine (Predictive, Personalized, Preventive, & Participatory): Catalyzing a Revolution from Reactive to Proactive Medicine.


After low-cost airlines (Ryanair, Easyjet ...) comes "low-cost" participatory medicine. Some of my readers have recently christened this long-lasting, clumsy attempt at e-writing of mine "THE LOW-COSTE INNOVATION BLOG". I am an
early adopter of scientific MOOCs. My name's Catherine Coste. I've earned myself four MIT digital diplomas: 7.00x, 7.28x1, 7.28.x2 and 7QBWx. Instructor of 7.00x: Eric Lander PhD.

Upcoming books: Doomsdare, a medical thriller (action taking place in Beijing) Fall 2016; Jesus CRISPR Superstar, a sci-fi -- French title: La Passion du CRISPR (2017). Special thanks to Prof. Emmanuel Lincot, lawyer David Kilgour and Isabelle Provost for their help.

I love Genomics. Would you rather donate your data, or... your vital organs?

Audio files on this blog are Windows files ; if you have a Mac, you might want to use VLC (http://www.videolan.org) to read them.

Concernant les fichiers son ou audio (audio files) sur ce blog : ce sont des fichiers Windows ; pour les lire sur Mac, il faut les ouvrir avec VLC (http://www.videolan.org).


Summarizing this Blog, also for French speakers - Résumé de ce blog


AUDIO VERSION
English version audio file.

This link is an audio file. Audio files on this blog are Windows files ; if you have a Mac, you might want to use VLC (http://www.videolan.org) to read them.
 

Audio file MP3 extension  
 
VERSION AUDIO (fichier son)
Version Française.
 

Concernant les fichiers son ou audio (audio files) sur ce blog : ce sont des fichiers Windows ; pour les lire sur Mac, il faut les ouvrir avec VLC (http://www.videolan.org).


Fichier son en français au format MP3

Ce que j'ai appris lors de mes études au MIT et à Harvard ?  
Here's what I've learned while studying at MIT/Harvard:

Ben il paraît qu'on se serait plantés de direction dans les années 70.  
We got it all wrong in the seventies.

On a découvert l'ADN, les 4 lettres, A-T-C-G, on a pensé "c'est tout basta. C'est ça le 'secret de la vie', bof, aucun intérêt faut aller voir ailleurs".  
Back then the 'secret of life' got discovered, or so we thought. Four chemicals, four letters, A-T-C-G. Tedious! Couldn't see what to make of it. No need to focus on these, as doing so wouldn't get us very far...

Du coup on s'est orientés plutôt en direction du cerveau, avec le cerveau comme chef d'orchestre des organes et les médecins comme spécialistes des organes. Et les chirurgiens comme des super-pros de l'organe (classement par spécialités, donc études et travail en silos et forte hiérarchisation entre organes plus ou moins nobles).  
So we decided to focus on the brain as the King of organs. Medicine should be all about organ technique -- and ultimately, organ replacement to deal with organ failure. Our MD's and surgeons became organ pros, working in silos (instead of working across the silo). Of course some organs (like the heart) were said to be nobler than others (digestive)...

D'après certains Prix Nobel du MIT, ceci serait arrogant car au final on ne sait toujours pas grand-chose du cerveau... Pour soigner vraiment le cancer, cibler les organes n'est pas franchement efficace ...  
Some people who got a Nobel Prize and are teaching (biology for ex.) at MIT say that this was a bit arrogant, since all we did was convincing ourselves we knew a lot about the brain, which honestly is not really true. To cure cancer, we have to target mutations in genes; not the organs. Cancer mortality is down by 20% from 1991 peak. This means that from 1958 (when data became available) until today, cancer mortality has been brought down by 10% only. How many decades will we need to make cancer become some kind of "chronic disease"? Maybe one, probably two... However, this can only happen if we target gene mutations; not organs. Bringing individuals' chromosomal variants together is the big task at hand. And, by the way, this happens to be the idea behind 23&me.

 

Pour soigner le cancer, faudrait cibler les mutations de nos gènes; pas les organes ...  

To cure cancer, we need to target gene mutations; not organs.

 

Du coup on est un peu dans une impasse - la médecine de l'organe culmine dans la transplantation afin de remplacer les organes défectueux, or on ne peut pas transplanter tout le monde -, il faut donc changer de système de santé ... en intégrant la e-santé, la médecine préventive, la génomique ...  
Our healthcare system is in a crisis. Organ centered medicine calls for organ replacement therapy as the ultimate solution. However, we were not able to industrialize organ donation. There's been organ shortage, organ trafficking, scientific polemics regarding brain death, etc. This calls for some kind of healthcare revolution: prevention, mHealth, digital medicine, telemedicine, 3D bioprinting, we are now exploring personal genomics, and of course this is only the beginning... A-T-C-G, the four boring letters from that 'secret of life' thing we talked about earlier, could help translate clinico-molecular data into safer, more effective drug choices for patients. This means chemotherapy will do a better job targeting cancerous cells. Revolutionary gene editing tools (software) like CRISPR will one day be used to change the genetic makeup of human embryos. Chinese scientists already can do that with monkeys (probably not only monkeys...)

In his stunning book "Life at the speed of light", geneticist J. Craig Venter writes that we are living in the "digital age of biology", in which "the once distinct domains of computer codes and those that program life are beginning to merge, where new synergies are emerging that will drive evolution in radical directions." 

Cet après-midi au MIT y a une démo pour réécrire l'ADN humain grâce à CRISPR Gene Editing. Les Chinois le font déjà (avec les singes, mais pas que à mon avis) ...

Je rappelle qu'il est interdit par la loi au citoyen français de faire séquencer son génome. Conclusion : ne tombez pas malades, et prônez le don d'organes (on ne sait jamais) ...  
In France, it is forbidden by law that French citizens have their genome sequenced -- it's punished by fines and you can also be punished by prison. So you'd better take care of your health and strongly support organ donation as someday it will be useful to you...

Je dédie ce post à l'@nthropologue Jean-Michel Billaut, net-économiste et spécialiste e-santé.
This post is dedicated to French Internet and Network Economist Jean-Michel Billaut.

http://99covers.com/wolowitz-from-m.i.t-facebook-covers/38102/1


1 commentaire:

Ethics, Health and Death 2.0 a dit…

Changer de carrière : objectif fixé en 2012, merci Jean Michel Billaut. Depuis : diplômée du MIT et de Harvard en génomique fin déc 2013. Fin janvier 2014 : ai tissé mon "petit" réseau de 900 VIP de la génomique sur Twitter, candidature validée par certains d'entre eux (lettre de motivation, vidéos de présentation et CV). Prête à passer à l'attaque et candidater de manière active. Vais-je aller m'installer en Australie ou en Californie ?? quel suspense (bientôt la réponse, stay tuned!)