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Archive for Monday, November 26, 2001

Future of health care full of benefits and fears

November 26, 2001

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— Imagine a world in which you carry your entire DNA profile on a plastic card in your wallet, which your doctor could swipe through a machine to make a nearly instantaneous diagnosis.

Or a world where such diseases as Alzheimer's, cancer or depression have been cured or controlled with new "designer" drugs.

Now imagine this world employers and insurance companies able to weed out workers who may be prone to certain diseases; governments or private entities with information on your genetic makeup; the chance to "design" children before they're born.

Both these worlds are coming and in the not-so-distant future, say experts and scientists involved in current medical research.

"We can't begin to imagine what life will look like even 30 years from now," said Richard Brown, director of the Life Sciences division at Midwest Research Institute in Kansas City. "The research going on now will have both tremendous benefits and tremendous problems. ... I don't think you can envision anything that can't happen."

The dizzying changes to come began with the mapping of the human genome, the catalog of DNA needed to make an organism. Researchers are moving even deeper into the cells to study proteins within the genes. It's called proteomics and experts say it will change everything we currently know about health care.

The research is aimed at fighting diseases, most of which occur because of variations and reactions in the proteins. Researchers also are studying the affects of toxins, such as anthrax or pollution, on proteins.

"What we are trying to do is find the molecular lock and key," said John Phillip, director of the pharmaceutical product development division at MRI. "Reactions in the cells are usually driven by the proteins, so we need to know how they work."

The hope is for discoveries leading to "designer drugs" that will target specific proteins to either prevent or more effectively treat diseases.

"I don't think many Americans realize how revolutionary this research is going to be," Phillip said. "Within 30 years, we will be having an entirely different conversation, with entirely new pharmaceuticals."

Mind and body

The research may help the mind as well as the body, said Dr. Dale Horst, director of the Psychiatric Research Institute at Via-Christi Medical Center in Wichita. Discoveries already made in the fight against Alzheimer's and Parkinson's may eventually translate into better treatments for mental illness.

"The hope is that basic research will find common features in these diseases. There's a lot of work going on in that area already," Horst said. "We have a way to go on things like schizophrenia and depression. But given some time, that certainly is what I see happening."

Midwest at the heart

The rush to be part of the biomedical frontier has reached into Kansas and Missouri. In the Kansas City-area, the Life Sciences Institute has brought together universities, research institutions and hospitals in an effort to make the area a nationally known center for life sciences research.

The St. Louis region has dubbed itself the center of the BioBelt, promoting and marketing a strong research base in both human and plant sciences. The Missouri Biotechnology Association, a statewide nonprofit group, promotes and recruits life sciences research and any resulting businesses for the state.

And Missouri Gov. Bob Holden earlier this year signed legislation and an executive order dedicating $21.5 million from Missouri's share of the national tobacco settlement for life sciences research.

Money, money, money

Despite these efforts, turning basic research into publicly available drugs will take many years, public education and lots of money. The machines needed for the research are astronomically expensive, and new labs, more scientists and venture capital are required.

The public needs to keep the long-term benefits in mind, said Dr. Michael Welch, vice chancellor for research and president of the Kansas University Medical Center Research Institute.

"It's a pretty well-repeated equation, that every one dollar invested in biomedical research brings in three or four dollars from federal sources," Welch said. "The hope is that the basic research will eventually spawn products, which spawn companies, which brings jobs and more money.

"People in the region then have access to the latest health care and the economy is dramatically improved. What better investment is there than that?"

Emotions run high

Economics may be the smallest hurdle that biomedical research has to jump, said Richard W. Oliver, professor at the Owen School of Management at Vanderbilt University.

The social, political and moral issues raised by the research will prompt the most emotionally-charged public discussion in history, he said.

"In feudal times, we worried about who could own property. In the industrial age, the big issue was who controls public property and the environment. In the information age, we are arguing about who owns my private information.

"In the coming biotech age, the question will be 'Who owns me?' Who has the right to my genes my employer, the government, me? The debate effects the essence of who we are."

The scientists themselves are torn by the potential problems of genetic and proteomic research.

"I am as excited about technological breakthroughs as any scientist," MRI's Brown said. "But it is a slippery slope.

"On one hand, we may be able to prevent genetic disorders. But the next step is, can we produce genetically-specific children? Should we? I have some pretty traditional values that will be tested by these questions."

But Oliver is convinced that the public will eventually work through those questions in part because there won't be much choice.

"Throughout history, we have overcome social and religious concerns about new breakthroughs. There have always been people who urge caution, and that is the right thing to do.

"The question is not the technology itself, but how we as a society decide to use it. Biological technology is going to happen. The positives are too dramatic, too big to stop it. History shows governments are virtually powerless to stop anything this big."

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