By Andrea Flores
The history of medicine has found fascinating discoveries made by prominent figures such as Edward Jenner and Alexander Fleming (Hajar, 2015). It may be argued that the approach scientists have had over the centuries towards the treatment of illnesses and disease over centuries has been relatively consistent over the centuries: artificial or naturally synthesised compounds that can be introduced into the human body to heal and/or prevent future damage. However, this may not be the same path medicine will be taking in the future.
To understand the future of medicine, it is important to characterise the history of this scientific field. Historically, as previously mentioned, the treatment of diseases has been mainly focused on chemical compounds introduced into an organism. For instance, the discovery of vaccines in medicine now provides acquired immunity for infectious diseases with the use of attenuated viruses to stimulate the production of antibodies prior a viral whilst antibiotics are prescribed to prevent and/or treat bacterial infections. The success of these discoveries has encouraged scientists to continue to pursue the discovery of new chemical compounds and biotechnologies that induce similar outcome in infections as well as chronic diseases such as cancer, diabetes and chronic heart disease (Mukherjee, 2020).
The success of medicinal chemicals relies on the number of chemical reactions in the human body that can be targeted in a specific manner. However, having millions of reactions occurring within a second challenges the development chemical compounds as realistically only a few of these can be manipulated. For this reason, Siddharta Mukherjee, an American-Indian physician and author, encourages the medical field to reorganise their approach to the treatment of diseases (Mukherjee, 2020). Therefore, understanding the influence the various discoveries in medicine on the focus of scientific research over the past centuries emphasises the need to reform these approaches.
Siddharta Mukherjee walks viewers through his futuristic view of medicine in his TED Talk “Soon we’ll cure diseases with a cell, not a pill” where he states that current medicinal chemistry only targets 0.025% of all the physiological chemical reactions occurring in the human body (Mukherjee, 2020). The author introduces the idea of a hierarchical approach that targets different stages involved in the treatment and prevention of disease in humans; starting from the organism’s cells all the way to their environment. He bases his on the systemised nature of the human body; where humans have a number of organs that are made from tissues which are then made from cells (Khan Academy, 2020). Hence encouraging the scientific world to deviate from developing a medicine that targets a specific disease to follow the nature of the human body where semi-autonomous units (cells) eventually give rise to organisms that live in environments (Mukherjee, 2020). To exemplify this approach, he gives an over-simplified timeline of the different treatments that have been developed to treat cancer; chemotherapy targeting cells, stimulating the immune system to attack cancer (i.e. stimulating natural killer cells) and changing the individual’s environment to reduce potential carcinogens.
Half-way through his talk, Mukherjee mentions that the metaphorical approach that medicine should undertake in chronic degenerative diseases is one of growth either at the cellular or organ level. He illustrates his innovative approach to medicine with his research on osteoporosis. Summarising his extensive research on this disease, which has involved the publication of numerous scientific studies, Mukherjee and his colleagues deviated from the mechanical and chemical treatment of osteoporosis and focused on the cellular treatment by investigating the role and function of skeletal stem cell (SSC). These self-renewal cells can divide and differentiate into a variety of cells found in the bones and cartilage (Bianco and Robey, 2015). In their research they have found that these SSCs migrate to the specific area where the bone or cartilage has been damaged in order to locally repair the injury. However, the number of SSCs cells in the human body decreases abruptly as the individual ages, making osteoporosis the most common bone disease (News-Medical.net, 2020). These discoveries encouraged his team to start thinking about ways in which this bone disease could be treated according to Mukherjee’s hierarchical scheme; at the cellular level treating the patients with SSCs, in-vitro building of cartilage for implantation as well as the establishment of new environments that not only prevent osteoporosis but more interestingly “passively loading and unloading bone […] to regenerate degenerating cartilage” (Mukherjee, 2020). Overall, this case study aims to underline the various medical treatments that can be developed with a reorganised approach that follows the systemised nature of the human body rather than merely focusing on chemical compounds targeting the suppression of metabolic reactions.
Mukherjee’s innovative approach to the future of medical treatments raises a number of questions and scepticisms. Following the speaker’s system, the questions at a cellular level include the effectiveness of the in-vitro cells in order to replace a pill, as well as potential consequences with regards to possibility that these cells could be malignant and would thus need effective apoptotic genes to prevent future consequences. Moreover, for the following levels, questions involving the logistics of successfully in-vitro organs implanted in the human body as well as the changes in the individual’s environment to not only prevent but stimulate the body to regenerate. However, these questions would only be answered if this approach is accepted and established in the medical world. If his theory were to be true, it would reveal that the burden on the treatment and cure of chronic degenerative diseases was not due to the lack of powerful pharmaceuticals but rather the lack of diversity in the ways in which scientists tackle medical issues.
Bianco, P. and Robey, P., 2015. Skeletal stem cells. Development, 142(6), pp.1023-1027.
Hajar, R., 2015. History of Medicine Timeline. Heart Views, 16(1), p.43.
Khan Academy. 2020. Tissues, Organs, & Organ Systems (Article) | Khan Academy. [online] Available at: <https://www.khanacademy.org/science/high-school-biology/hs-human-body-systems/hs-body-structure-and-homeostasis/a/tissues-organs-organ-systems> [Accessed 24 August 2020].
Mukherjee, S., 2020. Soon We’ll Cure Diseases With A Cell, Not A Pill. [online] Ted.com. Available at: <https://www.ted.com/talks/siddhartha_mukherjee_soon_we_ll_cure_diseases_with_a_cell_not_a_pill> [Accessed 24 August 2020].
News-Medical.net. 2020. Bone Disease. [online] Available at: <https://www.news-medical.net/health/Bone-Disease.aspx#:~:text=The%20most%20common%20bone%20disease,well%20as%20diagnosed%20and%20treated.> [Accessed 24 August 2020].
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