Playing off the well known idiom, the once in a lifetime snow storm in Florida this week reminds us that improbable does not mean impossible. Young people here giggle seeing snow for the first time. Yes, bridges and airports were closed so there is nuisance, but the excitement is refreshing. Borrowing a page from surprising nature, we accept that there are many opportunities for something new and almost magical to have impacts in our own lives.
I recall when the world wide web was developed from hyper -text in 1990’s. We were all so skeptical. Something we had never seen or experienced was going to take over our lives, in an enormous way. I didn’t have benefit during med school, so the actual text books and libraries required hours of study are now at our fingertips from anywhere. Learning is swift and efficient. There was no cell phone during residency (imagine!) and I recall when paged, diving into a store to call the hospital as I was driving home. The creative geniuses have had a field day finding ways to enhance our lives and are still at it, thank goodness, and we are all here for it.
So, as the new investment by businesses of $500 billion into “Stargate” project rolls out, we anticipate sea changes in healthcare and for us, cancer diagnosis and management. The infrastructure will analyze genomic data to create highly personalized treatments. The entire shift in medicine will change from reactive to proactive. Cancer “moonshot” was investigating fast tracking drugs which took decades to develop and billions of dollars (making costs so high). AGI can simulate molecular interactions and identify compounds in just weeks. There are already developments for IBS, a breast cancer vaccine in England, Sellas Life Sciences finalizing a leukemia vaccine, analysis of blood for cancer cells before any manifestation of illness (liquid biopsies), immuno and targeted therapy based on genetic studies all unheard of just a few years ago, and extending lives everyday.
Stargate will be the new massive endeavor that will invest in us to make medicine personalized to your genes as well as the genetic makeup of the cancer or disease. There will be personalized vaccines and treatments far beyond our current management. MCED (multicancer early detection) test studies at MD Anderson will detect many cancers that lack current screening modalities. Grail’s Galleri tests screen for 50 tumors, even rare soft tissue sarcoma. The cancers shed small amounts of DNA in the bloodstream and detect with 88% accuracy where the tumor is coming from. Fascinating. We don’t have long term randomized trials to see if this aggressive search leads to decreased death rates, but there is very low false positive rates and frankly, what is the downside? Perhaps random shooting in dark with radiology and endoscopies may end and the first step will be a blood test to be followed by these diagnostics. Many patients over the years say, “Doc I just saw my primary care and had bloodwork. Why wasn’t this found?” They are shocked to learn that blood does not detect cancer… until now, if we specifically request it.
Physicians will be tapping AMIE (articulate intelligent explorer) an AI research system. Developed with algorithms by engineers, not doctors, aiding clinicians by extensive use of search engines Current guidelines will look archaic. The growth will be at light speed with knowledge growth, diagnostic advancements and personalized treatments to avoid disease.
Fear not. The future is here and rapidly advancing in the next few years. Some aspect will have benefit to you and your family. The old slash, burn, poison for cancer will be outmoded and your treatments will be nuanced, hopefully more gentle and definitely personalized.
“So what’s my action item, Doc? ” We already fully embraced something that seemed out of this world with the web 30 years ago. I think we can handle, and even be excited for, the fantastic new Stargate explosion. So, in answer to the question, I say, “Have faith, its coming and always have hope”.
