“The medicine of illness,” treating health problems already discovered in the patient, will soon be seriously challenged by “the medicine of health,” or preventative and personalized medicine focused on the individual characteristics of the body. Given the socio-demographic imperative of increasing the life expectancy in Russia and because of the economic demands on the workforce, medicine that prevents many illnesses is an indisputable priority.
A strategy for Russia’s expansion on the medical technology market was outlined in the article “Medicine of the Future: Possibilities for Breaking through the Prism of Technological Prognosis” by the head of the Department of Science and Technology Foresight-Russia: at HSE’s International Research and Educational Foresight-Russia Centre, Alexander Chulok; deputy chairman of the State Duma Committee for Science and High Technology and chairman of the Medicine of the Future technology platform, Lyudmila Ogorodova; the director of the industry prediction center at the Siberian State Medical University, Ilya Kaminsky; and the chief of the genomics and proteomics research laboratory at the Immanuel Kant Baltic Federal University, Maxim Patrushev.
Russia already has a solid foundation in several areas of future medicine, Alexander Chulok and his coauthors emphasize. This involves, among other things, finding infectious agents, developing materials of specialized use for outside application such as tissue regeneration, and creating advanced composites for dentistry.
In order to take a large step in medicine of the future, the country must consider global challenges that exist. According to the article’s authors, these challenges can “create both threats as well as promising opportunities for Russia.” The basis of this work was the research HSE conducted together with member organizations of the Medicine of the Future technology platform.
Global challenges are associated with many countries’ insufficient development of cancer treatment and research, as well as cardiovascular and infectious pathologies. In addition, these challenges concern the spread of metabolic diseases, brain diseases and also “the inability of world science to withstand the aging of the population,” the authors say.
The development of the market is in turn defined by the demand for available methods of diagnostics and treatment. These methods are based, among other things, on technology for personalized medicine, on noninvasive (requiring no surgical treatment) rapid monitoring technology, and on telemedicine. A demand has also formed for maintaining the quality of life, particularly if an organ or its specific functions are lost.
The scientific and technological answer to these challenges envisages development in a number of areas identified by the authors:
It is necessary to take biomedical developments to a new technological level, Chulok, Ogorodova, Kaminsky and Patrushev stress. Bioinformatics technology, including genomics and proteomics (connected with the proteins of genetic carriers), allow healthcare to find adequate medicines for every ill person. This is localized, personalized medicine that takes into account the body’s characteristics and nuances throughout the course of an illness. No less than half of the medications released on the world market in 2015 will have localized and targeted pharmacogenetic characteristics, the authors of the article are projecting.
Russia should also keep its own developments in mind in the area of regenerative medicine, which allows for a host of problems to be resolved – from skin diseases, trauma and burns, to oncology and diseases of the brain and spine. Considering this scientific groundwork, Russia could well become a leader in creating biodegradable materials (those that dissolve after an operation), experts believe. Such materials are typically used to create materials for bones and internal organs such as plates, screws, surgical mesh, etc.
Scientific and practical results are also needed in the field of biocompatible materials, self-sterilizing surfaces and technology that can quickly identify pathogens and toxic substances. It is necessary to also take a chance on test systems based on genomic technologies for diagnosing cancer since the fundamental mechanisms of tumor formation will be identified in the coming years. In addition, methods for immunotherapy and gene therapy for leukemia, lymphoma and other types of neoplasms will be implemented.
To strengthen Russia’s competitive advantages, it is necessary to provide support to centers for translational medicine where preclinical research methods are progressing, the researchers note. Finally, a full complex is needed for cross-sector technologies (nano, bio, info, etc.).
The authors place an emphasis on prospects for molecular diagnostics.
In molecular medicine, it is essential to focus attention on complexes for analyzing disease markers so that it is possible to make a prognosis of a disease and create the best treatment scenario, the experts write.
To do this, molecular diagnostics must concentrate on research that can identify the combinations in changes to nucleic acid structures causing the disease. It is also necessary to determine regulator genes involved in the development of the health issue. It is essential to learn to identify the nuances of DNA structures that explain the patient’s sensitivity to medicines, or conversely, the patient’s resistance to them. It is also worth developing software to create a gene bank of the Russian population, the researchers believe.
Molecular diagnostics and other advanced areas of medicine have a huge potential in detecting warning signs and treating the most widespread health problems, such as heart attacks and strokes, as well as diseases associated with a low hygiene level – HIV, tuberculosis and hepatitis. The authors of the article suggest a plan for fighting these diseases.
Cancer incidence is growing on a global scale, leading to a decrease in the world’s life expectancy, population decline and economic damage. Fighting neoplasms is possible for “smart” medicines, while methods of genomic medicine will allow for diseases to be prevented in families with a predisposition for cancer, the experts say. Regenerative technologies are able to raise the quality of life for a cancer patient if the affected organ is replaced. There is also an extremely high demand for cancer vaccines.
It is worth creating a biological materials bank and a database for oncopathology. Computer systems should also be developed for diagnosing tumors on the basis of bioinformatics technology.
Russia’s scientific groundwork in biomedical oncology does not yet match that of the rest of the world, Alexander Chulok and his coauthors note. Fields connected with this also fall behind in development, including instrumentation, materials science and pharmaceuticals.
Demand is increasing for cardiovascular medicines: diuretics, cholesterol medicines and medicines for hypertension; yet, heart problems are increasingly being resolved with the help of prosthetics – coronary angioplasty and stents. “Significant breakthroughs are expected in the field of biocompatible and biodegradable materials. Russia is able to become an equal player on this market and in segments of [the market] such as materials and genomics,” the authors say.
An epidemic of chronic lung diseases is forcing the pharmaceutical market to grow rapidly. Inhalers, bronchodilators and antibiotics hold a considerable share of this market. The solution for many lung problems is linked with discovering the molecular basis of a person’s microbiota, with new data on the immune response of the individual experiencing chronic inflammation, and with developing preventative vaccines. The positions of Russian developers in these fields are currently rather low, and a modern scientific and technological foundation is practically nonexistent.
Diseases associated with a low level of hygiene – HIV, tuberculosis, hepatitis, etc. – are still having dismal effects on demographic processes. According to the World Health Organization (WHO), these diseases are ranked third and fourth for cause of death. Furthermore, the level of these diseases’ diagnosis in many countries, including Russia, is inadequate, and fighting the infections is complicated by instances of drug resistance. “Innovative ‘non-drug’ ideas for managing the infections are on the agenda. For now, expectations include creating preventative and highly effective vaccines against HIV, hepatitis and tuberculosis,” the researchers say. In addition, Russia currently lacks a technological platform that allows for the rapid production of diagnostic toolkits to fight reoccurring infections. This does not allow the country to be a market leader.
Russia has its success stories in a number of important medical fields, which makes it possible to count on future breakthroughs and for the country to hold considerable positions on world markets for medical technology. There is, however, little time for such a maneuver, the experts are projecting. “The windows of opportunity that our country could use will be relevant primarily in the next five to seven years,” they say. The time to act is now; this includes monitoring global trends, scanning the markets and taking inventory of domestic developments, Chulok, Ogorodova, Kaminsky and Patrushev conclude.