To open the new year, Focus asked the heads of HMS departments to comment on this question:
What trend in biomedical or social science do you think Americans should pay most attention to and why?
We told them they could respond themselves or pass the question on to a colleague in their department. “Interesting,” some of them commented right away. Here’s how they answered the question.
Joan Brugge, Chair of Cell Biology
There is an explosion of information relating to how differences in our genomes or in cancer genomes affect disease susceptibility and progression, as well as responses to therapeutic treatments. A major challenge will be in understanding the influence of this heterogeneity and how to personalize healthcare—both disease prevention and treatment—accordingly. Beyond this challenge to biomedical scientists in academics and the pharmaceutical industry is the enormous challenge to the healthcare delivery system, both in terms of dealing with the complexity of diagnosis and personalized treatment, but also its cost.
Paul Farmer, Chair of Global Health and Social Medicine
I think all Americans, since we all support healthcare and education and publicly shared infrastructure, should pay very close attention to “the delivery gap.” That is, we all pay for solid basic-science research and for some publication and dissemination; our best data suggest that, regarding healthcare, we too often pay more for less. We have for many years known about medical interventions, as simple as a beta blocker after a heart attack, that will save and improve lives. But it takes a long time in our patchwork system to see innovation taken up. By “a long time,” I mean decades, not years or months. We need a proper science of delivery that would help us move more quickly from Discovery (often the fruit of basic science) to Development of innovations to Delivery. I think Americans should ask for more attention to healthcare Delivery, whether here in the States or in the countless projects supported, throughout the world, by U.S. donors. It’s the third D, Delivery, that is too little studied.
Michael Greenberg, Chair of Neurobiology
I see major advancements in the understanding of brain development as it relates to normal learning and cognitive disorders, both from genetics and studies of the function of individual genes working at synapses and in neural circuits. I also expect we will see huge progress in understanding the mechanisms of mammalian aging.
Ellen Meara, Associate Professor of Health Care Policy
A central trend is the growth of behavioral economics, or the emerging evidence and use of evidence from psychology and economics in public policy, including healthcare. Americans should pay attention to this in the coming year because it is a favorite lever of Obama administration officials to help improve policy design. It affects everything from pension policy to healthcare IT to patient safety initiatives to the effectiveness (or lack of effectiveness) of programs such as the Medicare Part D drug benefit, in which an abundance of choice has led many seniors to enroll in plans that appear not to be in their best interests. Behavioral economics will be everywhere in any new health reform that gets enacted and in many other healthcare and policy realms even without the passage of health reform.
John Mekalanos, Chair of Microbiology and Molecular Genetics
From the perspective of the field of microbiology, we live in a dangerous world. The public should worry about “the microbial evolutionary arms race” that is best exemplified by the emergence of new lethal viruses and antibiotic resistant organisms. International travel and human activity has weakened the traditional transmission roadblocks of geography, climate and host range. Add to that the real possibility of the intentional use of pathogens to do harm. Microbes have the capacity to evolutionarily adapt rapidly and, therefore, our society needs to be prepared to combat old and new microbiological threats in a more nimble fashion than was previously necessary or considered prudent. In light of other financial priorities and staggering national debt, will we have the wisdom to still invest in new technologies to address microbial threats before they emerge or only afterwards, when it might, indeed, be too late?
Richard Platt, Chair of Population Medicine
Tracy Lieu, Professor of Population Medicine
The public’s and policymakers’ growing awareness of healthcare costs and access problems, and of the need to consider the value of healthcare, has created a new openness to developing evidence about the effectiveness, quality, safety and availability of medical care. The growing availability of electronic health data for a very large fraction of the population will have a transforming effect on our ability to learn what works and to understand how well we implement safe and effective care.
David Scadden, Co-Chair of Stem Cell and Regenerative Biology
Cells have been viewed as progressing down a one way street from an unspecialized, nimbly responsive youth to a highly specialized and restricted mature cell state. Parallels with our own fate as individuals have been easily applied. The last three years have taught us that such models are far too limited and that cells have a range and a plasticity previously unimagined. Fully mature, highly specialized cells can be reprogrammed back to the most immature state we can measure. In some cases, mature cells can be wound back partially to intermediate steps of differentiation that may be useful. Finally, mature cells can be converted from one cell state to another. The programmability of the cell is very real and fairly readily achieved. The next decade will see detailed understanding of just how cells can be converted from one identity to another and within what boundaries. From this will flow strategies for directing that programming to tailor–make cells from an individual for the particular needs of that individual. It will be an opportunity for personalized medicine at the level of the basic unit of life, the cell. Can we make cell programming tomorrow resemble what computer programming is today? We’ll know the answer by 2020.
David Sinclair, Professor of Pathology
The key trend I see is the ability, within just a few years, to sequence the genome of every baby born in the U.S.A. for a few thousand dollars and to determine their traits, disease susceptibilities and the people they are related to around the world. Add to that the ability to track movement, vital signs and even blood biochemistry in real time in patients and the elderly, to assess when a person needs urgent medical care or to assess or predict disease progression.
Bruce Yankner, Professor of Pathology and Neurology
The current economic downturn and several years of shrinking federal funding have placed the future of American science in jeopardy. Major centers of scientific education and research have become financially unstable and unable to move forward with initiatives begun over the past decade. Without a focused effort to further science education and basic research, we are likely to lose an entire generation of young scientists and science teachers. Such a loss will not easily be remedied when times improve economically, because the educational process is long term. This would have major consequences for the economic viability and competitiveness of the country, as well as our ability to address the world’s most pressing social, medical and environmental problems, since the scope of science in the United States is unparalleled.
Three basic approaches might help to reverse this crisis: 1) Create a new type of teaching force for science and math with incentives such as tuition loan rebates for those who become science and math teachers. Other incentives should be extended to those who devote themselves to basic research, such as grant programs that guarantee a sustained period of support. 2) Provide infrastructure funding to educational institutions that hire more science teachers and basic researchers. The funding should be directly proportional to the institutions’ commitment for salary support, providing a powerful incentive to further science teaching and research. 3) Improve the educational system by applying scientific methods and recruiting scientists to study how to create more effective schools. Bring the problem-solving approach of scientific research and development to bear on the practice of education. Establishing an education corps devoted to strengthening public schools through investigation and trial could have sweeping implications for generations to come.
(Bruce Yankner’s comments are reprinted by permission of the Princeton Alumni Weekly.)
