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Technology vital to the outcome
Material posted : Administrator Publication date: 08-07-2015
Gene therapy, implantable biosensors, test new drugs on genetically modified pigs, personalized tablet, mobile neurointerfaces ... "Money" begins a cycle of dialogues about the technologies of the future and how in the lifetime of the present generation they will change human society and the economy. The first interlocutors correspondent Maxim Kvasha and Alexander Zotin become deputy director of the Foresight Institute Center for Statistical Studies and Economics of Knowledge HSE Alexander stocking and MD Ruslan Saygitov. And the topic of the first conversation - the future of health care.

Ruslan Sajgitov: Speaking about possible breaks, it is necessary to consider some log, a time lag, from the moment of the beginning of researches in this area to a conclusion to the market of the certificated product. This technological log makes, under the different data, from 12 till 17 years. But there is more to come. How you think, what is the time passes from occurrence of new medical technology until when it will be recommended by professional community for wide use? In Great Britain - on the average from eight till 11 years. At us to it it is necessary to add some more years - on certification, adaptation...

Alexander Chulok: In Russia there are no system integrators, and this problem represents for us the big danger at occurrence to future economy. It is necessary to be able to collect technological and institutional innovations for very short time. By the way, on this way China has gone. Integrators are the companies which can combine from different units the uniform project, business, they operate not narrowly segmentno, and solve complex problems "on a turn-key basis", meeting the requirements the market or creating the new. Here again essentially important role is played by people who can act as a link, the bridge between possibilities of a science and requirements of the market, to finish a problem to the ready decision.

Money: Integrators are as surgeon Svjatoslav Fedorov, managed to organise the conveyor in ophthalmology? How in modern China new conveyor clinics? And in the USA - venture funds which, financing researches, can both lose, and win, taking up these risks? And what in Russia - whether there are at us examples of association of a science, business and the venture capital?

Amp-hr.: in Russia while with it not so, but there is also a positive. I will give an example. After the Baltic federal university of I.Kanta participated in working out of the forecast of scientifically-technological development of the Russian Federation till 2030, on its base have created chemical and biological institute. Its primary goal - to create proryvnye technologies, including using the forecast data, to form communications between business, science and education.

Editing genoma

River S: the First break in biomedicine - editing genoma. We have closely approached that we can change the information which is put in genome the most different organisms, including the person. It is expected that editing genoma, in itself representing obvious research interest, will allow to achieve correction of infringements which are accompanied by failure at level of fibers. The most part of defects does not lead to development of a serious illness, anyway at children's age. However some defects of genes can block their function completely. Heavy monogene diseases as a result develop, the number of their variants exceeds now some thousand. For example, it mukovistsidoz, hereditary forms of an immunodeficiency, serpovidnokletochnaja an anaemia. Till now genetic illnesses remain incurable. However with the advent of technologies of gene therapy the hope of correction of congenital defects genoma by introduction of a "correct" site genoma in cages of the patient was born.

D: Some the modified cages will change operation of all organism?

River S: If it is a question of diseases at children, yes. Frequently children with congenital defects do not have not enough one high-grade fiber. Its long absence can lead to irreversible consequences. Possibility of correction of genetic defects at zygote level - a germinal cage is already discussed. And some researchers even see in editing genoma the tool for giving to babies of special qualities - a spacious intellect, physical characteristics...

D: It will be very expensive or accessible to wide application?

Amp-hr.: in due course any technology becomes accessible to middle class - so business, such is technological evolution, a question in speed and application scales works.

D: personal genetic screening like service 23andme can be how much useful? You send dab from a throat - you receive the information on the genotype...

River S: In the USA this business was already generated, at us it only arises. However, in the field of medicine the analysis of the personal genetic information put on a stream yet has not resulted in real breaks. The technological result is reached (with some reservations), but mass change of behaviour in this connection has not occurred. The fact of predisposition to this or that disease does not move us to actions. Moreover, such knowledge can be dangerous: the raised probability can be ill to lead to depression and even a suicide. Any information should be correctly used to benefit. Examples we see in use of the personal genetic data at appointment or nenaznachenii certain medical products. In the tideway of the personalised medicine which now develops, it is already real practice, truth while in a narrow spectrum, basically in a chemotherapy scope at treatment onkobolnyh. The similar technology has found application also in diagnostics and tuberculosis treatment.

D: Presence of the genetic passport in the future can influence behaviour, for example, insurers, employers?

River S: it is obvious that presence of the information on probability of development of this or that disease (and it is necessary to tell that it can be established practically for everyone) can induce the insurance companies to enter raising factors. Discrimination at employment is possible also. All it can become a barrier to distribution of genetic certification.

Amp-hr.: from business positions important, during what moment the technology becomes a product and it carries what new consumer properties. Genetic certification can essentially change developed chains of creation of the added cost. One segments will lose the importance, and others, on the contrary, will sharply grow. Personification, adaptation to the concrete patient - very powerful trend in medicine.

D: whether There is any theoretical limit in personification? To everyone will write out a personal medicine under a genotype? Both from oncology, and for cold?

River S: While there is no answer. While discussion is conducted about possibilities of personification within the limits of small groups of patients with close characteristics of illness. But there are also exceptions. For example, already commercial products for individual vaktsinirovanija are now accessible.

Biosensor controls

River S: Other break in biomedicine - biosensor controls and implanted devices on their basis, is such tandem, a combination "bio" and "techno". They are used for detektsii, diagnostics of those or other diseases. An essence that this technical device in which the biomolecule or a live cage which, reacting to the target agent is arranged, is transformed, creating thus an electric signal which carries the information on a condition of the patient, environment. The device should be not necessarily introduced in a body. It can be, for example, nosimym.

D: But excessive diagnostics both with clinical, and from an economic point can be and is useless. For example, mammografija it is effective for women from 45 years, and for young - many the false definitions, unnecessary surgical interventions. And the trauma from diagnostics can be unfairly harmful, when the probability to reveal disease is insignificant.

River S: Truly. There are restrictions. There is no product which can be applied everything, always and at the slightest pretext.

Amp-hr.: for business it is often important to spend readiness of the population money, volume of solvent demand. We will remember biologically active additives, nootropy, preparations for a concentration of attention, a functional food... In the USA, for example, expenses of the population on medicines in wide understanding in times more than at us.

River S: Treatment of unevident illnesses - depressions, life-style type medicines prozaka, ostensibly cheering up, and etc.

Infectious danger

River S: Biosensor controls can be used not only in oncology. One of the most perspective directions - struggle against infectious diseases. These subjects become in the lead in media, especially after pork, a bird flu, after Eboly. For last five years NIH (National Institutes of Health, SSHA. - "Money") - the agency which distributes more than 90 % of the means allocated with a federal government on a biomedical science, - shows the large increase of volume of financing on infectious diseases, including on new infections. Another matter that in this area is not present for a long time already breaks. There were 90th years and antiretrovirusnaja HIV therapy, there was a 2010 and a new class of antibiotics. In 2015 - the amazing publication about use of bacteria for struggle against them "friends and companions". But it only flashes.

D: And how affairs from a HIV now are?

River S: Death rate falls, prevalence grows. At us - simply enormous rates. In Russia without exaggeration it is possible to speak about epidemic. Especially in group 30-39-летних.

D: And whether it is possible, what to a HIV problem any more do not give such attention because of success antiretrovirusnoj to therapy? People drink a cocktail and there live more or less tolerably 20-30 years. The HIV is not perceived any more as danger of death?

River S: I Think, for inhabitants it not a reason. And high rates of distribution of a HIV are reflexion of social problems or problems of system of public health services. Or and that and another.

D: But cost antiretrovirusnoj therapies falls?

River S: Yes. Passes ten years - patent protection comes to an end, appear dzheneriki.

D: whether There is a clear victory prospect over a HIV?

River S: Here it is necessary to speak about a complex of decisions, technological and institutional. The last are in many respects reduced to preventive maintenance, without it to stop epidemic it will not be possible. There will be no preventive maintenance - the HIV will extend and further, it is more than contaminations - more illnesses. Concerning fundamental breaks in HIV therapy it is possible to make a helpless gesture only. For 20 years of serious breaks has not occurred. Workings out in the field of reception of vaccines are now conducted, but to promote while, alas, it is not possible.

River S: In general, besides a HIV, returning of the "forgotten" infectious diseases - a potential problem. Especially considering present mobility of the population, transport possibilities, density in megacities.

Information modelling and cellular technologies

River S: Terms from working out of medicines before their introduction in medicine are greatest. Here again there should be a progress. In many respects these expectations are connected with development of information technology, in particular with attempts of computer modelling of live organisms - cages, animal, the person. Such models will allow to promote for limits of already realised concept, namely computer molecular screening - selection of perspective medicinal chemical or biological substances.

Amp-hr.: and further the 3D-printer which this personal medicine will print... But we will return to modelling. Private business is interested to reduce time of clinical test of medicines, for example, with 12 till three years. After all every year are the lost billions dollars. In the world now business models and bases of competitiveness cardinally change. Laboratories in classical understanding are necessary ever less. For breaks in medicine interdiscipline researches and an infrastructure for their carrying out, first of all programs and supercomputers, databases which in Russia practically are not present become necessary.

D: whether It is possible to expect that experimental biological objects (mice, monkeys) for which test medicines, will leave in the past?

River S: I do not think that the next 10-20 years they will fade into the background. Now a problem - creation of the large genetically modified animals (a pig, a macaque, a horse - with a certain profile at level of fibers). Work goes, and the next decade rather cheap decisions will be found. But information modelling will allow to achieve an acceleration of the rate of working out and introduction of medicines.

D: That is it is possible to imagine a pig with a human liver on which it is possible to test certain medicines?

River S: Approximately. With those genes which we will set, with a certain profile of fibers. In Russia, unfortunately, in this area much that is not present. Is not present vivariev, there is no infrastructure. There is no market of cellular technologies, the law on biomedical cellular products is not passed. And after all by means of these technologies it is possible to treat tens illnesses.

Amp-hr.: in medicine - creation of optimum conditions for working out of medicines, vaccines... And in agriculture - vydoi milk, stability to illnesses, productivity.

D: And what for the law is necessary? Whether its absence is connected with a sensation round deckman cages?

River S: As a matter of fact, the new class of therapeutic products is formed. Hence, game rules are necessary, it is necessary to be defined with terminology, with allowing and restrictive measures, with the rights and duties - both manufacturers, and the state and patients. The new law becomes the first step in this direction. Another matter that is not enough of it. In Europe and in the USA variety of statutory acts about it is developed.

D: What prevents to copy them simply?

Amp-hr.: as the economist I can tell that direct import of institutes seldom when appears successful, but also not to consider experience of our partners it would be imprudent.

Mobile nejrointerfejsy and miniaturization of devices

River S: the Following break - mobile nejrointerfejsy. A popular theme with double appointment. To the person the reading device fixing brain activity that is called, from the primary source is implanted. Further this information is deduced on the computer, processed and transmitted conditionally to "consumer". In this quality can act as own peripheral nervous system and muscles controlled by it, and external systems - live or mechanical. The person by means of thought can operate these systems. Experiences on experimental animals confirm it. Having dug here - creation mobile nejrointerfejsov which by means of wireless data transmission carry out information translation in two directions. C one party, goes transfer of "the digitized intentions" to target object (to own fabrics, other organism, mechanical system), with another is a management of brain activity of the carrier of the interface. Practical realisation - creation ekzoskeletov and operated artificial limbs, including touch. All it will allow to solve cardinally problems of traumas of a spinal cord, nejrodegenerativnyh diseases.

D: the Avatar?

River S: Why also is not present? Military, game use - obvious scopes nejrointerfejsov. Other break - miniaturization. Devices of medical appointment become ever less and that is especially important, is closer to the patient. Technologies of automatic dispensing of insulin from nosimyh and even implanted devices are already realised.

The following step - an adherence solution of a problem. So the situation when the medicine registered by the doctor and remains on the recipe is called. In a case with the chronic diseases demanding constant drug intake, it is the present problem. The patient speaks "yes, yes, yes", accepts everything that will register. Then to it it becomes better or everyday problems begin, and treatment is bombarded. According to the experts the CART, to 50 % of chronic patients at any stage stop the recommended treatment, independently reduce a medicine dose. And so until again will not take. The decision of this problem to me sees in the implanted microportioning devices which size allows to introduce them under a skin. And further - a trick. The device under in advance certain program doses a medicine, letting out the necessary quantity of a preparation during "correct" time and with "a correct" interval. The person is deprived necessity to remember treatment, it to control. But process, naturally, is launched with the consent of the patient. The patient always should have a right to a choice.

Amp-hr.: it is a separate theme - influence of technologies on human nature, now many foreign researches are devoted studying of an estimation of effects from mass distribution of technologies of a new wave on society. Almost all base laws as which we have got used to consider invariable, are exposed to transformation. It is inevitable.

Problems and counterbreaks

River S: At all positive tendencies in development of a science and technologies we fix signs of braking of an innovative chain. Each new technology demands more and more money, and the quantity of registered medical technologies falls. It is important for fixing because in Russia now there is a representation that is necessary more money - and all will turn out. It not so. It is important prioritizatsija. Without it is in any way. Expenses have gone to the USA downwards, recoil for the enclosed dollar all more low. And we in comparison with States are similar to schoolboys. And we should be defined with priorities.

D: In what areas particularly stagnation?

River S: At level of registration of medical products - practically in all directions. As a result we have public health services exit on an efficiency plateau. It can be noticed and on an oncology example, and on an example of struggle against cardiovascular diseases. To take an ischemic heart trouble - a death rate in the developed countries decreased all time, since 80th years of last century. However now in the USA, in a number of the countries of Europe fix death rate stabilisation. In our opinion, these countries (as well as others in the long term the next five-ten years) have approached to a limit of efficiency of the institutional and technological decisions developed and accessible for comprehensible money all last 30 years.

Amp-hr.: I would consider it not as a sentence, and is faster as possibility. It is necessary to look details, to think large areas, but to operate precisely.

D: For each cancer the small gradual progress instead of miracle break for all area?

River S: Yes. It is necessary to look, where there can be breaks and in what of them the Russian scientists can participate. Presence of reserves - a necessary condition.

Amp-hr.: on the one hand - reserves, with another - possibilities. It is necessary to study global calls which form a new landscape of a medical science, pass on the agenda the decision of the major social and economic problems, such as life improvement of quality. Who does not want to live long and happily?

Means of Makropulosa

D: the Droplet summarising. Even with stagnation in the future we receive the medicine much more personalised, better, but, obviously, more expensive. And this trend is actual for a long time already. If expenditure per capita on provision of pensions to the developed countries managed to be stabilised, expenses on public health services - are not present. And it will be more expensive not only to the countries as a whole, but also for concrete people. Also we will impose all it on a society with already high and still a growing property inequality... Whether we as a result will receive an inequality on duration and a quality of life, morlokov and eloev, a caste society?

River S: the researches showing communication between cost of medical aid and social intensity are unknown To me. Though I do not exclude that this communication takes place to be.

People with a high prosperity live on the average longer so was always. And we continue to observe this rupture. But occurrence of castes, most likely, is possible in societies with the highest property rupture. In the USA and Europe where the basic money for medicine are spent, it is improbable. In the states with a low level of development it in general proves to be true. In some countries of Africa very many people hardly lives till 30 years, but there are also those who has access to fruits of a civilisation and there live 70-80 years.

Amp-hr.: but in the developed society we will have full personnel revolution. Elderly highly skilled employees and in 100 years will work and than then to be engaged to thirty-year sybarites?

D: In the developed countries something similar already occurs now. Bebibumery instead of retiring, continue to work, and youth unemployment in Europe thus huge, and stagnant.

Amp-hr.: still a question: you where want to live? In the country with the population with middle age of 30 years or 80? It will be very different countries. Technologies, thus, will make radical impact on an alignment of forces on the world scene.

D: Social intensity - nevertheless a consequence. And what with possible development of the reason? Whether it will be valid in the long term someone to live for 200 years, and someone to die in 50?

River S: the Public health services really turn to magnificent service. But concerning a life time we, with available technologies and institutional decisions, most likely, have at present reached a plateau. At least, on horizon of 10-15 years. Japanese, strangely enough, tell about it, at which a life time the highest.

D: That is means of Makropulosa does not threaten us?

River S: It is a biological problem. Realities show what be beyond 85-year-old age at level of population we for the present we can not. By an old age at the person can and not to be obvious illnesses - it dies away.

D: But fading - not a cause of death, always any concrete disease?

River S: For centenary it is far not so. More quarters of people at this age simply die away, that is die if to simplify, as a result of an energy exhaustion. Also it is the most frequent cause of death centenary, according to some information, three times more frequent, than a stroke, seven times - than a cancer. Thus, for threshold overcoming in a life time, reached in the developed countries, we will be compelled not so much with illnesses to struggle, how many to solve more a shared problem, to solve a question with youth preservation.

D: That is those who promises a tablet of eternal life - charlatans?

River S: Today - yes.

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