Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Special Centennial Edition
Volume 7, Number 2, 2002

Genomics is creating a revolution in health and medicine. But only those countries that prepare their populations to join it will be able to fully reap its benefits.

Imagine you are sitting at an outdoor café in a European city, sipping tea and discussing the future of the world with some friends. Now imagine it is Oct. 12, 1492, the day Columbus landed in the Americas and changed the course of world history forever. Even if you had heard a news report of that event, you and your friends would have little idea of what it meant or of its enormous implications for the future. Yet if you did understand even part of it and could act on your knowledge the benefits could well be great.

Something similar is happening today at the dawn of the 21st century. Since Feb. 12, 2001, it has been possible for any one of us to go on line and browse the entire human genome, the map of the code that makes us human. Yet few of us can grasp much of what it means or what to do about it. Those who do from individuals to countries and regions will clearly be in a better position to reap the benefits.

Genomics has created a revolution in the life sciences, one that will change the way we look at and live in our world. Already, it has had a major impact on agriculture, and its influence will soon extend to everything from chemicals and energy to insurance, cosmetics and the military. But nowhere will its effects be greater than in medicine and health.

We have already begun to learn much about ourselves, even though we remain ignorant of what most of the data mean and what functions many genes play. As we learn more over the next two or three decades, what will happen? Health care will shift significantly from a reactive to a proactive endeavor. Doctors and technicians will increasingly focus on specific conditions in individual genotypes and phenotypes, and on probabilities rather than symptoms. They will know what diseases we are predisposed to and what we might do to prevent the onset of illness, as well as the reactions we are likely to have to specific drugs. We will carry genetic ID cards and consume ever more personalized medicines. We will need fewer and fewer surgeons. We will live much longer and remain much healthier throughout our lives.

We can already see some of these fundamental changes in the works. A number of biotechnology companies are successfully developing DNA- embedded silicon biochips that can test for thousands of genetic conditions. Eventually, these coin-sized chips may be able to screen for most diseases and defects known to have genetic roots.

Such diagnostic tools will lead to a shift toward highly personalized medical care. They will also turn our focus toward prevention rather than intervention. As a result, there could be a major change in the ratio of doctor bills to drug costs: from the current 9:1 to something approaching 1:1 over the next quarter century. Genomics should also spur novel ways of delivering "medicines." Consumer products such as soaps, shampoos, cosmetics, aerosols, foods and beverages may provide our daily doses of medicines. Genetically engineered health products could be purchased in supermarkets and health clubs, not just hospitals and pharmacies.

Future benefits
These developments occur mostly in, and may seem likely to benefit primarily, the world's richer countries. But developing countries should not be isolated from the life sciences revolution. By allowing us to better map out microbes and viruses, genomics will teach us more about the diseases and epidemics that plague the developing world and will help us develop more and better treatments to cure them.

Already, more than 250 million people throughout the world have been helped by more than 130 drug products and vaccines produced by biotechnology companies, according to the Biotechnology Industry Organization. And there are more than 350 biotech products and vaccines currently in the industry's pipeline. Meanwhile, supercomputing and "bioinformatics"--the use of software to facilitate drug discovery--promise to further accelerate advances in pharmaceuticals that will benefit both rich countries and poor.

The potential for genetically modified food crops to benefit poorer countries is widely acknowledged, but an equally important area of genomics for both developed and developing countries is the convergence between food and medicine. Just as crops can be genetically engineered to resist insects or to have enhanced nutritional value, they can also be genetically engineered to possess specific medicinal qualities.

For example, agribusiness firms already are trying to tap the exceptional cancer-fighting qualities of wild Italian broccoli and engineer those into commercial varieties. Others are working on bioengineered corn that can attack cancer cells, fight osteoporosis and reduce heart disease. Elsewhere, research is under way to reprogram the genes of certain fruits and vegetables to turn them into vaccines against tetanus, diphtheria, hepatitis B and cholera. To the delight of the world's children, getting a vaccine may soon mean eating an apple, a banana or a potato rather than getting a shot.

The link between agriculture and medicine will not be limited to plants. Already, some biotechnology companies are genetically engineering goats to produce milk containing antibodies and proteins that are known to fight human diseases, including cancer. Other companies are trying to produce antigens in mosquito saliva, turning pests into living vaccines for a variety of human diseases.

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