Editor's Note: The following is an edited transcript of the first podcast in the Veritas Riff series. For more information on the series, and for other installments in the series, go to veritasriff.org.
The Veritas Riff is a group of friends who combine deep faith with world-class expertise. In subjects ranging from politics, science, culture, business, medicine, and more they offer their informal take on the big questions facing us all. I'm the host of Veritas Riff, Curtis Chang.
In the 20th century, the Western world experienced a medical revolution of a profound nature. The discovery of antibiotic drugs targeted at specific bacteria fundamentally reshaped our world, so that today it is easy to forget how easy it was for most of human history to die of simple infections. Now in the early part of the 21st century we are potentially in the midst of another medical revolution. It's called genetic medicine and it concerns drugs targeted at specific DNA traits. Just what could this new era of genetic medicine look like? What are its promises and what are the potential pitfalls for that future?
To answer those questions I talked with Dr. Joshua Swamidass, a rising star in the field, whose work is based in the division of laboratory and genomic medicine at Washington University.
Right now, if I suffer a cut, and an infection begins to develop, a doctor can perform a blood test and give me an antibiotic specifically for that kind of infection—and basically I will know that I'll be healed. Is it conceivable that one day I can walk into a hospital with cancer and a doctor will sample my DNA, give me a drug for my particular kind of cancer, and I'll know that it will prove effective?
You've just described exactly what we have all hope for. That's what personalized medicine would look like.
You mean personalized to my specific DNA?
Exactly. So, rather than give you a medication that works for only 30 percent of patients, and hope that you're in the lucky 30 percent, we could give you a medication that is specifically intended for you.
How close are we to that vision?
We're not close. We're just in the beginning of a medical revolution. If you look historically at these things, revolutions like this can take decades to work out. There are a couple examples of genomic medicines already in place, and we can see them in the clinic right now. There is, for example, a particular drug that works very well with a particular mutation of lung cancer. That's being offered every day. That is just one example of what we are hoping to see as commonplace one or two decades from now.
It seems like cancer in particular is a promising target for this genetic medicine because cancer is inherently caused by individual genes gone bad, right?
Cancer is a perfect example, since every person's tumor is genetically unique. That means that an individual cancer patient might benefit from a drug that only could benefit a small number of other patients, who have the same genetic profile. In the next phase, we hope that medical care will be able to identify exactly the specific type of breast cancer this specific patient has, or the specific type of colon cancer, and use exactly the right drug to treat them. Hopefully we can do that in a way that's safer and more effective than a lot of the general toxins we normally use.
You've written publicly, most recently in the Wall Street Journal, that the scientific promise of genomic medicine is jeopardized by the economics of the drug industry. Why is that?
Approving any drug requires a massive investment. The costs of the final clinical trials are huge. It can take over a billion dollars just to get a drug approved. In that environment, drug companies only want to invest in things that can bring them multi-billion-dollar returns.