We have just published a White Paper which examines a set of cancers which can be detected in many cases in early stages. However for many of these there is little support for ensuring that this is accomplished resulting a three times increase in health care costs due to the failure to capture at an early state. The failure to capture at a early state is an economic and psychological problem. We believe that the issue can be re-mediated by addressing both issues. Further this analysis brings out an interesting and quite important observation about almost all health care proposals, namely that they merely project the past forward assuming that there will be no fundamental change in medicine and medical techniques. We believe that for many cancers in the 2010-2030 time period that significant genetic modalities of detection and therapeutics will alter the very structure of the health care delivery system.
We remark on the above diagram and a paradigm changing trend in medicine the following four steps:
1. Gene Markers for Presence: There has been a tremendous amount of work performed in all of the eight target cancers for gene markers for a predisposition for the cancers. Clearly having a gene is not totally predictive but it permits a measure for increasing vigilance and testing. Thus have a set of gene markers for cancers which can be re-mediated are quite useful. It does not stop the gold standard test of pathological resection. There as of yet does not appear to be a large set gene markers for presence. We know that the BRCA gene establish a high probability for breast and other cancers. However they in and of themselves do not establish presence. However we know that when a clonal cancer starts there will be the results of both primary and secondary pathways on the clonal cells themselves as well as other cells reacting to the clonal aberration which can be measured and used to detect presence.
2. Gene Markers for Staging: Gene markers for staging are the next step. This means that we can now, having detected the presence of the cancer, determine its aggresivity and then to take the appropriate actions. Prostate cancer is typical in this class. Some colon cancers also fall here as do some limited superficial spreading malignant melanomas. In fact it is know that certain melanomas regress, albeit may latter appear as a secondary met.
3. Genetic Therapy: There is a beginning effort in gene therapy now. It is slow and is progressing along the usual lines. However in the next twenty years this is expected to grow at a startling rate. This will be a case of many small victories until the tools are developed and then a massive growth phase. This will dramatically reduce the morbidity and mortality. The issue is will it educe the costs. Again with Federal funding and rights accruing to the sponsors such costs may be minimized.
4. Genetic Immunization: This is the final step in the time horizon we are looking at. Clearly there will be a way to establish what we see as an immunization. This is not akin to the cervical cancer immunization against the papilloma virus but an actual genetic insertion or modification to either repair or block the effects of the precipitating genes.
These four are also benchmark elements for policy formulation and Government funding. The basic research is completed to permit much of this to commence, albeit there are still some loopholes to be filled in, but a focused research program will be essential to re-mediate the cancers we have discussed herein.
If this is done, then a forward looking plan, one looking at remediation of controllable diseases via genetic means will evolve and become an integral part of any long range health care plan. It is not just a question of who pays what for what is currently performed. This is an event changing program.
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