The problem with prediction is that everyone disagrees about the future (and don’t look ahead anyway). Most of us look backward and assume that the view will be just the same (but more so?) if we turned around and looked ahead. The wonderful thing about hindsight is that not only is it easy, but everyone claims that they knew it all along once they can look in the rear-view mirror, but why not look ahead?
Let’s turn around and, just for a moment, try to look at where we’re going. We are right on the edge of a revolution in human medicine, and it’s easy to see if you look forward, not backward. Most people, researchers included, don’t look forward. Not only do they disagree that we’re about to change clinical medicine, but almost no one realizes that the change is already in progress. Oddly enough, even those who think of themselves as “at the forefront” of medicine are usually still looking backwards. They still focus on genes, genomics, and personalized medicine – all useful, but all of them 20th century concepts with 20th century assumptions – and miss the immense shift going on in epigenetics and our fundamental understanding of age-related disease.
It’s a though we were to search for our lost keys in the one place we didn’t lose them and that we’ve already searched – unsuccessfully – for years. We spend billions (actually hundreds of billions) of dollars and endless human resources searching for the key to Alzheimer’s disease in the one place that it doesn’t exist, then, rather than looking in a far more logical place, we give up or – perhaps worse – continue to throw immense amounts of money into the wrong place.
Do we really have endless money to waste ensuring failure?
The problem is that we can no more use genomics to understand and cure age-related disease than we could have prevented smallpox and polio using standard pharmaceutical drugs. Just as we needed to change our concepts and our tools – using immunization to address viral illness – so to do we need to update our concepts and our tools to cure Alzheimer’s disease and the entire gamut of other age-related diseases. Small wonder that we haven’t a single effective agent that actually changes pathology of any of these diseases. Not a one.
We throw money at symptoms, we turn our back on diseases.
Unfortunately, this basic naiveté with regard to disease also has inertial costs. I was on a call today with a major global pharmaceutical firm, whose stated criteria for which approaches to try next against Alzheimer’s disease is, first and foremost, the “consensus of current researchers”, those same researcher who consistently fail to find any effective interventions, anything that alters the progress of these diseases. If everyone agrees to continue searching in the wrong place, small wonder when no one finds anything. Worse yet, using consensus (it’s the way we did it in the 20th century, so it’s good enough for the 21st century), they ensure that other researchers will search the same place and that we will continue to throw money at failed assumptions and futile trials, rather than trying to actually understand fundamental pathology, reevaluate our assumptions, and moving into the 21st century.
Finding a cure for Alzheimer’s is feasible, but only if we look in the right place. We need to stop looking in the rear view mirror and focus on where we are going. It’s time to understand the role, not of genetics, not of genomics, not of personalized medicine, but the ongoing revolution in epigenetics and what it tells us about Alzheimer’s and other diseases, diseases that we once thought impossible to cure.
Things remain impossible only as long as your assumptions ignore reality.