Has modern medicine run out of luck?

This week I have mostly been doing 11 contact hours of teaching plus prep for that, and a little reading of James Le Fanu’s interesting if a bit depressing book The Rise and Fall of Modern MedicineThe 11 contact hours included six on Friday in which rather ridiculously I introduced the beautiful symmetry of the cowpea mosaic virus to two entirely different audiences on the same day — one at 11:00 am and the other at 2:00 pm. I was doing my best at 2pm but it was a long week, so I had probably had a bit more enthusiasm in the morning.

Towards the end of the final two hours of teaching on Friday, I was discussing the example of the Dystrophin protein in muscle cells. Basically I said that we don’t know how it moves around in muscle cells, although we have managed to determine that it moves rather rather speedily, given that it is a huge protein 100 nm across. I went on to say that this is because we know just enough about what goes inside the cells of our bodies to make educated guesses about what could be kicking Dystrophin round inside our muscle cells, but nowhere near enough to be sure. I put a positive spin on this, by saying that there is a lot of fun research to do by biologists and physicists to work out what exactly is going on in the gloopy soup inside our cells.

James Le Fanu comes at basically same problem but has a rather more pessimistic take on it. Executive summary of his book: Modern medicine started with some lucky chance discoveries, e.g., of penicillin, and technological advances, like those that enabled transplant surgery. These advances did not rely on us knowing anything about the biology that runs the cells of our body. Medical science ran out of these easy or lucky wins in the 1970s and 1980s, and then switched to trying to develop new treatments by understanding the underlying molecular causes of these diseases. This has failed.

For example, many people thought that sequencing the complete human genome would help us develop treatments for Alzheimer’s, cancer, etc. This has largely not worked out. Our bodies are hideously complex, and the cells are full of nanomachines, like Dystrophin, which we don’t have the tools to study in enough detail to work out what they do. Knowing our genes is not enough. All this means that rationally designing new treatments is very hard. Unfortunately, it may take more time than we would want.

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