News Feature
Published: 05 December 2019
Looking forward 25 years: the future of medicine
Nature Medicine volume 25, pages1804–1807(2019)
To celebrate the end of our 25th anniversary year, we asked thought leaders and experts in the field to answer one question: What will shape the next 25 years of medical research?
新闻专题
发布时间：2019年12月05日
展望25年：医学de未来
自然医学 25卷， 1804 - 1807页（ 2019年）
为庆祝25周年，我们请思想领袖和专家回答一个问题：未来25年的医学研究将如何发展？
Aviv Regev
Credit: Casey Atkins
Core member and chair of the faculty, Broad Institute of MIT and Harvard; director, Klarman Cell Observatory, Broad Institute of MIT and Harvard; professor of biology, MIT; investigator, Howard Hughes Medical Institute; founding co-chair, Human Cell Atlas.
Credit: Mouka Studio/Alamy Stock Photo
For many years, biology and disease appeared 'too big’ to tackle on a broad level: with millions of genome variants, tens of thousands of disease-associated genes, thousands of cell types and an almost unimaginable number of ways they can combine, we had to approximate a best starting point—choose one target, guess the cell, simplify the experiment.
But we are now on the cusp of an inflection point, where the 'bigness’ of biomedicine turns into an advantage. We are beginning to see advances towards these goals already, in polygenic risk scores, in understanding the cell and modules of action of genes through genome-wide association studies (GWAS), and in predicting the impact of combinations of interventions. Going forward, our success in harnessing bigness will rely on our ability to leverage structure, prediction and expanded data scale. Disease is highly structured at the molecular, genetic, gene program, cell and tissue levels; acknowledging and understanding this structure can help us reduce the overwhelming lists of genes and variants to a manageable number of meaningful gene modules. We cannot test every possible combination, so we need algorithms to make better computational predictions of experiments we have never performed in the lab or in clinical trials. But only when data are truly big, scaled massively and rich in content, will we have the most effective structuring and prediction power towards building a much-needed Roadmap of Disease for patients.
To achieve this, we need to invest in building the right initiatives—like the Human Cell Atlas and the International Common Disease Alliance—and in new experimental platforms: data platforms and algorithms. But we also need a broader ecosystem of partnerships in medicine that engages interaction between clinical experts and mathematicians, computer scientists and engineers who together will bring new approaches to drive experiments and algorithms to build this Roadmap.
阿维夫·雷杰夫（Aviv Regev）
图片来源：凯西·阿特金斯（Casey Atkins）
麻省理工学院和哈佛大学博德研究所的核心成员和系主任；麻省理工学院和哈佛大学博德研究所克拉曼细胞观察台主任；麻省理工学院生物学教授；霍华德·休斯医学研究所研究员；人类细胞图谱 创办共同主席。
图片提供：Mouka Studio / Alamy Stock Photo
多年来，生物学和疾病似乎“太大了”，无法在广泛的层面上解决：拥有数百万个基因组变体，成千上万与疾病相关的基因，成千上万种细胞类型以及几乎不可思议的结合方式，我们必须估计一个最佳的起点-选择一个目标，猜测细胞，简化实验。
但是，我们现在正处于转折点的尖端，在那里生物医学的“庞大”变成了优势。在多基因风险评分，通过全基因组关联研究（GWAS）了解细胞和基因作用模块以及预测干预措施组合的影响方面，我们开始看到朝着这些目标取得的进展。展望未来，我们在驾驭“庞大”上的成功将取决于我们利用结构，预测和扩展数据规模的能力。疾病在分子，遗传，基因程序，细胞和组织水平高度结构化；认识和理解这种结构可以帮助我们将大量的基因和变体减少到可管理的有意义的基因模块数量。我们无法测试所有可能的组合，因此我们需要算法来对我们从未在实验室或临床试验中进行过的实验做出更好的计算预测。但是只有在数据真正庞大，规模庞大且内容丰富时，我们才具有最有效的结构和预测能力，可以为患者构建急需的疾病路线图。
为了实现这一目标，我们需要投资建立正确的计划，例如人类细胞图谱和国际常见疾病联盟，以及建立新的实验平台：数据平台和算法。但是，我们还需要更广泛的医学合作伙伴生态系统，以使临床专家与数学家，计算机科学家和工程师之间进行互动，他们将共同带来新的方法来驱动实验和算法以构建此路线图。
Feng Zhang
Credit: Stan Grazier, Broad Institute
PhD investigator, Howard Hughes Medical Institute; core member, Broad Institute of MIT and Harvard; James and Patricia Poitras Professor of Neuroscience, McGovern Institute for Brain Research, MIT.
Although it is difficult to pinpoint an exact value, it is safe to estimate that more than 250 patients have been treated with gene therapies for monogenic diseases for which there previously were no treatment options. Add in the patients who have received CAR-T therapy, and that number rises into the thousands. This is an enormous success, and it represents the beginning of a fundamental shift in medicine away from treating symptoms of disease and toward treating disease at its genetic roots.
Gene therapy has been under development for more than 30 years, but several recent major advances have tipped the scales toward clinical feasibility, including improved delivery methods and the development of robust molecular technologies for gene editing in human cells. In parallel, affordable genome sequencing has accelerated our ability to identify the genetic causes of disease. With these advances, the stage is set for the widespread use of gene therapy. Already, nearly 1,000 clinical trials testing gene therapies are ongoing, and the pace of clinical development is likely to accelerate.
To fulfil the potential of gene therapy and ensure that all patients have access to this revolutionary treatment, we will need to continue developing delivery approaches that are practical and widely usable, to refine molecular technologies for gene editing, to push our understanding of gene function in health and disease forward, and to engage with all members of society to openly discuss the risks and benefits of gene therapy.
张峰（Feng Zhang）
图片提供：Stan Grazier，博德研究所
霍华德·休斯医学研究所博士研究员；麻省理工学院和哈佛大学博德研究所的核心成员；麻省理工学院麦戈文脑科学研究所神经科学James & Patricia Poitras教授。
尽管很难确定确切的值，但是可以安全地估计，已经有250例以上的单基因疾病患者接受了基因治疗，而这些疾病以前是没有治疗选择的。加上接受CAR-T治疗的患者，这个数字上升到数千。
这是巨大的成功，它代表了医学从治疗疾病症状转向从基因的根源治疗疾病的一个根本转变的开始。
基因疗法已经发展了30多年，但是最近的一些重大进展已将天平推向了临床可行性，包括改进的输送方法和用于人类细胞中基因编辑的强有力的分子技术的发展。同时，可负担得起的基因组测序提高了我们识别疾病遗传原因的能力。随着这些进展，为基因治疗的广泛使用奠定了基础。已经有近1,000项测试基因疗法的临床试验正在进行中，并且临床发展的步伐可能会加快。
为了发挥基因治疗的潜力并确保所有患者都能获得这种革命性的治疗方法，我们将需要继续开发实用且广泛适用的输送方法，以完善用于基因编辑的分子技术，以推动我们对健康和疾病中基因功能的理解向前发展，并与社会所有成员互动，公开讨论基因治疗的风险和益处。
Elizabeth Jaffee
Credit: Fred Dubs, Johns Hopkins University
Dana and Albert “Cubby” Broccoli Professor of Oncology, Johns Hopkins School of Medicine; deputy director, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.
“An ounce of prevention is worth a pound of cure.” Benjamin Franklin said this in reference to fire safety, but it can easily be applied to health too. The twentieth century saw amazing advances aimed at preventing the onset of disease—including vaccines and risk-factor interventions—nearly doubling life expectancy worldwide. Only two decades into the twenty-first century, healthcare has already entered its next phase of rapid advancements. By using precision medicine technologies, genetic vulnerabilities to chronic and deadly diseases at the individual level can now be identified, potentially pre-empting disease decades later.
My hope for the next 25 years is that someday a single blood test could inform individuals of the diseases they are at risk of (diabetes, cancer, heart disease, etc.) and that safe interventions will be available. I am particularly excited about the possibility of developing cancer vaccines. Vaccines targeting the causative agents of cervical and hepatocellular cancers have already proven to be effective. With these technologies and the wealth of data that will become available as precision medicine becomes more routine, new discoveries identifying the earliest genetic and inflammatory changes occurring within a cell as it transitions into a pre-cancer can be expected. With these discoveries, the opportunities to develop vaccine approaches preventing cancers development will grow.
But, as is the case today, prevention technologies can only be fully successful if they are widely available, to reduce unnecessary morbidity and mortality and healthcare costs and further raise life expectancy. Global accessibility is key to reduce global disparities. For these strategies to work, funding agencies should consider prioritizing prevention strategies.
伊丽莎白·贾菲（Elizabeth Jaffee）
图片提供：Fred Dubs，约翰·霍普金斯大学
约翰·霍普金斯医学院的达纳和阿尔伯特“古比”布罗科利肿瘤学教授；约翰·霍普金斯大学Sidney Kimmel综合癌症中心副主任。
“一盎司的预防胜于一磅的治疗。”本杰明·富兰克林（Benjamin Franklin）谈到消防安全时说了这句，但这句话也很容易应用于健康。二十世纪，旨在预防疾病发作的惊人进展（包括疫苗和危险因素干预措施）使全世界的预期寿命几乎翻了一番。进入二十一世纪仅二十年，医疗保健已进入下一阶段的快速发展。通过使用精密医学技术，现在可以在个体水平识别出对慢性和致命疾病的遗传易感性，有可能先发制人地应对数十年后出现的疾病。
我希望在接下来的25年中，有一天可以通过一次血液检查告知个人他们正处于患病风险（糖尿病，癌症，心脏病等），并且可以提供安全的干预措施。我对开发癌症疫苗的可能性感到特别兴奋。针对子宫颈癌和肝细胞癌的病原体的疫苗已经被证明是有效的。有了这些技术，随着精密医学的日趋常规化，将会获得大量数据，人们有望获得新的发现，从而发现细胞向癌前期转变时发生的最早的遗传和炎症变化。有了这些发现，开发预防癌症发展的疫苗方法的机会将会增加。
但是，就像今天一样，预防技术只有在广泛使用的情况下才能完全成功，以减少不必要的发病率和死亡率以及医疗费用，并进一步提高预期寿命。全球可及性是减少全球差异的关键。为了使这些策略起作用，供资机构应考虑优先预防策略。
Jeremy Farrar
Credit: Wellcome Trust
Director, Wellcome Trust.
Politics, demographics, economics, climate—how the world changes and interacts fundamentally affects all of us. Research is part of that and can help provide solutions to the great challenges we face, but only if the three pillars of science, innovation and society come together in an environment where people and teams can thrive. We must therefore take the opportunity today to shape how the culture of research will develop over the next 25 years.
Building a career in research can be incredibly rewarding, yet it often comes at a cost. The drive for research excellence—to which Wellcome has certainly contributed—has created a culture that cares more about what is achieved than how it is achieved. We can do better, and building a creative, inclusive and open research culture will unleash greater discoveries with greater impact.
Changing culture requires us to acknowledge the issue and then make a long-term commitment. As an independent foundation, Wellcome is able to acknowledge the issue and make that commitment. This is a permanent shift in our thinking. Working openly with, and as part of, the wider research community, we aim to make research inclusive, more inspiring, more fun, more rewarding. As a result, it will contribute even more to making the world a healthier place to live.
杰里米·法拉（Jeremy Farrar）
照片提供：惠康信托（Wellcome Trust）
惠康基金会董事。（注：流感专家）
政治、人口统计学、经济学、气候-世界如何变化和相互作用从根本上影响着我们所有人。研究是其中的一部分，它可以为我们面临的巨大挑战提供解决方案，但前提是科学、创新和社会的三大支柱必须在人员和团队能够蓬勃发展的环境中融合在一起。因此，我们今天必须抓住机会，确定未来25年研究文化将如何发展。
建立研究事业可能会带来令人难以置信的回报，但往往要付出一定的代价。惠康（Wellcome）无疑为之贡献了追求卓越研究的动力，这创造了一种文化，它更在乎取得的成就而不是如何取得。我们可以做得更好，建立一种创新、包容和开放的研究文化将释放更大的发现并产生更大的影响。
不断变化的文化要求我们承认问题，然后做出长期承诺。作为独立的基金会，惠康能够确认问题并做出承诺。这是我们思想的永久转变。我们与更广泛的研究社群进行公开合作，并作为其一部分，我们的目标是使研究更具包容性，更具启发性，更有趣，更有意义。结果，它将为使世界成为更健康的生活场所做出更大贡献。
John Nkengasong
Credit: John Nkengasong
Director, Africa Centres for Disease Control and Prevention.
Population wise, Africa is the continent of the future. By 2050, it is estimated that its population will be 2.5 billion people. This means that one in every four persons in the world might be an African, with rapidly growing economies and a rising middle class. These demographic changes have important implications for both communicable and noncommunicable disease patterns, including emerging and re-emerging infectious diseases; resistance to antibiotics; and rising rates of cancers, diabetes, cardiovascular diseases and maternal and child deaths. To meet its health challenges by 2050, the continent will have to be innovative in order to leapfrog toward solutions in public health.
Precision medicine will need to take center stage in a new public health order—whereby a more precise and targeted approach to screening, diagnosis, treatment and, potentially, cure is based on each patient’s unique genetic and biologic make-up. For example, universal newborn screening and a more accurate analysis of causes of death in this age group could be established to curb under-five mortality; genetic screening programs could help avoid progression towards aggressive cancers; and medicine side effects could be reduced if tests could predict negative reactions and enable caregivers to proactively prescribe alternative treatments.
In Africa, precision medicine should not be seen from the lens of sequencing whole genomes, diagnosing DNA abnormalities and developing medications targeted to very small populations. Rather, African countries should begin pursuing policy approaches and partnerships to advance precision medicine to meet the African Union’s Agenda 2063 goals. This includes the integration of precision medicine approaches into national strategies to improve healthcare—including genomic data policy—and increase diagnostic capacity, and the creation of biobanks, such as H3Africa, that encompass both physical and bioinformatics facilities.
约翰·恩肯加松（John Nkengasong）
图片提供：约翰·恩肯加松（John Nkengasong）
非洲疾病控制和预防中心主任。
在人口方面，非洲是未来的大陆。到2050年，估计其人口将达到25亿。这意味着，世界上每四个人中就有一个可能是非洲人，经济发展迅速，中产阶级不断增加。这些人口变化对传染病和非传染病包括新出现和重新出现的传染病均具有重要意义；对抗生素的抵抗力；以及癌症，糖尿病，心血管疾病和孕产妇和儿童死亡的比率上升。为了在2050年之前应对其健康挑战，该大陆将必须进行创新，以便朝着公共卫生解决方案迈进。
精准医学将需要在新的公共卫生秩序中占据中心位置，从而根据每个患者的独特遗传和生物学组成，进行更精确、更有针对性的筛查、诊断、治疗以及可能的治愈方法。例如，可以建立新生儿普查和对该年龄组死亡原因进行更准确的分析，以遏制五岁以下儿童的死亡率；基因筛查计划可以帮助避免进展为侵袭性癌症；如果测试可以预测不良反应并使护理人员主动开出替代治疗方法，则可以减少药物的副作用。
在非洲，不应从整个基因组测序、针对极少人群的诊断DNA异常和开发药物的角度看待精密医学。相反，非洲国家应开始寻求政策方法和伙伴关系，以发展精密医学，以实现非洲联盟的2063议程目标。这包括将精密医学方法整合到改善医疗保健（包括基因组数据政策）和提高诊断能力的国家策略中，以及创建包括物理和生物信息学设施的生物银行，例如H3Africa。
Eric Topol
Credit: Scripps Research Institute
Executive vice-president, Scripps Research Institute; founder and director, Scripps Research Translational Institute.
Twenty-five years ago, the World Wide Web was just getting off the ground. Therefore, when thinking of the medical research landscape in 25 years, it is reasonable to think big and without limits.
In 2045, I hope we will have developed a planetary health infrastructure based on deep, longitudinal, multimodal human data, ideally collected from and accessible to as many as possible of the 9+ billion people projected to then inhabit the Earth.
This infrastructure, by using hybrid artificial intelligence (AI) models—including various deep neural networks, federated AI, nearest-neighbor analysis and systems yet to be developed—could provide individualized guidance for the prevention and optimal management of medical conditions, acting as a virtual medical coach for patients and a platform for clinicians to review a patient’s real-time, real-world, extensive and cumulative dataset.
Some have projected that, by this juncture, artificial general intelligence (AGI) will have been developed, giving machines enhanced capabilities to perform functions that are not feasible now. Notwithstanding that uncertainty, it is likely that machines’ ability to ingest and process biomedical text at scale—such as the corpus of the up-to-date medical literature—will be used routinely by physicians and patients. Accordingly, the concept of a learning health system will be redefined.
埃里克·托波尔（Eric Topol）
照片提供：斯克里普斯研究所
斯克里普斯研究所执行副总裁；斯克里普斯转化研究所的创始人兼董事。
25年前，互联网才刚刚起步。因此，在思考25年的医学研究前景时，大胆而无限制地思考是合理的。
我希望到2045年，我们将基于深度、纵向、多模式的人类数据开发一个全球健康基础体系，理想地是从预计要居住在地球上的90亿多人口中尽量收集并对他们开放。
通过使用混合人工智能（AI）模型（包括各种深度神经网络，联合AI，最近邻体法和尚未开发的系统），该基础体系可以为预防和优化医疗状况提供个性化指导，面向患者的虚拟医疗教练，以及为临床医生提供的平台，用于审查患者的实时、真实世界、广泛而累积的数据集。
有人预测，到这一时刻，将开发人工智能（AGI），从而使机器具有增强的功能来执行目前不可行的功能。尽管存在不确定性，但是医师和患者仍可能会常规使用机器大规模吸收和处理生物医学文本的能力（规模如最新医学文献的语料库）。因此，将重新定义学习健康系统的概念。
Linda Partridge
Credit: Max Planck Institute for Biology of Ageing
Professor, Max Planck Institute for Biology of Ageing.
Human life expectancy has increased over the past 170 years in many parts of the world. Unfortunately, the healthy lifespan has not, and the period of life when a person lives with disability and illness at the end of life is growing, especially in women.
But ageing is malleable, and mounting evidence suggests that late-life ill health can be combated. In laboratory animals, including mice and rhesus monkeys, genetic, lifestyle and pharmacological interventions can increase not only the lifespan, but also the healthspan. In humans, improvements in diet and the implementation of physical exercise regimes can effect major health improvements, but better lifestyle is not enough to prevent age-related diseases.
The big hope is that 25 years from now, medical sciences will have progressed enough to enable people to have healthier and more active lives almost up until their eventual death. Going forward, the direct targeting of mechanisms of ageing, including with existing drugs, presents an opportunity to reduce disability and illness in late life. Sirolimus, an mTORC1 inhibitor, extends the lifespan of laboratory animals and in clinical trials has proved to boost the immune response of older people to vaccination against influenza. Other drugs, such as the combination of desatinib and the BCL-2 inhibitor quercetin, which kill senescent cells, are farther from the clinic but show promise. Plasma from younger mice has been shown to have a beneficial effect on the stem cell function of several tissues in older mice; work to identify the natural metabolites responsible for this effect could open up avenues for translation to the clinic. Geroprotective drugs, which target the underlying molecular mechanisms of ageing, are coming over the scientific and clinical horizons, and may help to prevent the most intractable age-related disease, dementia.
琳达·帕特里奇（Linda Partridge）
图片提供：马克斯·普朗克衰老生物学研究所
马克斯·普朗克衰老生物学研究所教授。
在过去的170年中，世界许多地区的预期寿命都在增加。不幸的是，健康的寿命并没有延长，一个人生命的最后阶段伴随残障和疾病的时期正在增长，特别是在女性中。
但是衰老是可延展的，越来越多的证据表明，晚年的不健康是可以防止的。在包括小鼠和恒河猴在内的实验动物中，遗传、生活方式和药理学干预措施不仅可以延长寿命，而且可以延长健康期。在人类中，饮食的改善和体育锻炼方法的实施可以带来重大的健康改善，但是改善生活方式不足以预防与年龄有关的疾病。
最大的希望是，从现在开始的25年后，医学科学将取得足够的进步，使人们几乎可以一直拥有更健康、更积极的生活，直到他们最终亡去。展望未来，直接针对老龄化机制（包括现有药物）将为减少晚年残疾和疾病提供机会。西罗莫司是mTORC1抑制剂，可延长实验动物的寿命，并且在临床试验中已证明可增强老年人针对流感疫苗接种的免疫反应。其他药物，例如desatinib和BCL-2抑制剂槲皮素的组合，它们可以杀死衰老细胞，距临床应用尚远，但显示出希望。研究表明，年轻小鼠的血浆对老年小鼠中几种组织的干细胞功能具有有益作用。鉴定引起这种作用的天然代谢物的工作可以为临床应用开辟途径。针对衰老潜在分子机制的保护药物已经出现在科学和临床领域，并可能有助于预防最难治的与年龄相关的疾病——痴呆。
Trevor Mundel
Credit: Bill & Melinda Gates Foundation
President of G lobal Health, Bill & Melinda Gates Foundation.
The most essential innovations in medical research over the next 25 years won’t just come from the explorations of bench scientists or the emergence of new technologies. They will come from what we do—as partners across the public and private sectors—to forge a new applied research ecosystem dedicated to the rapid discovery, development and delivery of life-changing tools that have been designed with the end user in mind.
This will mean finding new ways to share clinical data that are as open as possible and as closed as necessary. It will mean moving beyond drug donations toward a new era of corporate social responsibility that encourages biotechnology and pharmaceutical companies to offer their best minds and their most promising platforms. And it will mean working with governments and multilateral organizations much earlier in the product life cycle to finance the introduction of new interventions and to ensure the sustainable development of the health systems that will deliver them. If we focus on these goals, we can deliver on the promise of global health equity.
特雷弗·蒙德尔（Trevor Mundel）
照片提供：比尔和梅琳达·盖茨基金会
全球健康部总裁，比尔及梅林达·盖茨基金会。
未来25年内，医学研究中最重要的创新将不仅来自于实验室科学家的探索或新技术的出现。它们将来自我们作为公共和私营部门合作伙伴所做的工作，以打造一个新的应用研究生态系统，该生态系统致力于快速发现、开发和交付改变生活的工具，这些工具是为最终用户而设计的。
这将意味着寻找新的方式来共享临床数据，这些数据应尽可能公开和必要时尽可能封闭。这将意味着从药品捐赠迈向企业社会责任的新时代，这将鼓励生物技术和制药公司提供最好的思想和最有希望的平台。这将意味着在产品生命周期的更早阶段与政府和多边组织合作，为引入新的干预措施提供资金，并确保将履行这些干预措施的卫生系统的可持续发展。如果我们专注于这些目标，我们就可以实现全球健康公平的承诺。
Josep Tabernero
Credit: VHIO
Vall d’Hebron Institute of Oncology (VHIO); president, European Society for Medical Oncology (2018–2019).
Let’s briefly skip back 25 years. In oncology, who could have predicted that the stunning advances in genome sequencing would come to shape clinical decision-making? Who could have foreseen the increasing availability of genetic patient screenings or the promise of liquid biopsy policing of disease? Very few, which is why it is a fool’s errand to make sweeping predictions. But let’s try.
Over the next 25 years, genomic-driven analysis will continue to broaden the impact of personalized medicine in healthcare globally. Precision medicine will continue to deliver its new paradigm in cancer care and reach more patients. Immunotherapy will deliver on its promise to dismantle cancer’s armory across tumor types.
I also anticipate that AI will help guide the development of individually matched therapies, the harnessing and exchange of big data, and advances in telemedicine to bring crucial medical expertise to more patients everywhere. But the prospect is not all rosy. I worry about the exacerbating burden of comorbidities in cancer patients. We must collectively seek to strengthen and unify medical fields, with particular emphasis on oncology and cardiology. This is an emerging area for collaboration. Implementation research in the prevention and control of cancer will also be critical, as will be the shaping and strengthening of cancer policy-making at the global, national and regional levels.
With continued belief that scientific endeavors should be prioritized to respond to society’s and citizens’ needs, the scientific community must grasp future opportunities to uphold the very ethos of medicine as we continue to push boundaries in discovering new ways to extend and improve patients’ lives.
约瑟夫·塔贝内罗（Josep Tabernero）
照片提供：VHIO
瓦尔德希布伦肿瘤研究所（VHIO）；欧洲医学肿瘤学会主席（2018-2019年）。
让我们简短地回顾过去25年。在肿瘤学上，谁能预料到基因组测序的惊人进步将影响临床决策？谁能预见到基因患者筛查的实用性会增加，或者液体活检监控疾病的希望会越来越大？很少有人做到，这就是为什么做出大胆的预测是徒劳的事。但是，让我们尝试一下吧。
在接下来的25年中，基因组驱动的分析将继续扩大个性化医疗在全球医疗保健领域的影响。精密医学将继续在癌症护理领域提供新的范例，并惠及更多患者。免疫疗法将兑现其消除各种肿瘤类型的癌症势力的诺言。
我还期望AI（人工智能）将帮助指导个性化匹配疗法的开发，大数据的利用和交换，以及远程医疗的进步，以将关键的医学专业知识带给更多的患者。但是前景并不乐观。我担心癌症患者合并症的负担加重。我们必须集体寻求加强和统一医学领域，尤其是肿瘤学和心脏病学。这是一个新兴的合作领域。实施研究以预防和控制癌症也将至关重要，全球、国家和地区各级的癌症政策制定和加强也将至关重要。
长期以来，人们认为科学努力应该优先响应社会和公民的需求，因此，科学界必须抓住未来的机会以坚持医学精神，我们将继续拓展新的途径来扩展和改善患者生活。
Pardis Sabeti
Credit: Pardis Sabeti
Professor, Harvard University & Harvard T.H. Chan School of Public Health and Broad Institute of MIT and Harvard; investigator, Howard Hughes Medical Institute.
A cataclysmic global pandemic is one of the greatest risks to humanity. Over the last 25 years, we have seen SARS, Ebola, Zika and other viruses spread undetected for months, leading to international emergencies and often devastating consequences. Even in the best US hospitals, most infectious diseases are not properly diagnosed or tracked.
But advances in two fields, genomics and information science, can transform our fight against viral threats. Ultrasensitive genome sequencing technologies are enabling the detection and characterization of viruses circulating under the radar. The advent of novel CRISPR, synthetic biology and microfluidic tools have allowed the development of rapid, ultrasensitive point-of-care diagnostics that can be deployed anywhere in the world. The resulting diagnostic and surveillance data can be integrated across healthcare nodes, from rural clinics to city hospitals, thanks to powerful new information systems. Together with advances from AI and other fields, these information systems can aid the rapid detection of infectious threats, to track their spread, and guide public health decision-making.
Over the next 25 years, the development and integration of these tools into an early-warning system embedded into healthcare systems around the world could revolutionize infectious disease detection and response. But this will only happen with a commitment from the global community.
帕迪斯·萨贝蒂（Pardis Sabeti）
图片提供：帕迪斯·萨贝蒂
哈佛大学＆哈佛T.H. Chan公共卫生学院以及麻省理工学院和哈佛大学博德研究所教授；霍华德·休斯医学研究所研究员。
一场灾难性的全球流行病是人类面临的最大风险之一。在过去的25年中，SARS，埃博拉病毒，寨卡病毒和其他病毒传播数月未被发现，导致国际紧急情况，并往往造成毁灭性后果。即使在美国最好的医院，也无法正确诊断或追踪大多数传染病。
但是基因组学和信息科学两个领域的进步可以改变我们对抗病毒威胁的斗争。超灵敏的基因组测序技术可以检测和鉴定传播的病毒。新型CRISPR，合成生物学和微流体工具的出现使人们能够开发可在世界任何地方部署的快速、超灵敏的即时诊断服务。借助功能强大的新型信息系统，可以将所得的诊断和监视数据集成到从乡村诊所到城市医院的所有医疗保健节点。这些信息系统与AI和其他领域的先进技术相结合，可以帮助快速检测传染病威胁，跟踪其传播并指导公共卫生决策。
在接下来的25年中，这些工具的开发并将其集成嵌入到全球医疗保健系统中的预警系统中，可能会彻底改变传染病的检测和应对。但这只有在国际社会的承诺下才能实现。
Els Toreele
Credit: Médecins Sans Frontières
Executive director, Médecins Sans Frontières Access Campaign.
Of the many biomedical advances made by the scientific community, only those that can generate large financial profits are taken up for development by for-profit companies. This leaves many gaps—but also opportunities—in regard to developing new treatments to meet public health needs.
My hope is that the scientific community will step up and target efforts to develop innovative therapeutics and other health tools for populations across the world. This includes people affected by tuberculosis, hepatitis, Ebola, advanced HIV, neglected tropical diseases, vaccine-preventable diseases, antimicrobial resistance, snakebite—the list goes on. The creativity and brainpower of the global research community are required to find solutions addressing these grave human needs.
But to do this, we need a paradigm shift such that medicines are no longer lucrative market commodities but are global public health goods—available to all those who need them. This will require members of the scientific community to go beyond their role as researchers and actively engage in R&D policy reform mandating health research in the public interest and ensuring that the results of their work benefit many more people. The global research community can lead the way toward public-interest-driven health innovation, by undertaking collaborative open science and piloting not-for-profit R&D strategies that positively impact people’s lives globally.
埃尔斯·托雷勒（Els Toreele）
图片提供：无国界医生
无国界医生组织病者有其药运动（Médecins Sans Frontières Access Campaign）执行理事在科学界取得的许多生物医学进步中，只有那些可以产生大量金融利润的才被营利性公司拿来加以开发。在为满足公共卫生需求而开发新疗法方面，这留下了许多空白，但也带来了机会。
我希望科学界将加紧努力，并为开发针对世界各地人群的创新疗法和其他保健工具而努力。其中包括受结核病、肝炎、埃博拉病毒、晚期艾滋病毒、被忽视的热带病、疫苗可预防疾病、抗菌素耐药性、蛇咬伤影响的人。需要全球研究界的创造力和才能来找到解决这些人类迫切需求的解决方案。
但是要做到这一点，我们需要进行模式转变，使药品不再是利润丰厚的市场商品，而是全球公共卫生商品，所有需要这些药品的人都可以使用。这将要求科学界的成员超越其研究人员的角色，并积极参与研发政策改革，以维护公共利益为前提的卫生研究，并确保其工作成果使更多人受益。全球研究界可以通过开展协作性开放科学并试行非营利性研发策略，从而对全球人民的生活产生积极影响，从而引领公共利益驱动型健康创新。
联系客服
