If intelligent fridges and flying cars are not batty enough for you, the US military agency largely responsible for bringing us the Internet (which, common sense told so many, would never attract public interest) now wants to create cyborgian insects to go to war. One entomologist calls the idea “ludicrous.” Hmm.

“Common sense” is almost the antithesis of scientific method, and while futuring can never aspire to the validity and reliability of the hard sciences, it is not without methods, chief among which is to build (based on observation, not purely common sense) alternative scenarios and then consider their implications.

A credible futurist does just that in describing three scenarios of how the future of healthcare might unfold in the US. Of the three, his bet seems to be on what he calls the “incremental change” scenario. We would only add that when the increments are increasingly powerful and the intervals between are increasingly short, the net result is revolutionary.

Our confidence in the arrival of revolutionary cures for most disease conditions within the next 20 years is stirred but not shaken by the knowledge that new pathogens such as HIV, SARS, and bird flu are being introduced at an accelerating rate, currently estimated at one per year. We remain undaunted because scientists’ rapidly advancing knowledge of disease biology is accelerating their ability to find treatments. For example, a bird flu vaccine was recently created in an astonishing 36 days.

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The maturation of the biotech industry seemed to be the chief message of this year’s biggest-ever industry conference. The industry will need all the maturity it can get, given that it is now only two steps short of the 12 needed to create life. In a sense, that could be good news for Creationists — it will prove scientifically that Creation (of life, though not of the Universe) is indeed possible; however, a report that the International HapMap Project has produced new evidence supporting Darwin is bad news for Creationism, which is not based on science and does not even claim to be based on common sense.

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The Pentagon’s Defense Advanced Research Projects Agency (DARPA) is seeking proposal to insert MEMS (micro-electromechanical systems) into insect pupae, so the fully-fledged insect can be remotely controlled later, reports Gary Kitchener for the BBC News . The insects could then be used to find explosives and other substances. “A winning bidder, writes Kitchener, quoting DARPA, “would have to deliver ‘an insect within five metres of a specific target located 100 metres away [and] be able to transmit data from relevant sensors, yielding information about the local environment. These sensors can include gas sensors, microphones, video, etc.’”

Darpa’s previous experiments to get bees and wasps to detect the smell of explosives foundered when their “instinctive behaviours for feeding and mating… prevented them from performing reliably,” he notes.

The Future of American Healthcare

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Futurist Ian Morrison, writing in Hospitals & Health Networks magazine, proposes “three simple models” to “help in thinking about the prospects for structural change in health care (such as big health care reform, or a shift in paradigm toward prevention, or a rise of true consumer-directed health care).

The first is the “medical Pearl Harbor” model, in which it would take a health disaster — a full-blown bird flu pandemic, perhaps — to completely transform the health care system.

Second is the “Tipping Point” model, in which “circumstances, trends and people conspire to create a tipping point where complex social systems go off in a different direction and change rapidly to a new state.” For example: “aging baby boomers, burdened by ever-escalating out-of-pocket costs and the looming financial chasm of retirement, reach a point where they tip toward asking for a bigger role for government funding and regulation.”

Third is the “Glacial Erosion” model, which Morrison argues “is the most common form of change in American health care.” Cost-shifting to consumers falls within this model, since its effects are “incremental, diffused, insidious” rather than incitements to revolution. The cost of high-tech interventions, which we want “whether they are cost-effective or not,” also applies to this model. The notion of “Health care as a superior good,” in which “the top 10 percent of households based on income . . . can pay for both medicine and merlot” and “the top third of households may be OK,” while “the rest of us may be trading health care for cars, vacations or even food,” also falls within the Glacial Erosion model.

Over time, this model can still radically alter the landscape, with (quote):

• huge and widening disparities in cost, quality and service based on income of the patient;
• large and growing out-of-pocket costs for all, regardless of income and wealth;
• higher taxes for everybody (because on the one hand the ranks of Medicare and Medicaid must grow because of the glacial demographic forces we describe and because we are not heartless bastards, yet, and we will not leave people with absolutely nothing);
• lower reimbursement and profit per unit (maybe, but you technology vendors enjoy the inverse trend for the moment); and
• a perpetual sense of system in crisis.

Acceleration of Disease

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Humans are accumulating new pathogens — such as TB, bird flu, and HIV/AIDS — at a rate of one per year, scientists told the annual meeting of the American Association for the Advancement of Science. An epidemiologist at the University Of Edinburgh said “… this accumulation does seem to be happening very fast. So it seems there is something special about modern times – these are good times for pathogens to be invading the human population.”

Some may have been around for a long time and have only just come to light. Others that have emerged recently are entirely new, such as HIV and the SARS virus. Possible reasons include deforestation and the introduction of exotic livestock, which bring humans into contact with animals they seldom met in the past; as well as global travel, global trade, and hospitalization.

In addition, “Pathogens are evolving ways to combat our control methods. The picture is changing and looks as if it will continue to. We’re going to have to run as fast as we can to stay in the same place.”

Understanding Disease

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The US Food and Drug Administration’s approval of cancer drug Rituxan to treat rheumatoid arthritis was described by the Washington Post as “a symbol of [doctors’] rapidly advancing knowledge of disease biology.” Hitherto, a discovery that a drug designed to treat one disease could treat another tended to be serendipitous, but the Rituxan case marks a sea change whereby our vastly increased understanding of biology enables researchers to predict such effects.

Bird Flu Vaccine in Record Time

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It took Pennsylvania researchers in conjunction with scientists from the US Centers for Disease Control and Prevention only 36 days to produce a bird flu vaccine made from a genetically engineered human cold virus. The vaccine protected 100 percent of vaccinated mice and chickens exposed to the H5N1 bird flu virus. In contrast, production of a conventional flu vaccine requires months of work and large numbers of fertilized chicken eggs.

The team is working with the Food and Drug Administration to begin preliminary human tests of the vaccine, which could begin very soon if they are not already under way.

Adding to the good news is that the vaccine can not only stimulate several lines of defense against the H5N1 virus, giving it greater therapeutic value, but also is still likely to be effective against H5N1 mutatations.

* * *Biotech Matures Fast

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January’s annual JP Morgan Healthcare Conference, the biggest biotech investment gathering in the United States, drew a record number of 7,000 invitation-only attendees this year, “The mood,” reported Stephen Hauser in the Boston Globe , “was distinctly positive,” in part from “a sense that the world’s largest drug makers are still having trouble building up their own pipelines of future products, and see the specialized techniques and focused markets of biotechnology as a solution.”

Artificial Life

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Artificial membranes holding simple RNA enzymes have spontaneously acted like cells, including growing and (with a little help) dividing. The aim is “a growing, dividing, living organism of totally synthetic origins.” With only two of twelve preconditions judged necessary to accomplish this feat remaining to be overcome, a synthetic organism could be produced within this decade. The two remaining preconditions are that the cell must contain genes and enzymes that can be replicated, and they must be shared among daughter cells.

“Roughly a dozen laboratories worldwide are working on it,” reports Jack Lucentini in The Scientist , “and this has spurred major progress.” The J. Craig Venter Institute is one, using a “top down” approach in which existing biological structures are mimicked. More modern “bottom-up approaches” simply build from the most basic elements, which could lead to life forms currently unimaginable. Other labs involved include the Argonne and Los Alamos National Laboratories in the US, the University of Osaka in Japan, the University of Rome, and the French National Institute for Agricultural Research.

We Are Still Evolving

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To date, some 700 regions of the human genome contain genes that appear to have been reshaped by natural selection within the last 5,000 to 15,000 years, reports Nicholas Wade in the New York Times . They include genes for the senses of taste and smell, digestion, bone structure, skin color, and brain function.

A study of Africans, East Asians, and Europeans has revealed different set of genes affecting skin color, hair texture, and bone structure that may account for differences in racial appearance. The findings add to the evidence that human evolution has continued throughout the last 10,000 years.

The study is based on DNA data gathered by the HapMap project. Previously identified regional evolutionary differences in humans include resistance to malaria in some populations and a high degree of lactose tolerance in others where milk was a staple food.