Australia's Chief Scientist

Children of a revolution: the medicine behind living longer

We can imagine an Australia where a child born today can look forward to a century of healthy living, write Alan Finkel and Bob Williamson.

This article was published in the Sydney Morning Herald on Wednesday 31 January 2017.

 

Lately we’ve both been enjoying ITV’s drama “Victoria”. By all accounts Queen Victoria lived well, dying at the age of 81 in 1901.

A girl born in Australia in Victoria’s reign could expect to live to 51.

A girl born in Australia today has a life expectancy approaching 85.

That’s right: the modern plebeian can expect to live longer than yesterday’s queen.

Much of that progress can be attributed to public health interventions: vaccination, flush toilets, better nutrition. But those interventions only take progress so far before we confront the reality of our longer, more comfortable lives: chronic disease.

In the twenty-first century, we’ll go beyond, to live healthier, for longer – if we harness the power of two great revolutions.

The first is the genomics revolution. In a decade, the price to sequence a human genome – our unique DNA signature – has plummeted from US$10 million to less than US$1,000.That plunge down the cost curve will continue, until genome sequencing is a routine part of care.

The second is the data revolution. Ever-faster computers plus ever-smarter artificial intelligence are untangling the relationships between your genetics, your lifestyle, your environment and your health. In the laboratory, the search for biomarkers and breakthrough therapies is accelerating. In your pocket, your smartphone amasses your data and connects you instanty to automated advice.

Put the two revolutions together, and you have the promise of precision medicine.

Picture a future where a newborn’s genome is sequenced as a matter of course. Doctors don’t try out different cancer therapies according to the law of averages: they customise the treatment to your genome and that of your tumour. Guidance on diet and exercise is fine-tuned to mitigate your risk for diabetes and hypertension. Medicines are calibrated to you: ideal dose, ideal time. Algorithms parse your fitness tracker data, and alert you to problems long before the first twinge of pain.

This is not medicine as crisis response: it is medicine optimised to prevent the crisis in the first place.

As we enter 2018, close to 40 countries have already announced major precision medicine initiatives, including the US – now recruiting Americans for a database of a million genomes. China’s latest Five Year Plan commits more than US$9 billion to precision medicine research. The scale of ambition of the global leaders in this field is shifting the horizon of possibility for all.

Your life – all our lives – are going to change. The question today is how.

It’s easy enough to imagine an Australia where the wealthy can benefit from tailor-made care, at cost, here or overseas. But do we really want a two-tiered future: tailored healthcare for some, the old shop standard for the rest, particularly under-served groups like Indigenous Australians and rural communities? Or an Australia where insurance or employment can be denied to vulnerable people, on the basis of their genetic profiles?

The benefits of progress must flow to all. The challenge is to transform our healthcare system from treating sickness to optimising health, with our privacy and autonomy intact.

In the 2030 Plan released this week, Innovation and Science Australia has recommended that Australia adopt this challenge as a national mission. Independently, a new report commissioned by the Commonwealth Science Council from the Australian Council of Learned Academies (ACOLA) will be launched today. It provides the intellectual framework for the decisions we will all make in the years ahead ahead, patients, policymakers and healthcare providers alike.

We are proud to begin with an enviable healthcare system, and a strong record in research. Australians overwhelmingly agree that we ought to be contributors to global progress, and a destination of choice for clinical trials and biotechnology initiatives that accelerate access to lifesaving therapies.

We can imagine an Australia where a child born today can look forward to a century of healthy living. The report from ACOLA provides a blueprint for a responsible, ethical and cost-effective path forward.

Dr Alan Finkel is Australia’s Chief Scientist

Bob Williamson was the Professor of Medical Genetics at the University of Melbourne