Predictions for 2012

Due to a dearth of predictions for 2012 (since my blog only began in 2010), I have decided to do what I did last year and make a list of predictions that I think we'll be reading about in the news for the coming year.

The Arab Spring sputters out. With the exceptions of Tunisia, Egypt, Jordan, and Morocco, almost no Arab states are poised to make a real transition to democracy. Many of them are too poor to make a democratic transition likely, and several of them are cursed by their own oil wealth, which encourages corruption and enables autocrats to buy off opposition. There may be a few other Arab dictators that fall this year, but in the end they will most likely be replaced by other dictators and/or chaos. Some Arab states may successfully hold democratic elections, but find their newfound democracy short-lived and ultimately revert to authoritarianism.

Medical data processing costs continue to fall, as the work is increasingly offshored and automated. As computing power grows, it becomes easier and cheaper to process medical data from nearly anywhere in the world. The cost of sequencing a human genome continues to fall faster than Moore's Law, and currently stands at roughly $4,000. Computers can now identify breast cancer more accurately than human doctors can. IBM's Watson is currently being repurposed into a medical diagnosis tool, which will have access to more information than a human doctor could hope to acquire: the latest medical literature, clinical trials, patient histories, and (soon) the patient's genome.

Smartphone apps that monitor the user's health proliferate and become very popular. This has already begun to happen to some extent, but in 2012 health apps will proliferate as they become better and less invasive. The less the user needs to interact with the app, the more likely it is that the app will be used effectively. Look for more gadgets like Nike+, which combine the functionality of a smartphone app with a device that is worn near the body to measure some aspect of health.

The discovery of the Higgs Boson is confirmed. In December 2011, scientists at CERN confirmed with a high level of probability that they had discovered a new particle at the energy level believed to be associated with the elusive Higgs Boson, the last undiscovered piece of the Standard Model of particle physics which is believed to carry mass to all other particles. However, the level of probability was not high enough to be labeled a new discovery with any certainty. Since two independent teams found an anomaly at roughly the same energy level, it is highly unlikely to be a mistake. It will probably be confirmed by the end of 2012, thus completing the 40-year-old Standard Model.

The air starts to leak from the higher education bubble. Speaking as one of the suckers who just completed his education at the peak of the higher education bubble, I think that we've just about seen the highwater mark for tuition charges. Over the last decade, tuition for higher education increased at nearly twice the overall inflation rate. This cannot go on forever. The economics of university tuition will be difficult to sustain, because several factors are working together: The poor economy makes expensive university tuition look like a worse deal than before for those looking to maximize their payout. Government budget cuts will mean that the states are less generous about financial aid to students, and universities will need to adjust their charges accordingly. Finally, higher education itself is on the verge of a major overhaul, as presaged by MIT's announcement that they would start offering accreditation for a small fee for their free online courses. Tuition charges may continue to increase for another year or two...but I think they will increase by a smaller amount than they have in the past decade. And it's only a matter of time before they come crashing down.

PREDICTIONS:

As of 2012 – No Arab state has held free and fair elections resulting in a representative government as a result of the Arab Spring, with the possible exceptions of Tunisia, Egypt, Jordan, and Morocco.

By 2012 – Medical data processing costs continue to fall, as the work is increasingly offshored and automated.

By 2012 – Smartphone apps that monitor the user's health proliferate and become very popular.

By 2012 – The discovery of the Higgs Boson is confirmed.

By 2012 – Tuition at US four-year universities increases at a slower rate for the 2012-13 school year, than it has in the past decade.

The Future of Health Care - The Genomic Revolution

For the first time in decades, we are due for a completely transformational change in health care. We are on the cusp of the Genomic Revolution, and we will start seeing the earliest results in the immediate future. Personal genomics – the practice of tailoring prescriptions, treatments, and lifestyle choices to an individual based on their genes – will soon depose the old paradigm of medicine. No longer will doctors merely give patients the drugs with the highest chance of success; they will be able to predict whether or not the drug will be effective for a specific person. No longer will patients try to base their diet and exercise habits on generic recommendations of what is healthy and what is not; instead, they can determine the healthiest lifestyle for their genetic makeup specifically. Health care will become mostly preventative, rather than reactive.

Why now? What is the driving force behind this paradigm shift? For the first time in human history, we have enough computing power to cheaply and quickly sequence the human genome. In the very near future, nearly everyone will have access to their entire DNA code, which they can carry on their smartphones. When Craig Venter became the first person to have his genome sequenced in 2000 as part of the Human Genome Project, it cost $3 billion and took thirteen years. When James Watson had his genome sequenced in 2007, it cost $2 million and took two months. Today, sequencing a human genome costs about $6,000 and takes a couple weeks. Within the next year, it is very likely that companies will offer genome sequencing for less than $1,000. Some observers view the $1,000 mark as a tipping point: the point at which average people can afford the service, and at which health insurers may start covering it. And after we have $1,000 genomes, $1 genomes won’t be far behind. Let’s not forget that the cost has dropped nearly a thousandfold in the last three years. Fast-forward a few more years, and it is conceivable that the cost of genome sequencing will be essentially nothing. I envision a day in the not-too-distant future when Walgreens and CVS will have self-service genome sequencing machines, as quick, cheap, and user-friendly as self-service photo machines.

Of course, merely knowing one's genetic code is worthless without knowing how to interpret it. While biologists have identified thousands of disease markers, there is vastly more that we don’t know about our genetic code. Some services available now, such as Google-funded 23AndMe, can test DNA to determine one’s predisposition to a narrow range of diseases, but this is only the tip of the iceberg of what is possible. As the cost of genome sequencing approaches zero, nearly everyone will have it done. As the total number of genomes grows from thousands to millions to billions, scientists will have a treasure trove of data to analyze diseases and patient responses to medication. A machine called a microarray allows scientists to compare different DNA sequences and search for correlations. As more and more human genomes are available to be analyzed, patterns will become more evident and it will become much easier to unearth the specific genes associated with certain diseases. Patients who know the diseases for which they are at risk will be able to modify their lifestyle to prevent them from arising.

Those who are unlucky enough to get a disease in spite of (or because of) their lifestyle will have access to much more robust treatments than those currently available. By pinpointing the genetic location of a particular disease, scientists will be able to understand what caused the disease and how it can be reversed. Think of our genetic code like a computer program: Understanding the cause and location of the bugs will enable us to fix them. In the slightly more distant future, it will be possible to directly repair defective genes, such as those that cause cancer, through genetic therapy.

The next ten years will be the most transformative decade in human history for medicine, as we finally unlock the secrets of our genetic code which have been a mystery since the dawn of humanity. The things I have described here are by no means a comprehensive description of the benefits of the Genomic Revolution, and the new paradigm will not be without problems of its own. To be continued in another blog post…

PREDICTIONS:
By 2011 – At least one company offers genome sequencing for $1,000 or less
By 2014 – At least one company offers genome sequencing for $100 or less
By 2019 – Over half of all Americans have had their genomes sequenced
By 2021 – U.S. sales of personalized medicine (i.e. drugs tailored to the patient’s specific genetic profile) are greater than sales of non-personalized, mass-market medicine