Saturday, January 20, 2018

The dawn of non-invasive diagnostics

Recent news that a single blood test could provide the diagnosis of eight common cancers with 99% specificity (1) is a constant reminder that medicine is still stuck in archaic and invasive procedures to detect, diagnose and treat ailments. With a high concentration of human resources in provider settings, medicine has been slow in embracing emerging technologies and ideas, outside the domain. And this attitude is shared across the healthcare value chain including manufacturers, payers, and regulators.
It is unfortunate. Granted, Biology still remains to be the arena where humans could not progress exponentially. Their brains, with millions of years of deterministic training, have been well specialized to dominate engineering and chemistry. However, they could not understand the marvelous machines assembled by nature from a single cell organism to somewhat more complex humans, with any level of precision. Nature has had time to perfect designs of such beauty and humans, ever curious, have been trying to walk up to the cup of knowledge. But it has not been. Fossils indicate attempts at brain surgery many hundreds of thousands of years ago and despite higher structural knowledge, we have not advanced sufficiently to a differentiable plateau. In most simpler fields, we have demonstrably shown that humans are the weak links in decision processes - from transportation, energy, manufacturing and even, finance.
It is a conundrum. We are stuck - great strides in deterministic sciences do not translate into domains of high uncertainty and diversity. And, those who practice in these complex domains seem to have their blindfolds on as if they have nothing more to learn.  Diagnostics could provide the impetus to move higher - serum and stool harbor such information content, it is a shame we have not figured it out.
(1) Detection and localization of surgically resectable cancers with a multi-analyte blood test
1.        Joshua D. Cohen1,2,3,4,5, Lu Li6, Yuxuan Wang1,2,3,4, Christopher Thoburn3, Bahman Afsari7, Ludmila Danilova7, Christopher Douville1,2,3,4, Ammar A. Javed8, Fay Wong1,2,3,4, Austin Mattox1,2,3,4, Ralph. H. Hruban3,4,9, Christopher L. Wolfgang8, Michael G. Goggins3,4,9,10,11, Marco Dal Molin4, Tian-Li Wang3,9, Richard Roden3,9, Alison P. Klein3,4,12, Janine Ptak1,2,3,4, Lisa Dobbyn1,2,3,4, Joy Schaefer1,2,3,4, Natalie Silliman1,2,3,4, Maria Popoli1,2,3,4, Joshua T. Vogelstein13, James D. Browne14, Robert E. Schoen15,16, Randall E. Brand15, Jeanne Tie17,18,19,20, Peter Gibbs17,18,19,20, Hui-Li Wong17, Aaron S. Mansfield21, Jin Jen22, Samir M. Hanash23, Massimo Falconi24, Peter J. Allen25, Shibin Zhou1,3,4, Chetan Bettegowda1,2,3,4, Luis Diaz1,3,4, Cristian Tomasetti3,6,7,*, Kenneth W. Kinzler1,3,4,*, Bert Vogelstein1,2,3,4,*, Anne Marie Lennon3,4,8,10,11,*, Nickolas Papadopoulos1,3,4,*