There are still some major engineering problems. If you’re going to use a marine microorganism as your photosynthetic source of energy, how do you engineer that to be environmentally safe and efficient? We can solve the biology problems pretty quickly. We can make the prototype organisms. But can we build the infrastructure at the large scale that will allow us to produce fuel from them?
I think the engineering problem is going to be solved, but there has to be a business motive to do that, and the motive will depend on the cost of energy and its environmental impacts.
S+B: Most people, of course, still think of biotech as medical innovation. In that light, what is the significance of personalized medicine?
HASELTINE: In my mind, medicine has always been personal, if practiced properly. You are sick and a doctor interacts with you as an individual. This is one of the only times in your life when you have a professional response fully tailored to you as an individual. A good doctor wants to know about you and only you. Maybe he wants to know something about your family members, but that’s because of their relationship to you. If medicine isn’t personal, and isn’t therefore personalized, then it’s not really useful.
When people talk about personalized medicine they tend to focus on genetic inheritance, because it is fascinating to peer into your genetic past and present. But modern genetics, at best, is like looking at your future through a glass darkly. With very few exceptions, such as Huntington’s disease, you can’t say that if you have an inherited trait you’ll get the related disease. In most cases, you have a probability between 10 percent and 0.1 percent of getting the disease; you don’t know when or even if the disease will appear.
Ninety percent of breast cancer seems to have nothing to do with inherited genes. The same is true of prostate cancer in men. There is some role for genetics in predictive medicine, but it’s a much smaller role than people think.
I believe the whole field of what’s called genetic medicine is not really ready for prime time, if it will ever be ready. If I seem negative, it isn’t because I think genetics is unimportant. It is just that genetic inheritance is a very minor aspect of genomics, whereas the applications that I’ve already outlined — energy, agriculture, and materials — are here and important now.
However, there is one tremendous breakthrough that I consider the ultimate personalization of medicine — using your cells to build new, healthier organs. Regenerative medicine involves developing your body’s own replacement organs and tissues if they are lopped off, damaged, broken, or diseased. Combine that with materials science and you begin to build organs. I just was visiting Dr. Anthony Atala at the Wake Forest Institute for Regenerative Medicine. He leads an organization that is building new human organs. These are not artificial organs; they are made of your own cells.
It’s going to be possible to build a new pancreas for a person who is a diabetic. We will be able to regrow a retina, a heart muscle, and eventually even an entire heart. This is happening because, through genomics, we understand what a cell is doing, we can move genes in and out of cells, and now we have the ability to move genes around the body.
Another, more immediate benefit is differential diagnosis. Because we can define most of the things a cell does, we can define the characteristics of diseases much more precisely. For example, we used to look at leukemia as one type of white-cell disorder, but it turns out that there are perhaps 20 different leukemia diseases. Each will take a different course; each will require a different treatment.