To understand the future of medicine in 2064, we have to understand what the current state of world health and life expectancy is in the world today, what has the largest impacts and what the current trends. We also need to address some misconceptions which cause people to worry about imagined problems.
I am going to address what I think is plausible and likely and what should be achievable. This is to keep the length manageable. I am not going to address a range of scenarios. Things can easily end up being worse if people do not invest in fixing what they should fix or things could be better if research and development ends up being a lot better.
Creating longer and healthier lives is better for the world, for civilization and for the economy. This statement should be obvious and not require defense. However, I know it does require some defense.
When I describe how relatively easy it would be to save 35 million unnecessary deaths per year in the developing world, through clean cookers, safe child birth kits, clean water and other low technology means, there is objection that people are concerned about over population. People have 5 children in developing countries because they are worried that 2 will die before the age of 5 and they need children to take care of them when they are old. Most people have 1 to 3 children if they are confident that all of the children will live and they will have a secure financial future via retirement plans. So saving lives of the world poor and helping them get better lives will help control population growth.
Other objections are about feeding, housing and energy for a large future population.
Regular agriculture is on track to boost yields to 15 tons per hectare for most of the grains.
Rice breed, DH2525 (Y two superior No 2), produced a harvest of 13.9 tons a hectare during its trial planting in Longhui county in Hunan province.
Does the present breakthrough translate into a yield of 13.5 tons per hectare at commercial scale? Getting to 80% of that yield across farms growing rice would be more than 10.5 tons per hectare is realizable according to past experience.
We could use more fish farming and genetically guided breeding of animals to boost the efficiency of meat production. This would mean less grain would be needed for each pound of meat.
Large scale construction of greenhouses can boost yield by 6-12 times for regular greenhouses and 20-30 times for "advanced greenhouses" over open air agriculture. This also will increase water efficiency of the food production.
Similarly existing technology and process improvements in construction and energy can provide vastly more efficient buildings and energy generation. There have already been 30 factory mass produced skyscrapers and there are improvements which will be made in all forms of energy generation from improved turbines, new molten salt nuclear reactors and advanced solar power production.
What are the major factors reducing the life expectancy of people in the world?
Poverty is one of the biggest factors for the global population. Being poor in a developed country can result in about a 9-year loss of life expectancy versus being middle class or wealthy. Being poor globally can result in loss of life expectancy of 20 to 30 years.
So the economic situation now and the larger economic trends are important for a view of what is likely for the health and life expectancy of the future world.
Standard Chartered bank forecasts that by 2030 6 billion of the worlds 8.5 billion people will be in the global middle class ($10-100 per day on a PPP basis). The World Bank is working towards virtually eliminating extreme (less than $1.25 per day PPP) poverty by 2030.
If that economic transformation occurs then the world life expectancy is at about 82 years instead of 70.
The other big factors are to address cancer, air pollution, heart disease, alcoholism, Alzheimer’s, smoking and car accidents.
Effective early detection of cancer through imaging will be a low cost and rapidly deployable approach to lowering deaths from cancer.
Early detection of Alzheimer’s seems possible with imaging of the eye for almyloids. This would get people onto a preventative diet and exercise program which can delay the onset of Alzheimer’s for 20-30 years.
Sweden has one third of the deaths rates from car accidents than the US. Their approach can be copied by other nations. Also, there will be robotic cars on a large scale over the next 20 years and definitely well before 2064 that will nearly eliminate car accidents.
These kinds of changes should be widespread by 2045 to enable life expectancy to be about 90-100 years.
Technological improvement is key to advancing lifespans significantly beyond 100.
The best prospects for technologies to achieve multi-decade life extension are synthetic biology and molecular nanotechnology.
Harvard’s George Church is working on synthetic biology approaches to achieving indefinite lifespans. George's idea is to bring in sections of DNA from exotic organisms or genes that are rare for humans to enable all people to have desired genetic capabilities. He describes capabilities such as immunity to all viruses and cellular immunity to radiation and creating immunity to diseases. Several groups and companies are working to sequence and determine the genetic basis for long-lived animals and humans and determine how to engineer longer lived people. They are working on approaches to rejuvenate different kinds of cells including the neurons of the brain.
Synthetic biology costs are rapidly falling, so success in this area could rapidly become affordable after the initial development.
George has had a number of commercial successes using synthetic biology to develop biofuels and industrial products. The costs and precision of gene synthesis and gene therapy are rapidly falling (falling faster than Moore's law lowering the cost of electronics). I think significant treatments could arise from the synthetic biology area in the 7 to 30 year timeframe.
Molecular nanotechnology has the potential to enable radically improved nanomedicine. Molecular nanotechnology could be used to make any SENS therapies more effective and could enhance the effectiveness and affordability of synthetic biology. There are significant capabilities now with DNA nanotechnology and DNA origami.
Shawn Douglas has developed a method to design and fabricate nanometer scale robots. The robots are fabricated out of DNA and have the ability to delivery cancer drugs to a specific cancer cells.
Researchers have injected various kinds of DNA nanobots into cockroaches. DNA structures that are nanoscale hinged barrels have chemical logic built into them. They can use attached chemistry to sense their environment and delivery payload based upon what is detected.
Because the nanobots are labeled with fluorescent markers, the researchers can follow them and analyze how different robot combinations affect where substances are delivered. The team says the accuracy of delivery and control of the nanobots is equivalent to a computer system.
This is the development of the vision of nanomedicine.
This is the realization of the power of DNA nanotechnology.
This is programmable DNA nanotechnology.
The DNA nanotechnology cannot perform atomically precise chemistry (yet), but having control of the DNA combined with advanced synthetic biology and control of proteins and nanoparticles is clearly developing into very interesting capabilities.
"This is the first time that biological therapy has been able to match how a computer processor works," says co-author Ido Bachelet of the Institute of Nanotechnology and Advanced Materials at Bar Ilan University.
The team says it should be possible to scale up the computing power in the cockroach to that of an 8-bit computer, equivalent to a Commodore 64 or Atari 800 from the 1980s. Goni-Moreno agrees that this is feasible. "The mechanism seems easy to scale up so the complexity of the computations will soon become higher," he says.
An obvious benefit of this technology would be cancer treatments, because these must be cell-specific and current treatments are not well-targeted. But a treatment like this in mammals must overcome the immune response triggered when a foreign object enters
This should begin basic human trials in about 5 years.
I believe this will become a more mature nanomedicine within 10-40 years. Other forms of molecular nanotechnology and synthetic biology will also be developed 10-40 years.
By 2064, this will be widespread and affordable.
We must not just wait and expect for this to happen. We need to provide more financial support for work of researchers in working on Strategies for Engineered Negligible Senescence (life extension science) and support the work of companies like Calico (Google founders back company working on life extension) and Human Longevity Inc. (a genomics and cell therapy-based diagnostic and therapeutic company focused on extending the human lifespan).
We should try to make faster improvement to a better world.
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