We have reached a point in time where progress has been the fastest and the impact has been huge in thousands of years. The medical community has two common choices. One is to move forward slowly with traditional strategies, and the other is to embrace New technology advances rapidly.
Historical records: In the 6th century AD, Emperor Yang of the Sui Dynasty suffered from a strange disease in his later years. He had a dry mouth and tongue. He drank several liters of water and urinated several liters a day, and gradually became withered and skeletal. Now it is easy for everyone to judge that it is diabetes. , and knew how to treat it, but at that time it could only stay at the level of clinical symptoms, which was called "diabetes syndrome" and was also regarded as an incurable disease. There is even archaeological evidence showing that the pharaohs of ancient Egypt may have had diabetes 3,000 to 4,000 years ago. In other words, humans have been trying to fight diabetes for thousands of years.
By the time humans finally understood a little bit about what this disease was, it was already the 19th century. In 1838, a doctor in London detected sugar in the blood through chemical methods. The medical community gradually confirmed that "diabetes syndrome" is related to sugar. During this period, some people also discovered that pancreatic extracts can help solve the problem of diabetes. Symptoms, through a series of scientific and technological advances, humans have gradually constructed today's understanding of diabetes.
From the beginning, it was difficult to measure sugar in the laboratory, and then a palm-sized machine was able to test blood sugar. Several hundred years passed. In other words, it is only in the last 50 years that humans' control of diabetes has improved significantly, while progress over the past thousands of years has been very slow.
Many other diseases or health conditions (such as muscle degeneration and bone loss in old age) also have a similar process: after the emergence of certain technologies or scientific theories, sudden explosive to improve understanding and treatment of disease. We are now told that technology can bring humans a whole new way of understanding diseases.
It turns out that everyone needs different treatments
Technology has brought us many differences. Medicine has always summarized general principles from the ever-changing symptoms and treated most of them. The patient is cured to a certain extent, but this is not enough. Therefore, moving towards "precision medicine", the most suitable treatment can be "tailored" for each person. New technology allows us to more and more clearly distinguish each person's disease. Not like others.
For example, the most advanced field of precision medicine development is cancer. From the earliest days, it could only be distinguished based on the location of the disease. Lung cancer occurs in the lungs, and liver cancer occurs in the liver. Later, it progressed to pathological tissue sections. , can tell which cell type it is, such as epithelial cell cancer or adenocarcinoma, and each type has different treatments.
However, for the same lung adenocarcinoma, why are the treatment effects different for patients? It wasn't until technology advanced to the point where genetic testing was possible that doctors discovered that the same cancer was called lung adenocarcinoma, but had very different sensitivities to different drugs due to different gene expressions.
Before there was no way to distinguish this, doctors might give cancer patients the same medicine, and then check back after 3 months to see if it had any effect. If it worked, they would continue to use it. If it didn’t, they would try another medicine again. However, many patients do not have three months to "try the medicine on their own." Therefore, precision medicine can help us find effective prescriptions at an early stage, which is a great progress.
In the past few years, two major developments - the entry of biotechnology and information technology into medical care - have had a great impact and have also brought new challenges to medical care. Test 1: The explosion of data makes it difficult for doctors to follow up on their interpretation ability
The current development of biology and information technology is really a test for medical personnel. A thick stack of genetic data is placed in front of doctors, and doctors may not be able to follow up. It is also impossible to fully understand how to judge and how to use it in clinical treatment. In addition to genes, there are also protein bodies, metabolites, and many clinical symptoms and biomarker detection numbers.
Technology is capable of detection, but doctors may not be able to fully interpret it. For example, we can now detect 10,000 substances in blood. If we want to know which of them are related to diabetes, the simplest way is to draw blood from diabetics and healthy people and compare the concentration differences of which substances The largest; but things are not that simple, because it is likely that 50 of the 10,000 substances, forming an interaction pattern with each other, are the real symptoms of diabetes.
Previously, due to the load of traditional analysis capabilities, it was difficult for doctors to do such analysis; now, with the assistance of artificial intelligence (AI) and big data, we are beginning to be able to do it. This combination will produce a lot of knowledge in one fell swoop that surpasses today's medicine.
In the past, medical knowledge relied on a series of cell experiments, animal experiments, and clinical trials to accumulate bit by bit. Now we can rely on AI and big data to tell doctors many phenomena that were invisible in the past. These phenomena allow experts to return to the laboratory to verify whether the phenomenon is correct, forming a positive cycle. Test 2: Old diagnostic standards need to be renovated
Nowadays, popular wearable devices can continuously generate physiological monitoring numbers. One patient was very conscientious and took needles to measure his blood sugar every day. When he came back for a three-month visit, he showed the doctor a long record sheet. To be honest, when he saw a long list of hundreds of numbers, the doctor could only glance at it a few times. Give a vague comment: "Not bad!"
In medicine, the average value of the long-term trend is used to simplify the analysis strategy, and glycated hemoglobin is used as the average value of blood glucose measurement as the judgment standard. But here comes the problem. Some patients have really good control and their values ??are stable; some people have low values ??yesterday and high values ??today. It is normal to add up and divide by two; some patients have high and low values ??throughout the day, and the overall sum is This is normal. In fact, the clinical significance of these conditions is completely different.
(Compiled by Chen Junchen)