Major achievements in medical science in 2023 include mRNA technology for vaccines, CRISPR gene editing, 3D printing of human organs, and new drugs for weight loss and Alzheimer's. Utilization of continuous personal monitoring systems and artificial intelligence in healthcare also made significant progress. However, it is important to address poverty, nutrition, and access to healthcare to improve overall health.
To pen a column for the first of January can be an onerous task. Whether you like it or not, you are bound by an overwhelming idea. That another year has drawing to a close and a new one is just starting. That at the stroke of midnight something changes. It becomes imperative to be reflective. Looking back on what went by and what’s coming. Many of you must already be reeling under all sorts of lists and resolutions. The best of 2023, hits and misses, lessons, emerging trends, so on and so forth. Lists of political events, movies, books, music albums acquire a special meaning at this time of the year. No publication is an exception to this. Even if there is nothing new that has happened in a field, a somewhat contrived list needs creation. The world of healthcare and medicine doesn’t need such forced efforts. There is a lot that has happened and is waiting in the wings. And it concerns all of us in some measure.
What then were the major achievements of medical science in 2023 which hold out promise for our future well-being? Here is a shortlist I gleaned from multiple sources, largely from the Western world. If most of them sound high-level, it’s because they involve basic science at the cellular, molecular and genetic level. This is the future of advances in medicine for the global north. Let’s start with ‘mRNA’, a protein in our cells. Not least because it led to one of the most successful vaccines for Covid. But also because this year it won the 2023 Nobel Prize in Physiology or Medicine for Katalin Karikó and Drew Weissman for their ground-breaking research which fundamentally changed understanding of how mRNA interacts with our immune system. This contributed to the unprecedented rate of vaccine development, specifically the Pfizer and Moderna vaccines for Covid 19. MRNA based vaccines are being studied now for malaria, cancers and even in preventing coronary artery heart disease. A field waiting to explode.
Another area which witnessed major lab-to-patient movement in 2023 is the use of CRISPR, a gene editing technology that allows modification of DNA of living organisms. It’s a cheaper, simpler and more precise alternative to previous techniques. Recent clinical trials showed effectiveness of a CRISPR investigational drug for treating two common debilitating blood disorders - sickle cell disease and beta thalassemia. In 2023, the FDA approved them for clinical use in sickle cell anaemia.
Another interesting technology - 3D printing - is being increasingly used in healthcare for producing tissue models and prosthesis. There is however increased interest in producing human organs or organoids with use of stem cells and 3D printers. In 2023, for the first time, scientists produced human heart tissue with a 3D printer and though it’s early days yet, this may seem like an option to organ transplantation for those suffering from end-stage organ failure in the future. Organs for order through printers.
Then there have been important breakthroughs in the field of new drugs. A generation of weight loss drugs appeared on the scene a few years ago with dramatic effects. Semaglutide is one of a class of drugs known as GLP-1 receptor agonists, which regulate appetite hormones by lowering blood sugar and slowing the stomach’s rate of emptying. This causes people to feel full longer, so they avoid eating and lose weight. In 2023, we learned a lot more about other potential benefits of the drugs, including reducing the risk of heart disease and stroke. This is a space which is going to throw up a lot of work in the near future. A drug called Lecanemab was approved by the USFDA as a treatment for early Alzheimer’s disease in July 2023. The drug slowed down decline in memory by 27% and slowed down the decline in quality of life by 56%. There are newer drugs in the pipeline for a variety of cancers.
If all this sounded aspirational for our situation, there are areas which saw major leaps in utilisation in healthcare. Many of them have immediate application for the entire globe. Continuous personal monitoring systems (body patch to monitor sugars in diabetics) and watches to monitor health parameters came of age. Artificial Intelligence was increasingly used in improving various facets of healthcare including diagnosis, treatment algorithms and even filling gaps in underserved areas. Researchers in India reported increased accuracy by an AI based reporting system for chest X-rays to detect tuberculosis which continues to be a scourge and a major killer for our people. Finally, in a remarkable randomised controlled trial in tribal communities in Jharkand, a team led by Anurag Bhargava enrolled household contacts of 2,800 patients with confirmed pulmonary tuberculosis. Though pulmonary tuberculosis patients in both groups received food rations (1200 kcal, 52 grams of protein per day with micronutrients) for 6 months, only household contacts in the intervention group received monthly food rations and micronutrients (750 kcal, 23 grams of protein per day with micronutrients). Participants were followed up actively for developing tuberculosis. The study showed a reduction of tuberculosis incidence of 39% to 48% in the intervention group. This was the first randomised trial looking at effect of nutritional support on tuberculosis incidence in household contacts, where nutritional intervention was associated with substantial reduction in tuberculosis incidence in the household during 2 years of follow-up. A powerful proof of the connection between tuberculosis and undernutrition and the value of simple cheap nutritional intervention.
For a majority of our citizens, therefore, whilst we wait for global advances to trickle down, the collective message continues to be loud and clear. It is poverty, poor access to nutrition and delayed diagnosis that drives our disease burden and it is investments in these areas that will improve our collective health. 2014 is an important year in India and its politics. It will test how we balance our current focus on the optical to the actual needs of our people.
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January 01, 2024 at 12:43AM
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A new year wish for good health - Hindustan Times
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