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The Precision Medicine Issue Medicine Is Becoming Hyper The precision medicine issue Vol. 121 Nov/Dec $9.99 USD No. 6 2018 $10.99 CAD $2 million would save her life. The precision medicine issue Could you pay? Should you? Medicine is becoming hyper-personalized, hyper-accurate ... and hyper-unequal. p.38 The AIs taking over Curing cancer How to plan your from doctors with customized digital afterlife vaccines p.22 p.46 p.76 ND18_cover.indd 1 10/3/18 4:16 PM Artificial intelligence is here. Own what happens next. ND18 ETD19 Spread 16x10.875 D3.indd 2 9/28/18 10:59 AM March 25–26, 2019 St. egis Hotel San Francisco, CA Meet the people leading the next wave of intelligent technologies. Andrew Kathy Daphne Sergey Harry Anagnost Gong Koller Levine Shum President and Cofounder and Founder and Assistant Executive Vice CEO, Autodesk CEO, WafaGames CEO, Insitro Professor, EECS, President, UC Berkeley Microsoft Artifi cial Intelligence and Research Group EmTechDigital.com/2019 ND18 ETD19 Spread 16x10.875 D3.indd 3 9/28/18 10:59 AM 02 From the editor It’s been nearly two decades since the help meet the ballooning healthcare first human genome was sequenced. needs of an aging population. That achievement opened up the prom The problem? As medicine gets ise of drugs and treatments perfectly more personalized, it risks getting more tailored to each person’s DNA. But per unequal. Our cover story is Regalado’s sonalized or “precision” medicine has gripping and troubling account page always felt a bit like flying cars, sexbots, 38 of the parents who raise millions of or labgrown meat­one of those things dollars to finance genetherapy cures for we’re perpetually being promised but their children’s ultrarare diseases. Are never quite getting. This issue of MIT they trailblazers for a technology that Technology Review makes the case that, will one day provide cheap, custom in fact, the age of precision medicine ized care to everyone, or harbingers of a has been slowly dawning on us all this future in which only the superwealthy time­and we’re unprepared. and crowdfunding whizzes are saved? What’s changing fastest now is the IVF combined with genetic screening sheer volume of medical data avail can weed fatal diseases out of a fam able, and the tools for analyzing it. As ily for good, but, Laura Hercher argues Antonio Regalado points out in his page 68 , it could also lead to two Gideon Lichfield is editor in chief of MIT Technology Review. opening essay page 8 , the number of genetically distinct human castes­one people getting their DNA tested is now rich and diseasefree, the other poor in the tens of millions and doubling and diseaseridden. The rich and well each year. educated won’t only be better able to By pairing DNA data with people’s afford boutique treatments; they’ll be medical records, algorithms can predict more likely to have the technology, and your risk of certain common diseases hence the data, that helps them avoid and suggest drugs and diets to ward falling ill in the first place. them off, as Ali Torkamani and Erik All this has more than merely med Topol explain page 20 . Cancer drugs ical consequences. Nathaniel Comfort are now being customized to individual warns page 16 that our growing ability patients, as Adam Piore reports page to find genetic correlations with things 46 . Epigenetic data can forecast how like intelligence is threatening to long you’ll live, writes Karen Weintraub revive the ugly dogma of eugenics. And page 80 , and new “senolytic” drugs what, asks Mary Madden page 34 , can might keep agerelated ailments at bay any of us do to keep tabs on how the for more of that time, reports Stephen S. oceans of data about us are being used, Hall page 84 . or misused? Not just DNA sequences but data We’ll face this question even in death. of all kinds is being scooped up and As Courtney Humphries reports page crunched in vastly greater quantities 72 , people now in their 30s will have than before. As Rachel Metz explains generated enough data by the time they page 56 , it’s becoming possible to track die to power quite convincing digital mental illness just by monitoring how avatars of themselves. So who will own you tap, type, and swipe on your phone. you when you’re gone? At least Simson Better treatments and healthier liv Garfinkel page 76 has some advice on ing aren’t the only benefits. Doctors like how to prepare. Rahul Parikh page 28 hope to be able This issue of the magazine, therefore, to spend more time getting to know spans the entire arc of human existence, their patients as algorithms take on the from before you’re born until after more routine tasks. In a UK trial, AI sys you die. Through it all runs a simple tems are already replacing physicians question. We know that in health care, for simple consultations, as Douglas human beings are unequal. But just how Heaven reports page 22 . That could unequal are we willing to be? NIVEN NEPHI ND18_front_editorial_letter.indd 2 10/3/18 2:43 PM The future of work is here. How will you take the lead? Technology isn’t replacing people. It’s augmenting what people can accomplish. Is your organization prepared for what’s next? Let’s get to work. www.deloitte.com/us/futureofwork Copyright © 2018 Deloitte Development LLC. All rights reserved. Untitled-2 1 10/4/18 4:20 PM 04 The precision medicine issue 1 2 3 Health Illness Death Introduction 16 38 72 8 Opening a door to eugenics A cure for one Never let me go Precision Social genomics threatens What are the ethics of developing You’re definitely temporary, but a medicine’s to revive genetic racism and treatments only a tiny number of digitally enhanced version of you long journey entrench discrimination. people will needor can pay for? doesn’t have to be. Skeptics say By Nathaniel Comfort By Antonio Regalado By Courtney Humphries drugs based on genetic 20 46 76 insights have Your genome, on demand One tumor at a time Six things to do with your data gone nowhere. A detailed genetic profile can Personalized cancer vaccines before you die But look closer predict your risk for all kinds of are an amazing breakthrough. Here’s how to make sure your and they’re diseases. But they might not be a sustain loved ones can get into your everywhere. By Ali Torkamani and Eric Topol able business. By Adam Piore accounts after you’re gone. Or, By alternativelyhow to cover your Antonio 22 52 tracks. By Simson Garfinkel Regalado Dr. Bot will see you now evolution? What revolution? A chatbot might help you A skeptic pokes holes in the 80 avoid seeing your overworked façade of genomic drugs. Want to know when you’re The back page physician. By Douglas Heaven By Stephen S. Hall going to die? 88 Your life span is written into your Genes 28 56 DNA. We’re getting closer to pre I wish AI won’t replace your doctor The mental-health cure inside dicting how much time you have they would Machines can crunch numbers, your phone left. By Karen Weintraub fi n d letting your doctor focus on you. How our smartphone obsession By By Rahul Parikh could help treat brain disorders. 84 Sarah Cooper By Rachel Metz Finally, the drug that keeps 30 you young Diversity for genomes 62 We can make mice youthful again. Our genetic data comes mostly Profi les in precision medicine Are people next? Antiaging pio from people of European ances Advances in genetics have cre neer Judith Campisi thinks so. try. That’s terrible for everybody. ated dilemmas that would have By Stephen S. Hall By David Rotman been unthinkable a few years ago. These people’s stories tell 34 the tale. Your doctor’s data experiment Getting medical help now often 68 comes with a condition: give us Unequal by design your data first. By Mary Madden What if only the poor inherited genetic disease? Sadly, that’s where we’re headed. By Laura Hercher IMAGES GETTY BY IMAGE COVER ND18_front_contents.indd 4 10/3/18 1:54 PM WORLDCLASS EXECUTIVE EDUCATION AT BROWN UNIVERSITY Transforming Mid-Career Professionals An Executive Master’s degree from Brown University will prepare you to lead your organization, transform your eld, and build a powerful lifelong professional network. You will join a vibrant learning community and apply your new knowledge and skills through a critical challenge project. e results can be seen in our alumni who are proven leaders; impacting their organizations and the world. IE Brown Executive MBA Executive Master in Cybersecurity Executive Master in Science and Technology Leadership brown.edu/professional Executive Master of Healthcare Leadership Brown-34343 Print Ad_81875x105.indd 1 3/29/18 9:24 AM BROWN.indd 1 5/31/18 5:38 PM 06 Masthead Editorial Corporate Advertising sales Board of directors Editor in chief Chief executive ocer and publisher Vice president, sales and brand Martin A. Schmidt Gideon Lichfield Elizabeth Bramson-Boudreau partnerships Whitney Espich Marii Sebahar Jerome I. Friedman Executive editor Director, human resources [email protected] Joichi Ito Megan McCarthy Hilary Siegel 415-416-9140 Israel Ruiz Editor at large Assistant to the CEO Senior director, brand partnerships David Schmittlein David Rotman Katie McLean Kristin Ingram Alan Spoon [email protected] Deputy editor Manager of information technology 415-509-1910 Michael Reilly Colby Wheeler Director, brand partnerships Customer service and News editor Oce manager Debbie Hanley subscription inquiries Niall Firth Linda Cardinal [email protected] Managing editor 214-282-2727 National Timothy Maher 800-877-5230 Licensing and Director, brand partnerships San Francisco bureau chief communities Ian Keller International Martin
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