Tuesday, November 15, 2011

More unfilled promise from the sequencers

We are finally turning our attention to a piece that appeared in the Oct 19 issue of Nature, in which Stephen Baker describes the public health consequences of the sequencing 10 years ago of Salmonella enterica Typhi, the micro-organism that causes typhoid fever. Unfortunately, those consequences can be summed up in a single word; none. 

Baker is head of enteric infections at the Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, and coordinator of field and laboratory research in Ho Chi Minh City, Vietnam, and Kathmandu, Nepal.  He writes of the excitement and hope people felt when the sequence was complete -- and the subsequent disillusionment.  
Ten years ago, I was an author on the paper that announced the genome sequence of Salmonella enterica Typhi, the microorganism that causes typhoid fever (J. Parkhill et al. Nature 413, 848-852; 2001). The research was promoted with great fanfare, which declared that scientists were at a turning point in the fight against the disease. A decade on, we are no closer to a global solution.
Yes, more is understood about how the organism does its work, and why it only infects humans and so on, but as Baker says, "the promised concrete benefits — bespoke treatments, next-generation vaccines and low-cost diagnostics — have failed to materialize."

Why?  Because typhoid fever is as much a disease of poverty as it is of a particular organism.  And as such it is one of the neglected diseases that afflicts poor nations that don't have the will or the resources to commit to fighting disease.  Nor has it gotten the attention of foundations or corporations in the rich world that do have the resources to attack such problems, but that are focusing on diseases like malaria or tuberculosis or HIV, diseases that affect more people, or people in rich countries (though typhoid is estimated to affect 21.5 million people worldwide every year, so it is not a trivial problem).

Typhoid has been pretty much eliminated from the industrialized world -- it is doable, with attention to public health measures such as clean water and food and so on.  But that requires money and the will to address the problem.  Diseases of poverty are too often less scientific challenges than they are economic or political ones. 

And, as Baker says,
There are no advocacy groups for typhoid and other diseases of poverty similar to those that exist for HIV. Affected people and communities are not powerful constituencies. Decision-makers in endemic countries are typically drawn from the wealthier classes, and few have had typhoid fever, or have known someone who has died from the disease.
The hype and promise over the sequencing of Salmonella enterica Typhi mirrored the hype and promise over sequencing of anything a decade ago -- indeed, at its worst, the idea of immortality was seriously bandied about.  This story is a sober reminder that genetics has yielded results, but that those results are too often irrelevant to preventing disease.  This is as true for diseases of industrialized nations, heart disease, diabetes, cancers and so forth, which sequencing was supposed to eliminate, as it is for diseases of poverty.

Part of our belief system is that the world is so law-like that science and technology can understand everything, and fix everything.  This is still the legacy of the 400 year old Enlightenment period, the exciting idea that we control nature through 'knowledge. But that is at best a faint hope and is misleading in many ways.  Science and technology are, in a sense, 'safe': you can always apply more tech and get at least some sorts of 'results'.  It is easy to build institutions like universities and Pharma around this belief system.  Unfortunately, with more complex things like sociocultural environment the problems are simply different, and far less yielding.


Jonathan Latham said...

To extend your idea a little bit: The interesting phenomena of the moment, to my mind, is that science and technology are acquiring the role of obstacles to social solutions. Wealthy elites dont want 'change' and they can forestall it with 'safe' research or putative/partial technological solutions. A classic example is the GM mosquito (also sequenced I think) against Dengue fever. Dengue fever could be controlled by public health measures that would have numerous side benefits. The GM mosquito, however, will probably ensure that pressure for these big picture solutions never builds up.

As a result our societies are becoming institutionally sclerotic because no constructive social change ever happens any more.

Anne Buchanan said...

Agreed. Climate change is another case in point -- why change the way we do business when technology will fix up any problems our profligate use of fossil fuels might cause?