Foreword xii
Preface xiv
Chapter 1 Living well beyond 100 1
Great progress made, much more to come 1
Medical challenges and promises 4
Living well versus living longer 7
Social challenges and promises 10
Can we afford old age? 11
Government and business 13
The journey ahead 17
Chapter 2 A short history of biomedicine 21
Improving hygiene 21
The power of immunology 23
Monoclonal antibodies 24
The discovery of antibiotics 25
The DNA revolution 26
Recombinant DNA and cloning 27
Biotechnology 29
Unraveling the code 31
Conclusion 33
Chapter 3 Snapshot of the biosciences 35
DNA-based technologies 35
Genomics 37
Genetic testing 37
DNA chips 39
Pharmacogenetics 40
Cloning 41
Gene therapy 43
RNA-based technologies 45
Antisense technology 45
RNA interference (RNAi) 46
Protein-based technologies 46
Vaccines 47
Monoclonal Antibodies 48
Proteomics 49
Cell-based and other technologies 50
Stem cells 50
Antimicrobials 51
Conclusion 52
Chapter 4 Bio-driven convergence 57
Converging technologies 58
Telemedicine 58
Remote diagnostics 59
Biological drug factories 59
Biochips 59
Tissue engineering 60
Imaging 61
Multidirectional synergies 62
Shifting industry boundaries 64
Healthcare and IT 65
Medical information handling 65
Medical data storage 66
Computers and drug discovery 66
Remote monitoring and the wired home 67
Reshaping bioinformatics 67
Bioinformatics and gene banks 69
Personalized medicine 70
Systems biology and holistic medicine 70
Biosensors 72
Nano devices 72
Commercialization challenges 73
Technological challenges: biocompatibility 74
Regulatory challenges: clinical safety and efficacy 74
Political challenges: privacy and ownership 74
Social challenges: consumer advocacy 75
The road ahead 76
Chapter 5 The business of biomedicine 79
The pharmaceutical industry 79
Diminishing drug pipelines 82
The biotechnology sector 85
Medical device industry 89
Cardiovascular device segment 89
Orthopedic device segment 91
Neurological device segment 91
Medical diagnostics industry 92
Laboratory testing 93
Point-of-care (POC) patient monitoring and diagnosis 94
Prevention and disease management 95
Conclusions 97
Chapter 6 Healthcare under stress 101
Stress in developed nations 103
Healthcare funding 104
Major diseases of the developed world 105
Cardiovascular diseases 106
Cancer 106
Stress in developing nations 107
Acquired Immune Deficiency Syndrome (AIDS) 109
Malaria 111
Which technologies will succeed? 113
Illustrative cases 114
AIDS and malaria 115
Cardiovascular diseases 115
Cancer 116
Chapter 7 Wildcards for the future 125
Trends versus uncertainties 125
Wildcards 127
Society and politics 127
Public support of the biosciences? 127
A major pandemic? 129
Biotech rogue states? 130
Science and technology 131
Raging success or major meltdown? 131
Role of complementary industries? 132
Intellectual property regimes? 133
Qualified staff for healthcare and research? 133
Business and economics 134
Economic growth and global power shifts? 134
Venture capital and other funding sources? 135
Climate change and resource scarcity? 135
A scenario framework 136
The first overarching uncertainty: technological success 137
The second overarching uncertainty: societal acceptance 137
Multiple scenarios are possible 138
The role of stakeholders 141
Chapter 8 Scenarios up to 2025 143
Bio gridlock scenario 143
The view from 2025 143
How we got here 145
The world we live in 150
Analogous cases 151
Golden age scenario 153
The view from 2025 154
How we got here 154
The world we live in 158
Analogous case: information technology 160
Chapter 9 What it all means 163
You and your family 163
At work 168
Business and commerce 170
Society at large 172
Appendix A DNA, RNA, and protein 177
Molecules of inheritance 177
The structure of DNA 178
Cracking the code 179
Making proteins 180
Regulating gene expression 181
Appendix B Cloning genes 183
Restriction enzymes 183
Cloning procedure 184
Appendix C Complexity of the genome 187
Non-Coding RNAs 187
SNP variations 188
Glossary of Biomedical Terms 191
Acknowledgments 199
About the Authors 201
Index 203
