“The only hope is true innovation.” – Dr. Zerhouni
One fundamental barrier to progress is the complexity of biological processes. Up to this point we have spent a considerable amount of time and resources on the hardware of biology (DNA) but we are learning that understanding the software (pathways, regulatory networks, response to environmental insults, etc.) is essential to a mechanistic understanding of disease.
By developing an understanding of the biological pathways that allow us to function, we are beginning to understand why multiple genotypes can result in a single disease phenotype. This understanding also creates the possibility of targeting therapies at the junction points of pathways where a single intervention could potentially affect multiple diseases. The tools for this type of analysis are blunt now but they are improving. As they do, markets will begin to form around pathways that include diagnostic assays, medical devices, novel delivery systems, and therapeutics working in concert.
The state of Washington has done extraordinary work and has risen in rank as a grantee of NIH funds. It has the right skills from an academic, legislative, philanthropic, and entrepreneurial perspective to be a major contributor to global health. Given that the state aspires to have a vibrant life sciences sector, we have to recognize that the amount of funding, both public and private must keep pace with the opportunity. Currently the number of identified biomarkers doubles roughly every six months. But the explosion in data has not led to an explosion in knowledge. When you take the existing 1,500 identified biomarkers and assume $30 to $50 million to validate each one it will take up to $75 billion to analyze just the existing inventory.
An important lesson from the NIH is that culture wars are real and researchers ignore them at their peril. You cannot assume that everyone recognizes that what you do is holy (even though you know that it is). The US makes a considerable investment in public health but the results of that in investment are difficult to quantify. When this investment is called into question, researchers have to learn to engage in dialog because a dismissive approach is counterproductive and ultimately politically dangerous.
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