© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999

1.2.1.13 21st Century Medicine

It is always somewhat presumptuous to attempt to predict the future, but in this case we are on solid ground because most of the prerequisite historical processes are already in motion and all of them appear to be clearly pointing in the same direction.

Medical historian Roy Porter notes that the 19th century saw the establishment of what we think of as scientific medicine. From about the middle of that century the textbooks and the attitudes they reveal are recognizable as not being very different from modern ones. Before that, medical books were clearly written to address a different mind-set.

But human health is fundamentally biological, and biology is fundamentally molecular. As a result, throughout the 20th century scientific medicine began its transformation from a merely rational basis to a fully molecular basis. First, antibiotics that interfered with pathogens at the molecular level were introduced. Next, the ongoing revolutions in genomics, proteomics and bioinformatics²³²¹ provided detailed and precise knowledge of the workings of the human body at the molecular level. Our understanding of life advanced from organs, to tissues, to cells, and finally to molecules, in the 20th century. By the early 21st century, the entire human genome will be mapped. This map will inferentially incorporate a complete catalog of all human proteins, lipids, carbohydrates, nucleoproteins and other molecules, including full sequence, structure, and much functional information. Only some systemic functional knowledge, particularly neurological, may still be lacking by that time.

This deep molecular familiarity with the human body, along with simultaneous nanotechnological engineering advances (Chapter 2), will set the stage for a shift from today's molecular scientific medicine in which fundamental new discoveries are constantly being made, to a molecular technologic medicine in which the molecular basis of life, by then well-known, is manipulated to produce specific desired results. The comprehensive knowledge of human molecular structure so painstakingly acquired during the 20th and early 21st centuries will be used in the 21st century to design medically-active microscopic machines. These machines, rather than being tasked primarily with voyages of pure discovery, will instead most often be sent on missions of cellular inspection, repair, and reconstruction. In the coming century, the principal focus will shift from medical science to medical engineering. Nanomedicine will involve designing and building a vast proliferation of incredibly efficacious molecular devices, and then deploying these devices in patients to establish and maintain a continuous state of human healthiness.

The very earliest nanotechnology-based biomedical systems may be used to help resolve many difficult scientific questions that remain. They may also be employed to assist in the brute-force analysis of the most difficult three-dimensional structures among the 100,000-odd proteins of which the human body is comprised, or to help ascertain the precise function of each such protein. But much of this effort should be complete within the next 20-30 years because the reference human body has a finite parts list, and these parts are already being sequenced, geometered and archived at an ever-increasing pace. Once these parts are known, then the reference human being as a biological system is at least physically specified to completeness at the molecular level. Thereafter, nanotechnology-based discovery will consist principally of examining a particular sick or injured patient to determine how he or she deviates from molecular reference structures, with the physician then interpreting these deviations in light of their possible contribution to, or detraction from, the general health and the explicit preferences of the patient.

In brief, nanomedicine will employ molecular machine systems to address medical problems, and will use molecular knowledge to maintain human health at the molecular scale.

Last updated on 5 February 2003