Introduction to Medical Biology

Introduction to Medical Biology

• Technical application of biological material is biotechnology.

• Understanding biotechnology requires considering the starting material.

• Biotechnology uses living material or biological products to create new products in medicine, agriculture, pharmaceuticals, and environment.

• The ultimate goal of biotechnology is to benefit humanity through resistant crops, recombinant proteins, and higher milk-producing animals.

Developmental Stages of Biotechnology

• Developmental stages have occurred to meet specific human needs.

• Development based on observations and their practical application.

• The complexity of biotechnology has increased due to new technologies and a better understanding of life science principles.

• Categories of biotechnology:

  • Ancient biotechnology (pre-1800)

  • Classical biotechnology

  • Modern biotechnology

Historical Events in Biotechnology

• Biotechnology development can be divided into stages:

  • Ancient biotechnology (8000–4000 BC):

    • Early history related to food and shelter.

    • Domestication of animals.

  • Classical biotechnology (2000 BC; 1800–1900 AD):

    • Built on ancient biotechnology.

    • Fermentation promotes food production and medicine.

  • 1900–1953: Genetics.

  • 1953–1976: DNA research, science explodes.

  • Modern biotechnology (1977):

    • Manipulates genetic information in organisms.

    • Genetic engineering.

    • Technologies improve crop yield and food quality and broaden the array of industrial products.

Scope and Importance of Biotechnology

• Industrial biotechnology

• Biotechnology and the environment

• Biotechnology and agriculture

• Biotechnology in medicine

• P4 medicine:

  • Predictive

  • Preventive

  • Personalized

  • Participatory

Healthcare Delivery: Past, Present, and Future

• Past:

  • Health Model: Biomedical

  • Focus: Treatment of acute illness and injury

  • Time Frame: Immediate, short-term (days, weeks)

  • Importance of maternal and child health: Low

• Present:

  • Health Model: Biopsychosocial

  • Focus: Management of chronic illness

  • Time Frame: Medium term (months, years)

  • Importance of maternal and child health: Moderate

• Future:

  • Health Model: Health Development

  • Focus: Health optimization for all

  • Time Frame: Lifelong and multi-generational

  • Importance of maternal and child health: High

Variable Health Trajectories

• Health trajectories illustrate the impact of risk and protective factors on health development.

• A. Health development trajectories are influenced by risk and protective factors.

• B. Trajectories are not linear but fluctuate relative to influences at different points in time.

Eras of Modern Healthcare

• 1st Era (1900s):

  • Life expectancy: 47

  • Ideas and Theories:

    • Germ Theory

    • Medical Anatomic/Pathologic Framework

• 2nd Era (1950s):

  • Life expectancy: 66

  • Biological Systems Ideas and Theories:

    • Darwinian Evolution

    • Mendelian Genetics

    • Population Genetics

    • Neo-Darwinian Synthesis: Molecular Biology (1 gene, 1 phenotype)

    • Epigenetics 1.0 (Waddington)

  • Medical and Health Systems Ideas and Theories:

    • BioMedical Models

    • Social Epidemiology

    • Epidemiology (Smoking, Eating, Exercise, Stress)

• 3rd Era (Today):

  • Life expectancy: 79

  • Biological Systems Ideas and Theories:

    • Systems Biology

    • Genomics

    • Biocomplexity

    • Other "omics"

    • DOAD

    • Epigenetics

    • Network Biology/Biocomplexity

  • Medical and Health Systems Ideas and Theories:

    • Biopsychosocial Models

    • Complex Systems Science

    • Post-Genomic Synthesis (relational gene networks)

    • Lifecourse Health Development

    • Framingham

    • Alameda

    • Life Span Human Developmental Psychology

    • Lifecourse Sociology

    • Lifecourse Chronic Disease Epidemiology

    • National Birth Cohort Studies

    • Neurodevelopment

    • Lifecourse Health Development (LCHD) Synthesis

    • Social Network Analysis

    • New Birth Cohort Studies

    • Conceptual Pathway Research Influence

    • Health Development Model

Evolution of Health Development

• Two streams of scientific inquiry:

  • Biological System Ideas and Theories:

    • Development of conceptual constructs related to biological systems.

    • Darwinian evolution and Mendelian genetics influenced Neo-Darwinian synthesis and modern molecular biology.

    • Continues to evolve under systems biology, genomics, epigenetics, and complex systems science.

  • Medical and Health System Ideas and Theories:

    • Evolution from a simple biomedical model to a biopsychosocial model and then to a complex model of lifecourse health development (LCHD).

• The Eras of Modern Health Care suggest the timing of conceptual changes in relation to healthcare organization and delivery.

Comparison Between Evidence-Based Medicine and P4 Medicine

• Reactive Medicine—Evidence-Based Medicine:

  • Reactive: Responds after a patient is sick (symptoms-based).

  • Disease treatment system.

  • Few measurements.

  • Disease-centric with standard of care associated with population-based disease diagnosis.

  • Records not highly linked nor data integrated.

  • Large-scale diffusion of medical information mediated mostly through physicians alone.

  • Drugs tested against large populations (tens of thousands) to develop statistics for FDA.

• Proactive P4 Medicine:

  • Proactive: Responds before a patient is sick (based on pre-symptomatic markers).

  • Wellness maintenance system.

  • Many measurements, including complete genome sequencing, high-parameter blood diagnostics, many longitudinal omics measurements.

  • Individual-centric, with standard of care tailored more fully to multiple measurements on the individual.

  • Deeply integrated data that can be mined for continued improvement of health care strategies.

  • Social networking of patients to enhance shared experiences and diffusion of knowledge in consultation with their physicians.

  • Stratification of disease populations into small groups (50 or so) that can be effectively treated to achieve FDA approval.