The other day I was lying in bed scanning through Facebook on my phone. I was bored and didn’t feel like doing anything productive, so I ended up spending a lot more time on the site than I usually do, and I visited several pages that I rarely frequent. One of the pages I stumbled upon was the personal profile page of Mark Zuckerberg, the founder and CEO of Facebook. I briefly looked over his most recent updates and checked out some of the photos on his wall.
One wall post in particular caught my attention. According to the post, Mark Zuckerberg is on a mission to “cure all diseases”. In order to achieve this lofty goal, the Chan Zuckerberg Initiative, the company Zuckerberg and his wife Priscilla Chan established in December 2015, has committed to pumping three billion dollars into medical research.
This is undoubtedly a noble goal. But is it attainable?
Can we really “cure” all diseases?
When the average Joe hears that Mark Zuckerberg is on a mission to cure all diseases, he may be filled with hope and think to himself that we in a not so distant future will be able to develop new medical technology that allows us to combat virtually all of the illnesses that plague us. After all, there’s nothing a couple of billions of dollars can’t fix, right?
To someone who is knowledgeable about the human body and its associated diseases, however, Mr. Zuckerberg’s mission may not seem as straight-forward. Personally, I applaud the founder of Facebook for his efforts and his commitment to fighting human disease; however, I think his mission is somewhat misguided.
I get the impression from reading about the Chan Zuckerberg Initiative online that the founders of the company think that we can “cure” virtually all diseases through the use of drugs, vaccines, and other similar conventional medical treatments. Moreover, I get the impression that they think investing billions of dollars into cellular research and the development of new medical technology is the key to eliminating chronic diseases such as obesity, type-2 diabetes, colon cancer, and so forth. I don’t fully agree with this notion.
Let me explain why…
We need to rethink our approach to medicine
Contemporary humans are sick. In the developing world, acute, infectious illness is killing millions of people every year. In the developed world, acute, infectious disease is no longer a major public health problem, much thanks to modern medicine; however, that doesn’t mean that we’re healthy. There’s a pandemic of chronic disease in our world. Cardiovascular disease, colon cancer, acne vulgaris, type-2 diabetes, and a long range of other diseases and health problems are highly prevalent in most industrialized nations. We live longer than our ancestors, but we’re not healthy.
I get the impression that Mr. Zuckerberg believes we can cure most, if not all, of these diseases. Not by changing how we live and eat, but by developing new medical technology and drugs. I don’t think this is true. If there’s one thing history has shown us, it’s that most pharmaceutical drugs and other similar medications don’t treat disease, they treat symptoms. The tools your GP has in his tool box may eliminate some of the signs and symptoms of the health problems that plague you, but they are probably not going to do much about the underlying problems that made you sick in the first place.
Statins lower your blood cholesterol, but they don’t address the underlying problems that caused a build-up of LDL in your blood. Benzoyl peroxide, a topical application used to treat acne, kills Propionibacterium acnes and may hinder the development of acne lesions, but it doesn’t address the true causes of excessive sebum production and skin microbiota dysbiosis. Even antibiotics don’t really address the root causes of the diseases they are used to treat. I could go on, but I think you get the point.
A common approach to treating disease is to investigate and establish which lipids, hormones, cells, and so forth that are involved in each specific disorder, and then design drugs and other similar treatments that target these compounds. Based on the articles I’ve read, this is the type of strategy that will be used for most of the research projects funded by the Chan Zuckerberg Initiative. Unfortunately, this approach has not proven very effective in the treatment of chronic disease.
The Darwinian approach to medicine differs from the aforementioned one in that the main goal is not to establish the molecular mechanisms that are involved in each disease and then go on to develop drugs or “cures” for each individual disorder, but rather to find out why we get sick in the first place and then design treatments and lifestyle plans that address the underlying causes of the diseases that plague us.
Most chronic diseases can’t be cured with a pill or a drug
Pharmaceutical drugs may help us manage chronic diseases and improve the quality of life of those who suffer from them, but they don’t eradicate the conditions. We can’t get rid of chronic health problems such as breast cancer, obesity, diabetes, and heart disease with a single pill or vaccine (at least not in the near future). You don’t have to have a PhD in medicine to understand why this is true, all you need is a basic understanding of how the human body evolved, functions, and operates.
Human beings are, like all other organisms on this planet, biological systems that were sculpted by evolutionary forces over eons of time. Our bodies consist of a complex mix of adaptations and trade-offs that have accumulated throughout our evolutionary history. Most chronic diseases develop as a result of complex interactions between the human genome and the environment (including the microbiome). These interactions trigger changes in gene expression and epigenetic programming, thereby affecting the phenotypic expression of the organism. You can’t control these processes with a drug! A drug may change the expression of certain genes or receptors that are involved in the pathogenesis of the disease in question, “silence” certain genes, or affect the synthesis and/or absorption of various substances, but it will not address all of the factors that caused the disease to develop in the first place.
I get the impression that the people behind the Chan Zuckerberg Initiative’s plan to cure all diseases think that we need billions of dollars and massive research projects to understand why we get sick and what we can do to prevent and reverse chronic illness. What these people don’t seem to recognize is that we already have a pretty good idea of what’s causing most (not all) diseases.
A large body of evidence shows that most chronic diseases, in particular the so-called diseases of civilization, are not caused by “bad genes” or design flaws in the human body, but rather by a discordance between the modern environment and the human genetic-make up, comprised of genes selected in past environments (1, 2, 3, 4, 5). Many, if not most, of these modern diseases can indeed be prevented – or even “cured”, but not by a single drug, supplement, or medication.
It often seems like mainstream medicine operates on the belief that each individual disease has a unique set of causes. If we look at the final events that lead to the development of different diseases, this often holds true; however, if we look at the underlying causes of the conditions, we’ll see that most chronic diseases have a common set of predisposing factors. Genome-environment/microbiome mismatches and chronic low-grade inflammation are at the root of most of the diseases of civilization, including type-2 diabetes, obesity, colon cancer, and most autoimmune conditions (1, 2, 5, 6, 7).
This is one of the reasons why a medical treatment (e.g., drug, vaccine) that targets the cells, genes, or receptors that are involved in just one chronic disorder is not going to be particularly effective when it comes to bringing a sick patient back to health. In order to change the gene expression profile of the modern man in such a way that it falls within the evolutionary norm for our species, a multifaceted treatment approach that includes diet alterations, microbiota manipulation, and lifestyle changes, among other things, is needed (1, 2, 3, 4, 5).
Perhaps it’s time we stop looking for pills, drugs, and other simple solutions to our chronic health problems and instead start looking for treatments that address the underlying causes of the illnesses that affect us? I don’t claim to have all the answers, but if there’s one thing I’ve learned over the years, it’s that we can’t drug our way to health. Taking a pill with breakfast or injecting yourself with a substance of some sort is not going to be sufficient to make you healthy.
What about acute, infectious illness?
In the context of acute, infectious disease, drugs have proven much more effective. Modern medicine, in conjunction with improvements related to sanitation and hygiene, has helped us combat many acute, infectious diseases. Millions of lives could have been saved every year if people in developing nations had access to vaccines and antibiotics and other drugs that are used to treat infectious disease.
That said, I’m very skeptical of the drug-centric approach also here. When we wipe out a pathogen with an antimicrobial drug, we may unknowingly be setting ourselves up for a whole host of new problems. In some instances, antibiotics are absolutely necessary; however, there’s no doubt that they have been overused. We’re now dealing with the collateral damage of this overuse. Widespread use of antibiotics has not only triggered the development and spread of antibiotic-resistant superbugs, but has also caused an extinction inside our guts and paved the way for many inflammation-related diseases to develop (8, 9, 10, 11).
Not so long ago, antibiotics were considered to be harmless drugs. We now know that this is not the case. Actually, in many, if not most instances, the cons of using these drugs may actually outweigh the pros. I’d argue that our current approach to treating infectious disease is too simplistic. Instead of constantly trying to develop new drugs in order to wipe out the bugs that cause us harm, we should probably pay attention to why the pathogens are able to cause us harm in the first place. Often, the problem isn’t the bugs themselves, but rather that the human body’s ability to defend itself is compromised. Most people in the world today house a degraded microbiota and have a slightly compromised immune system; hence, they are prone to attacks by germs.
Instead of wiping out bad bugs, a better approach to preventing and treating infectious disease may be to nurture good bugs, and hence, solidify our immune defenses. This strategy may not work for all infectious diseases, but it will undoubtedly be effective in the prevention and treatment of some. This statement is supported by studies showing that a diverse, resilient microbiota acts as a natural defense against many pathogens, including C. difficile and microbes implicated in respiratory infections (12, 13, 14). A healthy microbiota may even enhance the host’s protection against viruses such as HIV (15).
I applaud Mark Zuckerberg for the time, effort, and money he puts into solving medical problems and finding effective treatments for various human diseases. However, I think his ideas are somewhat misguided. He doesn’t seem to know much about health, nutrition, or disease and seem to operate under the belief that virtually all diseases can be cured with conventional medical treatments (e.g., drugs, vaccines) and that the development of new, advanced medical technology is the key to combatting the so-called diseases of civilization.
This idea is based on a flawed understanding of how the human body works and develops. We are not machines that operate in a predetermined manner; rather, we are complex biological systems that were sculpted by natural selection and other evolutionary forces over billions of years. Some diseases, in particular acute, infectious illnesses, can indeed be “cured” with drugs, vaccines, and other similar medical treatments, but most can’t.
Chronic diseases such as colon cancer, type-2 diabetes, and heart disease are conditions that develop as a result of complex gene-environment interactions. In order to prevent and treat these types of diseases, we have to resolve the conflict that exists between our genes and our current environment. This can’t be done with a pill, drug, or any other “cure” (at least not without meddling with the human genome, something I’m very skeptical of doing). Rather, it probably requires a multifaceted approach that focuses on factors such as diet, microbiota manipulation, exercise, sleep, and epigenetic modifications.
Perhaps these are the things Mr. Zuckerberg should devote his time and money to?
Picture: Creative Common picture by AndersFrick.