Here’s how to encourage new medical innovation, says genetic researcher Geoffrey Siwo: Join forces with the people who need innovation the most, all over the world.
When he was a young biology student in Njoro, Kenya, with a big idea but zero resources, the genetic scientist Geoffrey Siwo once tested and confirmed a radical idea on HIV drug resistance by working it out at a little internet cafe. That success led him to realize that putting the right tools in the hands of more people could create more scientific discoveries. Today, the TED Fellow is one of the first scientists to take the helm at IBM’s new research lab in South Africa, dedicated to developing new technologies for health, along with energy, urban renewal and other ambitious quests.
We asked Siwo to share his thoughts on the future of medical innovation, in which he hopes democratic discovery and precision treatment will improve health care for the whole world. He broke the situation and solution down as follows:
Trial as error. Despite the advancements that the tech revolution has brought us, the traditional medical discovery model is slower than snail mail. Current discovery, Siwo says, is still based on trial and error, which is inefficient and unpredictable.
“Many pharmaceutical companies have large libraries, millions of chemicals, that they screen against various diseases to see which one works,” he says. “But even in a library of a million chemicals, there might be none that works. And there are so many diseases — we know there are more than 10,000 in existence — that we have nowhere near the manpower required to tackle even a good portion of them in pharmaceutical companies and chemical laboratories.”
Add to this the issue that, as a 2013 assertion in the British Medical Journal famously put it, “most medicines don’t work in most patients,” and you’ve got a seriously difficult condition.
”Even the most successful medicines, which are antidepressants, don’t work in about 38% of people they’re used on,” Siwo says. “Cancer medicines don’t work in more than 75% of the patients. So even where we think that we have succeeded in treating disease, we haven’t.”
When innovation is genetically biased, everyone loses. Medical research is still centered primarily in Western academic and pharmaceutical research labs in Europe and North America, and tests are done primarily on Caucasian populations, which means people who need those medicines the most may not be served by studies. Take, for just one example, malaria, which occurs principally in sub-Saharan Africa.
“None of the medicines for malaria was discovered in sub-Saharan Africa,” says Siwo, whose sister died of the disease. “Chloroquine’s development as an antimalarial drug was highly enabled by the US Army’s interest in the disease during World War II. Later, during the 1980s and ’90s, the World Health Organization (WHO) removed the antimalarial drug amodiaquine from the Essential Medicines List because of adverse effects on Caucasian populations — but it was brought back when resistance to alternative drugs emerged,” he says. In the meantime, populations of non-Caucasian descent, which might not have experienced the adverse effects, were denied the benefits of the drug.
The solution could be found in Africa. The story of amodiaquine and countless other drugs shows how no single medical solution will always work across all patients. The way forward? Personalized, precision medicine that takes into account individual variability in genes, environment and lifestyle, which influence disease progression, prevention and treatment.
To address this problem in Africa, Siwo formed the United Genomes Project.
“In Africa, genetic diversity is greater than that of all other world populations combined,” says Siwo. The project, which is on hold for the moment, aimed to gather genetic information from a diverse cross-section of Africans to create a comprehensive database that would help identify and create safe and effective medicines for Africans. His dream: for Africans to own their own genetic data, develop their own drugs, thereby leading the rest of the world in new areas of medicine and technology.
“An individualized approach promises to transform the way we prevent, manage and treat disease,” he says.
The dream is an upward spiral — more precise medicine leading to more complete feedback leading to better intelligence.
The pace of discovery will speed up when computers learn from humans. Siwo imagines a future in which seamless human-computer interaction will democratize the process of innovation even more rapidly. The problem with computers now is that we mainly instruct them to solve problems we know how to solve. But soon, he hopes, computers themselves will be able to learn from our conversations.
“If we can make computers understand human language, computers and humans could solve problems together,” he says. The ability to communicate this way would lower the barrier for engagement in scientific innovation.
At the same time, computing can also help us build models that can allow us to predict how drugs will interact with real, individual patients — looping back to the idea of precision medicine. “This requires collaboration: we’ll need data from patients, from different laboratories,” says Siwo. “If all this data can be integrated to build predictive models, it could have a huge impact on disease prevention, treatment and management.”
The dream is to induce an upward spiral: more precise medicine can lead to more complete and helpful information and feedback, leading to better intelligence for diagnosis and treatment, leading again to even more precise medicine, and so on.
Medical innovation will be transformed when tools for discovery are in the hands of the people. Not only do Africans need access to their own genetic information, they also need the tools and resources to pursue research. Siwo understands this from firsthand experience. In 2002, Siwo, then an undergraduate at Kenya’s Egerton University, began wondering about virus-like materials in the human genome.
“These materials — called endogenous retroviruses — are present in all of us, constituting almost 8% of our genome,” he says.
He wondered if these retroviruses might be “talking” to HIV — also a retrovirus — and in the process conferring drug resistance on it, amplifying HIV’s destructive power. Answering this question would normally require a lab and funding, but Siwo’s institution had neither. So he got online daily at a dial-up internet café (paying 1 Kenyan shilling a minute) to analyze DNA sequences, and established that the interaction was indeed possible. It was a major coup for the young student, and he was invited to a conference in the U.S. to present his findings to biologists, many of whom didn’t yet even recognize the presence of endogenous retroviruses in the human genome, much less their potential relevance to HIV treatment.
But the experience gave Siwo an even bigger idea: that despite the lack of traditional lab and budget, his scientific curiosity and access to a computer and internet empowered him to make an important discovery.
“The future of medical discovery in Africa, and indeed in all the world, should be democratizing the discovery process,” he says.
In his own experience, it is when people have the tools of discovery and innovation in their own hands that they can not only choose which problems they want to tackle but figure out how to tackle them — thereby bypassing the limitations of the world’s current medical innovation framework.
“Increasing access to young scientists everywhere is key,” says Siwo. “If I can do it, so can others.”