Does proteomics need a “big government” approach?
A big-government approach is warranted, some argue, because of the current limits of technology and knowledge. For example, computer-enhanced techniques including high-performance liquid chromatography and mass spectrometry are allowing researchers to reach conclusions even with the tiniest amounts of protein (see “Mining for Proteins”). But there is still no protein equivalent of the polymerase chain reaction, developed in the early 1980s, which allows almost limitless mass-production of genetic material for study.
Another reason for attempting a “Man on the Moon” approach to proteomics is the urgency of medical problems that are waiting to be addressed.
“Our ability to improve on human biology I would argue is one of the most important possible goals of the 21st Century,” says Daniel Perry, executive director of the non-profit Alliance for Aging Research, which advocates for more research dollars on diseases that affect older people.
In the next 30 years, “a wave of chronic disease and disability,” including a quadrupling of the number of people with Alzheimer’s disease, will sweep over the country as the population ages, predicts Perry, a former member of the federal Task Force on Aging Research and former advisor to the White House Conference on Aging.
“If we can fine-tune the human biology at the level of genes and proteins and growth factors, and use those insights to extend healthy years of life and reduce to a bare minimum the years and months or weeks spent in a dependent state at the far end of life, that would be an enormous social accomplishment,” he says. “I think it’s a goal and a vision that could very well be served by national leadership in the public sector.”
A big government approach isn’t universally embraced. Some scientists worry that serendipity – the chance discovery that dramatically shifts thinking about a biological problem – would be squelched by a bureaucracy which determines the research agenda in advance.
Other researchers believe that the diversity and complexity of the protein world simply doesn’t lend itself to a “Human Proteome Project.”
“There is no human proteome as far as I’m concerned,” says Emanuel Petricoin, Ph.D., co-director of a clinical proteomics program operated jointly by the U.S. Food and Drug Administration and the National Cancer Institute.
“The proteome is constantly changing and fluctuating in the context of the person, what that person is exposed to, the time of the day, the underlying disease process, so I don’t think we’re going to decipher a human proteome set,” Petricoin says.
“I think what we’re going to try to understand is the proteins that are changing as a consequence of the disease. We’re going to use those proteins as therapeutics, biomarkers and tools to basically drive the clinical decision. That’s where the money is in the pharmaceutical industry.”
While proteomics may lead to significant improvements in the diagnosis and treatment of disease, those applications will be expensive, at least initially, and health care consumers will be required to pay an increasing proportion of the cost, predicts ethicist Daniel Callahan, Ph.D., director of international programs for the Hastings Center in Garrison, N.Y.
The rich will be able to afford the higher price tag, but the poor will not. “A two-tier health care system is the inevitable result, and one where the gap between the tiers gradually increases,” Callahan writes in the June 17, 2002 issue of the Journal of Molecular Biology.
Callahan urges a different approach, one that places more emphasis on the socioeconomic determinants of health and disease prevention. “The principal test for biomedical progress would be its impact on population health rather than individual health,” he writes. “It would not aspire to conquer each and every disease, but only those that shortened life or harmed its quality to some significant degree.”
After all, he argues, “the main determinants of population health are not research progress and improved health care (except perhaps for the elderly). They are instead the socioeconomic conditions under which people live.”
In the United States, fully 50 percent of all deaths can be ultimately traced to behavioral causes, such as smoking, obesity and lack of exercise. “The best predictor of a healthy life,” Callahan concludes, “is education, followed closely by economic security.”
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