Monday, May 24, 2010

Modular Approaches to Our Post-Industrial Biologic Age

In a fav Disease Management Care Blog movie Bladerunner, Harrison Ford portrays a futuristic cop who tracks down genetically engineered humanoid "replicants" that have gone rogue. Too bad their emotions and free will get in the way of accepting their assigned tasks, like combat (the menacingly friendly Roy Batty), dangerous work (Zhora and her artificial snake ooo la la) or serving as a "pleasure model" (Goth-like Pris, ably played by sexy-no-more Darryl Hannah).

While there's plenty of theme to go around (so, just what is the definition of "human?"), it's the "modular" portrayal of biology that has caught the imagination of the DMCB. In contrast to the standard sci-fi plot of simply growing bodies, Bladerunner implies the creatures are assembled, Frankenstein-like, from parts manufactured in outsourced mini-labs.

Pretty good soothsaying for a 1982 film. Fast forward to May 2010 and the announcement that that Gibson and colleagues have inserted a new set of chromosomes into the bacterium Mycoplasma mycoides, creating a form of life that is without an ancestor. According to this article in The Economist, Craig Venter and colleagues assembled and combined the necessary blocks ("cassettes") of DNA and then used a virus to insert a newly completed genome into a DNA-free cell host. It started to divide and, well, Life Was Created, sort of.

So what does this have to do with disease management, you ask? The DMCB thinks the imagery of successful 'swapping" of the components of complex organic systems is having a far greater impact on our culture than we realize. At the height of Industrial Revolution, society reflected that Age's principles of scientific rationalism and standardization. Schools were one-size-fits all, soldiers and tanks assembled in huge symmetric formations and everyone lined up for their immunizations.

Since our transition to a post-industrial Information Age, the paradigm has now become more "biologic." DNA can be tasked to computing, complex organizations are referred to as living and Hollywood even portrays entire planets as animated with an interconnected network of life. And in the middle of all that are stem cell infusions, telomere manipulation, immune modulators and solid organ as well as facial transplants. Is it any accident that education is often based in experiential learning guerrilla war has become organic, and population-based health care is based on interdependent care interventions (value based insurance design, physician payment reform, shared decision making, medical homes, disease management and the like?)

The DMCB is out on a limb here, but it's not sure if cultural form follows function or vice versa. But in our age of organic, flexible, interdependent and plug n' play approaches to education, health care (and unfortunately war), it seems scientists, administrators, policymakers and provider organizations that use the same approach to the problems of our modern age are the ones poised to come up with the Next Big Advances. Like creating living cells or, which is just as exciting, reducing the burden of chronic disease.

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