As our world continues to get older, thanks to improving life expectancy and a lower fertility rate, our priorities will change.
An older population has specific healthcare needs, with the incidence of diseases like cancer, cardiovascular disease, arthritis and others all dramatically increasing with age. Our ageing population is an achievement, testimony to thousands of incremental improvements in healthcare, as well as some significant milestones.
The three great waves of innovation
Broadly speaking, the last 80 years have seen three great waves of innovation in medicine, each of which has transformed healthcare almost beyond recognition. The first was the discovery of small molecule drugs in the 1950s, relatively simple chemical compounds, made up of perhaps 20-50 atoms, which nonetheless were able to treat a range of illnesses effectively for the first time. Drugs such as Aspirin, Crestor and Cortisone had a huge impact over a long period, and small molecule drugs remain a mainstay of treatment for a wide variety of conditions accounting for about 90% of therapeutics currently on the market.
The last 80 years have seen three great waves of innovation in medicine, each of which has transformed healthcare almost beyond recognition.
The 1980s ushered in a new phase of pharmaceutical development with the discovery of biologic medicines, much larger proteins that are composed of around up to perhaps 20,000 atoms. Rather than being a synthesized chemical compound, biologic therapies are created using a living source, which enables them to target particular parts of the body, making them more specifically suited for certain conditions than small molecule drugs. Biologics generally work outside the cell only and work through their ability to act on the cells that are part of the body’s immune response, and since their discovery, biologic therapies have proved particularly effective in improving outcomes for patients suffering from autoimmune diseases and cancers.
The next wave of innovation in treatment is already underway and involves using genetic information itself to understand how the body works on a molecular level. While scientists have been able to sequence DNA since the 1970s, genome sequencing is the practice of mapping the entire DNA sequence of an organism’s genome. A full human genome sequence was first completed in 2003 by the Human Genome Project, allowing the building blocks of a human being to be fully captured for the first time.
The Human Genome Project’s achievement was immense, but it was also painstaking, taking 13 years to complete. Further work was necessary, not only to make the process less laborious, but also to understand what could be done with this data and what use it could serve.
Why genome sequencing is so powerful
Roughly speaking, the market for genome sequencing has two main applications: research and clinical. On the research side, understanding the full sequence of human DNA allows us to understand the human body on a molecular level and how genetic material affects life. Further research in this area will contribute to a better understanding of the makeup of populations as well as provide data for research into rare genetic conditions. Genome sequencing also finds a small market in the increased appetite for consumer products that explore ancestry.
Early cancer detection through the reading of DNA signals in blood is likely to become a reality within the next five years.
The clinical applications of genome sequencing are particularly interesting, especially given our ageing world. Diagnosis is one area set to be transformed. Pre-natal testing, now an invasive procedure with its own risks, will see huge changes, rendering it possible to screen a fetus for chromosomal abnormalities without the need to take an in-vitro sample. Early cancer detection through the reading of DNA signals in blood is likely to become a reality within the next five years. Illumina’s GRAIL subsidiary is a leader in this field and has just started a trial with 165,000 volunteers in the UK which could provide early detection for over 50 types of cancer. The genomic revolution also offers the potential for a step change in cancer treatment more generally, with the ability to better understand the mutations behind cancer likely to result in better therapies. Genome sequencing will enable not only better screening, but earlier treatment, better treatment choices, better monitoring of that treatment, and increased surveillance post-treatment.
The potential for such changes in the way we diagnose and treat conditions, as well the number of potential research applications, mean that there is a vast total addressable market for companies that can provide reliable genome sequencing services at a reasonable cost. Illumina is one such company. With its leading share in the machines and consumables needed to sequence genetic material, it is at the forefront of gene sequencing.
Genome sequencing will enable not only better screening, but earlier treatment, better treatment choices, better monitoring of that treatment, and increased surveillance post-treatment.
While genome sequencing has the potential to make huge improvements in healthcare, it is also a source of concern, raising profound ethical, societal and governance challenges. While improving diagnosis and curing diseases is undoubtedly good for society, there are questions to be asked about the philosophical implications of editing genes as well as about how sensitive data is used and protected. As companies like Illumina bring this technology to a greater market, rigorous debate is to be expected. Our stewardship focus means that we encourage these conversations, and will continue to monitor the ESG ramifications of genome sequencing while investing in companies that have the potential to transform health outcomes for the better.