Dean’s Message: All the Easy Problems Have Been Solved

Robert Hromas, M.D., FACP

All the easy diseases have been cured.

At this time, monogenic diseases all are well characterized, and we have excellent treatments for them. However, the disease we face now, like type 2 diabetes or lung cancer, are multigenic. There is not just one gene to study. We have to take into account multiple interacting genotypic and phenotypic effects of the disease. It makes that disease much harder to attack than one single pathway. We need approaches that we are not even considering now.

We also need to talk about applying mathematics, physics and artificial intelligence to these multigenic diseases. It is crucial that we not limit ourselves to incremental science, yet so much of what the NIH will fund is incremental. It is going to be the revolutionary ideas that are going to make the big advances forward.

Therefore, we need to welcome novel ways of training. How many physicians are being trained in natural language processing or machine learning? Hardly any. Yet these are going to play a huge role in medicine in the future.

We need to avoid training physicians in only what they need to know to be a good doctor right now. We do not know what will be important in the next generation. That is why we remain committed to a broad-based education in our medical school here. We let people tailor their training to their individual passions. We also teach them how to access different disciplines and create collaborations.

The future of medical discovery lies in understanding how proteins within a cell interact with each other in three-dimensional space. We need to see the cell not as a flat map but as an ocean with currents, kelp, fish and plankton all in a real-time ecosystem. When we solve that, we can begin to explore cell:cell relationships in three-dimensional space.

Solutions to these unsolved multigenic diseases lie in these protein:protein and cell:cell interactions within 3-D space. While progress has been made in in vivo imaging, such as with opticogenetic imaging, we need better methods to understand protein:protein and cell:cell interactions in vivo. It is in understanding these relationships that we will understand multigenic diseases.

In like manner, many of the population health problems we face are based on relationships within a family, community or a city. Small changes in one individual can result in massive changes in a family or a community. These too can be mapped into an ecosystem that will permit better understanding of societal effects on these multigenic diseases. Thus, I think the future of medical discovery lies in understanding the relationships that are the foundation of the complexity of life, from smallest to largest, from protein to community.

Robert Hromas, MD, FACP
Dean, Long School of Medicine

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In the 2021 issue of Future

Future is the official magazine of the Joe R. & Teresa Lozano Long School of Medicine at The University of Texas Health Science Center at San Antonio. Read and share inspiring stories highlighting our medical alumni, faculty and students who are revolutionizing education, research, patient care and critical services in the communities they serve.

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