Got Any Good Drugs?

By Frederic Golden

It was a blast of a New Year's party, but now that 2024 is history and 2025 is here, you're feeling terrible. It's not just a hangover. You're sweating. You're listless. You're aching all over. The doctor nods sympathetically while she pokes around here and there as physicians have done ever since Hippocrates. Then she goes high tech: "Your gene card, please?" she asks.

The computer digests the rectangle of plastic you hand her. "Yes, you've got a bad case of flu," she says reassuringly. "I'm having the pharmacy create a drug for you. It'll be ready before you're dressed, and you should be as good as new by tomorrow."

Maybe that's not exactly the way pills will be dispensed 25 years from now, but you can be sure that at molecular biology's current pace, it will be something like that. By then scientists will have decoded the entire human genome--all 140,000 or so genes that largely say who we are and which of 4,000 diseases our flesh is heir to. They will also have found exactly where common disease-causing errors lie along the genome's long, interlocked chains of DNA.

That will have enormous practical consequences. Your genetic profile, recorded on a chip, will let doctors--or, more likely, their computerized diagnostic tools--determine your exact level of risk for a particular disease and which proteins and enzymes your body lacks. There will be no more wasteful trial and error, with costly pills winding up in the trash because they produced unwelcome reactions or didn't work for you. Instead you'll get customized prescriptions, created to "fit" on the very first try, like a Savile Row suit.

And that's just for starters. In 2025's genetically based pharmacology, you'll not only have your pick of the old standbys--tranquilizers, antihistamines, painkillers and antibiotics, all compounded to your personal specs--but you'll see all sorts of new capsules and tablets for virtually every ailment and condition. These will range from mood and pleasure enhancers--legal and otherwise--for the pill poppers of the future to new medications for diseases likely to be much more common in an aging population, like Alzheimer's, cardiovascular problems and cancer.

"It will be a geriatric world, at least in wealthy countries, with at least 20% of the people 60 years or older," says Stanford chemist Carl Djerassi, synthesizer of the birth-control pill. For that reason, he predicts, drug companies will turn from contraception to conception in an effort to help older women have babies. As for aging men, they'll have at their disposal libido and sex-performance boosters that will make Viagra seem like baby aspirin.

Meanwhile, genetically engineered drugs will increasingly replace the scalpel for removal of tumors or cosmetic surgery like hair transplants. Indeed, after much hype and few results, gene therapy is finally making major strides--although not the way doctors thought it would. Once they hoped to cure diseases by repairing defective genes. Now it seems a lot easier to determine what proteins the broken genes should be making and replace them instead. Dr. Jeffrey Isner at St. Elizabeth's Medical Center in Boston has achieved remarkable results with a protein called vascular endothelial growth factor (VEGF2) in restoring circulation in the legs of diabetics and, more impressively, stimulating new vessel growth in patients with severe heart disease. Says former Eli Lilly chairman Randall Tobias: "The day will come when we regard all surgeries, except [treatment of] trauma, as failures of the pharmaceutical industry."

Unlike traditional medications, the brave new drugs will be designed "rationally" on computer screens, using gene information as a blueprint. VEGF2, for example, is a synthetic gene that makes a protein that in turn stimulates new vessel growth. In a few years, predicts William Haseltine, the biotech industry's champion optimist and CEO of Human Genome Sciences, based in Rockville, Md., we will have genetically based drugs for almost every serious ailment--"things we couldn't really work on well before, whether it's osteoporosis or Alzheimer's." Nor will these drugs simply attack symptoms, as aspirin does. "That's a chemical crutch," he says. In the new genomics, as Haseltine calls it, "it's the human gene, the human protein, the human cell--and not the chemical--that is used as the medicine."

The genomics may be new, but not the economics. When you take your gene card to the pharmacy in 2025 for flu pills, bring a credit card too. Made-to-fit drugs won't be cheap. Some of us may have to make do with two aspirins and all the liquids we can drink.

Frederic Golden, a former assistant manager of DISCOVER, is a TIME contributor who has followed the rise of molecular biology