Technology indistinguishable from magic

Our age of miracles: the medical breakthroughs of 2024

As many of you will know, I’m a cultural pessimist and techno-optimist. Thanks to the miracle of modern medicine, I believe that it won’t be too long before we’re all living to 300 - and spending most of it drooling into our phones as we gaze at TikTok reels featuring utter cretins.

There is a popular tendency to despair at the state of the world, and the 2020s haven’t been entirely perfect so far, but it’s easy to forget that we are also living in an age of miracles and wonder - in particular an age of medical breakthroughs. Indeed, just as the Second World War accelerated transport technology, the Covid pandemic which overshadowed the start of the Twenties probably did a fair bit to accelerate medical technology.

This decade we’ve seen huge advances in the treatment of malaria, diabetes, sickle cell and cystic fibrosis; previously deadly or debilitating illnesses are now well on their way to being fully treatable or eliminated. This year has seen further wonders, and I’d like to end 2024 by looking at some of the amazing medical breakthroughs of the past 12 months.

Schizophrenia

As the Financial Times reported in September, a new experimental drug known as Xanomeline-trospium or KarXT, which comes in the form of a twice daily pill, ‘will arguably be the first truly novel treatment for schizophrenia in more than seven decades.’

Schizophrenia is hard to treat, and existing medications basically all do the same thing, by simply sedating the sufferers through targeting the brain’s dopamine receptors. Most have unpleasant side effects, often causing people to stop taking them.

As science writer Saloni Dattani records in her round-up of breakthroughs - also threaded here, the new drug targets a different part of the brain, its muscarinic receptors, and if approved by regulators at the US Food and Drug Administration, could be transformative for those suffering from this incredibly cruel illness.

It was originally developed to treat Alzheimer’s, but ‘during those early trials, something unexpected happened: participants experienced fewer hallucinations, delusions, and episodes of agitation…. The results led researchers to test xanomeline as a potential schizophrenia drug. But it led to major side effects, like severe nausea, vomiting, and stomach pain, which ultimately sidelined the drug.’ This was resolved by pairing it with trospium, which neutralised those side effects using a method I’d be lying if I said I understood.

There has been significant recent progress in the study of the human brain and, as the FT notes, investors are clearly confident that good things are coming: ‘Venture capital investment in psychiatric drugs is also on course to record its second-highest year ever, with $654 million deployed so far, according to biopharma data platform DealForma. Moreover, the first two fully approved Alzheimer’s drugs in the US were launched in the past year. Roopal Thakkar, AbbVie’s chief scientific officer, says drugmakers are “getting better at cracking that code”, adding that improvements in brain imaging and the ability to combine different molecules to improve efficacy and reduce side effects mean there is an “opportunity here to go deeper than before”.’

HIV

When I was growing up, Aids was a terrifying prospect, an especially cruel death sentence that is still chilling to read about. Today it’s easily treatable, and with the battle to prevent the full-blown illness largely won in the West, the war to eliminate the virus moves on. A further improvement was made this year with Lenacapavir, an antiviral injection which has proven to be very effective. In tests within two African countries, it was associated with a 96-100 per cent reduction in HIV infection, far more effective than current PrEP pills.

Elsewhere, a German man was cured of HIV after a stem-cell transplant.

Allergies

Nut allergies can be life-threatening and, for the parents of children affected, stressful and terrifying. Many will have their lives vastly improved by Omalizumab, a new type of monoclonal antibody drug – drugs which target specific cells, usually for treating cancer – given as an injection. In a phase 3 trial, it was found that 67 per cent of participants on Omalizumab could tolerate 600 mg of peanuts compared to only 7 per cent taking the placebo. The treatment didn’t work for a lot of people, so there is some way to go still, but we’re inching closer to a time when allergies aren’t a constant source of worry.

Deafness

A new gene therapy trial gave hearing to a deaf child this year. As the Guardian reported: ‘Opal Sandy was born unable to hear anything due to auditory neuropathy, a condition that disrupts nerve impulses travelling from the inner ear to the brain and can be caused by a faulty gene. But after receiving an infusion containing a working copy of the gene during groundbreaking surgery that took just 16 minutes, the 18-month-old can hear almost perfectly and enjoys playing with toy drums. Her parents were left “gobsmacked” when they realised she could hear for the first time after the treatment. “I couldn’t really believe it,” Opal’s mother, Jo Sandy, said. “It was … bonkers.”

Via this thread of breakthroughs.

Meanwhile, the Hearing Aid feature on AirPods Pro 2 is also very cool and, if the advert doesn’t make you cry, you’re probably a replicant.

Blindness

A new Blindsight device from Neuralink offers huge hope to the blind. As Elon Musk says, it allows ‘even those who have lost both eyes and their optic nerve to see. Provided the visual cortex is intact, it will even enable those who have been blind from birth to see for the first time.’

Diabetes

A woman with type 2 diabetes was cured with stem cells taken from her own body - a world first. Meanwhile a new anti-diabetes drug, Tirzepatide, has proved successful in trials; participants with obesity and pre-diabetes who took the drug had a 90 per cent lower risk of progressing to diabetes compared to the control group.

Alzheimer’s

Tirzepatide is similar to Semaglutide, probably the stand-out drug of the decade due to its huge success in reducing obesity as well as a whole load of other health conditions. Semaglutide may be one of those rare drugs which drastically changes the face of society, quite literally.

Its health benefits seem to be immense, and people who took the drug were also 33 per cent less likely to die from Covid, and 19 per cent less likely to die prematurely of all causes. The drug, under the brand name Ozempic, also seems to be associated with a reduced risk ofAlzheimer’s. Next year we’ll know the full results of the Danish drug’s potential when two clinical trials conclude.

Heart implants

A baby received a living heart-valve implant for the first time. Unlike with existing heart valves, or ‘cadaver homografts’, this doesn’t have to be replaced, as it grows with the body.

Lung cancer

This year saw progress in the treatment of lung cancer. The oral drug Lorlatinib reduced progression of a specific type of advanced lung cancer by 81 per cent in phase 3 trials, compared to an existing drug; 60 per cent of patients survived 5 years without any progression in the cancer, compared to 8 per cent in the control group.

As Dattani writes, another new drug, Osimertinib, has shown to give sufferers an extra 40 months of life, as opposed to just 5.6 months. The drug inhibits the EGFR protein which in some lung cancers mutates and signals cancer cells to grow.

There is also a lung cancer vaccine trial ongoing. The new jab instructs the body to find and kill cancer cells, but also prevent them coming back, and experts have called it ‘groundbreaking’.

Skin cancer

‘A clinical trial of a combined mRNA vaccine and cancer immunotherapy treatment significantly improved odds of survival for patients with melanoma’, reported Semafor. The results ‘come from a Moderna-Merck trial involving 157 people with mid-stage cancer who were followed over two and a half years.’ This could open the way for personalised cancer therapies tailored to a person’s own immune system.

We’ve come a long way: Edward Jenner performing his first vaccination, on eight-year-old James Phipps, in 1796

Cervical cancer

It’s now possible to virtually eliminate cervical cancer with existing HPV vaccines, Dattani says. Scotland has detected no cases of cervical cancer in women born between 1988-1996, who were all vaccinated in their early teens.

Other cancer gains

A new personalised bowel cancer vaccine jab, which could help prevent the illness returning after surgery, has been given to a patient.

The NHS is also testing vaccines against bowel, breast, lung and skin cancer.

Data shows declining mortality rates for colon cancer, breast cancer and leukaemia

Meanwhile, a ‘beam of radioactive carbon ions has been used to destroy cancer cells in mice’, which could open the way for treatment on types of cancer that are close to vital organs, which makes current treatments risky.

Lupus

Researchers have identified the cause of lupus, an autoimmune disease that causes intense pain and can be life-threatening.

Parkinson’s

This remarkable before and after video ‘shows the improvement made by a Parkinson’s patient after just two days on a new drug treatment’, called Produodopa. From this year, 1,000 people will benefit from the drug via the NHS.

Speech therapy

An exciting new form of speech therapy decodes the attempted speech of a man with amyotrophic lateral sclerosis, a fatal form of motor neurone disease, ‘into text with 97.5 per cent accuracy, enabling him to communicate with his family, friends, and colleagues in his own home’.

Gene editing

Last year’s huge breakthrough in the treatment of sickle cell came from gene editing. As Derek Thompson wrote at the end of 2023, it was ‘this year’s top breakthrough not only because of heroic work done in the past 12 months, but also because of a long thread of heroes whose work spans decades.’

Further advances have been made with the technology this year, in particular with a new ‘bridge recombination system’ developed by the non-profit biomedical research Arc Institute. The Financial Times described how the new method ‘could enable more precise modifications of genetic code and avoid the need to break sequences and later repair them.’ It opens the way for a revolution in the way that genetic conditions are treated.

Patrick Collison, cofounder of the Arc Institute, described the breakthrough back in June, concluding: ‘As we stand on the brink of this new frontier, I’m reminded of a quote from Arthur C. Clarke: “Any sufficiently advanced technology is indistinguishable from magic.” With bridge recombination, we’re not just editing the genome anymore. We’re writing it. And that, my friends, is pretty close to magic.’

Have a Happy New Year everyone, and be thankful to live in such a time of miracles and magic - my normal doom-mongering pessimism will return after the holiday.