"Environmental pollution will cause the number of cancer cases to skyrocket"

 Foto: UOC

Foto: UOC

Maria Subarroca
Ramon Gomis, endocrinologist and dean of the UOC's Faculty of Health Sciences


What is on the horizon for medicine in the coming years? We caught up with the dean of the UOC's Faculty of Health Sciences, Ramon Gomis, to find out. Dr Gomis is an expert on health whose knowledge extends far beyond his specialization in endocrinology. He is a full emeritus professor at the University of Barcelona's Faculty of Medicine and an emeritus researcher at the August Pi i Sunyer Biomedical Research Institute (IDIBAPS), which he has directed since 2008. In addition to his prestigious medical career, he is also a playwright and author. In our interview, he tells us why, among other trends, we will be hearing a great deal about planetary health in the coming years.


What do you see as being the key trends in medicine for 2020?

Disease prevention. We have already learned that it is more important to focus on prevention than waiting for diseases to develop and subsequently putting efforts into treatment. For example, it is better to concentrate on stamping out smoking and reducing the number of cases of lung cancer and myocardial infarction than to put a lot of effort into treating lung cancers caused by individual and collective behaviours.

And secondly, there is the concept of planetary health and global well-being. We now know that our actions, attitudes, and behaviours have an impact that may affect the health of people living in far flung places of the planet. And not only do these pose a risk to current generations but to future generations as well. The climate summit in Madrid has recently taken place and there is a growing awareness that our actions now go as far as representing a threat to the survival of the human race as a whole. As such, I believe that disease prevention will go beyond looking at what we do on an individual and community level to also considering the global attitudes that affect the balance of our ecosystems.

What are the behaviours that affect planetary health?

Firstly, those related to energy use, because, if we continue to source our energy from oil and coal it will result in climate change that will also have repercussions for our grandchildren and great-grandchildren. Climate change will have an impact on our health. A rise in temperatures of an average of two degrees, for example, will cause higher mortality rates among the elderly population, the risk of contracting an infection will be increased and dehydration-related conditions and gastrointestinal illnesses will become more virulent.

In addition, when there are storms and floods, it results in people dying and there is an obvious health risk. Elsewhere, desertification is causing famines and we can't forget the fact that there are still people around the world dying from malnutrition.

Secondly, the impact of environmental pollution on those of us who are already elderly is limited but will be very significant for generations, such as those of my grandchildren, generating numerous health problems. Environmental pollution will cause the number of cancer cases to skyrocket, as well as an increase in the amount of immune-related diseases, such as multiple sclerosis or type 1 diabetes. High levels of environmental pollution also has an effect on fertility rates, as a result of endocrine disruptors.

In addition to combatting air pollution, we also need to protect soils and water resources. If we throw plastics into the Mediterranean, the fish end up full of microplastics that are harmful to the humans who consume them. Similarly, if you dump mercury into the River Nile, it ends up in the fish that we consume caught along the Valencia and Barcelona coast, and this mercury affects brain development in children and young people.

Our diet is another important factor: increased meat consumption results in the need for intensive livestock farming and nitrate pollution from animal slurry is linked to coronary heart disease.

These activities transcend medicine and relate to our economic model. How can they be transformed from a planetary health perspective?

We need to demonstrate that it's not enough just to recycle waste, we also have to reduce consumption. We are not talking about going back to a pre-industrial age. Planetary health does not mean doing away with what we understand as 'progress'; our goal is to achieve a global balance which ensures the health of everyone currently living in the world, as well as of those who will be living here in 100 years' time.

And the success of that does not only require the services of doctors. We need to train economists in planetary health, lawyers who can formulate laws to protect people's health, technology experts who are able to offer solutions... The input of all these professionals is required, for example, when it comes to trying to reduce pollution in a city by limiting the amount of traffic in circulation.

And we must not forget research, which is crucial. We need to find formulas for the reuse of CO2 and the reduction of its levels in the atmosphere. And, for example, if we reduce meat consumption, laboratory-produced protein would represent a positive step as a potentially highly efficient way of generating food for people.

An increase in the use of artificial intelligence is another trend for 2020. What are the main applications of this form of technology in medicine?

Artificial intelligence is an area with great potential for application in the field of medicine. Firstly, because it allows us to study the health of large population groups. For instance, when studying the effects of a drug, we look at what happens in two groups of people administered different treatments and then conduct a comparative statistical analysis. Some situations are impossible to simulate, however, such as the effects of living at an average temperature of 33°C compared to a temperature of 30°C and that is where big data and artificial intelligence come in, allowing us to carry out holistic studies on large populations, which provides us with a global perspective.

It can also be very useful with regard to the analysis of diagnostic tests. It is not feasible for every health centre to have a good radiology specialist on site to analyse CT scans, but it is possible for them to have a machine that will analyse it. Or even one that reads the patient's entire medical history and sends the condensed data to another doctor involved in the diagnosis.

Another application is the use of robotics in facilitating remote operations. This always needs to be monitored, however, even though algorithms can help with treatment-related decision-making. Even if machines can propose suggestions, final decisions need to be made by doctors, as artificial intelligence may have drawn conclusions from the data without considering all the circumstances. And we also need to define all the parameters that should be considered by the machine.

Genome sequencing has generated advances in nutritional genetics and pharmacogenomics. Will we see a customization of genome-based medicine in years to come?

Personalized medicine is on its way. In fact, analyses are already being carried out for patients with urinary tract infections to generate an antibiogram which identifies the most effective antibiotic treatment for a specific bacterium. It's a simple yet personalized process, and there will be more of this type of personalization. To give you an example, if we have a highly effective drug that causes side effects, such as hair loss or vomiting, in 70% of patients, genome analysis will enable us to identify those people who will not suffer side effects and administer the drug to them alone. In fact, in some cancer treatments, tumour markers that help doctors decide whether chemotherapy is needed have already been developed. And in the event of a possible diagnosis of multiple sclerosis, your doctor will be able to see if your genome is predisposed to the disease or rules it out. Nutrigenomics also has great potential: by taking blood samples from newborns with a heel prick to analyse their genome we can predict any possible food intolerances and design a customized nutritional plan.

The human brain still holds many secrets. What are the main obstacles we face with regard to combatting diseases such as Alzheimer's?

We can only develop cures for diseases when we know what causes them. When we have a case, such as diabetes, where we only know what the symptoms are, they can be alleviated but not cured. If we could detect Alzheimer's 30 years before it was developed, we could certainly at least find a way of delaying it.

The problem with many of these diseases is that the underlying problem has already existed for many years before the symptoms appear. That is the concept at the heart of the debate on what having or not having an illness means. That is, at what point does an illness begin? Is it when I have a malignant cell, or when I already have a tumour that is causing symptoms? When am I deemed to have Alzheimer's? When amyloid deposition begins to occur in my brain, even though I'm still fine, or when I start to exhibit symptoms?

We are currently treating it when the symptoms appear, as disease is usually identified on the basis of the symptoms. Conversely, however, the identification of symptoms does not necessarily mean the presence of some kind of disease. A headache may not be a sign of any disease or it may be an indication of meningitis, for example. The symptom is the same but a symptom does not always imply the existence of a disease. That's why internet medicine is so disastrous in my view because it's based on the assumption that a set of symptoms indicate the existence of a specific disease, and that's just not the case. You may have symptoms without any illness or it could be an indicator of something extremely serious.

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