1/ Check out my talk from this year’s @a16z Summit, where I give a brief overview on the future of medicine. CliffsNotes thread 👇
2/ Our earliest medicines were discovered in nature; later, we learned to use tools like chemistry to develop our own novel molecules; and when we couldn’t synthesize complex proteins ourselves (like insulin), we harnessed biotechnology to coax bacteria to produce them for us
3/ But the frontier of medicine is moving beyond chemicals and proteins; we’re increasingly able to program living things like cells, genes and mircrobes to serve as therapies 
4/ What does it mean to program a cell? In the case of cancer, it’s engineering a patient’s immune cells to recognize its own cancer and to recruit that patient’s immune system to attack
5/ Programming genes? Goal is to edit/correct for mututions with high precision w/o introducing new errors. You’ve seen CRISPR in the news; editing DNA in humans is controversial precisely because it’s challenging, risky and likely permanent. But it may also be transformative
6/ And microbes? One of the core aims of medicine is to ward off infection. But the micrbiome, the bacterial ecosystem inside of all of us, is central to regulating our health. Scientists are working to engineer “good” bacteria that offer therapeutic benefits: bugs as drugs!
7/ But the threshold for any prospective therapy is that it must first be proven to be safe and effective. So how do we turn cells, genes, bugs into medicine?
8/ There are 4 key imperatives for programming living things as medicines. They must be able to: 1) sense presence/absence of disease, 2) execute a predetermined course of action, 3) contain activity only to relevant sites, 4) terminate function and/or themselves
9/ This sounds futuristic but it’s already happening. We recently had the first @US_FDA approvals for engineered CAR-T cells and gene therapies. And there are many companies working on promising building blocks for the next generation of programmable medicines
end/ None of this will be easy and, of course, the burden of proof should remain high. But as we are increasingly able to program cells/genes/microbes as medicines, we will come closer to achieving medicine’s highest aim: to cure us of disease
(bonus ironic Easter egg: there’s at least one typo in this thread warning about the risk of errors in editing DNA)
