The Emergence of Regenerative Medicine: A New Field and a New Society

Abstract

WE ARE EMBARKING ON A GREAT ENTERPRISE: the formation of a new field of medicine that will improve the lives of people everywhere by curing disease. It will spawn academic departments as well as companies. I hope our efforts will stimulate progress by encouraging scientific collaborations and government funding. We who are active in this area must also ensure that the potential of regenerative medicine is understood by reimbursement authorities. The seeds of regenerative medicine were planted by researchers in disparate disciplines. Yet there is also a unity to regenerative medicine, which stems from a common need. Bodies eventually wear out and need components to be restored or replaced. The key insight of regenerative medicine is that every human being was once a single cell with the potential to transform into an adult body. Each of our cells retains that remarkable potential in a latent form. We have over the past decade learned how to identify the molecules that our bodies use to direct that great unfolding. We can now isolate, study, and produce those substances in virtually unlimited quantities and use them to regenerate our tissues and organs. Non-living components can also restore functions within the body. Materials engineered to atomic-scale precision hold immense promise for this application. Physicians already commonly treat patients by implanting artificial hip joints, heart valves, blood vessels, and even intricate parts of the inner ear. Today such devices perform poorly in comparison with nature, but within the foreseeable future they will function almost as well as our natural components. We will restore organs and tissues that have been injured by trauma, damaged by disease, or worn by time. The medical use of natural human components, together with high-technology non-living materials, could thus alleviate much human suffering. This medicine will be transforming. It can help everyone who ages: that is, all of us. It can also address pressing social, political, and economic issues, contributing to a healthier, active, productive older population. One such issue is the demographic transition. As a country becomes richer, security in old age depends less on having children and more on the durability of social arrangements. As a result, the species no longer replaces its numbers, and the average age of the population increases. This trend portends enormous economic and social difficulties in coming decades. It has been termed an “aging crisis.” Western Europe and the Pacific rim feel the crisis especially strongly. Spain affords a dramatic example. In 1960, the average number of children per family was 2.9, considerably more than the replacement rate. Today, the figure is about 1.2, which is less than half the replacement rate. The birth rate throughout the area encompassed by one view of Europe—from the Urals to the Atlantic and from the Baltic to the Mediterranean—is low enough to bring about severe demographic problems. Fifty years from now, the native-born population of Italy will be half its current size. The same will be true of Japan. North America would face similar problems save for immigration. People commonly retire when they reach 60 or 65 years of age. Yet many of them live for decades beyond that age. As the average age of the population increases, therefore, a dwindling number of young people supports the retirement of a growing number of older ones.