Abstract

Very considerable progress throughout the 20th century in disease prevention and the treatment of infections has led to progressive increases in life expectancy, particularly in the economically developed countries. Nevertheless, despite recent advances, we are woefully poor at managing the major common diseases once they are evident in individuals, including cardiometabolic and chronic degenerative diseases and cancer. This deficiency is indicative of a more pervasive problem, which is our inability to account for individual differences, poor patient and disease stratification and clinical pathology that is relatively unchanged in 50-100 years. The challenge for medical research over the next few years is to complete a revolution in the way in which we understand an individual's susceptibility to disease, using genetic, imaging and digital tools that will characterise the pathology of disease at a cellular and molecular level. This is how we will design better treatment, defray the risks of drug development, and increase the power of our clinical trials. Where advances have been most rapid, they have frequently occurred in those disciplines where it has been possible to isolate cells at high purity, particularly in immunology. We need to consider how the lessons from immunology can be applied more widely.