Diseases of Man in the First Third of the 21st Century and the Future: Evolution of Pathogens and Pathologies

The beginning of the 21st century became the era of an epidemiological transition, where acute infections as the main killers were replaced by chronic non-communicable diseases, however, the COVID-19 pandemic cruelly reminded us of the persisting threat from new pathogens. The health of humanity is now determined by a complex interaction of biology, technology, ecology, and society.

Dominant Reality: Chronic Non-communicable Diseases (CNCD)

These diseases, characterized by a long duration and multifactorial etiology, account for more than 70% of global mortality (according to WHO data).

Cardiovascular diseases (CVD). Remain the number one killer. Their "youthfulness" and spread in developing countries are related to urbanization, sedentary lifestyle, diet high in ultra-processed foods, trans fats, and sugar. An interesting fact: AI technologies are already being used for the analysis of ECG data and coronary artery scans, predicting the risk of myocardial infarction with accuracy exceeding traditional methods.

Oncological diseases. Cancer has ceased to be an unconditional sentence, turning into a more manageable chronic condition. The revolution was caused by immuno-oncology (therapy with checkpoint inhibitors, CAR-T cell therapy), which "teaches" the patient's immune system to recognize and destroy the tumor. However, the incidence of cancer related to lifestyle and environment (colorectal, melanoma) is increasing.

Metabolic and endocrine disorders. Type 2 diabetes has acquired pandemic proportions, directly related to obesity. It is not just a disease of carbohydrate metabolism, but a systemic inflammatory disease. Technologies for continuous glucose monitoring and "artificial pancreas" are being developed.

Neurodegenerative and Mental Disorders.

Alzheimer's disease and other dementias are becoming one of the main medical and social problems of aging societies. The focus is shifting from the search for treatment to early preclinical diagnosis using blood biomarkers and positron emission tomography (PET).

Depression and anxiety disorders are recognized as leading causes of lost years of healthy life. Their growth is associated with chronic stress, digital hyperstimulation, and social stratification.

Return and New Threats of Infections

The world has not become post-infectious.

The COVID-19 pandemic has become a global stress test, demonstrating the vulnerability of a globalized world to zoonotic infections (transmitted from animals). It has accelerated the development of platform technologies for vaccines (mRNA) and has given rise to a new nosology — post-COVID syndrome (long COVID), a chronic multisystemic condition whose mechanisms are not fully understood.

Antimicrobial resistance (AMR). This is a silent pandemic. Bacteria resistant to last-resort antibiotics (carbapenems, colistin) make common infections and routine operations deadly. According to some forecasts, by 2050, AMR could cause 10 million deaths per year.

Change in the ranges of vectors. Global warming is expanding the habitats of Aedes aegypti mosquitoes, carrying dengue fever, chikungunya, Zika virus, into previously safe regions, including Southern Europe and the southern United States.

Diseases of the Future: The Horizon of 2040-2050

Diseases induced by technology.

Digital neuroses and cyberdependence: From FOMO (fear of missing out) to clinical attention disorders due to constant multitasking.

Problems related to artificial environments: "Sick Building Syndrome", consequences of long-term exposure to new chemicals in materials and air suspensions from 3D printers.

Adverse effects from implants and biointerfaces: Rejection of neuroimplants, cyberattacks on implanted medical devices (cardiac pacemakers, insulin pumps).

Ecologically-induced diseases.

Consequences of climate disasters: An increase in cardiovascular and pulmonary pathology due to extreme heat and forest fires (PM2.5 particles), outbreaks of infections after floods.

Chemical pollution: Endocrine disruptors (bisphenol A, phthalates) in plastic are associated with rising infertility, obesity, and certain types of cancer.

Geriatric multimorbidity. The main patient will be an elderly person with 5-7 interrelated chronic diseases (e.g., diabetes + heart failure + kidney failure + osteoporosis). Medicine will face the problem of polypharmacy (multiple drug use) and their interactions.

Diseases related to genome editing. With the spread of technologies like CRISPR-Cas9, unintended consequences of gene therapy (off-target effects, long-term risks of oncogenesis) may arise, as well as ethical dilemmas related to enhancement (improvement) of humans.

Fundamental Shift: From Disease Treatment to Health Management

The future of medicine lies in the predictive, preventive, and personalized paradigm (P4-medicine).

Predictive: Analysis of the genome, microbiome, and data from wearable devices will allow predicting risks years before the onset of the disease.

Preventive: Based on the forecast, personalized interventions will be offered — from diet and lifestyle to preclinical therapy.

Personalized: Treatment will be tailored based on the genetic profile of a specific tumor or patient's pathology.

Participatory (collaborative): The patient will become an active co-manager of their health through digital platforms.

Conclusion

The diseases of the first third of the 21st century reflect the triumphs and costs of progress. We have defeated the plague and smallpox, but have bred pandemics of diabetes and depression. We have created antibiotics, but have triggered an antimicrobial apocalypse. In the future, we are facing not the emergence of one or two "new" diseases, but the complexity of the pathological landscape: the superimposition of technological, ecological, and social risks on an aging body. Success will depend on the ability of medicine to shift from reactive symptom management to proactive management of complex health trajectories throughout a person's life. The main challenge will not be the search for a "magic pill," but the systemic restructuring of the living environment, nutrition, and social relations in the interest of human biological well-being.
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