Physicists have long sought their grand “theory of everything,” but in the decades ahead, it is biology that will supply the one, grand conceptual category in which most aspects of human health, wealth, and happiness come together. The strength of our economy, the disease resistance of our children, the question of how long we live—even deeper questions such as what is life and who (or what?) is human—are all subject to the influence of the new world of life sciences, their emerging technologies, and the business acumen of those building industries to extract value from these sciences.

Above all, the life sciences are being transformed by the global nature of research and development, an enterprise in which the same or similar efforts are moving at different speeds in different places, with different values, different levels of government regulation, different elements of integration, and with different incentives and costs structures. Meanwhile, the life sciences themselves are being transformed by changing demographics, a confluence of technology, a global market, and an increasing array of options for extending human lifespan—a development that will perplex economists as much as ethicists. As we give ever more people the prospect of living ever longer, we will be forced to wrestle with the question of just how much longevity our society can afford, and what such a shift in the demographic center of gravity will mean.

Every entrepreneur in every startup is competing everywhere, accessing science everywhere, from day one. Intellectual property is a global issue, from day one. Capital is global. And the Web provides for real time, global collaboration never before imagined. For example, bioengineering researchers at UC San Diego have assembled a virtual human metabolic network that will give researchers a new way to hunt for better treatments for hundreds of disorders, from diabetes to high levels of cholesterol in the blood. This novel metabolic network builds on the sequencing of the human genome and contains more than 3,300 known human biochemical transformations that have been documented during 50 years of research worldwide. UCSD has made it available free online for any researcher in the world to use. The dark side of “one world” is that disease vectors do not understand borders, and people travel with pathogens riding their coattails.

For the past 2,000 years, medicine has been in a steady state, and the first time that the average patient was likely to receive benefit from an encounter with the average physician was about 100 years ago. Even today, although they have far better understanding and tools than in the past, physicians generally treat patients the same way Galen did - by addressing symptoms rather than the underlying course of disease.

However, with genomics and proteomics, predictive modeling, informatics, AI, and algorithms that can apply scientific data to individual disorders, medicine is gaining the capacity not only to dig deeper into the root causes of disease, but to get personal. Increasingly, doctors can determine the exact nature of the individual patient’s tumor - Fred’s tumor or Margaret’s tumor - not how it appears in the context of the average tumor. Moreover, they can begin to determine which specific interventions - at the molecular and systemic levels - will work most effectively for Fred or Margaret based on Fred or Margaret’s individual genetic makeup, lifestyle, and physiology.

Prompted by unexpected side effects of certain medicines recently brought to market, our regulatory system now adds to the pressure to move quickly beyond one-sizefits-all in every aspect of health technology. Patients vary from one to another, and their responses to drugs, medical devices, and diagnostics will also vary. In the past, therapeutics was the high value, high cost part of the formula, and diagnosis was cheap. With personalized medicine providing better tools to identify individual reactions to interventions, that proposition is reversed. Diagnostics becomes the key driver of value, and therapeutics becomes relegated to commodity status, the medical equivalent of high fructose corn syrup.

Gaining diagnostic access to illness at the deep, molecular level allows for medicine to become not only personalized but also predictive, which means that it can become preventive, which moves the name of the game from the treatment of illness to aggressive promotion of wellness. The shift to more personalized, predictive, and preventive medicine (the three Ps) will revolutionize the health care system and - especially when we consider costs and incentives - the rest of our lives as well. As custodians of public health and welfare, the federal government long ago imposed health warnings on cigarettes and alcohol. Then states outlawed smoking in public places, and made seat belt compliance and motorcycle helmets mandatory. Now New York City insists that restaurants ban trans fats and list the caloric content of their meals. In each case, new knowledge produced new possibilities for better outcomes that prompt new patterns of behavior. In medieval Europe, the primary objective of one’s brief life on earth was to prepare for the world to come. Now, we can expect to live 80 years or more, and we hope to live it in good health.

For pharmaceutical and biotechnology companies, the transformation of everything from diagnostics, to expectations, to social norms, represents both a constraint and a vast new opportunity. Until recently, big pharma has focused on discovering blockbuster drugs. Now, with the convergence of information technology, telecommunications, nanotechnology, power supplies, genomics, and proteonomics, smarter drug delivery and diagnostic labs on a chip, the smart money will move away from “blockbusterology” to spotting early warning signs of impending health problems. This transformation should expand pharma’s focus beyond the needs of the 10 percent who are sick to include the needs of the 90 percent who are well.

Fifty years ago, Philip K. Dick wrote Minority Report, a science fiction short story about future technology that provides specific, advance knowledge of crimes. Thirty years from now we will have technology that gives us specific, advance knowledge of illness. By that time, the cost of sequencing an individual’s genes will be down to $100. We may not only genotype every baby at birth but also implant a miniaturized smart card, updated throughout life via monitors circulating in the blood.

The ability of physicians to manage wellness through a combination of molecular access and IT will require equally dramatic changes in business models and investment strategies. Already, genome/proteome projects that are the first point of access to this systems approach are under way all over the globe, and Western companies take note: Chinese and Indian approaches to medicine have involved systems thinking for 5,000 years. Western, reductionist medicine must work harder to incorporate nodes and networks, along with an appreciation of how the social environment and belief systems affect the physiological environment.

And when I referred to high fructose corn syrup a moment ago, I wasn’t thinking only in terms of cost, but in terms of ubiquity. Go into a Whole Foods Market and you’ll see compelling evidence of the ways in which health consciousness permeates everything. Globally, we spent $214 billion in 2006 on prescription drugs, but we also spent $200 billion on nutraceuticals and dietary supplements, and this latter expenditure is not reimbursed by insurance. So where will the consumer see higher value going forward? The same individual who demonizes the motives and methods of big pharma often accepts the promise of holistic supplements with childlike faith.

Despite the fact that the US spends more per person on health care than any other country in the world, it does not rank even in the top 10 of countries in terms of average lifespan. Whereas we spend 16 percent of GDP on health, the average in other industrialized democracies, from Australia to Norway, is about 8 percent, and their measures of public health are generally better than ours.

The widening innovation gap in pharmaceutical R&D productivity has prompted the US Food and Drug Administration to implement its Critical Path Initiative not only to reduce the disparity between increasing R&D spending and decreasing novel drugs approved each year, but also to make medical research generally more efficient. The imperative grows stronger as our aging population becomes more susceptible to the chronic, debilitating diseases that are straining every nation’s health care budgets.

Health care costs in the US today are roughly $2.1 trillion, going to $4 trillion by 2015, which would represent about 20 percent of our gross domestic product. Chronic care already accounts for over 70 percent of that total. The cost of health care is the number one issue in most organized labor negotiations and a principal impediment to US industrial competitiveness. At General Motors, each car carries almost $2,000 of health care costs, more than the cost of steel. At Toyota, that number is about $300. The economics of health care are unusual in that innovation typically adds costs to the system. In the early 1980s, if you contracted AIDS, your life expectancy was at best two or three years. Now we can titrate the viral load and keep you alive indefinitely, but of course a living patient with a chronic condition is far more expensive than a dead one.

This highlights the necessity to innovate in ways that enhance prediction and prevention. We already face rationing health care and agonizing debates about withholding treatment for your mother to provide treatment for your toddler. Embedded ways of keeping Mom in great shape until she all of a sudden dies in her sleep is much cheaper than letting her decline into the need for chronic care. Intervening to prevent spina bifida before it occurs is cheaper still.

So who will pay for health care? Increasingly, in the US the payer is Medicare and Medicaid, but with political leaders reluctant to raise taxes to keep up with medical inflation, strapped governments are pushing costs back onto individuals through higher co-insurance and co-payments. With an increasing stake in paying for medicine, individuals confronted with the cost of their own chronic conditions will begin to make different choices. Ideally, they will opt out of the Burger Buster with fries and work to maintain wellness rather than waiting to get sick, then relying on the risk pool to pay for treatment. With the globalization of medical expertise, we will also see increased numbers of surgeries in places like Dubai. In Thailand, medical tourism is already the largest source of travel-related income.

Consider the number of biotech patent filings coming out of China and India, and you will see beyond doubt that the life sciences industries have matured, increasing competition for both human and technological resources. In the US and Europe, foreign postdocs are leaving the Pfizers and Mercks of the world to return to their countries of origin.

Clinical trials are now planned and conducted worldwide, particularly in China and India, where costs are 10 percent of what they are in the US or Europe. For national regulatory agencies this represents a significant challenge, particularly against the backdrop of the rising costs of bringing new medicines to market. Can duplicative regulatory requirements for approving new drugs be eliminated, without compromising safety?

Medical philanthropy and medical advocacy with a global focus is also changing the way medical research is conducted. The Gates Foundation, for example, has huge financial resources of “patient” capital - money whose returns are measured in terms of improvements in public health, not earnings per share. Gates resources are being directed toward solving global health issues, on which the foundation now spends about 60 percent of its funds. While the focus is on malaria, HIV/AIDS, and tuberculosis, the spin-off of innovation - potential therapies and vaccines - could be equivalent to the advances in IT, electronics, and materials science that resulted from NASA’s space research program.

The global nature of R&D means players will be coming to the field with different cultural backgrounds and widely divergent values. In the West, the church has performed a deft slight of hand in recasting questions about stem cells into a debate over when life begins, a debate that has impeded research and consumed endless hours of political discussion. But these ethical concerns are far from universal. I gave a speech in Moscow not long ago, and if I had become critically ill while visiting that city, Russian doctors might have begun shooting me up with stem cells immediately.

They are using the techniques clinically now to advance research, while we are still debating the spiritual dimensions of blastocysts. Then again, for my part as a venture capitalist, and passionate as I am about stem cells, I have yet to invest in any stem cell company. Much of the science is still too far away from products and markets.

Given the misguided debate in the US between 21st-century science and 1st-century theology, what can we expect when presented with the real issues - cell farms, women producing eggs for experimentation, the “human” rights of robots, human chimeras, and so on?

Which brings us back to the idea of the life sciences becoming the 21st century’s “theory of everything.” A few years ago, naturalist E.O. Wilson resuscitated the antique word “consilience” as the title and theme for his book about the unity of all knowledge. As biology converges with issues of law, ethics, religion, secular values, economic growth, and global competitiveness, we will truly see it defining and shaping more and more of how our lives are lived.