It's Time to Engineer Resilience for Humankind

The Immunotherapy Lesson

Medicine constantly reinvents itself, driven by changing needs of the population and evolving capacities of technology. Until 2015, the idea that the immune system could fight cancer was a fringe concept. Early immunologists were dismissed as dreamers chasing a phantom cure. Tumors, after all, grew from the body's own cells—how could the immune system learn to attack itself without causing chaos? The data were inconsistent, the mechanisms murky, the funding scarce.

What began as speculation about "immune surveillance" became engineering: mapping checkpoints, decoding T-cell receptors, and designing chimeric antigen receptors that could be programmed like software.

The Second Generation of Translational Medicine

Translational medicine is now firmly in its second generation following the human genome map. Gene-therapy manufacturing pipelines and cell-therapy platforms—once bespoke academic experiments—became reproducible technologies. By the 2010s, checkpoint inhibitors had turned from hypothesis to frontline therapy, and CAR-T treatments were curing blood cancers once deemed terminal. The field didn't just find new drugs; it built an entirely new therapeutic architecture.

While the biotech industry weathers a downturn—a natural phenomenon denoting the end of a first boom and the urgency to find the next-generation approach—we can appreciate how the technology of medicine changed the regulation of medicine.

Policy Follows Possibility

Policy—specifically how we fund, regulate, and price medicine—shifted around what became possible. The FDA rewrote its playbook to keep pace with the new era of genetic medicines and re-engineered immune systems, creating:

• Biomarker-based, tissue-agnostic approvals
• Accelerated pathways
• A dedicated Oncology Center of Excellence

CMS wrote new billing codes so hospitals could actually get paid to deliver these therapies. NIH and NCI went from cautious funders to full-on venture catalysts—Moonshot, IOTN, public-private biomarker alliances that made immune engineering a national enterprise.

Chemical Defense is Rotating Too

Techniques that could reprogram immunity to destroy cancer also expanded the horizon of what biology could do—for healing and for harm. Oncolytic viruses, engineered receptors, and modular gene-editing systems blurred the line between therapy and potential dual-use technology. Regulators have begun treating immuno-oncology not only as medicine but as part of the broader chemical defense landscape, where safety, oversight, and resilience must develop in lockstep with innovation.

What began as heresy became one of medicine's greatest triumphs—not by chance, but by re-engineering a system we barely understood.

The New Threat: Slow Apocalypse

Now we're staring at a different class of threat—not acute, but ambient. Chronic diseases creeping up through chemical exposure, metabolic chaos, neurodegeneration, infertility. A slow apocalypse that costs trillions and doesn't make headlines.

These ubiquitous conditions are rippling through healthcare systems with annual U.S. costs upward of the trillion-dollar mark. For half a century, we've been measuring harm instead of designing defense. We've built a surveillance system, not a shield.

The Four Rotations

To make resilience a core design principle of human health, four rotations must turn in sync:

1. Bench science — From measuring harm to designing defense
2. Translational medicine — From reactive treatment to early intervention
3. Policy — From reactive compliance to proactive incentives
4. Chemical Defense — From pathogen-only to chemical threat inclusion

When those axes align, they can reorient biotechnology from reactive care to proactive protection—not just treating illness, but engineering resistance to it. Like orienting lenses to amplify a single beam of light, progress in the biological sciences will require four coordinated adjustments simultaneously.

The Tools Exist

The tools we need already exist—they're just pointed in the wrong direction. Biotech has been optimized for repair, not defense. But the machinery is all there: toxicology, computation, pharmacology, cell biology. We've just been staring at the wrong part of the problem.

This isn't a dead end. It's a local minimum. Shift a few parameters—at the bench, in translation, in policy, and in chemical defense—and the model flips from reaction to resilience.

At the Bench: From Measuring Harm to Designing Defense

Toxicology has spent a century playing goalie for the EPA—defining limits, flagging danger, keeping civilization barely livable. But that caution trapped the field in observation mode. It measures what breaks instead of building what endures.

Time to flip it. The same hardware that built the biotech boom—single-cell maps, organoids, high-throughput screens, AI-driven perturbations—can create next-generation toxicology as a new discipline.

EPA's ToxCast and Tox21 programs proved the concept: pharma-grade tools can profile how thousands of chemicals interact with living systems. Shifting from evaluating toxicological apical endpoints to druggable targets is the holy grail of human biology—allowing us to modulate mechanisms of action that strengthen the body's ability to withstand exposures.

Translational Medicine: Build Early, Act Early

Medicine today is brilliant at crisis management and terrible at prevention. We can patch arteries and edit genes, but only after the system collapses. The next frontier is resilience by design—catching disease in its molecular infancy, when damage is still reversible and prevention is still possible.

The tools of the biotech age—omics, cell profiling, and AI-driven pattern recognition—make this future possible. They can reveal the subclinical changes that mark the earliest steps toward illness. And once we can see those steps clearly, we can stop them.

Policy: Constructing Incentives

The 20th century got it right—Clean Air Act, Montreal Protocol, lead phaseout—massive ROI on prevention. Every dollar spent saved thirty. Then we stopped.

Policy is leverage, and thwarting disease should be rewarded. There is evidence that the tide is turning toward incentivizing proactive protection of human health. The FDA's recent shift to surrogate biomarkers and early disease indicators hints at a new philosophy: catch it before it counts.

Chemical Defense: Innovation's Guardrails

Humanity learned to defend itself against fast-moving threats. We built vaccines, antibiotics, and surveillance systems that turned pandemics from civilization-ending events into manageable emergencies. Yet slow-moving threats—chemical exposures that accumulate in tissue and ecosystems—have slipped through the cracks.

These pollutants are the chronic counterpart to pathogens: bioaccumulative, mutagenic, and immunomodulatory. They don't regularly spark headlines, but over decades they erode the foundations of our society's physical and economic resilience.

The Goal

The goal is simple: protect humans from the constant chemical barrage of modern life so we can live longer, healthier, and freer lives.

We don't need a moonshot; we need a realignment.