Sunday, March 16, 2008
Medical Megatrends and the Future of Healthcare in America
Several megatrends will profoundly affect health care in the coming five to 15 years. Some are due to the explosion of basic understandings of cellular and molecular biology. Others are related to advances in engineering and computer science. Together they will create huge shifts in medicine: Medical care will be custom-tailored for the individual patient; the medical model will move from “Diagnose and Treat” to Predict and Prevent”; repairing or replacing tissue and organs will be much improved; your medical information will be available no matter where you are; and medicine itself will become much safer.
Why will this happen? The science of genomics – a word few knew and fewer still understood at the turn of the century – has opened a new era in medicine. Understanding the DNA code of life will allow us to predict diseases that will occur in later years; to create drugs targeted at a specific molecular focus; to prescribe a drug that will definitively work for an individual with few if any side effects; and to assay whether a disease such as a cancer will recur after a course of therapy. Knowledge of stem cells will advance. Already stem cells are used in the treatment and occasional cure of some leukemias, and preliminary studies are focusing on stem cells administered after a heart attack in hopes of restoring cardiac muscles and small blood vessels. Genomics will allow your physician to select the most appropriate medication for you, not just the one that works for most people. And he or she [more and more she since 50 percent of medical school graduates are now women] will also be able to select a drug that is less likely to cause a side effect in your body – all from knowing your genomic information.
New vaccines, courtesy of advances in immunology, prevent infections such as herpes zoster – the shingles – in later years and cervical cancer in younger women. We can expect more new vaccines and many will be administered by patch, orally or by nasal spray rather than by shots. Eventually, vaccines will prevent cancers and help treat cancer – a prostate cancer treatment vaccine is under review by the FDA and awaiting added clinical trials. Look for vaccines to help treat many chronic diseases like multiple sclerosis and type 1 diabetes and to help prevent Alzheimer’s, atherosclerosis and possibly even drug addiction. A vaccine may be made up specifically for you – a designer vaccine – to treat your specific cancer.
Xenotransplantation – using an organ from an animal rather than a human – will become available so that a person needing a heart or kidney will get it immediately and not need to wait and “hope” for someone else to die.
Just as basic medical science is advancing, so, too, is engineering and computer science. Imaging has progressed dramatically such that today’s CT scanners can produce exquisite pictures of our anatomy. Coronary arteries can be visualized inside to detect obstructions -- once seen only with the more invasive angiography technique – helping emergency room doctors diagnose the cause of chest pain.
Digitally recorded images can be manipulated and visualized in three dimensions; organs can be rendered in different colors – heart, red; lungs, blue; stomach, white; etc, -- all to get a clearer view. Think of the advantages to the surgeon who will now know just what to expect before beginning an operation. Increasingly, molecular changes in the cells can be detected and reported as an image. For example, we will be able to differentiate whether a cancer has spread or whether it has regressed after chemotherapy.
Engineering and computer science advances have created a myriad of medical devices that are smaller and more powerful with long battery life. The vice president’s implanted heart defibrillator is an example. So, too, are similarly implanted devices that go not to the heart but to the vagus nerve which travels down the neck from the brain. A tiny electrical impulse sent upstream can help reduce epileptic attacks or improve serious depression. Pumps the size of a cigarette box on the belt can pump insulin at just the right rate for a diabetic and the newer ones coming – “closed loop” models – will be able to continuously monitor blood sugar and tell the pump how much to inject. No more finger sticks!
The operating room is now a technologic marvel and will become even more so. More surgeries will be done in less invasive manners, such as those performed in the radiology suite where tiny catheters inserted via a vein or artery in the groin advance to a site of disease and correct it without typical surgery. Just two examples are inserting a graft to correct an aortic aneurysm and inserting platinum coils into a brain aneurysm – both done in an hour or so without open surgery and a long hospital stay and recuperation. Just as an airline pilot practices in a simulator before ever sitting in the cockpit, so, too, will surgical trainees demonstrate their competency before ever operating. Master surgeons will use the simulator to practice a specific surgical approach for an individual patient based on the patient’s own CT scan inserted into the simulator for the practice run. Robots will assist the surgeon based on the information uploaded from the simulated practice; the robot never gets tired, does not feel sore from leaning over the operating room table and can be programmed for “no fly zones” – specific areas not to venture into even if accidentally directed by the surgeon who is always in control of the robot.
And, at last, the time will come in five to 15 years when all medical information, from your doctor’s office notes to images for the surgery, will all be digitized and available n your medical record. Wherever you are your medical information will be available instantly – either via the Internet or from a record on a chip on a card in your wallet or on a flash memory device, now worn by our soldiers as a dog tag.
We will see complementary medicine become part of the mainstream of care as it is taught more and more in medical school and is subjected to the same types of scientific analysis as other medical techniques.
Once hospital trustees begin to recognize that they should spend as much time focusing on safety as they do on finances then they will insist that hospital CEOs and staff in turn focus appropriate attention on improving safety and reducing preventable medical errors, now all too common with some 100,000 preventable deaths each year in American hospitals.
Policy changes by government officials to make medical care more available, more affordable, safer and better distributed are moving at a glacial pace. But medical care as outlined above is changing rapidly. And it will continue to do so because of the convergence of laboratory discoveries, engineering skills and computational power, entrepreneurial focus, and the ability to patent intellectual property. The megatrends above are inevitable – albeit the time frame for each will certainly vary. Unfortunately, we cannot be nearly so confident that health policy will keep up with our medical knowledge and abilities.
Stephen C Schimpff, MD
Author “The Future of Medicine – Megatrends in Healthcare That Will Improve Your Quality of Life”
Retired Chief Executive Officer, University of Maryland Medical Center
Praise for Dr Schimpff
The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.
-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).