Wednesday, August 19, 2009

Medical Megatrends –Expect These Advances in Medicine Soon

In the book “The Future of Medicine-Megatrends in Healthcare” I refer to several medical megatrends will profoundly affect medical care advances 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 improvements in engineering and computer science. Together they will create huge shifts in medicine: First, medical care will become custom-tailored for the individual patient; second, prevention will come to the fore with the medical model moving from “Diagnose and Treat” to “Predict and Prevent”; third, repairing, restoring or replacing tissues and organs will be much improved; fourth, your medical information will be available, instantly, no matter where you are; and, fifth, medicine itself will become much safer and be of much higher quality.

Here are some of the advances in biological sciences. Genomics is at the heart of many. : Drug companies will be able to develop drugs that are designed from the beginning to be “targeted” to a specific problem – custom tailored. Already there are a number of new cancer drugs that fit this model such as Gleevec for chronic myelocytic leukemia. Today a physician must prescribe a drug knowing only that it works in “most” people but not whether it will work in you nor whether you will be among those to get a side effect. With genomic information, doctors will frequently be able to prescribe a drug for the individual knowing that first it will actually work and second that it will not have unexpected side effects. That will be a major advance. Genomics is already helping to subcategorize patients with the same type of cancer into those with good or poor prognoses – the former may need less aggressive treatment and the latter more aggressive approaches. Genomics also helps in early diagnosis. Imagine taking a sample of pus and knowing in less than an hour if it is infected with “staph” and whether it is resistant to antibiotics or not – a multiday process currently. And being able to predict what diseases a person might develop later in life [e.g. heart disease or colon cancer] would mean that a “prescription” for life style changes could be started to prevent or slow the disease occurrence [e.g., diet, exercise]. Or a drug might be prescribed early in life [e.g., statin to reduce cholesterol] or a procedure begun sooner than usual [colonoscopy for the person at high risk of early colon cancer.] All of these will mean more custom-tailored medicine for you and will change today’s medical paradigm from “Diagnose and Treat” to “Predict and Prevent.” And all of this will occur regardless of whatever healthcare reform emanates from Washington.

Other scientific advances are those of immunology which are making it possible to create new vaccines and improve our ability to transplant organs. There will be more vaccines to prevent many troublesome infections such as the new vaccines that prevent the “shingles” in older individuals and rotavirus diarrhea in infants. There are already vaccines that can prevent hepatoma, a type of liver cancer caused by one of the hepatitis viruses, and cervical cancer, usually caused by the human papilloma virus. And I will predict that there will be vaccines to prevent others cancers soon such as some types of leukemias and lymphomas and perhaps stomach cancer and some cancers of the head and neck. Look for vaccines to prevent or treat some of the most important chronic illnesses such as atherosclerosis and Alzheimer’s – these will be major advances. As to transplants, some day it will be possible to transplant an organ from a pig into a human without it being rejected. No longer will someone have to wait for another person to die to receive a heart, a lung, a kidney or liver.

Engineering and computer science is also advancing medicine rapidly. The new CT and MRI scanners give incredible images of our anatomy in a completely noninvasive manner. This means that diagnosis is much easier and more accurate and a surgeon knows exactly what he or she will find during surgery – a major advance.
Simulators - like those used by airline pilots for practice – will assist trainees before they ever approach a patient and will be used to test for competency and certification.
New technology in the OR will mean less invasive yet more effective surgery with a shorter recuperation time.
And there are many medical devices that have meant a restoration of normal function for many people. Think of the new heart pacemakers that regulate the heart’s rhythm or the defibrillators that prevent sudden death. Look for major advances here in the coming years. And similar devices can be used to reduce the frequency of epileptic seizures and even assist in treating depression.
In time, all medical information will be digitized and this will mean that there will finally be an electronic medical record – one that is available anytime, any place. This will mean much better health care for you, a big improvement for the doctor and a lower cost of care.
These are but some of the advances coming in the next few years. They will mean more custom-tailored medicine, better prevention, an increased ability to repair, restore or replace damaged organs, a medical record that is instantly available anytime or place and much safer medicine. It will be an exciting time to watch as medical care improves for all of us.

Sunday, August 2, 2009

World Class Health Care - An Imperative

In appropriating funds for the new Walter Reed National Military Medical Center and the new Fort Belvoir Community Hospital, Congress determined that the military should receive only “world class healthcare” but did not define the meaning of the term. When the Health Systems Advisory panel of the Defense Health Board described in the previous blog was assembled, it decided that its first order of business was to establish a benchmark for world class. After much discussion, research and debate, a document was prepared and is available at the web site listed below, in Appendix B. Here is a summary of what the panel felt were the key elements of world class.
The principal summary statement would be: A world class facility combines the best of the art and science of medicine in a focused manner, consistently and predictably delivers superior care and value, meaning high quality at a reasonable cost to both patient and society.
World class can be further defined as follows:
“A medical facility achieves the distinction of being considered world class by doing many things in an exceptional manner, including applying evidence-based healthcare principles and practices, along with the latest advances in the biomedical, informatics and engineering sciences; using the most appropriate state of- the-art technologies in an easily accessible and safe healing environment; providing services with adequate numbers of well trained, competent and compassionate caregivers who are attuned to the patient’s, and his or her family’s culture, life experience and needs; providing care in the most condition-appropriate setting with the aim of restoring patients to optimal health and functionality; and being led by skilled and pragmatic visionaries. The practices and processes of a world-class medical facility are models to emulate.”
“A world-class medical facility regularly goes above and beyond compliance with professional, accreditation and certification standards. It has a palpable commitment to excellence. A world-class medical facility has highly-skilled professionals working together with precision and passion as practiced teams within an environment of inquiry and discovery that creates an ambience that inspires trust and communicates confidence. A world-class medical facility constantly envisions what could be and goes beyond the best known medical practice to advance the frontiers of knowledge and pioneer improved processes of care so that the extraordinary becomes ordinary and the exceptional routine.”
The panel further defined all of these issues and those further comments are available at the site below. The critical point to make however is that world-class is not just about buildings, not just about people, not just about technology, not just about specific practices but it is about how all of these and more are interwoven together for the benefit of the patients and the patients’ loved ones in a manner that delivers superior care at a reasonable cost.
These are recommendations that all hospitals [and their boards of trustees] and providers across the country should consider and consider seriously. Nothing less should be acceptable.

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).