Charting New Plagues Like Predicting the Weather

The emergence of new infectious agents is closely related to human activities such as travel, trade, antibiotic usage and ecological degradation. The human-related factors of emergence will increase over the next 90 years. Human population growth on the planet will exacerbate epidemic activity. The breadth of transmission will continue to increase. The food and water supply of the world will become increasingly precious.

Indeed, while more than a billion inhabitants now live without adequate clean water, and more than two billion without adequate sanitation, these numbers will increase. Food production will become more and more centralized as we struggle to feed our population, and this will make the food supply increasingly vulnerable to contamination.

On the positive side new technology now allows us to characterize infectious agents more rapidly, and to produce effective vaccines more quickly. These two capacities will become central to our ability to control human infection. In addition, our ability to accurately map the planet and its ecosystem should allow us to develop and test predictions of disease occurrence much as we now do the weather.--Public Health and Community Medicine Professor Ann Kimball

We Will Cure Cancer, Strokes, Diabetes and Alzheimer's Disease

The next 90 years will witness dramatic changes as medical science solves the mystery of common chronic diseases like cancer, atherosclerosis causing heart disease and stroke, diabetes, and age-related dementias like Alzheimer's disease. Our understanding of the brain will be dramatically different in terms of detail and complexity. Persons will have the potential to live out their life span (which will exceed 90 years) and to delay onset of disability. Medical care will be more self-directed as information is more accessible, of higher quality, and user friendly.

Care will not be as invasive and minimalist techniques will overtake traditional surgery. The institutions we now associate with health care (hospitals, the doctors office) will predictably be surpassed by facilities driven by technology changes. The major threats to health will come from geopolitical, economic forces and from individual behaviors.

Ninety years ago we could not have predicted the health catastrophes of nuclear holocaust, the global AIDS epidemic, or environmental contamination. "New" diseases will emerge. We can, thus, predict that medical science will continue to be reactive to social forces and that social forces will continue to be major determinants of health and disease."--UW Medical Center Medical Director Eric Larson

Predictions on Weight Loss and Diet

During the next hundred years, the area of weight control will undergo several metamorphoses. Initially, drugs will become available which control appetite and help people lose weight. Other drugs will enable those who wish to eat whatever their hearts desire without the fear of gaining unwanted weight. (Of course, given the continuing rise in the world population and the increased depletion of resources, it is not clear that the food to accomplish that will be available). In the next phase, the precise genetic make-up of newly conceived fetuses will be determinable and the risks for excessive obesity (and/or leanness) and its associated health problems will also be known such that early interventions (probably dietary) will be used to achieve whatever the "ideal" body size of any particular era might be."--Psychology Professor Steve Woods

The Six Million Dollar Man Is a Bargain

At present, millions of medical devices are implanted in humans each year. At present, millions of medical devices are implanted in humans each year. These include pacemakers, blood vessel replacements, hip joints, eye lens implants, drainage tubes, heart valves and cochlear implants. The devices save lives and improve the quality of life. But they never work as well as the original part being replaced. Basically, the body views most of the materials we now use as "foreign objects" and simply walls them off. Thus, we get aberrant healing and poor mechanical and electrical communication between the implant and the body. The path to the future of medical implants demands that the body recognize these devices as "natural" and heal them in a facile manner.

Science fiction writers have had no problem imagining where biomaterials should go. The Tin Man of The Wizard of Oz, The Six Million Dollar Man, RoboCop and StarTrek's Borg have all been seamless integrations between metals, plastics, electronics and living flesh. Evidence suggests this seamless integration can really be achieved.

Envision prosthetic limbs that heal into the skin for a bacterial seal, the bone for mechanical support and the nerves for control. An artificial heart that functions about as well as a healthy natural heart would--extending hundreds of thousands of lives. A robust artificial pancreas could improve the quality of life for millions, as could an electronics-electrode array artificial eye for the vision impaired. Finally, can "dip-stick" diagnostic devices be built that offer early home detection of cancers and other life-threatening conditions? The potential now exists to engineer synthetic surfaces so that they control biological reactions with precision. Thus, we can imagine creating a new generation of biomaterials that might revolutionize health care and diagnostics.--UW Engineered Biomaterials Director Buddy D. Ratner

Bloodless, Sterile, Painless Surgery

It will be commonplace for citizens of the late 21st century to visit their physician who will send them to a room in which a whole body ultrasound scan will be made of the entire human body. This scan will the be compared to the patient's previous scan, as well as to that of a data base of healthy individuals, and a computer with pattern recognition capabilities will detect any anomalies. The computer will recognize the development, for example, of a pre-cancerous region and recommend the application of therapy.

The patient will return to the whole body scan room, where a second, more accurate scan will be made of the region of interest, and the once the pre-cancerous region is targeted, a short burst of high intensity, focused ultrasound will be used to kill that tissue. This use of therapeutic ultrasound will be administered in a minimally invasive manner, with remarkable accuracy and specificity, and will result in bloodless, sterile and painless surgery.--Applied Physics Laboratory Physicist Larry Crum.

Look Ma, No Cavities Ever as Dentists Throw Away Their Drills

A remarkable improvement has occurred in dental health during the past several decades with dramatic increases in retention of teeth. Indeed, the majority of our grandparents had lost all of their teeth and were wearing full dentures before the age of 50. Our parents had some tooth loss, were functioning with combinations of fixed and removable restorations, and were fighting a slowly progressive battle with generalized periodontal disease. In contrast, the majority of our children are essentially caries-free and can expect to retain their dentition for a lifetime. There is every reason to expect that such advances will continue at an even greater pace during the decades of the 21st century. Most people will retain all of their teeth for a lifetime and be protected from oral disease by vaccines and by new preventive approaches derived from knowledge of the human genome. For those few teeth that are damaged or lost, unique biological materials will substitute for tooth structure without the need for drilling and entire replacements for the teeth will be grown in the jaw.--Dentistry Dean Paul Robertson

Looking Inside the Brain

As technology revolutionized genetic research and resulted in the Human Genome Project, new technology will revolutionize neuroscience. We will be able to provide access to information on billion of neurons in the brain. We've seen this already with the patch-clamp, a device used to literally listen to the electrical signals of single ion channels, developed only in 1980. By the end of a generation, we'll have reached a point we can't even envision.--Physiology and Biophysics Professor Bertil Hille

Killing Brain Tumors with Antibodies

I am certain that the imaging technology of today will be fused with interventional procedures, making surgery much less invasive. I predict that open craniotomy for ruptured blood vessels will be history, as better intravascular techniques develop. Already, the use of small coils introduced through the vasculature and placed into aneurysms are making a substantial contribution in this regard. Furthermore, magnetic resonance scanning will be incorporated with laser and focused ultrasound to obliterate brain tumors. Of course, I'd anticipate that immunotherapy for malignant brain tumors becomes the primary treatment modality, and only a biopsy of the tumor tissue would be needed to classify it, and raise the requisite antibodies that would be specific to it.--Neurological Surgery Professor Sean Grady

Childhood Addictions Will Grow

Addictions among children to food, drugs and alcohol will continue to rise. Currently, our children are more obese than ever. This can be attributed to the availability of food and apathy toward physical activity. Children will spend more time interacting with computers, and less time being active. We will have a better understanding of addiction at the molecular level, but the solution will never be a quick fix.--Pediatrics Professor Tom Pendergrass

We Must Rethink Many Conventional Beliefs

The field of bioethics, which has surged ahead during the last 30 years, as new technologies and new forms of health care have challenged the long tradition of medical ethics, faces several major issues as we enter the next millennium.

Ironically, these coming problems remind us of the problems that medicine faced some 150 years ago. A new science was revolutionizing medicine: germ theory and all that it implies about the prevention of infectious disease and the understanding of the immune system was challenging a millennium of medical science. Similarly, molecular biology, or "gene theory" is challenging the science that medicine has lived with for this last century and with the new molecular medicine brings particular ethical questions. We will know more about the health future and fate of individuals than ever before. We will know more about the health history and expectations of families. Questions of confidentiality and about advice and education will force us to rethink many conventional beliefs.-- Medical History and Ethics Chair Al Jonsen

Health Services Won't Exist as We Know It

"Looking back to the future" is sometimes helpful. Allegedly in a meeting of the Chicago City Council at the turn of last century, there was much private excitement about investing in horses as the wave of the future, but deep public concern about how the city would ever pay the increasing bills to keep the streets clean. That was before cars, airplanes, computers, a freezer in the kitchen and a satellite dish in the backyard. Back then, health care meant nurses in people's homes, except those who went to the hospital--as a last refuge.

Ninety years from now? We can't possibly comprehend that world. Today's mega-trends tell us the world as we know it won't last that long, simply because the earth can't support the predicted population. Even short of that dire prediction, i.e., if wars or other disasters keep the global population within sustainable limits, I do not believe any of the health sciences will exist as we now know them. Given the pressures of over-population and the possibilities of technology, I think the major focus of health care will be managing information, both on earth and in other parts of the universe. Systems will be much more controlling, and our descendants will recall with curiosity that Americans once were so devoted to privacy and individualism. They also will recall that once even smart people separated mind, body and spirit and thought of medicine as prescriptions at the pharmacy and cutting bodies open. Ghastly primitive!--Nursing Dean Emeritus Sue Hegyvary

Rates of Discovery, Demographics Transform Medicine

Approximately 90 years ago, the Flexner Report ushered in an era of modern medical education. Since that time, changes in medicine and medical education have reflected the changing role of medicine in society and advances in biomedical science. We are currently in an era of extremely rapid change in medicine, and I expect that three factors should have a profound impact on the way medicine and medical education evolves over the next 90 years.

1. The Stunning Rate of Scientific Discovery. The body of medical information required by a physician for day-to-day practice is currently estimated to turn over every five years. Furthermore, this stunning turnover rate is expected to shorten further. Medical education programs must prepare tomorrow's physicians with learning skills to engage in lifelong learning and to incorporate advances in information technology into the daily practice of medicine.

2. The Changing Demographics of Our Region and Country. By the mid-21st century, major demographic shifts are expected. The physician workforce must reflect the changing demographics, and all physicians should be sensitive to the cultural differences in how people approach health and health care. Academic medicine must work to ensure that medical education is fully accessible to individuals from all backgrounds.

3. The Requirement to Constrain Health Care Spending. The population of individuals over age 65 is expected to double by the year 2030, and the population over age 85 is the fastest growing segment. This has very serious health care cost implications for our country which is already spending more than any other in the world on health care. The improved health status of the elderly and advances in biomedical science should be helpful, but it is likely that more conservative, outcomes-based practice standards will be needed to constrain health care spending. Academic medicine should play a pivotal role in developing and disseminating these standards, and in conducting the research that will underpin the practice of medicine over the next 90 years.--Medical School Dean/VP for Medical Affairs Paul Ramsey

Drugs Continue as Cornerstone of Medical Therapy

Pharmaceuticals are the cornerstone of medical therapy and their impact increases at a remarkable rate. Thanks to the introduction of protease inhibitors and combination therapy, only two years after researchers publicly despaired of ever finding an effective treatment, infection with HIV leading to AIDS evolved from a virtual death sentence to a treatable disease.

Pharmacists are a unique source of information to other health care professionals as well as to patients. In the future, community pharmacists will maintain individual charts and keep patients informed of relevant new developments that may mitigate her or his disease and improve quality of life. ... Because change is so rapid, pharmacy will probably be the first to require post-licensing certification. Provisions of services complimentary to, but not in competition with, other elements of the health care system will be a future role for all pharmacists working in the community. In a career that spans 35 years of close observation of the profession and the industry, I have never felt as enthusiastic by the future prospects of pharmacy and pharmaceuticals as I do today. The future promises much.--Pharmacy Dean Emeritus Milo Gibaldi

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