Throughout human history, each passing century has brought revolutionary changes to healthcare and medicine. Between 1914 and 2014, we have extended the average human life expectancy rate by approximately 25 years, due to discoveries like penicillin (in 1922), inventions like the cardiac pacemaker (in 1952), and achievements like the eradication of smallpox (1980). In this time period, we have learned to repair hearts, mapped DNA, and even performed a partial brain transplant, accomplishments, once inconceivable, but now commonplace. Conforming to the trajectory of history, new advances in science, engineering, and computer technology will revolutionize healthcare and medicine over the course of the next century. The roots of this change are already visible today.
In this article, we will explore: 1) recent trends and advancements in healthcare & medicine, 2) gene therapies using stem cells, 3) robotics in medicine, 4) electronic medical records, 5) biotechnology, 6) telemedicine, and 7) other promising trends in healthcare & medicine.
RECENT TRENDS AND ADVANCEMENTS IN HEALTHCARE & MEDICINE
Perhaps nothing in modern history has had such an impact on the fields of healthcare and medicine as the advent of the Digital Age. The adoption of computer technologies in healthcare and medicine has led to new practices, treatments, and methods that have saved hundreds of millions if not billions of lives over the past quarter-century. Once unfathomably complex medical research is possible today with just a few keystrokes. And healthcare delivery, medical record-keeping and doctor-to-doctor collaboration have all been made more efficient and effective.
As computer technologies improve, great strides will continue to be made. Some of the biggest computer-driven medical new advancements since the year 2000 have included:
- The adoption of the computer by medical professionals;
- The decoding of the human genome;
- The rise of stem cell research; and
- The development and use of the functional MRI (fMRI) to map brain activity.
Of course, not all advances have been as significantly driven by new and emerging computer technologies. Others have included:
- The increasing life expectancy of HIV-positive patients;
- The reduction of invasive surgery through the adoption of non-invasive surgical techniques;
- The use of targeted therapies in cancer treatment; and
- The discovery that the use of Hormone Replacement Therapy, once commonly used to treat menopause symptoms, is life-threatening.
Of course, due to global inequities in healthcare access and delivery, these trends and advances are of far more relevance to those in developed nations. A report, “Global Health 2035: A World Converging within a Generation” from a global commission co-chaired by former U.S. Treasury Secretary, Larry Summers, noted that these inequities could be eliminated within a generation given our current trajectory of medical advancement, and increases in global investment in medical R&D. Given the tremendously beneficial potential of probable medical advancements, such as gene therapies, hopefully advancements in healthcare delivery keep pace.
GENE THERAPY USING STEM CELLS
One of the most promising advances is the use of stem cells in gene therapy. Gene therapy involves the insertion of healthy genes in a person’s cells to replace unhealthy ones, by means of a virus. The National Institutes of Health (NIH) defines stem cells as having two important distinguishing characteristics:
First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions, they can be induced to become tissue- or organ-specific cells with special functions.
Research has involved the two main types of stem cells: embryonic stem cells and adult stem cells. Within the past ten years, researchers discovered a way to program some adult cells to assume a stem cell-like state. These are known as induced pluripotent stem cells.
Much research regarding stem cells has been driven by ethical concerns about the use of embryonic stem cells: namely, the ramifications of conducting experiments on cells that could under the right conditions develop into human beings. In the United States, Presidents Bush and Obama have enacted and maintained restrictions on federal funding of embryonic stem cell research, but have not outlawed it. However, six states have. In Europe, outright bans of embryonic research exist in Lithuania, Austria, and Germany; restrictions exist in all other countries. By contrast, Asian countries have the loosest restrictions on stem cell research in the modern world.
Beyond the legal and ethical considerations, key stem cell research trends, according to a research trends analysis of academic publications involving stem cells over the past six years, have been: 1) regenerative medicine; 2) drug development; 3) applications of induced pluripotent stem cells; and 4) policy analyses of stem cell research.
Currently gene therapy treatments using stem cells, are relative rare because the treatments are expensive and complex. There are also still many unknowns and many risks, including a cancer risk – the inserted genes can activate nearby cancer-inducing genes. Because of the unknowns, there are also ethical concerns regarding human trials.
Despite the challenges, many researchers are optimistic about the potential of this treatment method. It has the potential to provide an effective cure for diseases that are currently incurable. Gene therapy using stem cells could be used to repair damaged organs and reduce the number of people who need transplanted organs. This method could also be used to repair burn damage. Finally, this innovation could be used to safely test pharmaceutical drugs before they are introduced to humans.
Gene Therapy — The time is now: Nick Leschly at TEDxBoston
ROBOTICS IN MEDICINE
Robotics technologies have come a long way from George Devol’s industrial robotic arm of 1961. The sensing, thinking, and adapting technologies, which are the hallmark of robotics have been refined for use in healthcare and medicine. Today, robots like Aethon TUG and the Vasteras Giraffe deliver medicine and/or medical equipment in hospitals, unmanned robotic surgeries are available to patients, and exoskeletons that enable paraplegics to walk are on the market. These are just a few of the advancements in robotics technology that are transforming the fields of medicine and healthcare.
Current research in medical robotics primarily includes the use of robots in rehabilitation therapy, disabled and elderly patient assistance, drug delivery, minimally invasive surgery, image-guided surgery, patient monitoring, and biological systems modelling for diagnoses, among other areas.
Service robots – robots designed to assist people perform a specific task, usually one that is tedious or dangerous, are commonly employed in hospitals to assist in patient care, and to transport medical equipment. Other types of robots, such as the Da Vinci, assist doctors in the performance of surgeries. Smaller robots, like the ViRob Miniature Medical Robot, are introduced into the patient’s body and deliver drugs directly to sites of infection. Still other robots, like the RIVA, are designed to dispense intravenous solutions and/or pharmaceuticals to patients.
Some medical practitioners and futurists predict that robots, in humanoid form, will play an increasing role in patient care. Others predict the advent of increasingly smarter robotic surgical tools. These may be external or internal, as we grow better at developing capable miniature robots. Further, as government adoption of service robots becomes more widespread, robots may be deployed to provide medical assistance in disaster areas or battlefields.
Advances in robot technologies will be critical in refining exoskeleton and prosthetic technologies. And artificial replacement limbs could give rise to humans with augmented capabilities.
Robot Surgeons are the Future of Medicine
ELECTRONIC MEDICAL RECORDS
The continued adoption, refinement, and usage of electronic medical records (EMRs) by hospitals has been a goal of the medical community for many years. Before the advent of EMRs, disparate recordkeeping methods and sharing protocols led to errors in the administration and delivery of healthcare. A single badly written document could lead a doctor to prescribe a type of medication to which a patient might be allergic. Further, even inside a single hospital, there might be disparate systems for pharmacy orders, records, and other parts of a patient’s record. Standardizing, consolidation, and digitization of records cannot only improve patient care. It can also provide hospitals and data experts a treasure trove of data to be mined for medical research.
While real privacy and implementation issues currently exist, we have begun to use the Internet for many fundamental transactions, such as banking. Websites, such as WebMD, have put medical information at the fingertips of many patients, acclimating them to online medical information and making them active participants in their own care. It is not unexpected that we would be open to – and indeed even expect – our medical records to be integrated into our online lives. The ubiquity of mobile health or mHealth is also fueling patient openness to EMR, which in turn is fueling increased medical investment in such systems. Also fueling this increased investment: new wireless technologies, like remote monitoring and telemedicine, that benefit from data and input.
Today, approximately 80% of physicians use an EMR of some type. 8 out of 10 of these reported improved patient care due to their use of online medical records.
Many doctors, nurses, and patients dream of the days when new patient forms are auto-populated, records are seamlessly shared between doctors and referrals, and other features that will greatly increase the personalization of care. Further, EMR will fuel the adoption of other projected trends such as self-service kiosks for hospital registration, full home diagnostic systems, GPS tracking of patients with dementia, semantic databases, and use of large data pools by medical researchers and public health experts to predict outbreaks.
EMR/EHR Done Right
Biotechnology, which is the technologies associated with the manipulation of living tissue and organisms, is another field in which the breakthroughs of the near future promise to transform our world. Biotechnology has been used for centuries, notably in agriculture and cross-breeding of animals, but only recently, with our greater understanding of biology on the cellular level, have we begun to explore the full potential of the field.
Medical biotechnology research usually revolves around solving diseases. Creative approaches to diseases may come not from a trained physician but the educated layman, as many of the resources once exclusive to high-end laboratories are available to the public. The creation of artificial organs is another aspect of biotechnology that has garnered much attention both inside and outside of the medical community. A third area of biotechnology that holds considerable promise is nano-biotechnology, which uses biological tissues to create nano-devices and nano-particles that can then be used to address biological issues.
Gene therapy using stem cells is a good example of biotechnology, as is bioprinting (see below). Cloning, genomic analysis, antibiotics, and DNA profiling (a keystone of forensic analysis), are other notable examples. But they likely only scratch the surface of the possible.
In time, biotechnology may allow us heretofore unparalleled medical advantages. Scientists are currently using the field’s methods to explore:
- Decay-fighting microbes;
- Biologically-based pacemakers;
- Spit tests to diagnose cancer;
- Asthma warning sensors;
- Stents that dissolve in the bloodstream;
- Nerve regenerators;
- “Smart” (autonomous) wheelchairs;
- Augmentation via prosthetics; and
- Complete models of biological systems.
These are just a few of the possibilities. By 2114, biotechnology may have eliminated the very need for many of these innovations.
Bringing biotechnology into the home: Cathal Garvey at TEDxDublin
To make sure that the most people benefit from these innovations, the medical community must also look at how they can more effectively deliver healthcare. Enter telemedicine – which involves the remote delivery of healthcare and medical services. In developed nations, this applies to rural areas in which residents lack easy access to medical or hospital facilities. In developing nations where access to healthcare is generally more limited, this has far broader implications and potential benefits.
Experts predict anywhere from an 18.5% to a 56% annual growth rate in the tele-health market worldwide through 2018. This massive growth is supplemented by advances in and refinements of remote monitoring technologies, EMR, and service robots built for domestic care, and research in and development of more robust home diagnostics and remote touch. Telehealth is also driven by related computing trends, such as enterprise mobility management, cloud computing, and social networking.
Applications of telemedicine can be seen in the provision of medical advice by healthcare providers to patients through social networking, mobile devices, and videoconferencing. Service robots are now used to provide homecare and remote monitoring to patients in need. Remote monitoring of discharged patients is another example of telemedicine currently in practice.
The potential benefits of telemedicine are significant. Use of this healthcare delivery method can reduce the overall costs of healthcare making it less expensive for, and more accessible to, the consumer, as well as leaving more money for research. By completing diagnoses remotely, telemedicine can filter out those not needing hospital visits from those who do, making healthcare delivery more efficient. It can heighten patient awareness and active management of their own health. Telemedicine can also increase healthcare access in areas traditionally lacking it.
Telemedicine enthusiasts envision a day wherein home diagnostic, medical robots, and medical equipment, along with wireless connectivity and EMRs integrate seamlessly to allow all but the most serious of patient ills to be treated remotely.
Jennifer’s Story – How Telemedicine works
OTHER PROMISING TRENDS
These are not the only trends that promise to revolutionize our world. Bioprinting – the use of additive manufacturing processes and 3-D printer technology to create living tissue and organs, may make organ donation a thing of the past. In fact, bioprinting could be used to synthesize drugs (prescribed remotely of course), making pharmacies a thing of the past as well. Advancements in wearable tech have significant implications for remote healthcare devices. And innovations in virtual reality will us to better train medical students, diagnose medical conditions, test medical treatments, and improve overall patient care.
Any of the aforementioned breakthroughs may be stymied by the economic and regulatory environment of a researcher’s or research team’s home country. The politics of, and finances available to their sponsoring organization, will play a role. Testing and adoption by the medical community and consumers, as well as standardization of products (i.e. common record-keeping protocols for disparate EHR systems), will affect how quickly the benefits of new medical technologies reach those in need.
However, the collaborative tools, the computing power, and most importantly, the curiosity to solve some of our most challenging medical mysteries exist. By 2114, we may have used biotechnology to retard the aging process, gene therapies to eradicate all current forms of disease, and domestic robots to replace doctors and hospitals. One thing is for sure; the future of medicine a century from now will look very different than that of the present day.