Sci-fi or fact? The future of modern medicine

 The therapeutic approach known as gene therapy aims to replace a potentially defective gene though the introduction – usually using a vector such as a harmless virus - of a normal gene in the cells predisposed to the possible ailment. Considerable progress in longevity and quality of life is expected from this revolutionary technique, but for now gene therapy in humans is at the early clinical research stage and common medical applications might not been seen before the next decade. Today’s column looks at the next scientific advances that will significantly impact the practice of medicine while waiting for such newer therapies to arrive.

Telemedicine, which connects patient and doctor via Internet-based webcam, is already gaining popularity in the USA, some European countries and also, to a limited degree, in Thailand. The online connection offers counselling, life coaching and convenience for patients who do not need to spend several hours travelling and waiting to see their doctor for the monitoring of their illnesses. 

E-medicine roughly corresponds to the expansion of technology and smartphone apps. A first generation of simple connected devices already exists: the pacemaker is coupled with a defibrillator for irregular heartbeat, there’s an insulin pump for diabetes and a deep-brain stimulator for severe Parkinson’s disease. The next generation of devices will offer smarter connections. For instance, a device implanted into the tummy of a diabetic patient will assess the level of blood sugar for a one-week period. The information will be transmitted via the patient’s smartphone to the doctor’s computer and he or she may adjust the treatment dose according to week’s findings. The doctor’s online prescription of antidiabetic medicine will then travels through the patient’s phone to the implanted device and induce a release of the adjusted dosage of the drug. This means that patient will probably no longer need to go to the hospital, stop at the lab for blood tests, see the doctor with the result and pass by the pharmacy to collect the medicine!

Advances in surgery come from the continuing bioengineering development in the field. Following minimally invasive operations in 1988 using the laparoscopic technique and the first robotic surgeries in 1996, some surgeons believe that the newer generations of robots will be able to perform semi-automated and even automated surgeries in the near future. In 2001, the world’s first “Lindbergh tele-surgical operation” was carried out by a surgeon located in New York on a patient in France 6,000 km away. The name Lindbergh was given in a nod to the first non-stop trans-Atlantic flight made by the famous aviator in 1927. 

Imminent robotics surgery opens valuable applications in remote practice for humanitarian causes, conflicts or simply to help junior surgeons benefit from experienced practitioners far away. In breast cancer treatment, special light and surgical glasses help surgeons to actually see cancer cells during the operation (they glow), allowing them to remove more effectively the whole malignant mass. Surgery with ultrasound technology is in development and may allow interventions for certain illnesses without the need to open the skin, thus leaving no post-operative scar. 

Advances in medical imaging allow for visualizing tumours in 3D, which assists doctors in selecting the best surgical procedure. The high-tech equipment will likely go deeper in terms of image precision from today’s macroscopic tumour to tomorrow’s smallest tissue and even capture abnormal cells involved in the disease formation. The precise nature of tumour cells will be known from high-definition imaging that could eventually eliminate the required pre-intervention biopsy and exam of tissue sample under the microscope. 

Stem cells usage with both embryonic and adult cells is already paving the way for wider regenerative medicine indications but like other genetic-driven approaches (genetic testing and gene therapy), still needs to be performed within the scope of proper medical evaluation. 

While these new medical trends are no longer science fiction, it will be some time before we can benefit from them on a daily basis. In the meantime as well as in the future, ensuring good quality of life in the long term relies on the well-proven and effective healthy lifestyle behaviour, meaning maintaining a healthy body weight, taking regular exercise, avoiding toxins (smoking, excessive alcohol intake and improper use of cell phones) and controlling stress. 

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].