Future Medicine

Dear present,

I would like you to meet a patient from the year 2035. He is Mr. Abhijeet Pradhan. Abhijeet is a video-blogger by profession. He lives in Bangalore.

Abhijeet quit his software job five years back, when he was of age 40 years, to follow his new passion. He travels widely and posts his blog in various social media and video journals. From the earnings of his posts in social media and previous software job savings, Abhijeet manage his expenses. Abhijeet also supports his younger brother financially to study biotechnology at Mumbai. Their dad passed away at youthful age of forty-two years because of heart failure, when Abhijeet was still studying in the school.

Abhijeet has a medical coverage insurance account which is connected to his performances in parameters like exercise, diet and maintaining a healthy lifestyle. His health bonus is decided by the real time analytics of the software data. Abhijeet has quit smoking years ago. When his performances improve, his insurance pay out decrease on daily basis.

Abhijeet has a wearable device which collects his blood samples and create reports without him feeling anything. The device also records vitals like pulse and blood pressure, sleep duration and respiratory pattern. The data is analyzed by artificial intelligence software and discussed by videoconferencing from the comfort of Abhijeet’s home by teleconsultation with a multidisciplinary team. Part of the health counselling and treatment team also are chatbots with humanoid form and voice.

Thanks to the advanced data, the unpredictability of health issues has decreased since the year 2030. Hence, the insurance cost of people like Abhijeet have also gone down substantially, leaving in his hand more money. Following Artificial Intelligence driven algorithm guidance by his virtual counsellors and nurse practitioners, his cholesterol level is controlled well. So is Abhijeet’s blood pressure.

Like everybody else, Abhijeet too has undergone a detailed genetic analysis, which helps to predict and manage the future risk of disease susceptibility. The genetic study of Abhijeet have predicted higher level of disease associated SNPs, the ribonucleotides in his genes, thereby predicting future higher cardiovascular risk like his father. Accordingly, Abhijeet has integrated heart-healthy lifestyle. Low-fat, high fiber food items are delivered to his home in the form of purchase of healthy food by amazon pantry and use of preventive medications are updated for Abhijeet on regular basis.

Abhijeet takes one pill a day which consists of aspirin, ACE inhibitor drug, blood pressure, blood sugar medicine and an anti-cholesterol drug. The pill is such designed that a single capsule is able to do job of 8 to 10 pills which people earlier used to take. The pill has sequential release pattern and barrier walls to release drugs in a manner to have 24-hour effectiveness. By the use of nanotechnology, the pill size has become small to replace the 10 to 12 medicines being taken by earlier generations.

Thanks to integration of various health provider platform of hospitals and health financing and insurance groups of earlier decades to a single platform, Abhijeet is able to receive healthcare in a manner only imagined earlier. Previously, various health platform and patient information databases at various cities, hospitals or health insurance groups were not able to recognize each other or act to improve the health delivery process. For example, in the event that Abhijeet prior required any treatment outside his city or state, he needed to pay an additional sum from his pocket to cover up the expense. The scan and blood reports were not digitally portable from one hospital to another or from one emergency clinic to another outpatient clinic when required by the doctors to review the problems. Now, Abhijeet and others like him, gets better healthcare with lower costs, higher quality, greater efficiency, and more equitable access to care.

Once day while Abhijeet had been on a weekend trip to Shimla, three hundred and sixty kilometers from Delhi, he developed severe chest pain. The watch which Abhijeet had on his wrist, recorded an ECG and sent wirelessly to the server to be interpreted in real-time by the ECG analyst. The analyst read the ECG as abnormal pattern, and immediately alerted his cardiologist. Doctors after looking at ECG confirmed that Abhijeet is having a massive heart attack at the peak of a Himalayan Mountain.

In normal course of events of today, Abhijeet would have been transported to Delhi by ambulance after getting fast aid at Shimla. Fortunately for Abhijeet, the government had put up a virtual tele-robotic surgery facility recently at many places far from the metros, including Shimla.

As soon as Abhijeet reached to the center, he was rushed into the virtual Cath lab. There, a technician put Abhijeet on to the machine and connected to the monitors. The cardiac surgeon sitting in Delhi did an angiogram. It showed a critical stenosis with a dangerously big clot in Abhijeet’s main coronary artery, the LAD artery of the heart.

The doctors decided to operate immediately since the time was ticking. In a technique called Virtual Angioplasty, where the tele-robot at Shimla hospital controlled by the Delhi cardiologist operated on Abhijeet’s heart. As the technician stood guard, the tele-robot, through a fine guiding catheter deftly steered into the coronary artery and placed a stent accurately at the site of obstruction. Soon enough the pain and sweating Abhijeet had reduced. He went into restful sleep.

After surgery, Abhijeet stayed in ICU. One important injection needed for post cardiac surgery to maintain blood flow in heart was transported to the Shimla hospital by a drone carrier. As the drug was administered in proper time, Abhijit’s heart function became much better.

The hospital transmitted the computerized information about Abhijeet’s treatment, seamlessly without the inclusion of any paperwork to his insurance company. The claim was before long approved without any physical scrutiny. The discharge and billing payment were all done in cashless manner in a matter of hours.

Abhijeet was allocated a virtual nurse practitioner to take care of his diet and drugs punctuality check post discharge. Abhijeet got a teleconference later in afternoon with his heart surgeon whom he has never met. While preparing to get discharged, Abhijeet received a message on his mobile concerning the next hospital visit schedule as well as the follow up plan.

The Vision of the 21^st-Century Health Care System

Abhijeet’s world is in future. It sounds like fantasy, but the basic framework for the future medicine has already been cast. The high-quality, rich clinical information and common-sense efficiency we see in Abhijeet’s case are all within our grasp. From many other complex sectors like defense, finance and mass production, such transformations have in fact already taken place. It is time that the health care followed the rest of our competitive economy and information society into the 21^st century.

What will be the future of medicine? As the world gets changed with Big Data, artificial intelligence, robotics surgery and biogenomics, how does the future doctor look in his office? What will be a patient treated for in future, and how? These are the questions which look so urgent today as the post pandemic acceleration of digital era and changes in health care has gained speed. One thing is an established fact; the traditional doctor- patient- hospital model of health care will be transformed in various ways.

Emerging technologies of future health

1. Gene therapy

The basis of all illness and response to it lies in our genes. For decades, doctors tried to treat only the symptoms and effects arising of genes, manifested as various diseases like diabetes, heart attack or immune response diseases. Finally, the time has reached an inflection point where there is scope of direct genetic level intervention, thereby curing and eradicating a host of diseases.

Today, most of the genetic based diseases have no cure. Only the symptoms can be controlled by long term medical therapy. With the gene therapy, there is hope that in future many of these conditions can be truly healed by treating the genetic roots of the diseases.

Gene therapy has been under development for more than thirty years. Initially the use of genetic techniques was only for diagnosis of hereditary problems. Recently, several major advances have tipped the scales toward clinical treatment feasibility. A huge advancement has been accomplished by further developed conveyance strategies and the improvement of robust molecular technologies for gene editing in human cells. The affordable genome sequencing has greatly helped in our ability to identify the genetic causes of disease. The time is not far when everyone can afford to have his entire genetic make-up analyzed and stored for clinical use.

With these advances, the stage is set for the widespread use of gene therapy. This strived as a major success, as it the beginning of a fundamental shift concerning medicine.

2. Preventive technologies

In the 21^st century, healthcare has already entered its next phase of rapid advancements. By using precision medicine technologies, genetic vulnerabilities to chronic and deadly diseases at the individual level can now be identified, potentially pre-empting the disease decades later.

Current strategy of checking handful of parameters like blood pressure, diabetes and few other health parameters in a three to six months gap would be replaced in future by a real-time prevention amounting to 24/7 data monitoring on a vast number of diseases. The best thing is that the patient will not even need to be in the hospital for the check-up. Wearable devices, artificial intelligence and remote monitoring services will take care of most of the issues off the hospital site, while they remain in home or at the workplace.

“My hope relating to the next 25 years aims at a day when a single blood test could be effective in informing individuals of the diseases, which they might be subjected to (diabetes, cancer, heart disease, etc.), and those safe interventions will thereafter be available. My excitement treads on the pathway of instilling the possibility of bringing in the cancer vaccines. Vaccines targeting the causative agents of cervical and hepatocellular cancers have already proven to be effective.” Says Elizabeth Jaffee, Dana and Albert “Cubby” Broccoli Professor of Oncology, Johns Hopkins School of Medicine.

3. Use of data

Till now doctors have used only a few data points like blood pressure, sugar and cholesterol to predict disease or treat the problems. But millions of such data inside a human body in form of biochemical, physiological and sociocultural patterns is still unexplored for medical use. Previously, the data were either not captured or were simply too complex to analyze by traditional medical practitioner.

Dr. Eric Topol, the Founder and Director, Scripps Research Translational Institute, is a big advocate of the usage of technology in augmenting healthcare predicts that data analytics is going to make human race healthier and better.

“In 2045, I hope we will have developed a planetary health infrastructure based on deep, longitudinal, multimodal human data, ideally collected from and accessible to as many as possible of the more than nine billion people projected to then inhabit the Earth.’’ Dr Topol says.

Several upcoming infrastructures are hybrid artificial intelligence (AI) models—including various deep neural networks, federated AI, nearest-neighbor analysis. These would be extremely useful for individualized guidance for the prevention and optimal management of medical conditions. We are only beginning to understand how much the data analytics is going to influence the heath decisions by doctors as well as patients. The integrated data would work as a virtual medical coach for patients and a platform for clinicians to review a patient’s real-time, real-world and cumulative dataset.

4.Prevent pandemics

A cataclysmic global pandemic is one of the greatest risks to humanity. Over the past 25 years, we have seen SARS, Ebola, Zika and other infections spread undetected for quite a long time, prompting global crises and regularly devastating results. Recently, corona virus pandemic has shown clearly, how devastating the destructive power of global pandemics of viruses and other organisms can be.

“Advances in two fields, genomics and information science, can transform our fight against viral threats. Ultrasensitive genome sequencing technologies are enabling the detection and characterization of viruses circulating under the radar”. Says PardisSabeti who is  Professor, at Harvard University & Harvard T.H. Chan School of Public Health and Broad Institute of MIT and Harvard.

The advent of novel CRISPR, the synthetic biology and microfluidic tools have allowed the development of rapid, ultrasensitive point-of-care diagnostics that can be deployed anywhere in the world. The subsequent diagnostic and surveillance data can be coordinated across medical care hubs, from rustic centers to city emergency clinics, because of incredible new data frameworks. These data frameworks can help the fast recognition of infectious virus and bacterial threats, to follow their facets of spread, and mandated public health decision-making. Such abilities would help to sequence the gene code of any new emerging virus swiftly. It can also help to reduce the cycle timeline of development of new vaccine in case of an outbreak.

At present any pandemic threat is detected and acted upon only when it has spread to a significant geographical territory. Over the next decades, the development and integration of these tools into an early-warning system embedded into healthcare systems around the world could revolutionize infectious diseases like Covid virus pandemic detection and response.

5.Aging

Human life expectancy has increased over the past 150 years in most parts of the world. Unfortunately, the prolonged lifespan does not assure anything as the period of life when a person happens to live with disability and illness at the end of life. A significant possibility is emerging where clinical sciences will have adequately progressed to enable people to have better and more unique lives essentially up until their passing away. Going on, the newer techniques targeting the aging, fusing with existing drugs, presents an opportunity to reduce inadequacy and ailment in the late stage of life.

Gero-protective drugs, which target the underlying molecular mechanisms of ageing, are coming over the scientific and clinical horizons. Organ synthesis in laboratory environment to create a new heart, kidney or liver is also in near horizon to help organ transplantation on demand. The need for taking a heart or kidney from another person for transplanting to a diseased person would not be essential in future. There would not be any rationing or waiting list for receiving the organ donation of liver, skin or the heart.

These research outcomes, along with preventive health, may help to us in various age-related diseases and increase life expectancy.

Digital health care and future health

For traditionally, the health care, compared to most other fields of our lives, has been resistant to adoption of the digital way that 21^st century has ushered in. Health care providers have mostly continued to have the typical ‘appointment, investigate, revisit and treat model’.

A Mumbai based international currency trader recently blogged in a moment of exasperation, “I can transfer ten million dollars from one account to another across continents in a flick of moment without getting out of my chair. I can order and relish the food from finest restaurant in Mumbai by bringing it to my home without having to stand in the waiting. But when it comes to health care it is archaic like a Victorian relic! Yesterday, I jammed my great toe in the door which became black and swollen ominously with throbbing pain. I was afraid it might be a fracture in the toe bone. I called up my clinic and took an appointment. After waiting more than one hour at the orthopedician’s clinic, he had a cursory look and sent me off for a CT scan of leg. Now, after waiting at the CT scan, getting the test done and collecting a hardcopy film of the scan and the report, I have come back and waiting at the clinic to be seen by the doctor again. It has been half a day, and it is not even complete!”

The utilization of cloud information, virtual consultation and automated far off the site medical procedure like tele robotic surgery will be distinct advantage in medical care conveyance. The “tyranny of distance”, which has made individuals being compelled to make a trip to large urban communities or to venture out to the emergency clinic by suffering swarmed roads and gridlocks would be relieved by the digital healthcare. It will make healthcare simple, accessible and more affordable just like finance, purchase of air ticket or ordering your favorite food has become at present.

The last mile connectivity of consultation, tests and pharmacy would be seamlessly integrated by digital network, augmented by artificial intelligence. A heart patient will have his pulse and blood pressure monitored and medication virtually adjusted by algorithm-based decisions. A diabetic, on the routine consultation, can have a virtual teleconsultation from home and the changed medications delivered at home. Only the more serious cases would be seen by a senior physician, thereby reducing load on the health system and eliminating long and seemingly endless ques at the hospitals.

A glimpse to how future of health will impact mankind

Health information from traditional annual physical check-ups and other tests, previously only available in a surgery or lab, will be replaced by data from sensors on/around our ‘smart’ bodies. These miniature sensors will include our clothing and eventually have an impact on the skin and blood. This data will be immediately accessible to us. Our doctors would have access to the data with our consent to manage any problem in real time. A new field relating to ‘predictive medical data mining’ will give early admonitions of physiological difficulty ahead or signs of illness as it develops.

Regenerative medicine will continue to be a very important area of research. For instance, we could reprogram a few cells to perform jobs that are different from their original intent. Cells that happened to create scar tissue pertaining to the damaged heart could be subjected to change so that they make the patient’s heart go on to pump normally again, vastly improving quality relating to life as well as longevity.

Era of individualized treatment or ‘personalized medicine’ will progress. As we find out more about the particular genetic makeup, we will be able to give specific drugs to target it. The risk of drug failure or drug allergy will be reduced significantly once we know how the biochemical molecules in drugs interact with any specific person’s cell biology

Robots will become important part of health care. Already, many Scandinavian countries as well as Japan use robot to carry out many tasks from assisting patients like health workers to doing complex surgeries. The robotic surgery is evolving rapidly to take over precision surgeries and those procedure which takes ultra-endurance times resulting in surgical errors by surgeons due to exertion and fatigue. The technology trend will expand further in future healthcare to most parts of the world.

Will the technology be a barrier between the sacred doctor-patient relationships? Will the intimate and emotional interaction that care givers and the unwell become mechanized and soulless like withdrawing money from bank ATM or shopping on e-commerce platforms.

There is concern amongst sociologists that the last few anchors of social interactions like doctors’ consultations and nursing care are being replaced by the numbed down and contactless mechanical methods. Putting up artificial neural intelligence in all decision making may take out one vital element from the process of medical consultation—the soft touch of real doctors and the intuitive human ability to choose “a real and practical solution” than “the best solution” when faced with a clinical scenario.

Other Experts think on the contrary. “We believe consumer health technologies — Apps, wearables, self-diagnosis tools — have the potential to strengthen the patient-physician connection and improve health outcomes.” Says – Dr. Glen Stream, Chairman, Family Medicine for America’s Health.

“Everything in the world has changed in last twenty-five years,” a doctor said in a conference about future of digital health, “I think it is time for us to change too. I believe my patient will like it.”