What are the most important medical issues to focus on in the 21st century

Great Debates
1

In the 20th century it seems we made a lot of medical progress in things like public health, pharmacology, surgery,nutrition (IDing and synthesizing all the vitamins, understanding the role of vitamins, minerals and phytochemicals in health), diagnostics, and lots of things I’m forgetting.

What do people think are the most important advances we either will make or should make in this century?

I’d list things like
Reversing and preventing aging. This would be huge since most chronic and fatal diseases are due to aging. Very few 21 year-olds have heart disease, diabetes, cancer, chronic joint pain, dementia, etc.

Understanding the brain will be big. Not only could it treat mental illness (which is a huge problem globally) it would increase cognition, make people more resistant to life stress and trauma and make like more emotionally enjoyable (less malaise, anxiety and melancholy) for people not clinically mentally ill.

Robot surgery. When this becomes big then ideally it’ll make advanced surgery something almost everyone has access to at an affordable price.

Advances in understanding the immune system should be big at combating autoimmune diseases and making people more resistant to infections and cancer.

Curing obesity should happen this century.

Diagnostic improvement. This would be big both for helping Id the right illness (fewer people suffer for years with no diagnosis or a misdiagnosis), and for constant monitoring of BP, sugar, sleep patterns, etc.

Stem cell made cells, tissues and organs.

Most of these seem feasible in the first fifty years of the century though (except reversing agimg) I have no idea what the last fifty will do.

2

Nanotechnology.

3

Gene therapy. If we can correct genetic defects it will be as big as anti-biotics was in the last century.

4

Real-thing penis enlargement. Dammit, if we can put a man on the Moon . . .

5

Lifestyle changes. Lifestyle aspects like smoking, overeating, failure to exercise dwarf medical advances.

6

I sa a study once that compared people who did everything right with lifestyle (no smoking, good diet, low bmi, Low stress, good sleep, exercise, etc) vs people who did all the wrong things. The people who did everything right added about 10 years life expectancy, and they still died. The diseases of lifestyle are mostly just diseases of age lifestyle just accelerates then. Very few twenty years olds who smoke, eat bad food and never exercise get diabetes, cancer or heart attacks. So Curing aging would make lifestyle mostly moot for health.

7

Developing an effective vaccine against malaria.

8

Another vote for malaria. It kills on a massive scale, mostly children, and causes unbelievable economic devastation through lost wages, missed education, healthcare spending, and overpopulation (when a quarter of your kids are likely to die, you have a few extra just in case.) Eradicating it would be one of the greatest triumphs of humanity to date.

9

meta-problem, paying for he hings you mention.

There is a big meta problem too. If you save my life again how do I pay for food and utilities while I set here and vegetate for another decade.

10

This. Not just because of any increased lifespan, but because of the quality of life issues. Even if cancer or heart disease still happens, it would be much better to not spend a few decades deteriorating before they do.

And we need to continue work against cancer, since extending lifespan just makes cancer more likely to happen. In fact some theories on aging postulate that aging is in part something the body uses to prevent cancer cells from replicating out of control (which is why successful cancer cells are “immortal”). If that’s so, then eliminating aging means that we’ll have to replace that control on cancer with our own technology.

Single payer health care. This is already a problem with a known solution; Americans just refuse to apply it.

11

Antibiotic research is going to have to become publicly funded. The bugs are becoming immune to mist current ABs, and there is too little profit in such, so the pipeline for new meds is empty. Within the next couple of decades it will become common for people to die of simple infections the way they did prior to WW2.

12

Minimally invasive surgery using “robots” (at least; remote manipulation of tools that are inside the body) is already pretty advanced.

If the goal is to make us healthier and live longer, it’s easy to decide which “medical issues” to focus on. The ones that kill and annoy us:

Starting with birth: preemies.
Until we get old: cancer and vascular disease in the western world; malaria and some other communicable diseases elsewhere in the world.
After we’re (chronologically) old: joint and organ replacement, and whatever it is that causes “aging” in general.

Most folks who think about this think of Keeping Healthy as different from Curing Conditions, and I think this is the right way to broadly divide approaches. Most medicine historically has been about Curing Conditions, and now we can get better at Keeping Healthy. For example, if you have the wrong genes, let’s fix that so you don’t get breast cancer or Alzheimer’s. If you have the wrong metabolism, let’s fix those genes so you don’t get hyperlipidemic-related vascular disorders.

After we attack Keeping Healthy, can “medicine” extend to “Making Better”? Maybe, and the push for that won’t wait until we fix Keeping Healthy first. If you can give me genes my parents forgot to cough up to make me stronger/smarter/prettier (the list goes on), I want those genes now.

We’ll see big advances in:

  1. Which genes you wish you had, and how to get them
  2. Organ and joint replacement
  3. If (1) doesn’t fix aging, then finding a way to fix the root cause
  4. Getting rid of the remaining big communicable diseases, either by host defense, eradication of the disease itself, or actually winning a bug/drug war for good

Then our real problem starts. When nobody gets old or croaks of natural causes, we are totally screwed. When everyone is brilliant, it will expensive to get the garbage collected. From a fiscal standpoint we need people to be healthy during their work life, and then die suddenly. To the extent that does not happen, society will not survive economically. Not to mention the already over-populated world will finish polishing off whatever is left of Gaia. Our already-invasive species will be like a mouse population exploding during a banner harvest year. Fun times, then.

13

Once there is a cure that is, oh, say, 50 percent effective, it is unethical to try something new that probably won’t work, but also might be far more effective. There’s a good chance this is why the cancer problem keeps getting worse* despite an enormous research effort. New treatments can’t be tried until the patient has failed other treatments and thus has such an advanced case that nothing is likely to work.

Over time, the ethical conflict between giving state of the art treatment vs. trying something new will likely crop up with other diseases. So my vote for the most important medical issue for the century recently started is: Research ethics.

See page 2 here:

14

There’s another thread on this…fwiw, my comment was that your exact point was made to me in the first pharmacology lecture I had on antibiotics in med school. More than 30 years ago…

15

And as in that thread my entry is decreased antibiotic use.

Another related one that has been in a recent thread of its own - the better understanding of our microbiomes and how to impact them in positive ways. I am fairly confident this century will see that and that it will impact the rates of autoimmune diseases, allegies, obesity, and more. I am also fairly confident that we as of now don’t know enough to say anything more than breastfeeding good , ges outdoor and pet exposure early in life, and eat lots of a variety of fiber rich foods

Malaria huge.

Probably a few decades out for each but clearly within this century.

16

In Canada, at least, THE medical issue will be funding .

Today, even before the baby boomers have started placing what will be a huge demand on the health care system, and as we expect more and more expensive high-tech therapies to be proven effective, health care already consumes over 40 percent of Ontario’s budget. If nothing changes, in fifteen years, it will consume about 75 percent.

“Who will pay, and how” - that is the big question for the 21st century.

17

I totally forgot about affordability, that is going to be a huge issue. Providing chronic care cheaply is something the entire wealthy and middle income world has to find ways to solve.

As far as my statement about robots, I am sure robots will become more and more autonomous at diagnosing illnesses, recommending tests, performing surgeries, etc. And as time passes they will get cheaper and better. I’m assuming that’ll be part of what drives down costs.

But again, if we could reverse/prevent aging that would be a massive boon. Young people tend to overall have low health care costs.

18

To the last two points is our getting comfortable with the realization that sometimes less is more and that just because we can do something is not a reason to do something.

19

With so many people hitting old age soon, we really need a serious dialogue on end-of-life treatment. I think as more people are entrained by the prolonged death throes of their elderly parents, the tendency of medicine to preserve life no matter the cost will be reevaluated. We need to be able to get to the point where we can look at the 86-year-old patient suffering from dementia and feel comfortable saying it’s not in her best interest to have a quadruple by-pass, without anyone being accused of being a heartless “death panel” monster.

I think there is another issue that will be brought to the forefront by aging Boomers. As a critical mass of them start developing dementia, I anticipate calls to legalize assisted suicide.

20

… why can’t we put a moon on the man? I’m with ya.