The most important advancement in medicine in the last 25 years was the development of genetic modeling in animals, enabling us to figure out how fundamental mechanisms of physiology and disease work, such as in bone loss. That, in turn, allows us to develop novel drugs.
Twenty-five years from now, our kids will only know some diseases, such as osteoporosis, from old books, and by then we will probably know how to repair tissues with stem cells. However, I am not very hopeful about our struggle against cancer. The big worry is a disease that might spread over the world rapidly. SARS was a good example of how a little virus can change how people behave, how economies and travel are affected, and how our public-health system is inadequate to cope with it. And SARS was a relatively harmless virus.
I believe some clever people will get a handle on the genetics of our innate behaviors: What controls the behaviors of reproduction and love? I also think that the next revolution in science might be new imaging techniques to observe our cells and molecules in real time within the entire body during infections or cancer or even while we watch our favorite movie star on video in our doctor’s office. Then we might be able to understand ourselves in molecular terms; at the moment we are mostly guessing.
Josef Penninger, scientific director,
Institute of Molecular Biotechnology of the Austrian Academy of Sciences
Endoscopic surgery has matured over the last 25 years to become the dominant tool used by surgeons for joint and abdominal procedures, and its use is catching up in the area of the chest. Traditional open procedures increase pain and recovery times and the trauma induces immune suppression. Endoscopic approaches have broadened the population of patients who can undergo these procedures. The cause of knee pain is rapidly diagnosed and treated as an outpatient procedure with immediate recovery of mobility. Gallbladder surgery no longer requires a week of hospitalization and weeks of recovery. Robotic heart surgery enables us to close intracardiac holes, repair valves, and anastomose arteries for bypass surgery. Besides therapy, diagnostic techniques allow thorough evaluations of our insides, ranging from the vocal cords to the rectum. Artificial body parts will evolve over the next 25 years. Joints are already being replaced with success. Mechanical hearts will mature and become suitable for widespread permanent replacement of failing human hearts. Devices that replace kidney and liver functions will follow. We will also see devices to provide lung function, artificial vision, and perhaps nerve function.
Mehmet Oz, professor and vice chair of surgery,
Columbia University and New York-Presbyterian Hospital
If there is a single characteristic that distinguishes scientific medicine from all other forms of healing, it must surely be our emphasis on seeing—or at least being able to demonstrate in graphic form—the structure and actuality of the objects, substances, and interactions that form the basis of our art and science. The great 17th-century English polymath and physicist Robert Hooke went so far as to predict that the peak of medical accomplishment would be reached when a machine had been invented to allow doctors to see through the body with such clarity that everything occurring within it would be made easily visible. Anyone who has spent more than a few minutes as a bedside clinician would agree that it is hard to quarrel with that. I feel strongly that despite other magnificences—the most obvious ones being related to the consequences of unraveling the mysteries of the human genome—accomplished in the past two and a half decades and likely to appear in the next, the greatest practical advancements in medicine are those in the field of imaging, as it proceeds to expand in the realms of anatomy, physiology, and even the biochemistry of the body.
SHERWIN B. NULAND, clinical professor of surgery,
Yale University School of Medicine