“The doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease.”
— Thomas Edison, 1903
AS many commentators have observed, our current acute, hospital-based public health system is primarily concerned with managing illness, rather than creating health. Nevertheless, if we scan the horizon for what the future brings in health care, we can see developments in the genetics, technology and artificial intelligence (AI) areas that will revolutionise how health is delivered, and will transform the role of the medical doctor, shifting the paradigm from one of treating sickness to one of health coaching.
A futurist is a person who studies the future and makes predictions about it based on current trends. A medical futurist is one who does exactly the same thing, but with a focus on medicine. So, let us be medical futurists together today, and imagine a tomorrow by examining the recent scientific literature available (all references are less than 1 month old).
Let’s get the potential bad news out of the way.
The issue of antimicrobial-resistant superbugs has become so serious that the World Health Organization held a high-level meeting on antimicrobial resistance at the United Nations General Assembly on 21 September 2016.
There have been recent advances that bring some hope. In relation to new treatments, a 25-year-old PhD student from the University of Melbourne hit the news recently for her research published in Nature Microbiology describing the development of a star-shaped polymer that can kill six different superbug strains without antibiotics, simply by ripping apart their cell walls.
In another article in the Journal of Medicinal Chemistry, scientists created a hybrid antibiotic by tying together two different antibiotics with a molecular “rope” which made it operate in a completely different way than the original antibiotics, leading it to be effective against microbes previously resistant.
Australian researchers have discovered that peptides contained in the milk of Tasmanian devils can kill some of the most deadly antimicrobial-resistant bacterial and fungal infections, as reported in Nature Scientific Reports.
Similarly, scientists published an article in Nature Chemical Biology about a new antibiotic that was mined from the human gut, which can reverse resistance in pathogens and help kill off methicillin-resistant Staphylococcus aureus (MRSA) bacteria – in mice with lethal MRSA infections, the drug helped cure 100% of infections.
It is possible that the antibiotic apocalypse being prophesied by some may be averted through ongoing intensive research in this area.
Personalised medicine and pharmacogenetics are already concepts that have been translated to clinical care, where treatments are customised specifically for individuals, so that we are now potentially able to link an individual’s genetic makeup with targeted drugs so that the trial-and-error method of checking for drug efficacy and dosage is no longer necessary.
In addition to genomics telling us more about our genotypes, new genetic modifying tools, such as CRISPR, allow researchers to target a specific area of genome and cut out and insert new DNA, which means that we can repair genes responsible for diseases such as sickle-cell anaemia, as published in Science Translational Medicine.
Alternatively, we can potentially use a virus to deliver a specific gene to the brain to treat Alzheimer’s disease, as published in Proceedings of the National Academy of Sciences.
More recently, as published in Science, geneticists at Harvard University have managed to recode the entire genome of a synthetic E. coli bacteria, which is the first synthetic genome ever assembled, paving the way for the potential creation of “super-humans”.
Technology is also advancing rapidly.
Surgeons are now able to use accurate 3D printed bones to help fix severe fractures, a new move which speeds up recovery and saves patients from operations. Doctors are exploring the use of 3D-printed prosthetic ovaries using gelatin to restore fertility in women.
Robotic-assisted surgery is no longer science fiction and is now commonplace in urology, gynaecology and ear, nose and throat surgery, and progressing in other areas. For example, the world’s first robotic operation inside an eye has been performed with surgeons supervising robots that could complete these high precision tasks much more easily than a human can.
There are discussions about implementing so-called Nursebots in nursing homes that remind patients to take their medicine, use the bathroom and get ready for appointments.
But how far can technology go? Can a computer or robot replace a doctor?
The University of Southern California’s Institute for Creative Technologies, funded by the Defense Advanced Research Projects Agency, has created a virtual therapist, designed to detect signs of depression and post-traumatic stress disorder in patients by tracking and responding to their visual and verbal cues.
What about health apps? In June 2016, an in-house “live challenge” pitted health app Babylon’s AI against a senior accident and emergency nurse and an Oxford-educated junior doctor. The health app AI was consistently faster and more accurate in triaging patients than its human rivals: it scored 92% accuracy compared to the doctor’s 82% and the nurse’s 77%. Bear in mind, health app AIs still have a long way to go. A recent JAMA Internal Medicine article reports that doctors still make a correct diagnosis more than twice as often as 23 commonly used symptom-checker apps.
But health apps are quite different to serious AIs based on supercomputers like IBM’s Watson, which is already being used in cancer care with remarkable results, with a report indicating that the AI identified a treatment that the doctors had not found in 30% of cancer patients (over 300 people). Watson has also been trained to read 25 million published medical papers in about a week, something that would be impossible for a human.
From December 2016, doctors at the University Hospital of Giessen and Marburg’s Centre for Undiagnosed and Rare Diseases will start using IBM’s Watson to speed up their diagnoses.
Google has created an AI program called DeepMind that combines external memory and deep learning that learns how to do tasks independently, and could pave the way for more sophisticated AI assistants to help, support, and even replace doctors.
According to a recent article in the New England Journal of Medicine, through machine learning – where the computer not only recognises patterns from data, but learns from it – not only will doctors be able to more accurately predict prognosis, or save money by skipping expensive and unnecessary tests, but some of them, such as radiologists or pathologists, may even be replaced by computer algorithms.
In other words, as AIs like IBM’s Watson become more sophisticated, and by tapping into the enormous repositories of patient health records sitting in electronic medical records, research articles, and other databases, they will be able to see patterns, link variables, and learn over time, to become faster, better and more efficient diagnosticians than humans.
But doctors are more than just diagnosticians or technicians – and this is the one area that technology can never replace – doctors, supported by the technologies, will be the face of human compassion and kindness in our health care system.
My argument, therefore, is that doctors should embrace the increasing role of technology in health care, but not at the expense of being empathetic carers for our patients; quite the opposite, we should increase the ability of our doctors to have empathy for our patients so that they can grow as compassionate, kind clinicians – the one single thing that machines can never be tomorrow, but the most important thing that patients want today.
Professor Erwin Loh is Chief Medical Officer at Monash Health and Clinical Professor at Monash University.
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