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Monday, January 4, 2010
The Changing Face of Medicine
What's the Next Big Thing?
By Michael Smith, North American Correspondent, MedPage Today Published: January 04, 2010
It's tough to make predictions, especially about the future.
That famous observation from baseball great Yogi Berra applies in spades to medicine.
What technological advance or new insight will shape the next few years? As Yogi noted, it's tough to predict:
It could be -- as Leif Ellisen, MD, PhD, thinks -- tumor genotyping.
The Massachusetts General Hospital researcher says that in the future doctors won't treat cancer based on where it starts -- the lung or the prostate, say -- but on what genetic susceptibility it has.
"More and more, it's the genetic drivers or the genetic profile that determines how a tumor is treated," he told MedPage Today. "That's going to change the whole way we think about cancer diagnosis and treatment."
Or it could be the role of a novel retrovirus, dubbed XMRV, that's implicated in two completely different diseases -- prostate cancer and chronic fatigue syndrome.
"It's very exciting because this is a new human retrovirus," said Robert Silverman, PhD, of the Cleveland Clinic, one of the people involved in discovering the new virus.
There are already two retroviruses that are known to cause human disease -- HIV and HTLV-1 -- and XMRV may be the first of many more, although it's "early days," Silverman said.
Or the next big thing could be research -- currently under way -- that might finally pin down a cause for multiple sclerosis. (See Radical MS Theory Stirs Interest)
Indeed, there are a host of technological advances or insights that might transform lives, according to Nick LaRusso, MD, of the Mayo Clinic's Center for Innovation in Rochester, Minn.
Progress in medicine since the end of World War II has been greater than everything the world had seen before, LaRusso said.
"I would predict that the degree of change in the understanding, diagnosis, and treatment of diseases is only going to continue and accelerate," he told MedPage Today.
But "one of the most profound changes that needs to take place -- and is likely to take place -- is making available those advances that we have already seen," he said.
LaRusso's center at the Mayo is looking for "new ways to develop better health," he says.
That includes technological advances -- new biomarkers, new imaging machines, new surgical procedures -- but it also means finding new ways to get what's already known to people who need it, he said.
"I would say the technology is way ahead of the delivery models," LaRusso said.
The current healthcare reform project in Washington will be part of the change, he said, as will new ways of getting specialized knowledge to primary care physicians at a distance from large medical centers.
"You're looking at changing a delivery system -- a fee-for-service system, a visit-to-the-doctor for reimbursement system -- that's been in place for 100 years."
There will, of course, also be technological changes.
LaRusso, a liver specialist, thinks that organ transplantation will evolve in two new directions -- cellular transplants, using stem cells to grow new organs, and xenotransplants, using organs harvested from animals.
"This is an area close to my heart," he said, "and there are thousands of people dying now around the country because they can't get a kidney or they can't get a liver or they can't get a heart."
It's also likely, he said, that vaccines both for infectious diseases and for cancers will be a growth area.
And "there's the whole issue of genetics." As genetic profiling gets cheaper and cheaper, it will be possible to tease out risk factors for various diseases on an individual basis.
"You can envision that becoming a standard approach when an individual is born," LaRusso said.
But in the long term, he said, the pace and direction of change will outstrip predictions: "It's going to be very difficult to predict with any degree of confidence what medicine will look like even 10 or 20 years down the road."