Biggest challenges facing medicine over the next 50 years – an important factor to consider when entering this field.

In the next 50 years the world as we know it may transform into an unrecognisable state of continuous development that we potentially cannot cope with. On the other hand medicine may remain comparable with the way it is now. There is no method of predicting the path we may take, but the next 50 years involves today’s generation of prospective medical students, so these challenges will influence us the most. It is important to consider how modern life may evolve, but initially we must observe how past medical difficulties were overcome.
    During the past century advances in science and engineering were applied to many medical problems. In the 1800s doctors developed the first instruments to examine and understand the body such as the stethoscope or kymograph1. The astounding reduction in infant mortality and hygiene improvements by the influence of Lister and Semmelweis have also transformed medicine. Furthermore many of the revolutions such as the discovery of penicillin, psychiatric improvements and transplants were preceded by extensive phases of trial and error before eventual successes2
. The origin of the great challenges of the past may be due to insufficient knowledge since scientific understanding of metabolic processes and the level of available technologies were not as sophisticated as they are today. Nevertheless, medical practitioners were pioneering in understanding the body and finding solutions.
    In addition, a potential issue facing future doctors is meeting patient expectations. Many patients think there is a doctor waiting to immediately see them once they arrive at the A&E.  This isn’t the case and promotes aggravation and anxiety to the patient and his/her family.

    So, what might patients expect from doctors in 50 years?

The roles of GPs are ever changing, despite many of them working at the limit of their ability with constantly rising demands and requests. Also, updates, studies, appraisals, revalidations and communication add to their workload. Perhaps they may be expected to spend more time, take on more patients with our expanding population or possibly offer multiple services to deal with the emergence of new conditions.
    “Technological advances may begin to undermine the valuable role of medical professionals3.” Undoubtedly without the large pharmaceutical companies we could not have created and tested many of today’s most significant drugs. Two factors that make drugs important are that they treat a large number of people with diverse complications and they have led the way to treating diseases. However in 2014/15, the MRC spent a total of £771.8m on research4
. Perhaps we can question the necessity of medical research as there could be alternative treatments instead of prescription drugs. Similarly there must be a limit to the number of chemically based new drugs. The funding for this research can arguably be distributed in other ways, by relieving poverty in the less developed countries for example. Given the importance of other global problems research may not be as valuable as practical aid.
    Scientific knowledge is growing exponentially and the rate at which we discover gene variants for common diseases is increasing. Moreover “knowledge reorients the entire medical system5”. Coupled with technological advancements and genetic sequencing techniques, the way in which patients are diagnosed and treated can become dependent on each person’s genetic composition. Allegedly medical knowledge is doubling every eight years, so potentially for students who will graduate in 2020, the information they acquire in the “first 3 years of medical school will be just 6% of what is known at the end of the decade6
”. Therefore if this intelligence develops much faster than our ability to understand it effectively the most important skill we must adopt is to identify the suitable information for the right situation.
    With the inevitable technological advances, the arrival of personalised medicine raises ethical concerns. Personalised medicine involves tailoring disease prediction, prevention and treatment to each patient’s unique genome7. Therefore the patient can be prescribed a bespoke combination of specific drugs / treatment programme, in contrast to the present day in which most similar conditions are treated in the same way. In effect, the 100,000 Genomes Project could, when completed, provide a new genomic medicine service for the NHS8. On the other hand, it is essential to study the impact of genomic screening with safety in mind.

Is the medical benefit to a child, with a possible removal of a genetic disease, greater than the harm of removing the child’s autonomy?
    Expanding antibiotic resistant bacterial strains is a major concern for human health. In 80 years since penicillin was discovered, antibiotics have been overused and bacteria are pressured to develop resistance. The challenge of increasing bacterial resistance is a combination of what is discussed above, therefore is the greatest challenge to medicine in the future. Moreover, “in the EU 5-12% of hospital patients acquire an infection during their stay with 400,000 having the resistant strain9.” This resistance is spreading quickly, due to more travel and unnecessary use of antibiotics e.g. agriculture. New resistant mechanisms are emerging with Escherichia Coli as in China in 2015 where Colistin, the last resort drug, was ineffective10. With regards to patient expectations, a clinician often is pressured into prescribing a broad spectrum of antibiotics patients by acting quickly on incorrect information. However we are limited in terms of biomedical advancements as we haven’t yet found “new antibacterial substances since the 1980s11”. Serious complications ensue if antibiotics cannot destroy bacteria such that simple infections can be lethal. In addition to this with a rapidly growing knowledge, our chances of eradicating the resistant strains may rise.
     “Wherever the art of medicine is loved, there is also a love of humanity (Hippocrates)”. Despite the prospect of future medicine in 50 years appearing to be intimidating, medicine always has a profound purpose in society. It is important to remember that as humans we always seek to improve our situation and practitioners always endeavour for the best interest of the patient. Occasionally we may struggle to find a solution, however with deeper knowledge and preparation, we have the power to overcome these challenges.

 

The links to the references used in the preparation of this blog are given below.

  1. http://www.sciencemuseum.org.uk/broughttolife/themes/technologies.aspx
  2. Book title: The rise and fall in modern medicine, by Dr James Le Fanu.
  3. Biological Sciences Review journal link: http://my.dynamic-learning.co.uk/ViewPage.aspx?tid=5406f457-b9fc-47ec-8814-90d21a1d2a90&fn=dps0026-0027.swf&i=f20ae2ad-af22-4e07-8c11-3213e81665ee&baseTitleID=1825&r=true&vle=true&minPage=26&maxPage=31&searchText=future of medicine
  4. http://www.mrc.ac.uk/about/spending-accountability/facts/
  5. https://www.jimcarroll.com/2011/10/trend-the-future-of-knowledge/#.Vo7b06SzV9Q
  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116346/
  7. https://www.futurelearn.com/courses/the-genomics-era/2/steps/48237
  8. http://www.genomicsengland.co.uk/
  9. http://themunicheye.com/news/A-Sweet-Deal-for-Antibiotics-3173
  10. https://www.newscientist.com/article/dn28633-resistance-to-last-resort-antibiotic-has-now-spread-across-globe/
  11. http://sciencenordic.com/what-are-major-challenges-modern-medicine

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