Diagnosis and treatment of disease 20 years from now will depend on factors such as average life span, medical and technical advances and changes in the health care system.
So, in 2033, how will we receive medical care?
What can we expect to see in terms of diseases? Will we be living even longer?
Some eventualities are fairly certain, while others will be a challenge.
Advances in medicine and treatment are not as cut-and-dried as we would like. In fact, living longer creates a paradox for the medical community.
“The good news is that life expectancy continues to increase; the corollary is that we can predict with certainty we will see increased incidence of diseases that are associated with aging,” said Dr. Stephen Prescott, president of Oklahoma Medical Research Foundation. “Twenty years from now, there will still be a big burden of cancer. Probably to a lesser extent we’ll see cardiovascular disease, stroke, heart failure.”
But research is paying off. Treatments are far less invasive. Side effects are not nearly as debilitating.
“Truly exciting things are happening — breakthrough therapies,” Prescott said.
“Childhood leukemia was an absolute death sentence. Now 90 percent are cured. The type of testicular cancer that Lance Armstrong had now is curable. There are a number of examples of that. I think it’s coming … (that we’ll see) deadly diseases turn into chronic diseases.”
Rise of infectious diseases
Researchers also are seeing troubling signs of antibiotic-resistant strains of infection, both viral and bacterial.
The U.S. overcame drug-resistant tuberculosis in the 1990s. But researchers are seeing a looming threat emerge as drug resistance worsens abroad and far more dangerous strains develop and spread, including some that are all but untreatable with standard drugs.
“Will other types of diseases come back? It’s troubling because we’ve lived through a beautiful age where every infectious disease can be cured,” Prescott said. “We need to make sure we don’t fall out of the antibiotic age.”
But, Prescott said, within the next 20 years, great opportunities exist for finding new ways to treat infection — finding the equivalent of modern antibiotics.
“I think we will see combination therapy that will attack (the infection) from two routes. It’s going to be hard, but we know so much more about bacteria than we used to,” Prescott said.
DNA sequencing and personalized medicine
Imagine a baby being born in a birthing room. The obstetrician is with the mother as the pediatrician waits by to the thump the baby’s feet and give him an Apgar score.
By 2033, another process likely will be added to assessing the baby’s health — the doctor will swab his mouth for a DNA test.
By the time the baby is ready to go home, doctors will have his complete genetic profile with information on his health risks and assets, Prescott said.
“It took $3 billion and 10 years to sequence (the first) human genome. They do it now in an afternoon for about one thousand dollars. That’s where we’re headed,” he said.
We’re heading toward a time when medicine will be personalized to our own DNA sequencing, Prescott said.
“In the science of medicine, there is a revolution in understanding our genes, blueprinting our bodies’ risk of disease and understanding how genes are turned on and off,” he said. “With personalized medicine, more and more people will know their own DNA code. There’s a tailored prescription for you.”
What will we learn from that?
A lot, said Prescott.
“It will tell us if this person has a risk for cancer, heart disease and how these genes interact with others — whether it’s a high risk or a low risk,” he said. “I guarantee there will be good news and bad news. None of us is as perfect as we would like to be. We’re all going to discover that this is the hand we’ve been dealt.”
Structure of the health system
With all the advances that come from the medical community, reports indicate the U.S. still lags in overall health behind other developed countries — despite spending more on health care than any other nation.
“It’s true that we are No. 1 in what we spend in health care. But this is nuanced,” Prescott said. “What are the definitions of healthiest? When you dig in, it reflects a vast disparity in the country in what care is received and the quality of care received. The fact is that people in the lowest economic strata get lower quality care and are more likely to have advanced disease.
“If you compare U.S. to Sweden, Sweden is a homogeneous society. Take an analogous swath of society of middle-class people in the U.S. compared to Europe and the results are comparable.”
In order for the country’s overall numbers to improve, the health care system must evolve into one that can provide equal care across all economic levels.
“For many years we’ve had a guaranteed right to health care. It’s the law that hospitals cannot deny care to anyone. It doesn’t matter whether they have insurance or not. And the hospital has to absorb those costs when patients can’t pay.” Prescott said.
“That is not true in India. If they don’t have money to pay, they die on the sidewalk. Would we like to go to that system? You either pay or you die. I don’t think that reflects the society we want to be. There’s room for colossal changes. We don’t necessarily have to have a system that is government-run, but we do need to get more systematic. That would increase all our benefit.”
In the end, Prescott says we need to think about the cost of the disease instead of the cost of the treatment.
“We tend to focus too much on what does that IV cost?” he said.
But how much will it cost if that patient doesn’t get the IV or the treatment?
“Probably a lot more,” he said.