The first 50 years of the NHS saw enormous advances in the technology of healthcare. The physician's medicine cabinet in 1950 was virtually bare and the only imaging available was a primitive X-ray. Today’s practice of medicine is incomparable and the speed of change isn’t likely to slow down says Steve Ginn as he looks at some of the key predictions for the future.

Genetics and pharmaceuticals

When Dr Francis Collins of the Human Genome Research Institute said that the Human Genome Project provided a tool to ‘uncover the hereditary factors to virtually every disease’ it was hard not to be impressed.

We are rapidly realising that advanced genetic testing can pinpoint the cause of a disease so exactly that any condition will be considered an individual event and will have an individually tailored treatment. 

Being able to obtain a unique DNA signature for each patient will enable identification of disease susceptibility and optimal drug, vaccine or gene therapy treatment. Because of the enormous genetic variability between individuals, this leads to a corresponding variability in responses of patients to modern medical treatments.  In the future, instead of wasting time on trial-and-error treatment, physicians will be able to use a genetic test to identify patients with the most potential to respond to a drug. 

It may also be possible to combine genetic treatments with other technologies. Professor Sikora, a leading cancer researcher in Hammersmith Hospital, suggests that susceptible people may be able to be implanted with a ‘gene chip’ which would detect the earliest signs of genetic mutations that produce cancer. A patient could then check themselves with a home computer which could then contact the GP by email to arrange an appointment for review.

Nanorobots

Nanotechnology, the control of matter on an atomic and molecular scale, is another big hope. The name comes  from the microscopic scale at which this work is measured - by the nanometer.  

The field has its own journal ‘Nanomedicine’ and the latest issue discusses futuristic topics such as the advances in using nanotubes to fight bacteria and nanoparticles for cancer diagnosis and therapeutics.

Expectations for a subspeciality of ‘Nanorobotics’ - the technology of creating machines or robots on a nanometer scale - are even higher.  Robert Freitas, senior research fellow at the Institute for Molecular Manufacturing in California, describes its development as one of humanities ‘greatest and most noble enterprises’. 

Once introduced to the body these ‘nanomachines’ will be able to repair cellular structures, isolate cancer cells on an individual basis and deliver drugs directly to specific receptors. Nanotechnology may even make indefinite lifespans for humans possible if it’s potential is fully realised.

Sensors

We’re used to sensors being all around us in our homes, cars, security systems and household appliances. In the future, sensors will be embedded in the walls and ceilings of our homes or even woven into clothing to monitor our health. 

Remote transmission of pulse rate and blood pressure from the homes of patients with chronic illness is already possible. New devices that can sense hypoglycaemia in diabetic patients and can differentiate between the odours produced by ear, nose and throat infections are nearly complete. This last technology has further applications in hospital infection control when combined with air monitors to detect and report any visitor who might transmit airborne infection.

Bionics

From the Cybermen in Doctor Who to the Borg in Star Trek, lovers of science fiction will already be well acquainted with alien races who are part machine. This technology is now being developed and has already found some impressive applications.

The most widely reported example is Mr Nagle, a man from Massachusetts, who was left paraplegic following a knife attack. He was fitted with a 4mm-square chip or ‘Braingate’ that reads signals from the primary motor cortex of his brain allowing him to open emails, play computer games and operate a prosthetic limb. 

The possibilities of ‘cyborg technologies’ appear almost limitless. As well as providing prosthetic limbs  or restoring sight we could be seeing applications with the intent of enhancing the human body beyond its natural capabilities. Imagine for instance putting on a prosthetic suit and running from London to Manchester; or implants that could allow you see clearly at night. 

Robots in Surgery

Researchers at the University of Nebraska have developed a machine about the size of a lipstick which is able to drive around a patient's  body and act as the eyes and hands of a surgeon who could be many miles away. 

'We think this is going to replace open surgery' says Dr Dmitry Oleynikov, a specialist in minimally invasive surgery who heads the team, who further speculates that such machines could be used to treat patients on a battlefield or even in space. 

Nearer to home London doctors have begun pioneering the first fully robotic heart catheter ablation and angioplasty.  With this technique the cardiologist sits at a console outside the operating theatre and uses a joystick or mouse to guide the magnets. It’s also possible to preprogramme the computer so the entire operation is automatic. 

The Challenges of Technology

Over the coming decades it is a certainty that technology will play an increasing role in the provision of healthcare.  It is possible that with advances the doctor’s role will become obsolete - or perhaps we will find that our patients need our help more than ever to provide a friendly human face and a guide to the technologies on offer.

More concerning is that given the budget difficulties of the NHS it may be just the rich who will benefit from the advances. It could leave a technologically poorer group in society who can’t afford the new healthcare and with a dramatically lower life expectancy and higher morbidity.

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