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Medicine's Brave New World

As the millenium approaches, doctors are assessing the impact technological changes will have on the medical field.


In a special issue devoted to technology and medicine, the British Medical Journal, its American equivalent, the Journal of the American Medical Association, and other journals around the world reveal a brave new world that resolves some medical dilemmas but also poses difficult ethical problems.


"Cures aren't really our final destination," said Dr. Thomas Reardon, president of the American Medical Association, at a recent London press conference.


Predicting and preventing diseases, mostly through technologies that allow us to better understand our genes, will be more of a focus than trying to diagnose and treat them, Reardon said.


Changes in the next 20 years will eclipse all the advances of the past 200 with information technology and genomics (the ability to map the genetic makeup of organisms), said Dr. Richard Smith, the editor of the British Medical Journal.


In fact, some of that future is already here, reports CBS News Correspondent Wyatt Andrews. Already parents with heredity diseases like Huntington's can go to an in-vitro lab for a gene test on embryos just eight cells old. Doctors can then implant in the mother embryos that test free of the disease.


Knowing your own genetic makeup will eventually be routine and for some it will be a heavy burden.


"Genomics will give us a much more profound understanding of disease," says Smith.


Dr. Charles Wilson, of the Institute for the Future in California and a neurosurgeon at the University of California, San Francisco predicts vaccines will have the biggest impact.


Future vaccines will be able to cure diseases such as cervical cancer and hepatitis C. Some will be edible or inhalable and many will contain snippets of DNA.


One paper in the British Medical Journal predicted that drugs and lifestyle changes would be the preferred prescription for people genetically predisposed to a given disease, rather than trying to manipulate the genes themselves.


In the future doctors will rely on computer software and extensive data bases to help them make difficult medical decisions and use the Internet to consult with far-away experts.


Patients will be better informed and become more involved in medical decisions, relegating the physician to the role of adviser. E-mails will replace visits to the doctor's surgery.


Sensitive biosensors will monitor everything from an individual's blood pressure to air quality and bacterial infections in hospitals.


Sufferers of irritable bowel syndrome will be able to detect imminent diarrhea with gut sensors and forestall it by pressing a drug-filled pouch under the skin, the paper said.


Japanese engineers have designed a toilet that weighs whoever sits on it and tests the urine for bacteria and sugar levels. It then transmits the results directly to the doctor.


In fact, ost of the tests performed by laboratories will be done automatically by sensors either worn by or implanted in patients, or built into hospital beds.


Hospital beds and operating tables will be replaced by units equipped with sensors that can provide suction and ventilation during surgery or monitor vital signs and release intravenous fluids during recovery signaling the end of traditional intensive care units and the risk of spreading infections that they pose.


In addition, ceiling vents installed in hospital lobbies will monitor the air to detect and report any visitors who might spread airborne infections to patients.


An under-skin sensor for diabetics that regularly monitors blood sugar levels and a "wristwatch" device that does the same by producing tiny electric shocks to open pores enough to extract fluid are under development. Those technologies will replace the frequent finger-prick blood tests that diabetics now must perform.


Diabetics also can look forward t implanted insulin reservoirs that will automatically release the right amount of insulin at the right time, eliminating the need for daily injections.


Those advances will not only make life more pleasant for diabetics, but will also save them from the sometimes fatal complications of their disease, doctors note.


In addition, robotics technology being introduced into electric-powered wheelchairs will allow users to balance on two wheels, drive through sand and gravel, or climb curbs and stairs.


Technology already in limited use will become less expensive and more widespread. This includes cochlear implants which help the deaf by bypassing the parts of the ear that don't work and sending messages directly to the brain. More than 20,000 people worldwide already benefit from them, Wilson said.


"These advances will not only be for the rich. They will become more simplified and will get less expensive. Home monitoring will be a huge saving," he said.


The affluent will always have things the rest don't, but the gap will not be extreme when it comes to fundamental new technologies, he added.


Dr. John Eisenberg, the director of the Agency for Health Care Policy and Research at the U.S. Department of Health and Human Services, urged doctors to take advantage of technology and called for global assessments of what methods would provide the best value.
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