2023 FUTURE OBSERVATORY

5147 MEDICAL TREATMENT

It is arguable that, for much of the nineteenth century and some of the twentieth, the improvement in general living conditions, rather than surgery (or even medicine), was the main contributor to improved health. Cleaner water and better sanitation probably saved more lives than all the doctors put together. Now, though, doctors are conquering many of the infectious diseases which were the traditional killers. Indeed, in view of the size of the challenge, it comes as somewhat of a surprise to learn that eight out of 10 children in the world have been vaccinated against the five major killer diseases of childhood. The problem is, unfortunately, the distribution of this new robust health which the world is experiencing. The problem is not a function of medicine but of political decisions.

Thus, smallpox has already gone, and polio may soon follow; though malaria is proving very stubborn and, of course, new diseases - such as AIDS - continue to emerge. We also know how to deal with the diseases of poverty; as indicated above, we just lack the will (and consequently the dedicated resources) to offer these solutions to everyone, around the world.

Increasingly we are even learning to deal with the problems which occur, at one extreme, within the human cell, and, at the other, in the holistic environment to which the individual is exposed. Once again, more than half our general groups (though, once more, fewer of our experts) thought that (all) diseases would be eradicated or at least controlled, although - perhaps surprisingly in view of the media hype - only just over a quarter thought that cancer would be cured or prevented.

As in much of the rest of human life, however, here too it seems that IT may have a major - albeit less obvious - impact. Where cost is becoming a major, perhaps (in the form of cost effectiveness) the major, factor in treatment decisions - we can now cure more things than we can afford - the use of computer controls on administration may prove to be one of the major drivers for better, or at least affordable, medicine.

The UK government's Technology Foresight Steering Group - reporting in 1995 - indeed makes the point that in 15 years time the cost of treatment rather than a lack of knowledge will probably be the chief limiting factor in the treatment of today's currently incurable diseases. Once again, technology not be the limiting factor. As for so many other areas, what we do will be decided by political decisions.  

Medicine is, given the resources, already meeting its traditional challenges. Infectious diseases, and those of poverty, are being conquered; and the everyday problems of patients are being addressed more and more successfully.  

The Economist[k] suggests this will have 'huge implications', and illustrates the point "In 1993 the Regenstries Institute at the University of Indiana published the results of a trial that produced savings of over $800 per hospital in-patient when doctors used computers to order tests or to receive reminders. The savings across the whole country could approach billions of dollars - for just one computerised procedure." 

Clement Bezold suggests "Health-care delivery becomes more effective and efficient. Multi-specialty [local] physician groups direct most care, aided by other health care providers and supported by expert systems." He predicts that, as a result, "... the number of hospital beds is cut by over two thirds in just two decades [to 2010]..."

This is not a trivial point, since - as The Economist points out - "There will be more careful assessment of the benefits of medical treatment...Those who finance health care - i.e. governments and insurance companies - are...demanding more information about the cost, effectiveness and quality of the services they are buying." Going further, Millet & Kopp suggest that ‘home health monitors’ "...will serve as a live-in medical team...Simply by analyzing your breath, for instance, you’ll be able to track a host of physical functions..."

The UK government's Technology Foresight Steering Group - reporting in 1995 - made the point that "In 15 years time the cost of treatment rather than a lack of knowledge will probably be the chief limiting factor in the treatment of today's currently incurable diseases - if that is so, science and technology will be increasingly targeted at reducing costs." 

9 May 2003 

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