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The ever-evolving world of medicine

As medicine evolves to face the rising challenges in health, we get a preview of how medicine will look in the future.

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By Alfredo N. Mendoza V

 

Medicine is the most tedious of sciences—because of the amount of skill, intelligence, and practice needed to safely manipulate the human body, which goes down to the cellular level. Not only that, medicine is both a social and personal concern, especially because the advancements in medicine further our understanding about ourselves and our health and how we can achieve a better lifestyle. We probably anticipate more developments in medicine than in any other field in science, mainly because health problems like diseases, chronic illnesses, and lifestyle vices have become more frequent than ever.

  • FINAL FRONTIER Bio Printing is the final frontier of medicine. While still in its infancy, we can see similar ventures in medicine, like in stem cell research and in regenerative medicine. Imagine a printer, but instead of documents, it prints human tissue, and instead of ink, it uses cultured biological material to ‘print’ tissue, and maybe, eventually, entire body parts. The above is an example of a 3D bioprinter, with many similarities to an ordinary printer too. The 3D bioprinter like the above ‘prints’ cell cultures, also incidentally named as ‘bio-ink’ which will eventually grow into tissue. (photo from cellculturedish.com)

  • RISK REDUCTION Anesthesia is an especially risky specialization, because of the amount of risk involved when handling anesthetics, but with digital monitoring equipment, anesthetics becomes easier to handle with accuracy. The digital monitoring equipment may also be put in smartphones as apps, thereby increasing mobility of physicians in hospitals. (Image extracted from Google Images).

  • CELLULAR LEVEL Immunotherapy is more effective in the reduction of tumors compared to chemotherapy, but in its current price range, it is only available to a few, and some people who would opt for the treatment may have to go to other countries like the US. The above illustration from pancreaticaction.org shows activated lymphocytes attacking cancer cells. Activating lymphocytes can be achieved by the increase of specific hormones in the body which will enable the lymphocytes to seek out the cancer cells in the body.

  • PRINTED MATTER With the advent of 3D printers, more advanced and more affordable prosthetics may be available in the future—imagine prosthetics being ‘printed’ and assembled in the hospital immediately, without the need for requesting suppliers.

    In the Philippines, we hold medical doctors in high regard not only because of their training, but also for their direct involvement with people, especially during their voluntary work. Medicine is the most socially anticipated field in science, and it is also the most academically active—a field where millions worldwide collaborate in—from the pre-medical professions to the specialized and general medical professions.

    Medicine has become the only way in understanding health. Gone are the days, albeit not completely, of the faith healers, the shamans, and the animists. Enter modern medicine and its advanced ways of curing ills once thought to be incurable.

    But the advances in medicine can only be equaled by the worsening of illnesses too. In 2014, the world witnessed the worst and most widespread ebola virus epidemic—which occurred mostly in West Africa, and in limited numbers in the United Kingdom, Italy, Spain, and the US. With a mortality rate of more than 70 percent, according to the World Health Organization, ebola claimed almost 12,000 lives from its initial infection in 2013 to May 2016. Other new and unfamiliar diseases have also surfaced—new influenza strains like the AH1N1, which caused a pandemic causing almost 15,000 deaths worldwide and widespread panic in 2009—with cases in 168 countries, including the Philippines. There was also the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak in 2012, which also prompted countries to tighten its borders, and which especially threatened the OFWs in the Middle East. Much more recently is the Zika virus outbreak in South America.

    As medicine evolves to face the rising challenges in health, we get a preview of how medicine will look in the future—a combination of digital medical technology, bloodless and closed surgeries, improved monitoring devices, and biological reconstruction that only the pre-modern leaders of medicine could have dreamed of.

     

    Cancer immunotherapy

    For the longest time, the most common medical procedure against cancer was chemotherapy—a cancer treatment that uses anti-cancer drugs known as chemotherapeutic agents to combat the growth and proliferation of cancer cells in the body.  The problem is, not only are the cancer cells targeted by these drugs, but the healthy ones as well. This treatment also causes drastic changes in the body including hair loss and nausea. Immunotherapy introduces a new method where the body’s immune system, through a series of special medications, detects the cancer cells themselves and prompts defense cells (lymphocytes) to seek out and dissolve them, unlike in chemotherapy or in radiotherapy where healthy cells are also damaged in the process.  Immunotherapy is undoubtedly more effective than previous cancer treatments and may rid a patient completely of cancer, like what happened to former US President Jimmy Carter, who was diagnosed with cancer, but eventually beat it through immunotherapy. Medications for immunotherapy are now available in the Philippines, but they come at very steep prices, with treatments costing as much as R250,000, and while this elicited outrage from the medical community in the country, it will take a while for prices to go down.

     

    Digital management of anesthetics

    Anesthetization is a particularly risky operation, which may result in the patient’s death if anesthetics aren’t handled properly. That is why some hospitals abroad and in the Philippines have begun implementing digital management of anesthetics through the use of computer devices and even smartphones. This will reduce the risks an anesthesiologist usually takes before preparing the patient for a medical operation. This technology combines both informatics technology and medicine in a very accurate tool to limit, monitor, and evaluate the status of patients in anesthesia.

     

    Treatment of deadly diseases

    Significant developments have also emerged in the field of pharmacology, where diseases once thought to be incurable have become possible of being cured by new and more effective drugs, and these developments are on the roll—and there is no doubt we will see more developments in the next few years.

    Fil-Am medical immunologist and pathologist Katherine Luzuriaga was part of a research effort that had cured HIV in an infant a few years ago. While it had been decades since the last significant developments in HIV, Luzuriaga’s contribution to the research effort has rekindled hopes for finding a cure for the dreaded disease. There is another incurable disease, which may be on its way to being finally eradicated. The World Health Organization reported this year that more than a million individuals have been cured completely of hepatitis-C through the application of Direct Acting Antivirals (DAAs). The most common form of hepatitis, hepatitis-C affects about 170 million people worldwide annually and takes 400,000 lives in the process.

    This major breakthrough in the creation of DAAs, which have a 95 percent cure rate, seeks to put an end in all forms of hepatitis. The “cure,” however, isn’t really affordable. Each treatment cost almost P50,000 per pill, or nearly P5 million for a complete 12-week treatment. Research has also given way to a hormonal drug called seralaxin that may help fight acute heart failure by prompting blood to pump more efficiently and for veins to open wider to alleviate the deficiencies in blood circulation. This, however, is still in the experimental phase in the US, and it will take some time, too, like the DAAs, for seralaxin to be in wide use.

     

    Advanced prosthetics and artificial organs

    Medical developments in the US and other leading countries usually take long before they resonate in countries like the Philippines, but an improved relationship between the two countries means that more Filipinos have become more mobile to acquire healthcare in the US. New sophisticated prosthetics such us fully controllable bionic limbs, bionic eyes to restore sight to blind people, artificial hearts, artificial kidneys, and bionic hearing aids may not come soon to the Philippines, but, already, we can see them being the standard in the future of therapeutic health and recovery. An effort has also started in Europe for the development of internal defibrillators, which automatically activate during a cardiac arrest. In 2015, an 80-year-old British man became the first recipient of a bionic eye transplant which restored some of his vision, which he lost over time through macular degeneration. In 2012, American Aimee Copeland lost her hands and legs after acquiring a life-threatening flesh-eating bacteria. Now her limb movements have been restored thanks to her fully electronic bionic hands, which she can control via her smartphone. Bionic prosthetics are one of the main foci of medicine and occupational therapy today and, currently, scientists are on the verge of developing natural-sensing touch on newer, more advanced prosthetics.

     

    Gamma knife and closed surgeries

    The advances in radiology have made energy instruments more precise and more controllable than ever before. Non-invasive (closed) surgeries like the removal of tumors, gouts, and vascular malformations like varicose veins are now possible, thus reducing the number traditional “open” surgeries where there is greater risk to the patient. Gamma knife procedures remove brain tumors by projecting pinpoint-precision gamma radiation to where tumors are and, thus, dissolving them. This procedure is used with monitoring equipment and constant MRI imagery to accurately locate tumors. Only one hospital in the Philippines has a gamma knife center, but, with advances in medicine going as fast as advances in electronic gadgets such as smart phones, we will eventually expect an inclination toward energy-based non-invasive, and robotic-assisted surgeries.

     

    Laparoscopic surgeries

    In the past, there was no other method in surgery than by opening the person himself, but with medical tools becoming finer and smaller every year, it seems that minimal invasive surgeries, or laparoscopy, will eventually become the norm.  Imagine a tumor within your stomach which needs to be removed. The riskier way is to cut the stomach itself and then search for the tumor.  While in laparoscopic surgeries, without cutting the patient, a laparoscope, a small camera at the end of a medical tube, together with advanced catheters, can be inserted in the body, which can then pinpoint the tumor visually and then dissolve it through electricity or through incision.  In the Philippines, laparoscopy is in full use, and it requires a great deal of skill and technological understanding to fully use it.  Not only that, medical research, including here in the Philippines, is exploring new uses for laparoscopy beyond just removing tumors and clearing clogged arteries, like internal suturing of damaged organs, placement of bionics like internal defibrillators, stents, and other helpful artificial medical aids, electrotherapy, and the restoration of movement for stroke victims.

     

    Bioprinting and molecular medicine

    Once thought to be within the realm of science fiction, the creation of organic human material like tissue is now closer to reality. Imagine a printer, but instead of text files, it prints actual human tissue through, instead of ink, a rigorous process of cultivation, genetic and biological manipulation and stem cell inclusion. The applications for this technology are innumerable.  Bioprinting is seen as the final frontier of medicine—where medical tissue are mass-produced from natural sources to heal, or even replace damaged parts of the body. Not only that, bioprinting will especially be of concern in plastic surgery—where burn victims, and other people whose skin have been severely damaged, may be able to repair restore their skin with new skin, blind people replacing their eyes with new ones, or, ultimately, where amputees will be able to restore their limbs completely. Indeed, it promises to be the ultimate example in regenerative and molecular medicine. Several prototypes of bioprinters have already surfaced and are currently in development.

    And, of course, there are more things to see and experience in this very interesting field, including the number of ways people do to get better and healed in the future, especially in a time of great technological strides. But no matter how far we will go in medicine, the worst and most damaging societal ills are not cured by medical means, but only by political means, through education—and that probably takes more work and participation than any kind of medical research breakthrough.

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