Jim Baen's Universe

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Your Medical Care in the Coming Three Decades

Written by Stephen Euin Cobb

Let's take a little romp through the next few decades of your medical care. Not an exhaustive examination, just an informal tour. We have a lot of ground to cover so let's step lively. Let’s start with your prescription drugs.

Future Prescription Drugs:

Traditionally, drugs have been discovered through careful and time consuming searches of nature's bounty of defensive and offensive chemicals: poisons from plants, bacteria, fungi and animals. While this is still the main source of drug development today the era in which this method dominates is about to draw to a close.

The transition has not yet gained its eventual dominance, but soon all drugs will be designed from scratch to perform precisely what we need them to do.

The tools needed for this are few, but complicated.

(a) A complete map of the human genetic code. This tool was finished in 2003 and has been made available for any researcher on earth, or indeed anyone at all, to download for free.

(b) An understanding of how the control molecules (proteins mostly) within the body do their job. This tool has been under construction for a century, and while we are making wonderful strides there is no use in pretending that it will ever be completed. Fortunately, absolute completion is not needed. Humans flew in planes long before our fluid dynamic formulas fully explained how the wing worked. This tool is perhaps one or two percent complete today, and may not reach ten percent for a decade or two, but this need not be considered discouraging. Many wonderful results will be achieved before we reach five percent.

(c) Enough supercomputing power to accurately predict the shape into which a freshly deigned (and not yet synthesized) linear protein molecule will fold itself. This is the tool which the previous two tools make powerful.

For years we have had the ability to synthesize any linear protein molecule we wished. But it's been of severely limited usefulness since the long, chain-like or string-like, protein molecules we make will fold themselves based on the electrostatic attractions and repulsions of their many and various component atoms to their many various other component atoms.

If we knew enough to place the atoms just so, we would be able to force a molecule to fold itself into any shape we wanted. This is origami on the molecular scale. The shapes we could create, by the way, would not be limited to drug molecules. They could just as easily be microscopic machine parts. But that would be a different topic.

In accordance with Moore’s Law our computers are doubling in power approximately every 18 months. Already we have dozens of supercomputers scattered around the world capable of the vast computations needed for protein folding calculations. Based on Moore’s Law, the following rough prediction can be made: in ten years the world will contain tens of thousands of supercomputers capable of protein folding calculations, perhaps one in every university and hospital; and in twenty years the notebook computer you buy for the kids for Christmas will also be such a supercomputer.

Think I'm kidding?

In 1976 the Cray-1 supercomputer was the most powerful computer in the world. Los Alamos National Laboratory bought the first one, followed by Lawrence Livermore National Laboratory, and in 1977 The National Center for Atmospheric Research got one too.

The Cray-1 was an immensely powerful machine. Today it's remembered as one of the best known and most successful supercomputers in history. The Cray-1 used the revolutionary new 64 bit data bytes with 24 bit address bytes. It had a clock speed of 80mz and a maximum main memory of 8MB.

For comparison, however, my old Pentium One notebook computer (which I haven't used for several years because it isn't powerful enough to run anything beyond Windows 95) also used 64 bit data bytes and 24 bit address bytes, but it had a clock speed of 200mz and was equipped with 64MB of RAM. In other words, after thirty years of Moore’s Law, what was once the greatest supercomputer in the world isn't powerful enough to be even a second-rate home computer. Extrapolating this into the future yields the following: the most powerful supercomputer on earth today in 2007 will be too slow and too inadequate to run even the simplest of the popular software items that will be available thirty years from now in 2037.

But I digress. Back to protein folding.

Today’s supercomputers are doing it, and tomorrow’s will do it more and faster and better. In the meantime distributed processing is helping to fill the need. (Distributed processing is similar to parallel processing in that different parts of a program are run simultaneously on many computers which communicate with one another over a network.) The largest and most famous distributed project is probably SETI@home. A similar project for protein folding is called Folding@home and is done by people volunteering the computing power of their home computers and PlayStation 3 systems. Folding@home reported nearly 1.3 PFLOPS of processing power in September of 2007.

The fruits of all this labor will be a wide variety of new drugs, each of which will be targeted specifically to the observed vulnerability of its intended disease or malady.

Future Surgery:

The days in which surgeons routinely cut holes in their patients large enough to conveniently insert both of their hands is also rapidly drawing to a close.

Sometimes called keyhole surgery, or pinhole surgery or even band aid surgery, Minimally Invasive Surgery (MIS) is a surgical technique in which operations are performed through small incisions of about a quarter to a half an inch using a flexible or rigid tube bearing remote manipulators, a fiber optic light system and a tiny video camera.

Used for years in special cases where no other procedure would be possible such as certain brain tumors and heart valve surgeries, MIS is quickly being applied to more conventional procedures such as hysterectomies and prostatectomies.

Already one company has introduced a robotic platform which they call "The da Vinci Surgical System." It sells for one and a half million dollars (roughly half the price of an MRI machine). As of October 2007 at least three hundred were in use in twenty nations around the world. Overly simplified, it's an electronic puppet which reproduces exactly the movements of the surgeon’s human-sized hands but on a much smaller scale. The surgeon becomes blessed with the manipulative precision available only to someone born with hands smaller than those of a mouse, and the ability to view their work area so closely as to notice scratches on the side of a human hair.

In a decade or two every hospital will have several MIS machines, most clinics will have at least one; and some will probably begin to appear in the offices of your general practitioner.

Speaking of which, let's next examine your doctor, and your relationship with him or her.

Your relationship with your doctor:

The importance of your personal doctor to monitor your health and to treat your diseases and injuries will continue for some time, but how the doctor does this will change and these changes will come in several sudden technological jumps rather than through a slow progression.

One jump will be in the monitoring of a patient's blood chemistry. Today, anyone taking Celebrex, for example, must have a blood test every six months to verify that their liver is still functioning normally. This blood sample is removed from the body using a needle, then shipped to a laboratory for the testing.

The U.S. Patent Office has already granted patents for a device that will do this blood test without removing any blood from the patient's body. It can do this because the device is implanted inside the body, just under the skin, and outputs its test results using the same technology found in RFID chips. What's more, it provides the additional advantage that it can take a reading anytime. Ten thousand readings per day becomes no greater task than just one.

At first these implantable blood monitoring devices will gain popularity for those most in need of frequent blood testing—diabetics and those with kidney failure for example. But as they become cheaper and commonly understood they will also become more readily available and more socially acceptable.

Eventually only the very poor will lack them. Parents will be seen as irresponsible if they don't get them to monitor their child’s health. And of course the day will come when your Great Mother, sometimes referred to as your government, will mandate that all children must have them by a certain age, just as today’s children are required to have specific vaccinations. At that point, no law abiding citizen will be able to opt out.

Your doctor will still monitor your state of health, but you'll both save time since most office visits can be skipped. Just send the accumulated readings from your implant to the doctor’s office through the internet. Or set your medical implant’s access code to allow your doctor’s computer to logon to it remotely and download the data periodically without bothering you.

Micro-Doses:

Improvements to these medical implants—again beginning for those most in need of it but eventually spreading to the general population—will after a time allow them to release medicines directly into your bloodstream.

The medicines which people take today as pills or by injection once or twice each day, will then be taken as tiny "micro-doses," perhaps once every sixty seconds. No more swallowing pills or giving yourself an injection. These doses will not only be smaller and more frequent, they will be given based on the real-time measurement of the current concentration of each medicine in your blood.

Micro-robotic Repairmen:

Eventually, perhaps three decades from now, the necessary technology will become sufficiently small and sufficiently sophisticated and sufficiently reliable that microscopic robots—each one only the size of a single red blood cell—will roam through your bloodstream constantly searching your body for something that might be wrong: cancer, polyps, cuts, bruises, even cracked or broken bones.

Let's say you accidentally cut your finger. The micro-robotic sentries which happen to be passing through the area of the cut will notice the damage and immediately begin work. More and more will congregate in the damage zone and work together: anesthetizing the pain; cauterizing the severed capillaries; pulling the lacerated tissue back together and sewing or gluing it closed. To an outside observer your cut would seem to be healing itself by magic since this entire process might be complete in less than four minutes.

Because the repairs are done with such speed it wouldn't matter much whether you got a paper cut or a life threatening gash to the throat. The faster blood flows out of the damaged area, the faster the micro-robots can accumulate and do their stuff. Which means big, ugly, bloody cuts will be closed and sealed faster than tiny scratches. And the micro-robots won't care much if the bleeding is internal or external; the work remains mostly the same: stop the bleeding, stop the pain, and reconnect the tissue. Internal bleeding only adds the chore of cleaning out the blood; unless of course it can be gathered and shoved back into the bloodstream when it belongs.

Human Life Expectancy—Reaching Escape Velocity:

Every year throughout my entire life the Average Human Life Expectancy has increased. Not once in the last fifty-two years has it gotten shorter. Not once.

But how long can science keep a record like that going? And just how long can a human being live? Is there a limit? A limit that is genuine and unbreakable? Some say yes; some say no. The most accurate answer is, of course, that we don't know yet.

Some people anticipate a future in which our medical technology becomes so good that people no longer die of old age. Not rarely; but never. Death would only come by accident, or some mysterious and not yet understood disease.

But even if there is a hard limit to this fleshly body, who says we have to stay inside bodies of flesh?

In his novel 2001: A Space Odyssey Arthur C. Clarke described an advanced alien civilization which briefly visited Earth three million years ago and then moved on to other explorations and discoveries. In chapter 37, paragraph 13, he wrote: "And now, out among the stars, evolution was driving toward new goals. The first explorers of Earth had long since come to the limits of flesh and blood; as soon as their machines were better than their bodies, it was time to move. First their brains, and then their thoughts alone, they transferred into shining new homes of metal and of plastic."

Even forty years ago, in 1968, Arthur C. Clarke was able to envision this possibility. With the advantage of four decades of progress, I described in one of my novels (Plague at Redhook) a situation in which advanced alien nano-robots replaced all the living cells of a small group of people with artificial cells which mimicked the behavior of their original living cells. And they replaced them with such skill and craft that the people remained unaware that the transition had been made. They had become immortal and immune to all disease but did not know it.

What if all this nonsense becomes real?

Extending human life expectancy beyond its apparent limits is a noble goal and fun to think about, but what if it becomes real? What if you were faced with the fact that you might actually live 300 or more years? What would you need to do—besides celebrate? More specifically, what should you be doing differently right now?

I have three pieces of advice:

(1) Keep busy; keep active; keep learning. Hobbies are as important as career.

(2) Reinvent yourself every decade or two. Change profession or hobby or residence or city or nation or language or spouse or something.

(3) Invest a percentage of your income. This may be my best advice. Even a mediocre 401-K plan will let any moron become a millionaire in 40 years or less. 40 years may sound like a long time to wait for the good life, but those 40 years are going to pass whether you invest during them or not. If you live 300 years beyond your current age, at least you would be a millionaire for 260 of them. Or do you want to spend the next three centuries being just as poor as you are now?

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Stephen Euin Cobb is an author and futurist, and host of the podcast The Future And You.

You can learn more about Stephen Euin Cobb here or here.

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