Medicine for the new millennium

Until recently, it took some four decades for the discoveries of pure science to find their way into the everyday miracles of technology. The vast chemical industry of the 1920s grew from advances that organic chemists had made in the 1880s. The primitive atomic weapons of 1945 were based on work that Albert Einstein published in 1905. Even the “miracle” plastics of the 1960s were built on chemical developments from the Depression era.

Today, that development cycle has been reduced to a few months, and even in the purest of sciences, many laboratory researchers can tell inquiring reporters or meddlesome funding managers what practical applications might eventually emerge from their theoretical efforts. Modern society's hardheaded demand for a short-term payoff----the modern equivalent of academia's traditional “publish or perish”----simply requires it.

Nowhere in science do new findings move from the laboratory to daily practice faster than in medicine. Almost by definition, biomedical research aims not to understand but to heal. And though a possible new treatment must work its way through a long, formalized series of studies to prove its safety and efficacy, when scientists announce the results of experiments in mice, we almost always know what new therapies to expect for human patients. And they will not take forty years to arrive but ten, or even five.

On that basis, this is one of the easiest forecasts we have ever made: the first decade of the twenty-first century will be one of the most remarkable and productive in the history of medicine---not just in history to date but in all the history there will ever be.

Dozens, even hundreds, of new treatments will reach beleaguered patients. Doctors will learn to repair damaged heart muscles, prevent Alzheimer's disease, avoid scarring after severe cuts and burns, wean addicts from drugs with relatively little hardship, and prescribe a host of wow psychoactive medications capable of easing mental illness more effectively and with fewer side effects than any now available. They will build artificial replacements for failing organs. And, of course, they may develop a vaccine against HIV, the virus that causes AIDS.

All that would make the next fifteen years a banner period----but there is more. No fewer than four all-out revolutions will transform the practice of medicine in the next decade. These are far-reaching developments, the kind of discoveries that change both our understanding of entire fields and the way doctors approach their patients. Rather than trying to cover the many individual advances that will contribute incrementally to medicine over the next few years, we will focus on these few transcendent developments.

Our candidates for the next medical revolutions are:

Gene therapy: In the last ten years, biomedical researchers have learned more about the workings of our genes than at any time since the discovery of DMA's famed "double helix," some forty years ago. In the next decade, that theoretical understanding will be applied as practical medicine. Doctors will learn not just to treat hereditary diseases but to cure and even prevent them. They may also reduce our susceptibility to disorders that, if not directly inherited, at least are influenced by predispositions that are governed by our genes.

A cure for cancer: In the early 1970, President Richard Nixon declared a $10 billion "war on cancer." Today, we understand this fearsome disease much better as a result of that research effort. Yet the sought-after miracle has remained out of reach. In the United States alone, more than half a million people die of cancer each year, while another 1.2 million new cases are diagnosed.