Medicine – Part Ten

The 21st century and beyond

At last we reach the end of our little sojourn through the history of medicine. We have come a long way from drilling holes in people’s heads and whipping ourselves to drive off the plague (well, some of us have). Many of the childhood diseases that terrified us during the industrial revolution are rare. While technology has advanced hugely, many still go on pilgrimages to places like Lourdes to get healing when all else fails. We are in the strange position of having almost God-like powers in some areas, yet we still seem so helpless in others. This brings its own issues and challenges. Let’s look at what medical wonders can we see in the 21st Century and what advances we might see in future, alongside the challenges we will face.

“Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.”-Infogalactic

“The Human Genome Project (HGP) was an international scientific research project with the goal of determining the sequence of nucleotide base pairs that make up human DNA, and of identifying and mapping all of the genes of the human genome from both a physical and a functional standpoint. It remains the world’s largest collaborative biological project. After the idea was picked up in 1984 by the US government when the planning started, the project formally launched in 1990 and was declared complete on April 14, 2003. Funding came from the US government through the National Institutes of Health (NIH) as well as numerous other groups from around the world. A parallel project was conducted outside government by the Celera Corporation, or Celera Genomics, which was formally launched in 1998. Most of the government-sponsored sequencing was performed in twenty universities and research centers in the United States, the United Kingdom, Japan, France, Germany, Spain and China.

The Human Genome Project originally aimed to map the nucleotides contained in a human haploid reference genome (more than three billion). The “genome” of any given individual is unique; mapping the “human genome” involved sequencing a small number of individuals and then assembling these together to get a complete sequence for each chromosome. Therefore, the finished human genome is a mosaic, not representing any one individual.”-Wikipedia

A face transplant is a medical procedure to replace all or part of a person’s face using tissue from a cadaver. The world’s first partial face transplant on a living human was carried out in France in 2005. The world’s first full face transplant was completed in Spain in 2010. Turkey, France, the United States and Spain (in order of total number of successful face transplants performed) are considered the leading countries in the research into the procedure.

On 20 March 2010, a team of 30 Spanish doctors carried out the first full face transplant, on a man injured in a shooting accident. It became the first full face transplant in the world. On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the Henri-Mondor hospital in Créteil. In March 2011, a surgical team, led by Bohdan Pomahač at Brigham and Women’s Hospital in Boston, Massachusetts, USA, performed a full face transplant on Dallas Wiens who was badly disfigured in a power line accident that left him blind and without lips, nose or eyebrows. The patient’s sight couldn’t be recovered but he has been able to talk on the phone and smell.

In April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women’s Hospital face transplant team, led by Bohdan Pomahač, performed the nation’s second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter, 30, of Indiana, including the nose, muscles of facial animation and the nerves that power them and provide sensation. Hunter suffered a severe shock from a high voltage electrical wire following a car accident in 2001.“-Wikipedia

Unsurprisingly technology is leading the way in medical advances. Ever more sophisticated tech is leading to new breakthroughs. One of the ways in which this is helping is in replacing parts of the human body with an artificial replica. This has tremendous scope for benefits, but also raises ethical questions. Remember the character of Darth Vader from the Star Wars films? “He is more machine now than man,” was a line from the series. Back then a fantasy, now increasingly a potential reality. Jesus made lame beggars walk and blind men see. We can now do the same. Are we worthy of such power? And how will we use it?

Robots can be used to generate objective measures of patient’s impairment and therapy outcome, assist in diagnosis, customize therapies based on patient’s motor abilities, and assure compliance with treatment regimens and maintain patient’s records. It is shown in many studies that there is a significant improvement in upper limb motor function after stroke using robotics for upper limb rehabilitation. In order for a robotic prosthetic limb to work, it must have several components to integrate it into the body’s function: Biosensors detect signals from the user’s nervous or muscular systems. It then relays this information to a controller located inside the device, and processes feedback from the limb and actuator, e.g., position or force, and sends it to the controller. Examples include surface electrodes that detect electrical activity on the skin, needle electrodes implanted in muscle, or solid-state electrode arrays with nerves growing through them. One type of these biosensors are employed in myoelectric prostheses. A device known as the controller is connected to the user’s nerve and muscular systems and the device itself. It sends intention commands from the user to the actuators of the device and interprets feedback from the mechanical and biosensors to the user. The controller is also responsible for the monitoring and control of the movements of the device. An actuator mimics the actions of a muscle in producing force and movement. Examples include a motor that aids or replaces original muscle tissue.“-Wikipedia

Advancements in the processors used in myoelectric arms have allowed developers to make gains in fine-tuned control of the prosthetic. The Boston Digital Arm is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel. Recently the i-Limb hand, invented in Edinburgh, Scotland, by David Gow has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand to grip in precision, power, and key grip modes. Another neural prosthetic is Johns Hopkins University Applied Physics Laboratory Proto 1. Besides the Proto 1, the university also finished the Proto 2 in 2010.[70] Early in 2013, Max Ortiz Catalan and Rickard Brånemark of the Chalmers University of Technology, and Sahlgrenska University Hospital in Sweden, succeeded in making the first robotic arm which is mind-controlled and can be permanently attached to the body (using osseointegration).“-Wikipedia

What challenges are we facing? Obesity is being described as an epidemic. Increasingly it is being put down as the cause of death. Obesity is causing strokes, heart disease, increased cancers, diabetes, heart attacks, back pain, fatigue, osteoarthritis and numerous other conditions. Obesity is self-inflicted, which is very different to many of the conditions we have seen previously. While issues of drink have always been present, especially in Western society, obesity has not and ranks alongside smoking as a modern scourge. The causes are eating too much of the wrong types of food and lack of exercise. Is this the sign of a decadent society in decline? Who can say. What is certain is that obesity related illnesses and conditions are taking up more and more of GP and hospital time, all of which could be avoided with a balanced diet and regular exercise. Waves of government campaigns have been launched to tackle it, with varying levels of success. All the while childhood obesity is continuing to rise.

Dementia and the challenges of end of life care and the moral dilemmas that surround it are a pressing issue. There are many appeals to the courts over the right to die. Recently the Supreme Court ruled that relatives will no longer need legal permission to end treatment for those in a persistent vegetative state. There have been several examples of people travelling to clinics in Switzerland to end their lives through voluntary euthanasia, for example Dr. David Goodall. This opens up a huge can of ethical worms whose scope is too great to go in to here. That could be a whole other series of articles. Dementia has now overtaken cancer as the disease that people fear the most. A study by the Alzheimer’s Society forecast 1 million people with dementia by 2025 and 2 million by 2050. The study went on to say that dementia care already costs the UK over £26 billion a year. That’s even more than we send to the EU annually. Alzheimer’s Research UK says that there are currently over half a million people with a dementia diagnosis. The issue of assisted suicide is most prominent in relation to those suffering from dementia. The late, great Terry Pratchett was a prominent campaigner for the right to die and wanted to end his own life when he chose. I am personally torn on this. The Christian part of me says no, God decides the time and place of your death. You have no right to kill others or yourself. Another part of thinks that if I was in Terry’s situation I may think very differently.

There are still plenty of killer diseases out there. Indeed, some that we thought long vanished are making a comeback. Some parts of the world lack vaccines and people who contract diseases there, for example tuberculosis, then travel around to other parts of the world, potentially spreading them. Others have refused vaccination altogether. There was a scare that the MMR jab caused autism. This led to a drop in the number of vaccinations and several measles outbreaks, such as in Swansea. Over 1,000 people were infected and there was at least one recorded death. Others reject vaccines for various reasons, with some wild conspiracy theories abounding. I will say this; there is a reason smallpox was all but wiped out. The last recorded natural case was in Somalia in 1977. Before then it had troubled humanity for 3,000 years.

Other dangers lurk in places like Africa. Ebola has raised its ugly head, with an outbreak in 2014-15. Several countries were affected in West Africa and a reported 11,000+ died. International aid was thrown at the region, strict quarantines introduced, troops deployed, and good medical practices adhered too. Some countries like Nigeria dealt with the crisis and became Ebola free by themselves. However, there were warning signs for what may come in the future as several nurses that had travelled to treat patients were diagnosed with Ebola after they returned. With today’s modern and interconnected world, the potential the mass spread of a killer disease between continents is very real. The doomsday scenarios is if a disease like Ebola, which saw a death rate of up to 90% in the Congo outbreak of 2002, manages to mutate and becomes airborne. This would then have the potential to create a scenario like that of the Black Death during the Middle Ages. There has been an new outbreak in 2018. Don’t have nightmares.

© Jonathon Davies 2018

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