Jim Baen's Universe

NonFiction articles

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