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January 2011 Issue

George Atweh, MD
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Physicians 'Foretell the Future' of Medicine

Published January 2011

The field of medicine is ever-changing, and with the start of a new decade, we will see even more alterations to the way health care is delivered.


So far in the 21st century, significant progression like decoding the human genome, the adoption of information technology, stem cell therapy and the decrease of certain diseases have opened the doors for discovering treatments and cures for some of the most devastating illnesses.


But what comes next for health-related research and patient care?


In 1999, the public relations and communications office asked members of the Academic Health Center what they saw for the future of medicine. In this issue of Findings, we revisited the topic and asked clinicians and researchers to share their predictions.


"In cardiology, I believe that we will see a boon in advanced imaging modalities to visualize the heart and blood vessels, perhaps at the molecular level.  This will not only improve diagnostic accuracy, but it will also advance our understanding of disease pathogenesis and help to individualize therapeutic approaches. We will see continued emphasis on prevention of atherosclerosis with much of the focus directed towards the impact of obesity and diabetes.  There will be emphasis on less invasive approaches to treat valvular heart disease, and patients with heart failure will be treated with small but sophisticated implantable assist devices that effectively support heart function and reduce the need for transplantation.  There will be increasing pressure to demonstrate cost-effectiveness of therapies, which may limit the application of tissue regeneration (i.e., stem cell therapy) for patients with heart disease.”

Neal Weintraub, MD, Mabel Stearns Stonehill Chair of Cardiology, Professor and Chair of the Division of Cardiovascular Diseases


"I’m hopeful the next decade will bring a more personal delivery system of health care with a comprehensive, coordinated team approach. We’ll see increased interdisciplinary team care with advance practice nurses, pharmacists and other health professionals joining forces to meet the expanding need for primary health care. Innovations in how doctors are compensated will reflect the incentivizing of increased quality of care and cost effectiveness. Through data from the electronic medical records, physicians will be able to track and improve their own effectiveness and enable patients to be more actively engaged in their care.”

Barbara Tobias, MD, Associate Professor of Family and Community Medicine


"The last three decades have witnessed an unprecedented scope of investment in the war on cancer that resulted in remarkable gains in our understanding of the molecular basis of cancer. As a result, a novel class of drugs referred to as ‘targeted therapies’ are being developed and used to treat many different types of cancers. Although the impact of these agents has been huge in some types of uncommon cancers, the success rate has been more modest in the more common types of cancer. As our understanding of the complexities of the process of malignant transformation continues to evolve and new targets are identified, the success rates of targeted therapies will continue to increase. The ultimate goal of targeted therapies is to identify the mutations that lead to a particular type of cancer and design specific therapies that neutralize the effects of the relevant mutation(s). The day will come when the treatment of a particular patient will be personalized (i.e. custom-tailored) based on an analysis of the pathways that led to the development of their particular type of cancer.”

—George Atweh, MD, Koch Chair and Professor of Hematology Oncology and UC Cancer Institute Director


"In pain medicine, the road map to the next century is not clear and murky at best. We will see many interventional procedures that will help alleviate patients’ pain and improve their quality of life. We will see decrease for reimbursement across the board on most of the procedures.  At the same time, we see advancement in the technology of non-invasive procedures.  I predict more emphasis will be on pain, losing weight and exercise, as I hope patients realize that normal weight and exercise are essential to live a healthy life.”

—Hammam Akbik, MD, Associate Professor of Anesthesiology and Chief of Pain Management

"Over the next decade, a major focus of research and clinical development in transplantation will be the role of anti-donor antibodies in acute and chronic rejection responses. We anticipate further improvements will be made in diagnostic testing and development of new antihumoral therapies.  In a manner similar to the development of T-cell-targeted therapies for cellular rejection, new therapies are being developed and evaluated for humoral alloresponses.  These therapies provide the ability to specifically target individual B-cell populations and also plasma cells. Once effective new therapies have been developed, short- and long-term clinical trials can start to determine whether these therapies can reduce graft loss and improve long-term allograft survival rates. These approaches are very exciting, as they may also provide a means for treating autoimmune diseases where autoantibodies play a major pathogenetic role.”

E. Steve Woodle, MD, Chief of the Division of Transplant Surgeon


"As our health care system evolves, the pharmacist will play a more active and vital role in providing direct patient care services.  We are currently seeing the initial stages of this as pharmacists are immunizing patients against preventable disease and working with patients to manage chronic diseases thru medication therapy management (MTM) services.  However, this role will significantly expand.  The pharmacists will be at the forefront, collaborating with other health care providers, to initiate innovative services to help patients manage chronic and acute illnesses effectively using drug and non-drug therapies. The pharmacist, as part of this health care team, will interact with physicians, nurses, and allied health professionals to provide patient-centered care.  This new level of collaboration will require pharmacists to possess not only medication knowledge but also the knowledge and skills associated with teamwork, communication, cultural competence and reflection.”Gaining these skills will start during an individual's academic career but will also require a licensed pharmacist to continue learning and growing professionally by participating in continuous professional development (CPD) programs.  The profession of pharmacy will face challenges as our health care system evolves.  Given our rich history, academic training and professional expertise, we look toward this evolution and take on the challenges that lie ahead knowing that we are and will be part of a unified health care team.”  

—Bethanne Brown, PharmD, Associate Professor in the James L. Winkle College of Pharmacy


"Fertility preservation will be widely available by 2020. Sperm cryopreservation has been reliably executed for decades.  However, women and children are at a loss for fertility preservation, if indicated.  By 2020, the techniques currently under investigation (in vitro maturation of human eggs, testicular and ovarian tissue cryopreservation and others) will have proven efficacy, enabling men and women the chance at fertility after cancer, trauma and profound disease.  Currently, these techniques are considered experimental. At the present time, embryo cryopreservation is the only reliable chance at fertility preservation. This only allows couples the chance at fertility preservation. Therefore, there are limited treatment options for patients with childhood cancers and female patients without partners. Additionally, access to fertility treatments should improve with the growing awareness of infertility causes and treatment options.   Refinements will continue to be made which will allow women to preserve fertility longer and allow women of advanced reproductive age to conceive their own genetic children where this was not possible in the past.” 

—Krystene DiPaola, MD, UC’s Center for Reproductive Health


"In the next 10 years, there will be effective, affordable, accessible prevention methods for HIV and AIDS: Microbicides for women and MSMs, universal circumcision for men and post- and pre-exposure prophylactic drugs. There may even be an HIV vaccine that works. There will also be significant progress towards—if not the achievement of—curative drug therapy for people infected with HIV as well as significant progress towards ending mother-to-child transmission of HIV. I believe there will also be universal access to sterile syringes/needles for injection drug users.”

—Judith Feinberg, MD, Professor of Infectious Diseases, HIV researchers


In 1999, Seeley said…


"The prevalence of obesity will continue to grow in developed and developing countries over the next 20 years, and as a consequence, associated disorders such as diabetes, heart disease and some cancers will also become more prevalent…”


In 2011…


"In the last 10 years, we have seen continued increases in obesity with some of the greatest increases observed in our children. The future does not look much better. Both rates of obesity and its severity are likely to increase with the result being that the human and monetary costs will continue to escalate. In fact, it is hard to see how we might contain long-term health care costs without a more concerted effort to prevent and treat obesity. New effective therapies in the next decade are likely to be intelligent combinations of dietary, pharmacological and surgical therapies that will help a larger portion of the obese populationThe escalating costs of obesity will hopefully bring together disparate partners in government and private sectors to do more to prevent obesity as well.”

Randy Seeley, PhD, Donald C. Harrison Endowed Chair in Medicine, Professor in the Division of Endocrinology, Diabetes and Metabolism and Director of the Cincinnati Diabetes and Obesity Center


"Over the next decade, diabetes will become the biggest public health burden in the U.S. The disease will continue to increase in prevalence such that 20 to 25 percent of Americans will be affected by 2020. The vast number of affected people, the relatively long lifespan of people with the disease and the broad range of required treatment will cause health care costs associated with diabetes to soar. Moreover, since more young people will be affected, the time period over which diabetes care is necessary will be extended. Complications of diabetes including renal failure, stroke and heart disease will remain significant causes of mortality across the U.S. population. However, because of the magnitude of the problem, diabetes will drive advances across the spectrum of medical care, from basic science and pharmacology to health care delivery and effectiveness research. As the disease that will touch virtually everyone, diabetes is likely to have an impact beyond health care, affecting the food industry and farming, architecture and urban design, education and social planning.”

David D’Alessio, MD, Albert W. Vontz Chair of Diabetes and Director of the Division of Endocrinology, Diabetes and Metabolism


In 1999, Brehm said…


"The changing dynamics of the health care system will require that health professionals be skilled to work in a variety of settings with a focus on interdisciplinary approaches. Educational strategies will evolve to meet these trends…”


In 2011…


"During the past decade, the interdisciplinary approach to health care has continued to gain momentum due to the evolving focus on patient-centered care. The emphasis on interdisciplinary collaboration for patient-centered care will continue into the next decade. With this health care approach, the patient becomes an integral member of the interdisciplinary team that considers the patient’s cultural background, values, preferences, needs and lifestyle habits in the design of care.  Patient-centered care will be essential for the sustained improvement of clinical outcomes and health in the United States.”

Bonnie J. Brehm, PhD, RD, Professor, College of Nursing


In 1999, Broderick said…


"The next decade in medicine will give us the entire genetic instruction set for human beings and the location of some errors in our individual instruction sets that may predispose us to various diseases…”


In 2011…


"The pace of genetic technology over the past decade has been breathtaking and can be evidenced in our own work at UC. For example, we used 400 microsatellite markers in the early 2000s to look for genes related to intracranial aneurysms, whereas in 2011, sequencing of the whole genome of an individual person is now possible involving determination of the status of 6 billion base pairs. In the past 10 years, scientists have identified genetic variants associated with a variety of rare and common diseases as well as normal human traits, but as per my prediction, these findings have yet to lead to new treatments or prevention strategies except in rare situations. The last 10 years brought us the first true machine brain interfaces with which scientists began to understand the language that brain cells use to talk to one another and which enabled individuals to move cursors on a screen or move a robotic arm simply by thought. The next 10 years will see acceleration in the area of brain machine interfaces where electronic devices will allow better control of brain function (treatment of abnormal brain movements, seizures and depression) as well as allow individuals trapped by major spinal cord or brain injury to control their environment by the power of their thoughts alone.”

Joseph Broderick, MD, Albert Barnes Voorheis Chair, Professor and Chair of the Department of Neurology

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