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Where next?

Medical knowledge, medicines, drugs, and techniques are expanding exponentially, and so are the associated industries and costs. The success stories are legion. A mere half-century ago, much of the current medical knowledge and practices would have seemed unbelievable or just science fiction. There is no way such progress will stop, but that does not mean there are not negative aspects. Nevertheless, I have focussed on examples of downside features driven by a general failure of people to look after themselves. The worst downside for me is that large sections of the population assume that no matter what they do to their bodies, all their difficulties and problems can be sorted out by modern medicine. The usual villains of smoking, obesity, drugs, alcohol, etc. blight the lives of millions and shorten the lives of many others. These types of medical problem need a total new assessment by government, with more effective education and actions that make people responsible for their actions.

Rather different difficulties are emerging from genetic developments that produce drug-resistant diseases, as merely by reducing antibiotic levels, etc. will not reduce the new strains of infection.

There is also the innate human urge to experiment and to genetically modify crops, people, and animals. In some cases, there has been progress, but as with all new and experimental ideas, it is impossible to know or predict what the associated downsides are. For example, anyone who found a genetic solution to a common cold would be hailed a hero, but if there is a mutation from the treatment, that means we lose some other attribute in later generations—we cannot reverse the clock and start again. If our attempts at improvement and cures mean we cause some premature deaths, then it is unfortunate, but if we endanger the entire human species, it will be disastrous.

In reality, the fantastic growth rate of medical knowledge means that individually we can only access and understand a minute fraction of the total literature and knowledge. This automatically means we will make increasingly more errors.

A non-standard view of the situation is to say that, if the database of medical knowledge is increasing faster than we can understand it as individuals, then effectively the technological advances mean we are increasingly more ignorant of the total knowledge base!

A final comment on databases and records related to medicine is that because people relocate and are treated by quite different medical experts at different sites, then there would be a real advantage in having records that are accessible from each site. Whilst the benefits are clear, the implementation of such a system is difficult, and so far, at least in the UK, the attempts have been a very large drain on the available money for the health service. The first trials in 2002 cost around ?10 billion before being abandoned. Computational skills and expertise with large databases have improved since then, and a new proposal to make this transition to a paperless health service is budgeted at some ?5 billion. In a smoothly running situation, this may be successful, but in times of crisis, with failures of communication networks, then it will generate even more problems. Security and confidentiality may similarly be compromised.

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