24 March 2010

My Grandchildren's World Part III: Medical Technology

In my children's and grandchildren's lives human genetics will be much better understood. Relatively inexpensive tests will be able to flag a host of conditions with genetic causes in infants and screening for them will become as routine as vaccinations and blood typing. The immune systems and its autoimmune disorders will also be much better understood, as will the biological basis of many mental health conditions. There will be other biotechnology based treatments as well, some flowing from the understanding of gene biology that drives health conditions.

Continued Advances In Treatments For Physical Health

The physical health applications of this knowledge will flow naturally from the existing state of medicine.

Gene therapies will permanently cure conditions like hereditary blindness in children. Chronic autoimmune diseases like diabetes type I, multiple sclerosis, and lupus will have cures. A childhood mouth rinse at the dentist will greatly reduce their susceptibility to cavities. Gut bacteria transplants will become a common tool to help treat obesity. People at high risk of developing certain kinds of cancers will start early and regular screening tests, and cancer therapies will work more often and produce fewer side effects. Sometime in my grandchildren's lives, there will probably be a cure for AIDS, and there will be effective immunizations against most forms of hepatitis. An improved understanding of nerve cells will make it possible to cure paralyzing spinal injuries. A quick and cheap test will be able to diagnose most cases chronic fatigue syndrome and an anti-viral drug regime will provide an effective treatment for it.

Cheap home test kits you can get at a drug store, like the pregnancy tests available now, will allow you to determine if your kids have bacterial (and if bacterial, whether it is a antibiotic resistant strain) or viral infections so that parents can provide the appropriate treatment for routine childhood illnesses without going to a doctor. Similar test kits will allow people to test themselves anonymously for all of the major sexually transmitted diseases with a single pinprick of blood.

Combination drugs that deliver "drug and vitamin cocktails" will replace the handfuls of pills taken by so many of us end up taking as we get older in a single pill that extended release methods will allow us to take just once a day.

Kits and response training for conditions that require swift treatment, like drugs to administer during strokes, electric shock treatment for cardiac arrest, and liquid wound sealers for major traumas will become as commonplace as CPR training.

Multiple forms of long term vision corrective technologies will make glasses and contacts anachronistic. Non-invasive surgeries and drug therapies will make long hospital stays and major surgeries rare. Once the patents on these new breakthroughs run their course, it will become much cheaper to treat some of the most expensive diseases. We won't necessarily extent the maximum lifespan very much; our bodies are built to self-destruct at a certain point. But, far more of us will be living into our nineties and even beyond a century. Our lifespans will be extended by a about a generation, and the percentage of us whose quality of life is impaired by ill health will greatly decline.

The commitment made this week in the United States to provide health care through a system that doesn't deny coverage based upon pre-existing conditions, already adopted in most of the world, will remove many of the privacy fears associated with diagnostic and genetic testing for physical conditions.

Forensic Technology

It is only a matter of time, that will have probably arrived sometime in my grandchildren's lives, before there are comprehensive databases of DNA profiles, finger print patterns, retinal scans patterns, and dental records for identification purposes for everyone on the planet. This will be used for purposes ranging from identifying people who can't communicate, to powering security systems, to establishing paternity, to making identity theft and false identities impossible for all but the most sophisticated to maintain, to identifying criminal suspects.

Non-invasive brain scans will be able to reveal signs that children have suffered traumatic child abuse in ways that existing physical evidence cannot.

Ubiquitous digital surveillance devices of increasing quality on police cars, in police stations, and in a variety of public places will make it easier for juries to evaluate allegations of police misconduct, statements from criminal defendants, and identify suspects who may have committed crimes in public places.

Arrest and conviction rates in impulsive stranger rape cases will soar to well over ninety percent. All but the most meticulous burglars will be caught before they have an opportunity to commit hundreds of crimes. Crime scene investigation units will be used far more widely, because they will be able to solve such a wide percentage of crimes.

People on probation and parole will probably routinely receive implants that track their location twenty-four hours a day and scan their systems for prohibited drug use (or for failure to take mental health drugs that they are required to take as a condition of probation or parole) many times a day.

Mental Health

The way new medical technologies impact mental health will have much greater social consequences.

In my grandchildren's world, mental health conditions will be identified much more strongly with a specific biological basis and classified accordingly, and diagnosis will involve medical tests to a much greater extent.

A few genetic mental conditions may be succeptible to treatment. Mental retardation from single gene disorders like Lesch-Nyhan disease, Gaucher disease and phenylketonuria (PKU) may be particularly receptive to gene therapies that can at least limit their impact.

Since so many mental health conditions have a strong hereditary or other biological component present at birth, parents will know from the time a child is an infant that the child is at high risk for conditions ranging from schizophrenia, bipolar disorder, autism spectrum disorders, ADHD, many anxiety disorders, select learning disabilities or psychopathy, and parents will be told what to expect and approximately when.

Early genetic tests will be able to determine if a child is likely to be resilient in the face of traumatic events or exceptionally vulnerable to them, and will be able to tell is a child is likely to be able to sustain stable personal relationships and marriages, or is likely to be prone to unstable long term personal relationships. A child's susceptibility to substance abuse problems will be revealed. Parents will know if a child will have a tendency towards novelty seeking behavior or impulsively. It may even be possible to make an initial assessment of a child's likely IQ range (or at least if the child is likely to be mentally retarded based upon conditions present at or shortly after birth), is anticipated aptitude for facial recognition, has propensity to stutter, or is likely to have a strong musical aptitude.

Early testing will be able to determine is a child is likely to have a homosexual or transgender identity (and probably to identify multiple subtypes of these gender identities, such as distinctions between people prone to be "butch" or "fem" lesbians).

Life may be particularly difficult for people who have mental health conditions that are not placed on a definitive biological basis, despie the fact that they are real. These people may face something like the problems that people with chronic fatigue syndrome, whose primary biological basis has jsut been discovered, have experienced in the last few decades, forced to advocate for theselves in the face of deep skepticism from the medical establishment which will be even more revered then than it is now.

Treatments will remain more elusive, and even the desirability of treating these conditions will remain controversial. Finding satisfactory long term treatments for many complex mental health conditions will prove far more difficult than developing diagnostic tests to determine if they are present, and many of these conditions will remain incurable. But, relatively easy permanent cures to some conditions, like phobias or PTSD that involve memory or problem concepts, may be possible in a handful of one time sessions.

Not everyone will want to know what these tests could tell them. Our society has spent thousands a years moving away from a sense that our mental lives and futures are governed by fate or destiny and moving back in that direction will be uncomfortable to say the least. The evolving science of mental health may become as hot of a topic in my children and grandchildren's lives as reproductive health has been in the last half century. Just as reproductive health had missteps that dramatically influenced the attitudes of whole generations (like attitudes towards IUDs caused by the defective product the Dalkon Shield), there will probably be missteps in the rapidly developing world of mental health treatment that transform our attitudes about this field. A drug touted as safe will turn out to have harmful side effects when taken on a long term basis, or will become simultaneously less effective and addictive, or will lead to inner mental discomfort for people strongly pressured or forced to take them because it changes a core part of who they are.

On the other hand, an increasingly biologically oriented view of mental health may move the criminal justice system from a punishment orientation to a treatment orientation for a much broader array of mental health condition driven behavior.

The way that society chooses to deal with the knowledge that some individuals are at particularly high risk of criminal or anti-social behavior in a way determined with indisputable medical tests is also going to pose profound moral and philosophical, as well as practical challenges.

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