The future of medicine

• Someone who believes in the radical transformational potential of technology, and who anticipates that technology will result in very significant improvements in the quality of life in the relatively near future - but who is willing to go beyond predictions and theorising, to roll up his sleeves and become vigorously involved in building better technology.

That's how I'd describe Mike Darwin, the speaker at the Extrobritannia (UKTA) meeting at Birkbeck College in central London this Saturday. In other words, Mike is an eminent engineer as well as a philosopher. Specifically, he's an engineer in the field of preservative medicine.

But there's more. Mike appreciates that the process of refining new medical processes can be intensely messy and flawed. Just because we're surrounded by hi-tech, it's no guarantee that medical trials will be pain-free or mistake-free. Far from it. There are technological uncertainties, organisational impediments, and cultural hurdles. Without a willingness to embrace this ugly fact, there's a real risk that developments in medicine will slow down.

Mike's topic on Saturday is "Whatever happened to the future of medicine"; the subtitle is "Why the much anticipated medical breakthroughs of the early 21st century are failing to materialize". In his own words, here's what the talk will address:

The last half of the 20th Century was a time of explosive growth in growth in high technology medicine. Effective chemotherapy for many microbial diseases, the advent of sophisticated vaccination, the development and application of the corticosteroids, and the development of extracorporeal and cardiovascular prosthetic medicine (cardiopulmonary bypass, hemodialysis, synthetic arterial vascular grafts and cardiac valves) are but a few examples of what can only be described as stunning progress in medicine derived in large measure from translation research.

The closing decades of the last century brought confident predictions from both academic and clinical researchers (scientists and physicians alike) that the opening decade of this century would see, if not definitive cure or control, then certainly the first truly effective therapeutic drugs for cancer, ischemia-reperfusion injury (i.e. heart attack, stroke and cardiac arrest), multisystem organ failure and dysfunction (MSOF/D), immunomodulation (control of rejection and much improved management of autoimmune diseases), oxygen therapeutics and more radically, the perfection of long term organ preservation, widespread use of the total artificial heart (TAH) and the clinical application of the first drugs to slow or moderate biological aging.

So far, so good. But Mike continues:

However, none of these anticipated gains has materialized, and countless drug trials in humans based on highly successful animal models of MSOF/D, stroke, heart attack, cancer, and immunomodulation have failed. Indeed it may be reasonably argued that the pace of therapeutic advance has slowed. By contrast, the growth of technology and capability in some areas of diagnostic medicine, primarily imaging, has maintained its exponential rate of growth and, while much slower than growth in other areas of technological endeavor, such as communications and consumer electronics, progress has been impressive.

Why has translational research at the cutting edge of medicine (and in particular in critical care medicine) stalled, or often resulted in clinical trials that had to be halted due to increased morbidity and mortality in the treated patients? The answers to these questions are complex and multifactorial, and deserve careful review.

And in conclusion:

Renewed success in the application of translational research in humans will require a return to the understanding and acceptance of the inescapable fact that perfection of complex biomedical technologies cannot be modeled solely in the animal or computer research laboratory. The corollary of this understanding must be the acceptance of the unpleasant reality that perfection of novel, let alone revolutionary medical technologies, will require a huge cost in human suffering and sacrifice. The aborted journey of the TAH to widespread clinical application due to the unwillingness on the part of the public, and the now extant bioethical infrastructure in medicine, to accept the years of suffering accompanied by modest, incremental advances towards perfection of this technology, is a good example of what might rightly be described as a societal ‘failure of nerve’ in the face of great benefit at great cost. It may be rightly said, to quote the political revolutionary Delores Ibarruri, that we must once again come to understand that, “It is better to die on our feet than to live on our knees!”

Mike has spoken once before at an Extrobritannia meeting. See here for my write-up. It was a tremendous event. I'm expecting a similar engrossing debate this Saturday too. No doubt some of the discussion will focus on the main thrust of Mike's life work, cryonics: very few people in the world are as knowledgeable about this topic.

If anyone reading this is going to be in or near London on Saturday, it would be great to see you at this meeting.