Your implant will diagnose you now: a vision of medicine in the 21st century

IT IS A DREAM for some, a nightmare for others. Designer babies, "Star Trek" medical devices, brain implants and womb transplants may sound like fantasy but could all become commonplace in the next half century.

Rather than visiting the local GP, we will increasingly live in "intelligent houses" which monitor our health through body implants and consult the Internet to find the expert in our problem.

But alongside the array of technological breakthroughs, the darker side of future medicine conjures up a picture of a Brave New World, where brain function could be assessed in the womb and parents who continue with pregnancy knowing their child carries an illness could face stigma and be forced to meet the costs of treatment.

These are some of the predictions made in "Clinical Futures", an analysis of likely changes in medicine over the next 50 years, published today by the British Medical Journal publishing group.

According to David Delpy, Professor of Medical Physics at University College, London, an instant diagnostic device might well work using near- infrared light which can penetrate deep layers of body tissue. "Given developments in computing, allied to the ability of near-infrared light to distinguish the absorption arising from different molecules in the body, we may yet see the day when, like Dr McCoy in Star Trek, the doctor merely waves a machine with flashing lights over the patient to make an instant diagnosis," said Professor Delpy.

He added that there would be increased growth in patients looking after their own health. "Technology is going to push diagnosis right down to the local level," he said. "People are going to diagnose themselves, buying small testing kits in Boots, and monitor their own health, driven increasingly by healthcare insurance."

He suggested there might be lower premiums or no claims bonuses on healthcare insurance for those who monitored their own health carefully. "People are also going to be consulting across the Internet, finding the consultant who has the most expertise in their particular problem and then dashing around Europe to get themselves treated. This also means the role of doctors is going to change quite significantly."

Professor Delpy foresees a world where body implants would monitor blood pressure, heart rate and other health indicators. They could be linked to the "intelligent house" which would continuously monitor data from the implants, spotting anything from a cold to an impending heart attack.

Seen as particularly useful device for elderly people living alone, the house could look after its inhabitant by booking appointments with doctors or adjusting a diet by controlling the ordering or cooking of the right foods.

"Everybody will be so interlinked that a large part of routine functions will go on around you without you knowing," said Professor Delpy. "Your car will be driven out ready for you in the morning and your breakfast will start cooking itself."

In cancer treatment, one specialist predicted that a "golden age" of drug discovery and gene therapy would begin.

Early forms of gene therapy for cancer are being attempted and more would be tried. One approach would be to tag cancer cells to make them more visible to the body's immune system. Alternatively, cancer cells could be tagged with genes that make them better targets for anti-cancer drugs.

With an ageing population, cancer incidence will inevitably rise. But Karol Sikora, Professor of International Cancer Medicine at the Imperial College School of Medicine, said that by 2020 concerted action against smoking could reduce cancer incidence by 20 per cent, and dietary modifications a further 20 per cent.

Leslie Iverson, Visiting Professor at the department of pharmacology at Oxford University, predicted remarkable developments in brain and nerve repair. Brain cell transplants, when foetal cells are injected into the damaged area of the brain, would help tackle degenerative diseases such as Parkinson's and Alzheimer's.

New techniques will also be used to regenerate nerve fibres, by finding ways to bridge the scarring between damaged nerves, using powerful chemical promoters of nerve cell growth. "The prospect of making the blind see again and the deaf hear will remain an elusive but not impossible goal in this field of research," he said.

For those with weight problems, anti-obesity drugs which target the centres of the brain which control weight could be developed. Then it may be possible to provide a treatment regime that would permanently readjust the body weight control system downwards (or upwards for anorexics).

Genes that predispose people to mental illnesses such as schizophrenia, manic depression, and even addiction to drugs or alcohol, would be identified and screened out.

But Catherine Peckham, Professor of Paediatric Medicine at the Institute of Child Health, said that the advances in technology must be accompanied by a debate on the influence this had on society.

She predicted that artificial wombs could become a reality within 10 years. And by cloning sections of DNA that contribute to physical or mental fitness, and screening out unwanted characteristics, genetic engineers would have the ability to produce designer babies. "I think they could become a possibility, but I hope they won't," she said yesterday.

Because of the inherent risks in multiple births, pressure to abort one of naturally occurring twins could be brought to bear in order to reduce the risk of disability.

Increased knowledge of how childhood development affects adult health might promote aggressive state "nannyism".

"In an era when adoptable children will become increasingly scarce, child confiscation might become the preferred method of enhancing living conditions for children, rather than attempts at across-the-board improvements," she said.

Despite this the scientists all said they saw the future as optimistic. "There is great potential and it is very exciting," said Professor Peckham.

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