Medicine in 2016 - a Happy New Year?

2016 looks like becoming a very important year in the development of medicine. Over the last few years people have been looking more critically at the direction of modern medicine, at the way in which it has been driven by procedures and drugs, and questioning whether the cost of modern medicine is sustainable and is providing the benefits that are claimed.

 I can see huge changes in the two major killers in today's world – cancer and heart disease.

Cancer – in the past chemotherapy has been blunderbuss essentially damaging the most rapidly dividing cells which are assumed to be the cancer cells but at the same time knocking off any rapidly dividing normal cells in the body as well – giving the well-known side-effects. In recent years however much more selective chemotherapies have been developed which target the cancer cells specifically, giving much fewer side-effects, but more importantly a much better outlook. Unfortunately because the selective drugs are only applicable to selective cancers, the number of patients receiving them are relatively small, and thus it is difficult for the drug firms to recoup their research costs. This makes them extremely expensive, and insurance companies and Governments are going to have to decide which ones to fund, and for how long. While this is a real problem, it does give a real opportunity for quality and increased duration of life for many cancer patients. Example of these drugs include treatments for melanoma, myeloma, lung cancer, prostate cancer, pancreatic cancer and others.
Thus the diagnosis of even widespread cancer no longer needs be seen as a death sentence as it has in the past.

Heart disease – this has tended to be the pinup boy of medicine over the last couple of decades, as doctors have discovered bypass surgery, angioplasty and stenting. The same time the pharmaceutical industry has come up with a variety of drugs both to treat symptoms and to try and reduce the incidence of heart disease.  .

There has been a very strong emphasis on lowering cholesterol, and even though only one of the cholesterol-lowering drugs that have ever been shown to reduce heart disease (the statins),
The emphasis on cholesterol has continued, but more and more conventional doctors are looking critically at the evidence and the advice we have been giving to our patients in the past. By telling people not to eat fat, we have forced them into eating food containing lots of carbohydrates, which is led to an obesity epidemic. Doctors are now looking at whether we should be giving statins as frequently as we are recommending -for most doctors there is no debate - patients with definite heart disease should be on statins, their value in other situations is very debatable, in fact dubious.
People are also looking at the benefits of angioplasty which is being done every time doctors see what appears to be a significant lesion in a coronary artery. The evidence appears that only lesions that are symptomatic should be treated, and there is very little evidence that stenting any
lesion actually reduces the risk of heart attack or death. Over the forthcoming years, I suspect the number of angioplasty procedures will drop significantly.

Because of the increased cost of effective cancer treatments, I suspect that governments and insurance bodies may well be looking more closely at all other procedures, and confirm that they are value before funding them.

But perhaps the most frightening aspect of health which has the prospects of returning us to the Middle Ages is the development of drug resistant bacteria which could render most of our antibiotics impotent. Because of the speed of development of resistance, and the cost of developing new forms of antibiotics, the drug industry is unlikely to be spending a great deal of money on this problem.