The challenges to modern medicine

Question 1

What are the aims of modern medicine

Answer 1

Longevity
Quality of life
Life free of disease or disability
These should guide our clinical decisions when treating patients

Question 2

What are the three changes that have had a major influence on health

Answer 2

Ageing population- need to tailor services differently, new inheritable diseases arise
Population Growth
Technological Advances- many countries cannot absorb new platforms

Question 3

How have deaths from NCDs changes globally and why

Answer 3

Increased

Due to population ageing and growth

Question 4

How has the total number of deaths in the world changed and why

Answer 4

Increased

Due to population ageing and growth.

Question 5

How has the total number of deaths from neonatal, communicable, maternal and nutritional diseases changed and why

Answer 5

Decreased
Due to population growth
Risk exposure and risk-deleted mortality rate

Question 6

How has the total number of deaths from injuries changes and why

Answer 6

Increased

Risk exposure, population growth and ageing population

Question 7

What represent some of the biggest risks to health

Answer 7

Diet high in processed meat
High BMI
Drug use
High fasting plasma glucose

Question 8

Where does death from dementia place in the leading causes of death in the UK in 2015

Answer 8

1st

Question 9

Describe the changes in the prevalence of mental health

Answer 9

It is increasing.

Question 10

Describe how burden represents a challenge to medicine

Answer 10

The magnitude
? Some people more susceptible than others
- Illness can be analysed at cell level (Biomarkers/DNA)

Question 11

Describe how ageing represents a challenge to medicine

Answer 11

Ageing still mystery
Chronic diseases (NCDs) 
Longer lifespan = dementia
-   ? Brian cells studies, no cure for dementia as we cannot access brain cells- only linked to function of the brain.

Question 12

Explain how we are starting to analyse disease at a cellular level

Answer 12

Some people may be more susceptible to disease than others- hence we are starting to analyse disease on a cellular level (biomarkers)

Question 13

How has the distributed deaths changed since 1915

Answer 13

1915- even distribution, peaks at birth and at around 70

now- majority of deaths occur over the age of 50.

Question 14

Describe the consequences of an ageing population

Answer 14

More people living over the age of 90- we need to shift resources to supply this. Greater percentage of total expenditure spend on this target group on high need, high cost cases. (5% of population accounts for over half the spending).

Question 15

Describe how obesity represents a challenge to modern medicine

Answer 15

Obesity (pollution, stress & diet change DNA)
Most diseases linked to obesity
Population vs Individual management

Question 16

Describe the efficacy of current measures to prevent obesity

Answer 16

Government intervention at a national level is failing with obesity, genetic treatment is the future.

Question 17

Describe personalised medicine

Answer 17

Interventions adaptable to individual patient’s genetic composition
High expectations
Access to information

Question 18

Describe the contribution of the NHS to our health

Answer 18

Contributes to about 10% of our health, the rest is genetic and formed by social and economic interactions

Question 19

Describe real-time cancer diagnostics

Answer 19

Intelligent electric surgical knife
Vaporized smoke analyzed by a mass spectrometer to detect the chemicals in biological sample
Real-time identification of malignant tissue
Cheaper, more accurate diagnosis
Higher success rates for patients

Question 20

Describe remote-controlled microbiots

Answer 20

Can reach any organ in the body for surgery.

Question 21

Describe the applications of targeted therapies

Answer 21

Blocking the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth
Could unlock the immune system- cytotoxic T cells that recognise cancer cells

Question 22

Describe how antibiotic resistance represents a challenge to modern medicine

Answer 22

“ the end of modern medicine” CMO 2015
No significant investments in new antibiotics
Misuse, lack of control, patients demands, competencies

Question 23

Describe how technology, evidence and information represents a challenge to modern medicine

Answer 23

Technology: Benefits (reduces cost, more targeted, higher success rates), Risks-overdiagnosis and treatment-worse in countries with no guidelines.
Population & individual access to knowledge
Evidence: generation, access- half of findings may be untrue.
Artificial Intelligence: diagnosis & treatment- to help with increasing volume of evidence (medical knowledge doubles every 73 days).

Question 24

Describe artificial intelligence based therapy

Answer 24

A human cannot digest billions of experimental data, thousands of clinical trials vs. patient’s individual parameters and mutations

Artificial intelligence algorithms expedite in minutes all available evidence into real benefits, allowing the most personalized treatment

This may dramatically increase treatment efficacy

Question 25

Describe how today’s and the future workforce represents a challenge to modern medicine

Answer 25

Shortage of health professionals (numbers/Types)
? Competencies (quality/safety)
Curriculum development (Edu/Training)
Multidisciplinary Team /Skills (transferable/change)

Question 26

What are the impacts of these challenges on medical practice

Answer 26

We have to:
Master information technology & access to evidence (costs!!)
Counselor/Coach/Partner- can’t just be healers, need to councel and support them in treatments and decisions
Chronic diseases NCDs): Prevention & Control
Work in interdiscipenary team
Design & quality improvement of service
Break the silos between service
Maximise Population Benefit (Leapfrogging H Systems) - move services in a more advanced way