The Future of Medicine in 2031

Nov. 1, 2006 — -- The ABC News Medical Unit asked doctors and medical experts in a wide variety of specialties about advancements in their fields in the next 25 years. These are their predictions for diabetes, Alzheimer's disease, stroke, asthma and ophthalmology.

DIABETES, 2031

By C. RONALD KAHN, M.D., president, Joslin Diabetes Center

Twenty-five years from now, if we properly and adequately invest in research, approaches to prevention and treatment of diabetes and its complications will be fundamentally different from those that exist today. These will provide completely new opportunities for prevention and treatment.

Prediction and prevention of type 1 diabetes, which is usually diagnosed in children and young adults, will be a reality, through genetic and immune screening or screening of organs and tissues for molecules that can act against the self.

There will be genetic screening for those at risk for type 2 diabetes, which causes the body to not produce enough insulin, or the cells ignore the insulin, with opportunities for prevention. Drugs to decrease insulin resistance, which causes muscle, fat and liver cells to not use insulin properly, will be used for both treatment and prevention of type 2 diabetes. In addition, genetic profiles for each individual will allow personalized treatment approaches that selectively target specific pathways or processes that are known to be involved in development of disease, as well as personalized approaches to improving nutrition (nutrigenomics).

ALZHEIMER'S DISEASE, 2031

By RONALD C. PETERSEN, M.D., director of the Mayo Alzheimer's Disease Research Center

Ultimately, Alzheimer's disease research is moving toward prevention. If we can identify patients before they develop symptoms and intervene with treatments, we may be able to prevent the disease before any damage is done to the nervous system.

Drugs and other treatments, like vaccines and immunotherapies, will be available to dramatically reduce or even interrupt Alzheimer's in the brain and body. It is likely that we will be able to tailor therapies and lifestyle alterations to an individual's likelihood of developing the disease.

All these efforts depend on continued growth in the investment in Alzheimer's disease research by the federal government, the medical industry and the Alzheimer's Association.

STROKE, 2031

By LARRY B. GOLDSTEIN, M.D., professor of medicine (neurology); director, Duke Center for Cerebrovascular Disease; senior fellow, Center for Clinical Health Policy Research; chairman, Stroke Council, American Heart Association/American Stroke Association

In the future, more people will realize the importance of reducing the development of stroke risk factors. Programs dedicated to reducing childhood obesity, encouraging exercise, improving diet and nutrition and reducing exposure to tobacco smoke will pay off -- people will have lower rates of stroke and other cardiovascular problems, provided that these approaches are vigorously pursued.

Better public education and more effective organization of stroke-related services may lead to more patients arriving at hospitals in time to receive treatments that can reverse the effects of an acute stroke.

With advances in brain imaging technologies, experts will be able to identify patients who might benefit from treatments longer after symptoms develop. Within hospitals, patients will see better outcomes and fewer complications because of improvements in the organization of care.

For those with disabilities, a variety of treatments now under study, such as drugs and cell-based therapies, may improve the brain's capacity to heal. All of this will require continued research and application of the results of that research to clinical care.

ALLERGY AND ASTHMA, 2031

By CLIFFORD W. BASSETT, M.D., fellow of the American Academy of Allergy, Asthma and Immunology; fellow of the American College of Allergy, Asthma and Immunology

Allergy vaccines

Novel pharmacologic devices for asthma care (skin patches, inhalational treatments, intranasal devices)

Better understanding of numerous asthma-associated genes that will allow more exact and better patient response to medications

"Smart" devices to keep track of asthma medications delivered, especially to children (possibly through telemetry to treating practitioner)

Genetic profiles of high-risk allergic individuals (to reduce risk of allergic reactions, such as food allergies), as well as assist in choosing which medication or therapy would have an optimal effect

Food allergy vaccines -- sublingual or oral home-based administration (seasonal and year-round allergies) with enhanced safety profiles

Hypoallergenic "high-risk" foods and hypoallergenic pets (cats, dogs, horses, lab animals)

Long-acting pharmaceuticals (once-a-month treatments) for allergy and asthma

Improved treatment of snoring

OPHTHALMOLOGY, 2031

By RANDALL OLSON, M.D., chairman of ophthalmology and visual sciences at the University of Utah

Options for lens surgery will be truly spectacular. Instead of changing glasses, people will be able to have lenses that adjust periodically for perfect focus inserted in their eyes.

A leading cause of blindness -- age-related macular degeneration -- will be tamed. There will be effective preventive treatments for the majority of people with genetic risk for blindness. This means that most now at risk can expect good vision for the rest of their lives. Glaucoma, another big blinding disease, will in 25 years be successfully treated at the optic nerve.