For the past few years, I’ve been one of the caretakers of my 99-year-old father. A year ago, my wife and I joyfully added another person to our caretaking roles, our son Benjamin. As I tucked him in the other night, I started musing on the history and future of medicine. It turned into this letter.
A few weeks ago you turned one year old and Grandpa turned 99. It amazes me to imagine what medicine will have to offer you if you should live to age 99.
When Grandpa was your age, the world was in the midst of the so-called Spanish flu, a global pandemic that killed an estimated 50 million people. Sir William Osler, the father of modern medicine, had just died. And the world was still a decade from the discovery of penicillin, the first antibiotic.
As I rock you to sleep, I share the dreams I have for you on what I hope medicine will look like as you get older. I see products of imagination and the power of collaboration between ingenious scientists, compassionate clinicians, inventors, polymaths, and more.
Although the human body does a fine job of balancing a multitude of organ systems and has great sensitivity to recognize when health is off-kilter, it isn’t specific enough to distinguish diseases. It’s up to doctors to prod and probe for diagnoses. Self-monitoring of nascent irregularities in chemical composition or cell type or structure could one day be captured through medicine’s newfangled machines.
Many diseases stem from an underperforming or overactive immune system. Perhaps before you turn 99, medicine will be able to re-engineer our immunologic responses and teach our bodies to catch rogue cells before they multiply into cancer or inflammatory processes that compromise quality and quantity of life.
To assist that miraculous engine we call the human body, maybe there will be a biological filter that catches aberrant cells that escape natural detection. We might even have portable scanners, akin to Star Trek’s Tricorder (there’s already a prize for developing one), that can show anatomic and functional changes inside the body.
As a child, Grandpa used a common outhouse to pee and poop. Maybe you will have a personalized metabolic toilet that monitors your chemistry, vitamin deficiencies, levels of stress hormones, and other markers of health and illness from your waste products.
It’s not out of the realm of possibility that you will track your health using a wristband that monitors you and provides alerts 24/7. You might wake up in the morning and stare into a mirror that analyzes your retinas for signs of disease, scans your body for new or worrisome moles, and senses anemia or worrisome changes in blood flow.
In Grandpa’s youth, engine problems in the Studebaker and other cars were detected only after damage had been done. The same was true for ailing bodies. But for you, a quick exhalation into a breath analyzer could catch the early chemical signature of pending trouble, long before clinical symptoms manifest themselves. Just like today’s Tesla technology that detects oil leaks before the oil level drops and long before oil appears on the ground, these early-warning systems detect trouble brewing and nudge you to prevent it by changing your diet, lifestyle, or behavior.
The icebox of Grandpa’s early-20th-century life has transformed into the 21st-century smart refrigerator that we can call from the grocery store to see what we need to bring home. Perhaps the 22nd century’s equivalent will use the Internet of Things to collect data gathered by your personal medical devices and display recommendations of food choices on the door — need a little more water, a little less sugar, a better choice of protein?
As you get older, it’s almost certain that medicine’s understanding of neurotransmitters will be far better than it is today. It’s possible you’ll be able to get readouts on their current state of affairs. Low in tryptophan, an essential amino acid for serotonin that is central to, among other behaviors, mood and sleep? Add a little more chocolate, yogurt, and fish to your diet.
And for conditions that require medicines, an implantable miniaturized therapeutic delivery system to provide tailored remedies.
If that fails, you might be able to turn to synthetic biology, growing organs on a chip and using engineered stem cells to replace systems that prematurely lose their utility.
Grandpa was born on a kitchen table at a time when the structures of the elements of life were just being uncovered. The rediscovery of Gregor Mendel’s pioneering work in genetics was still underway. Your grandchildren may be incredulous when they hear there was an era when genes could not be edited, and there was no cure for many cancers. The exactitude of the surgeon’s knife will be mirrored in the molecular splicing of genetic material.
Perhaps your journey through a life span will see the design of engineered chemicals that scavenge for bodily debris and remove cellular trash, mitochondrial replacements to reboot the fuse boxes of our cells, or telomere enhancers that slow the aging process.
You are taking your first steps just as Grandpa is taking some of his last. As your decades pass, perhaps science will learn how to regrow nerves and muscle, helping those who are weak or paralyzed take their own steps again.
The biological wonders of Mother Nature, still hidden today, could be unmasked as Father Time ticks along in your life.
And though today you marvel at towering blocks, I hope you will get to witness and conceivably contribute to the soaring science that tomorrow brings. In the words of Dr. Seuss — not a physician but a medicine man nonetheless — “You’re Only Old Once.” But let that day be a century from now and may you be as healthy as possible.
As I put you down to sleep with your sneezes and sniffles, maybe, just maybe, in 2118 we will have found the cure for the common cold.
Howard A. Zucker, M.D., is commissioner of health for the state of New York.