During the NHS’s first 50 years the organisation saw enormous advances in the application of technology to healthcare.  During the 1940’s a physician’s medicine cabinet was virtually bare and the only imaging available was X-ray; even the humble mobile phone was the stuff of science fiction.  Over the same period computers went from being primitive calculators, contained in specially cooled rooms and running off punch cards, to being highly portable and with incredible processing power.  Some research is moving so fast that futuristic techniques are close to being available now, whilst ideas that appear highly theoretical today will, in coming years, become increasingly practical.

Nanotechnology and Nanorobots

Nanotechnology is a field which covers the control of matter on the atomic and molecular scale.  Its name is derived from the scale at which this work is conducted – that of the nanometer.  The allied field of Nanomedicine covers its medical applications and this is already becoming one of the biggest industries in the world with 2004 sales reaching $6.8 billion.  The field has its own journal ‘Nanomedicine’and the October 2007 issue discusses such issues as using nanotubes to fight bacteria and nanoparticles for cancer diagnosis and therapeutics. Further from practical use are ‘Nanorobotics’ the technology of creating machines or robots on a nanometer scale.  Expectations for this are high; Robert Freitas, senior research fellow at the Institute for Molecular Manufacturing in California, describes its development as one of humanities ‘greatest and most noble enterprises’.  Once introduced to the body these ‘nanomachines’ will be able to repair cellular structures, isolate cancer cells on an individual basis, and deliver drugs directly to appropriate receptors.  If all the possibilities for this technology are realised nanotechnology may even make possible indefinite lifespans for humans. 

Genetics and pharmaceuticals

When Dr Francis Collins of the Human Genome Research Institute, published in the New England Journal of Medicine that the Human Genome Project provided an audacious tool to ‘uncover the hereditary factors to virtually every disease’ it was hard not to be impressed.  With advanced genetic testing we will be able to pinpoint the cause of a disease so exactly that any condition will be considered an individual event and will have an individually tailored treatment. A unique DNA signature for each patient will enable identification of disease susceptibility, and optimal drug, vaccine or gene therapy treatment.  There is enormous genetic variability between individuals, leading to a corresponding variability in responses of patients to modern medical treatments.  In the future, instead of wasting time on trial-and-error treatment, physicians will be able to use a genetic test to identify patients with the potential to respond to a drug. 

It may also be possible to combine genetic treatments with other technologies; Professor Sikora, a leading cancer researcher in Hammersmith hospital, suggests that susceptible people may be able to be implanted with a ‘gene chip’ which would detect the earliest signs of genetic mutations that produce cancer.  A patient could check themselves up with a home computer and which could then contact the GP by email to arrange an appointment if something is amiss.

Sensors

Sensors are all around us, and we are used to them being in our homes, cars, security systems, and household appliances. In the future, sensors will be embedded in walls and ceilings of our homes and workplaces, or woven into clothing, and will monitor our health. People are already planning for this: in an issue of the BMJ devoted to technology, Charles Wilson, Director of the Institute of the Future, predicted that "inpatients may be implanted with tiny sensors as part of the admission process, and throughout the patient’s hospital stay the chip will provide values instantaneously for laboratory tests." Remote transmission of pulse rate and blood pressure from the homes of patients with chronic illnesses is already possible.  Close to hitting the market are devices that sense hypoglycaemia in diabetic patients and can differentiate between the odours produced by ear, nose and throat infections.  This latter technology has further applications in infection control as in future hospital lobbies could be vented with air monitors that detect and report any visitor who might transmit airborne infection.

Robots in Surgery

Robots used in surgery have potential advantages of precision and miniaturization as well as articulation beyond normal manipulation and when it comes to their use, the future may be sooner than we may think.  Researchers in the University of Nebraska have developed a machine about the size of a tube of lipstick which is able to drive around a patient’s  body and act as the eyes and hands of a surgeon who could be many miles away.  ‘We think this is going to replace open surgery’ says Dr Dmitry Oleynikov, a specialist in minimally invasive surgery who heads the team, who further speculates that such machines could be used to treat patients on a battlefield or even in space.  Nearer to home London doctors have begun pioneering the first fully robotic heart catheter ablation and angioplasty.  With this technique the cardiologist sits at a console outside the operating theatre and uses a joystick or mouse to guide the magnets. They can also preprogramme the computer so the entire operation is automatic. 

Bionics

From the Cybermen in Doctor Who to the Borg in Star Trek, lovers of science fiction will be well acquainted with alien races who are part machine.  Fortunately such technology is now being developed by the forces of good and has already found some impressive applications.  The case of Mr Nagle from Massachusetts has been published in Nature and the results have been spectacular.  Mr Nagle was left paraplegic following a knife attack.  Now he’s been fitted with a 4mm-square chip or ‘Braingate’ that reads signals in the primary motor cortex of his brain and this has been allowing him to open emails, play computer games and operate a prosthetic limb.  ‘After my injury I was depressed for two years’ he said . ‘It’s been three years now, and this BrainGate has been unbelievable’. 

The possibilites of such cyborg technologies appear almost limitless.  As well as providing prosthetic limbs for accident victims, or restoring sight to the blind, within our lifetimes we could be seeing applications with the intent of enhancing the human body beyond its natural capabilities.  Imagine for instance putting on a prosthetic suit and running from London to Manchester; or implants that could make you see clearly at night. 

The Challenges of Technology

Over coming decades it is a certainty that technology will play an increasing role in the provision of healthcare.  Is it possible, that with its advance the doctor will become obsolete?  Or will we find that patients need our help more than ever to provide a human face, a friendly smile and a guiding hand? More concerning, is that given the budget difficulties of the NHS today, will it just be the rich who will benefit from the changes to come, or will we all be able to look forward to an era of amazing technological possibilities?