During my lifetime, there have been numerous seminal breakthroughs in medicine that greatly changed our ability to prevent or treat disease. A few notable ones are discussed here, including a couple that are imminent.
I can still recall the palpable excitement when, at the age of 8, I joined scores of other children to get the Salk polio vaccine shot. At the time, polio infections caused widespread paralysis and permanent disability, and parents were terrified at the prospect of their children needing breathing support indefinitely from an "iron lung."
The influence of the iconic Salk vaccine went further than the short-term reassurance of parents; it gave rise to an almost mystical belief in the goodness, or at least the unquestioned value, of vaccines. That belief translated into widespread acceptance of subsequent vaccines to prevent a broad spectrum of viral and bacterial diseases. The Centers for Disease Control and Prevention estimates that, worldwide, between 2021 and 2030, more than 50 million deaths will have been prevented through immunization in 194 countries.
The second breakthrough was a two-part combination: open-heart surgery, which only became possible with the advent of cardiopulmonary bypass, also known as "being on the pump," when a machine takes over for your heart and lungs during surgery. The machine removes blood and adds oxygen before pumping it back out to provide oxygenated blood to the organs of the body.
While the patient is hooked up to the pump, the surgeons can perform a variety of procedures, including bypassing clogged, atherosclerotic coronary arteries, replacing defective valves, or even a heart transplant. Currently, about half a million of these procedures are performed in the United States each year, prolonging patients' lives and dramatically improving their quality of life.
More breakthroughs are imminent.
Artificial intelligence is all the rage in many aspects of our lives. In medicine, it is being applied to tasks ranging from patient triage to the detection of abnormalities during diagnostic procedures. It is especially good at reading X-rays. During my last colonoscopy, the gastroenterologist used a new AI tool called "GI Genius" to help detect abnormalities such as polyps or adenomas (precancerous lesions) in the colon.
According to the Food and Drug Administration, which evaluated and approved it, here is how it works: "The GI Genius is composed of hardware and software designed to highlight portions of the colon where the device detects a potential lesion. The software uses artificial intelligence algorithm techniques to identify regions of interest. During a colonoscopy, the GI Genius system generates markers, which look like green squares and are accompanied by a short, low-volume sound, and superimposes them on the video from the endoscope camera when it identifies a potential lesion. These signs signal to the clinician that further assessment may be needed."
In a large clinical trial, colonoscopy plus GI Genius identified lab-confirmed adenomas or carcinomas in 55.1% of patients compared to 42% of patients with standard colonoscopy.
Next on my non-exhaustive list of imminent breakthroughs is gene therapy, a remarkable marriage of genetics, molecular biology, and medicine. Genetic therapies using various approaches are already FDA-approved for a handful of diseases, including Leber congenital amaurosis, a rare inherited condition that leads to blindness; CAR T-cell therapy for certain blood cancers; and sickle cell disease and beta thalassemia, which are caused by mutations in hemoglobin, the protein that carries oxygen in red blood cells.
Many rare, lethal genetic diseases whose molecular defect is known are candidates for gene therapy. There have also been some promising results in treating Parkinson's disease, but no treatments for it have yet been approved by the FDA.
Drugs for weight loss
Drugs called glucagon-like peptide-1 (GLP-1) receptor agonists (brand names Victoza and Ozempic) have been used for years to help people with Type 2 diabetes control their blood sugar levels. Two drugs in this class, liraglutide (Saxenda) and semaglutide (Wegovy), are now FDA approved in formulations specifically designed for weight loss in people without diabetes. They mimic a hormone released by the intestine after eating that suppresses appetite. Weight loss can be in the range of 10% to 20% of body weight.
That might not seem to be an earth-shaking advance, but especially in people who are obese, it can reduce the incidence of high blood pressure, diabetes, cancer, and stress on joints, all of which can compromise longevity. These drugs could be a real boon to public health in the U.S., where 40% of the population is considered obese.
This list enumerates a few notable advances that make medicine so exciting and so valuable to people. I can't wait to see the next round!
Henry I. Miller, a physician and molecular biologist, is the Glenn Swogger distinguished fellow at the American Council on Science and Health. He was previously the founding director of the Food and Drug Administration Office of Biotechnology.