What can sci-fi teach us about the future of health? | Ara Darzi

In State of Wonder, the American writer Ann Patchett imagined the discovery made by a charismatic but despotic professor, Dr Annick Swenson, who travelled deep into the Amazon basin and found a tribe in which the women went on bearing children until the end of their lives. While their bodies aged as normal, their reproductive systems stayed daisy-fresh.

Membership Event: Ann Patchett in conversation

“This is the end of IVF. No more expense, no more shots that don’t work, no more donor eggs and surrogates. This is ovum in perpetuity, menstruation everlasting …”

A miracle fertility drug, taken in this case from the bark of an endemic jungle tree, is one of science’s most enduring dreams. Miniature robots designed to prowl the bloodstream when injected through a vein seeking out and destroying undesirable micro-organisms is another. And there are many darker visions of monsters, plagues and organ trading.

Dreaming is what we should be doing, in science, in medicine and in life. If we do not imagine the future, how can we invent (or prevent) it? That is why I welcome what is described as the world’s largest health science-fiction prize, which seeks to unlock an array of hypothetical futures.

“Writing the Future” is open to writers of any nationality who are asked to submit a story of up to 3,000 words about the state of health and healthcare in the UK in the year 2100. The winner, to be announced in October, will take home £10,000.

As director of the Institute of Global Health Innovation at Imperial College London, I spend a lot of time debating the future of medicine. But change is hard to predict, and it doesn’t help if you spend much of your time with healthcare insiders, as I do, trying to solve the problems created in the past.

So why not ask people more familiar with conjuring dreams to help us out? The aim with this prize, for which we have provided a small sum in sponsorship, is to attract outsiders who can bring a fresh perspective with a story that displays ingenuity and insight, as well as being a cracking good read.

Thinking about the state of our health 83 years from now is vital if we are to continue delivering the best possible care. Looking back 83 years to the 1930s, the NHS was yet to be founded and penicillin existed only on Alexander Fleming’s petri dish. Of every 1,000 babies born, 63 died in infancy. Yet just 40 years later, babies were being conceived in test tubes.

The big gains are likely to come from innovations in the general purpose technologies that have transformed our world

The health industry has actually been remarkably good at innovation. Some advances have been the result of technical wizardry, such as in-vitro fertilisation, organ transplants and CT scanning for cancer. Others have transformed the outlook for whole populations, such as antibiotics, vaccination, and the contraceptive pill.

Asked to think about future innovations in health, most people might mention a new HIV vaccine, a cure for Alzheimer’s disease – or a drug to confer long-lasting fertility. These would certainly be blockbuster gains for humanity but with the rising cost and diminishing returns from drug development, there are likely to be few such silver bullets in the next decade.

The big gains are likely to come from innovations in general-purpose technologies – smartphones, computing, bio-engineering – that have already transformed our world. Until 1998 there were no online bookstores. Yet today, Amazon has 40% of the books market. Until a dozen years ago few people banked online. Today 60% do. Mobile phones may play as significant a role in healthcare in this century as the stethoscope did in the last.

So what is next? We have made astonishing progress in the last eight decades. More of us survive childbirth and infancy, our lives are longer and there is more that medicine can do to help when we are sick.

We have made enormous strides against the major killers of the past such as smallpox, tuberculosis and diphtheria. The new challenge comes from the chronic conditions that blight so many lives in the modern world – diabetes, cancer and heart disease. Here, advances in genomic medicine could help us to identify individuals at risk and allow us to intervene earlier.

Entrants for Writing the Future may have very different visions of what is to come. Social enterprise Kaleidoscope Health and Care, which conceived the prize, has its own ideas about how to encourage innovative thinking in health.

Established in 2016 by Richard Taunt, a former civil servant and director of policy at the Health Foundation thinktank, its 10 staff include clinicians and managers who have seen the problems from the inside and want to “change the conversation” by attracting talent that can see beyond the limits of budgets and hospital walls.

One way they do this is by offering envelopes containing £100 in cash to selected individuals to spend in any way they like – on coffees, a lunch, or a train ticket – as long as it is in the cause of having an unexpected conversation about health and care that they can blog about afterwards.

We need innovative thinking in healthcare now more than ever. There is substantial interest in Writing the Future from leading science fiction writers around the world. We should all expect to be excited, enlightened and entertained.

What can sci-fi teach us about the future of health? | Ara Darzi

Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

On Friday 10 March, I will perform an operation in public for the first time. In a live demonstration, I will aim to show how robots can assist surgeons to cut more safely, with greater precision, and achieve better results for patients.

I should say at the outset that no patient’s life will be put at risk during this event. I will be operating on a surgical mannequin – a specially adapted version of the shop mannequin designed to respond like a human body – and the event will take place at the Science Museum in London.

I will be using the same surgical robot that I used in 2001 when I performed the first such operation on a patient in the UK. It has three arms controlled from a console a few feet away, where I sit, allowing me to cut and stitch with great precision. Almost 16 years on, this will be a nostalgic moment for me. From cutting-edge technology to museum piece in less than two decades.

I am taking part in this demonstration, together with Professor Roger Kneebone, head of the Centre for Engagement at Imperial College, because I know that technological innovation of the kind represented by the robot has transformed surgery. But it will only continue to do so in the future if we have the vision and the courage to support it.

Critics will say that past technological advances have not delivered on their early promise. Certainly there have been challenges. Last year a research paper published in the Lancet comparing robotic with non-robotic surgery for prostate cancer found both achieved similar outcomes after three months.

The Times reported the story under the headline “Robots no better than human surgeons”. The Daily Mail, however, went with “Robots are better than humans at cancer ops”, on the grounds that the patients who had the robot surgery suffered less pain immediately after the operation. Is the glass half-full? Or half-empty?

I am firmly in the former camp. As I wrote in the Lancet at the time, the fact that the robot-assisted surgery achieved an equivalent outcome should be seen as a positive result. It shows that the innovation has preserved the intended purpose of the surgery. Advances in technology such as this provide the platform on which additional innovations can be developed, to further improve the quality and safety of surgery.

The device, called the iknife, can detect almost instantly whether tissue is cancerous or not

Consider where we have come from: in little more than 100 years since the two-part silver scalpel, with handle and replaceable blade, was invented by Morgan Parker in 1915, it has increasingly been replaced by the electrosurgical knife – a probe carrying an electric current that burns through tissue, sealing the tiny capillaries as it cuts, reducing blood loss, improving the surgeon’s field of view and the speed of the surgery.

Now a third advance is imminent, with the invention of an electronic “nose” attached to the electrosurgical knife. This absorbs the smoke given off as the blade burns through tissue and analyses it in a mass spectrometer. The device, called the intelligent knife or iknife, can detect almost instantly what kind of tissue the surgeon is cutting through – whether, for instance, it is cancerous or not. Instead of sending tissue samples to the laboratory and waiting days or weeks for them to be tested, the surgeon will in future be able to tell whether all the cancer has been removed before the operation is complete.

Membership Event: Robot Surgery Live

Advances such as this are ushering in a new era of precision surgery, in which established clinical and pathological signs are linked with state-of-the-art molecular profiling, enabling us for the first time to tailor specific interventions to the individual biology of the patient.

I was delighted with the interest and enthusiasm shown by the Science Museum in displaying the first surgical robot ever used in Britain as part of their robotics exhibition. It will remain with the museum as a donation from the department of surgery at Imperial College London.

But if we are to continue moving forward, we need disruptive innovators who are ready to challenge dogmatic practice and an environment in which they are free to experiment. What today looks revolutionary is tomorrow’s museum exhibit.

Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

Lord Darzi: Age of risk-free medication is ending

The quickly evolving resistance detailed in these reports is turning typical infections into untreatable illnesses.

The world is getting into an era the place a child’s scratched knee could destroy, in which sufferers entering hospital gamble with their lives and schedule operations are as well dangerous to carry out.

Each and every antibiotic ever produced is at chance of becoming useless. The age of safe medicine is ending.

In a single of the largest assortment of cases outdoors the Indian subcontinent, researchers from Public Wellness England discovered 250 Uk residents who had grow to be contaminated with bacteria carrying the enzyme NDM which rendered them resistant to all present day antibiotics.

NDM – New Delhi metallo-beta-lactamase – is an enzyme initial identified between patients in New Delhi, India in 2008. When connected to common bacteria such as E.coli or Klebsiella that take place naturally in the human gut, it supplies them with an powerful shield that can see off practically any attack.

E.coli and Klebsiella are usually harmless but they can cause significant damage if they get into the bloodstream or the urinary tract. In most circumstances, they are easily dispatched with a course of antibiotics. But when the bacteria causing them have been protected with the NDM enzyme they triggered virtually untreatable infections.

The only drug that could handle them, it turned out, was an antibiotic developed in the 1950s named colistin. Colistin was abandoned in the 1980s as newer antibiotics superseded it. But its premature obsolescence has been a blessing – colistin proved effective against NDM-carrying bacteria since the NDM enzyme had not had a likelihood to build resistance to it.

The reprieve is, even so, only temporary, as the researchers note. Resistance is a procedure of evolution and it can only be a matter of time just before colistin fails as well.

Worryingly, just four out of ten of individuals contaminated with the resistant organisms had travelled to India and a “substantial number” have been recognized in primary care.

Previously there had been no evidence of onward transmission of the resistant infection from people who brought it back from India. Now the researchers say: “Clearly NDM-constructive bacteria may possibly be discovered in the neighborhood.”

The report underlines the tremendous challenge that antibiotic resistance presents to the future of well being care and the gravity of the predicament with regard to treating serious infections.

The WHO document, primarily based on data from 114 nations, confirms what experts have prolonged warned – that the crisis is not a prediction for the potential, it is taking place now. Resistance to final resort antibiotics has been documented in all areas of the globe.

Dr Keiji Fukuda, WHO’s Assistant Director-Standard for Health Safety stated the world is headed for “a publish-antibiotic era”, in which frequent infections and small injuries which have been treatable for decades “can as soon as again kill.”

His warning echoes that from Professor Dame Sally Davies, England’s Chief Health care Officer, who last December declared that with the growth of resistant bacteria, in a handful of many years typical surgical treatment such as hip replacements may possibly be deemed too hazardous to undertake.

“What I learnt frightened me – not just as a doctor but as a mother, a wife and a friend”, she wrote in a report prepared for the Globe Innovation Summit for Well being (Want), organised by the Qatar Foundation in Doha which I chaired.

Much more than 500,000 individuals die from resistant infections globally every yr and that variety is specified to rise. In the US each resistant infection costs the wellness care technique an additional $ 29,000.

Dame Sally Davies’ report, created with a panel of worldwide professionals, referred to as for stronger regulation to restrict the use of antibiotics in people and animals, incentives for the development of new drugs, and worldwide collaboration to keep track of the spread of resistant organisms to minimize the alarming variety of deaths globally.

The Want report, presented at the summit of 1,000 wellness care leaders from around the world, mentioned that the amount of pharmaceutical businesses creating antibiotics has dropped substantially from 18 in 1990 to five these days simply because of poor returns. Increased charges, longer patents and guaranteed revenue for innovators need to be explored.

Greater hand washing, raised standards in the food sector and education to boost hygiene and sanitation in homes, colleges and workplaces are also needed.

Unless of course we address these concerns urgently, the reduction of powerful antibiotics, which offer crucial cures for hundreds of thousands of people, will be the subsequent global calamity.

* Lord Darzi is Director of the Institute of International Well being Innovation at Imperial College London

Lord Darzi: Age of risk-free medication is ending