Kary Mullis

Take Two Aspirins and E-mail Me in the Next Microsecond. Medicine in the Age of Real Medicine

Thursday, 29 June 2000
14:30 - 15:00 CEST


Computer aided medicine early in the next century will have largely replaced personal human-mentored medicine today, which is too expensive and also, as medicine becomes more complex, too difficult or inefficient for humans to pursue.

Our current medical establishment is based on a human-mentor (doctor) guiding an individual through medical informatics. It won’t always be a human.

Typically today, a patient appears in a clinic or doctor’s office. A doctor takes a medical history or obtains one from a former doctor. He analyses it with regard to the present medical situation which he obtains from questions and physical examination. Sometimes, if he knows the patient, he relies on a personal and more or less faulty memory of the patient’s history. Patients, typically, think this is good. Other information he obtains by sending body fluids to a laboratory where they are analyzed for various (usually less than twenty) chemical structures. Patients, typically, think this is necessary.

All of this information a doctor analyses with special attention to the present cause of a visit, his problem for the moment. Sometimes he is unaware or forgetful of deeper levels of information which might impact on the situation. He is not a computer. He cannot faultlessly assign finite coefficients to the assessment of factors other than those presented by the immediate situation, and as a human, he is woefully incapable of making shrewd and impersonal decisions. He decides on a diagnosis of the present problem and prescribes a treatment. Hopefully, but due to practical exigencies, not always, he personally monitors the outcome of the therapy. Sometime no one, or some other doctor, monitors the outcome, or the sequelae of the outcome, or the sequelae of that. Years go by.

This will be replaced by computer-internet facilitated guidance and feedback. Information which a patient at home can provide will be conveyed to a non-human mentor through questions and answers and the internet. Information regarding physical measurements such as blood pressure, galvanics, temperature and the chemical constituents of bodily fluids will be provided from a physical device in the home or the point of patient care which will analyse bodily fluids and upload the information to the medical informatics computer. This will not be limited to twenty of so things that a doctor might remember or be empowered financially by HMOs to investigate. This will involve hundreds or thousands of chemical analyses and be a daily and ongoing process. Medicine in the coming century will be less a crisis-oriented activity and more an ongoing and preventative process.

When physical intervention is appropriate such as the administration of drugs, there will be no reason here on earth, as there is no apparent reason in heaven (Star Trek), for the intervention of a fallible human being into the medico-physico-chemical decisions of a computer. Amen. Drugs will be prescribed, billed and delivered by a computer.

When complex physical therapies like heart valve replacement are required, depending on the robotics of the era, some of these will still depend on skilled human manual manipulations. Surgeons will be the last medical specialists to practice. People traditionally do not like machines cutting and pasting them and will retain this aversion for a longer time than it is appropriate. But people will be comfortable early on in the next century with machines who can describe to them in colloquial languages chronic or acute medical situations and the remedies thereof as long as these remedies do not require the shedding of blood.

Individual People will take a larger responsibility for their healthcare. Diet, as well as regular supplements of chemical and herbal origin, will be a normal part of the day, like toothbrushing and handwashing, for self-interested citizens of the next century. The information allowing this, like that for most tasks, will come from computers.

Point-of-patient care diagnostics will be micro-miniturized. Analysis will be done at home from small volumes of bodily fluids. Personal computers and internet connections will do the analysis. The information will be collected by closely connected physical peripherals as, e.g., optical disk drives operating on specialized medical analyser discs fitted with sample application ports, microfluidics and analytical structures addressable and readable by an optical drive system indigenous to the computer.

Toilets might well be fitted for the regular introduction of wastes to such analytical equipments for urine and stool analysis including the identification of the donor. Simple procedures for drawing and analyzing very small volumes of blood will be convenient, painless, and ubiquitous.

Related Laureates