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FUTURE TRENDS RESEARCH BENEFITS AMERICANS ARE LIVING LONGER, MORE PRODUCTIVE LIVES; INFANT MORTALITY RATES HAVE BEEN REDUCED, ONCE INCURABLE COMMUNICABLE DISEASES HAVE BEEN CURED. RESEARCH HAS PRODUCED SAFE, COST EFFECTIVE VACCINES AGAINST A NUMBER OF DISEASES SUCH AS HEPATITIS B THAT HAVE THE POTENTIAL TO SAVE MILLIONS OF LIVES A YEAR IN MAY 2001, THE FDA APPROVED “GLEEVAC” FOR USE IN TREATING A SERIOUS BLOOD CANCER. THE DRUG WAS DEVELOPED AFTER MORE THAN 40 YEARS OF THE JOINT EFFORTS RESEARCH AGENCIES AND INDUSTRY. NEWLY DEVELOPED MEDICATIONS FOR SCHIZOPHRENIA HAVE REDUCED PSYCHIATRIC HOSPITALIZATIONS NEARLY 30 PERCENT FROM 1996 to 1998. CHALLENGES REMAIN THERE IS STILL A FORMIDABLE LIST OF DISEASES FOR WHICH THERE ARE NO CURES OR EFFECTIVE TREATMENTS AND THE EMERGENCE OF NEW, LIFE-THREATENING DISEASES. CHRONIC DISEASES LIKE CANCER, CARDIOVASACULAR DISEASE AND DIABETES CONTINUE TO CLAIM THE LIVES OF MILLIONS OF AMERICANS EACH YEAR AND DRAINING BILLIONS OF DOLLARS FROM THE NATION’S ECONOMY. THE AGING OF OUR POPULATION IS CREATING ENORMOUS CHALLENGES IN HEALTH CARE. IN 2010 THE ‘BABY BOOMERS’ STARTING TURNING 65 AND THE NUMBER OF AMERICAN’S OVER 85 WILL HAVE INCREASED FIVE-FOLD. SOCIETY MUST FIND WAYS TO PRESERVE THE PHYSICAL COGNITIVE, AND SOCIAL FUNCTIONING OF OUR OLDER CITIZENS. INFECTIOUS DISEASES, THE SECOND LEADING CAUSE OF DEATH WORLDWIDE, PRESENT AN EVERGROWING THREAT WITH THE EMERGENCE OF INFECTIOUS AGENTS LIKE HEPATITIS C OR THE RE-EMERGENCE OF TUBERCULOSIS, MALARIA IN MORE VIRULANT AND DRUG-RESISTENT FORMS. MENTAL ILLNESS CONTINUES AS A NATIONAL CONCERN, PARTICULARLY AMONG OUR YOUNGER CITIZENS. IN THE UNITED STATES 1 IN 10 CHILDREN AND ADOLESCENTS SUFFER FROM MENTAL ILLNESS SEVERE ENOUGH TO CAUSE IMPAIRMENT. MAJOR THRUSTS IN RESEARCH GENETICS CLINICAL RESEARCH GENETICS OBTAINING THE COMPLETE SEQUENCE OF THE HUMAN GENOME IS ONLY THE PRELUDE FOR THINGS TO COME. CLINICAL RESEARCH MOVING KNOWLEDGE FROM THE LABORATORY BENCH TO THE PATIENT IS NEITHER EASY NOR INEXPENSIVE. CLINICAL RESEARCH IS DRIVEN BY CLINICAL TRIALS WHICH REQUIRES SETTING UP TEAMS TO DESIGN RESEARCH PROTOCOLS, RECRUIT PARTICIPANTS, CONDUCT THE TRIALS AND ANALYZE THE DATA. TRANSLATING BASIC RESEARCH INTO EFFECTIVE THERAPIES. FOR EXAMPLE… THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES CONTINUES TO SUPPORT PROGRAMS TO BUILD THE INFRASTRUCTURE FOR CLINICAL TRIALS INCLUDING THE AIDS CLINICAL TRIALS GROUP AND THE HIV VACCINE TRIALS. TECHNOLOGY COMPUTING POWER, BIOTECHNOLOGY, DISTANCE TECHNOLOGY, AND SENSOR TECHNOLOGY WILL MAKE DELIVERY OF HEALTH CARE IN THE U.S. UNRECOGNIZABLE FROM CARE WE RECEIVE TODAY. GENOMICS SCIENTISTS ARE PERFECTING METHODS OF TURNING RAW BIOLOGICAL MATERIAL INTO DRUGS, VACCINES, AND DIAGNOSTIC TESTS. MAJOR DEVELOPMENTS IN COMPUTER CHIP TECHNOLOGY, NANOTECHNOLOGY, AND COMBINATORIAL CHEMISTRY ARE SIGNALING THE DEVELOPMENT OF THE “LAB-ON-A-CHIP.” IN THE 21ST CENTURY WE WILL BE ABLE TO DETECT THE RISK OF GENETICALLY CAUSED DISEASES FROM THE MOMENT OF CONCEPTION THROUGHOUT THE LIFESPAN. THE WORLD WIDE WEB MEDICAL INFORMATION IS ONE OF THE MOST-RETRIEVED TYPES OF INFORMATION ON THE WEB – WITH OVER 100,000 MEDICAL WEB SITES. THE INTERNET IS AN ENGINE FOR CHANGE BECAUSE IT PROVIDES AN INFRASTRUCTURE FOR HEALTH PROFESSIONALS AND CONSUMERS TO ACCESS RESOURCES AND DATABASES. DISTANCE TECHNOLOGY AND SENSOR TECHNOLOGY NEW TECHNOLOGIES IN HEALTH CARE ARE BEING INTRODUCED AT BLINDING SPEED. THEY ARE STUNNING IN THEIR BREADTH AND AND HOLD TREMENDOUS IMPLICATIONS FOR THE WAY HEALTH CARE WILL BE DELIVERED IN THE FUTURE. WHAT DO THE PEOPLE THINK WILL BE THE FUTURE OF HEALTH CARE? FROM A SURVEY CONDUCTED BY THE BAYLOR COLLEGE OF MEDICINE… A LARGE MAJORITY OF AMERICANS EXPECT THAT THE NUMBER OF PEOPLE UNABLE TO AFFORD MEDICAL CARE WHEN THEY ARE SERIOUSLY ILL WILL INCREASE IN THE NEXT FIVE YEARS. EIGHT IN TEN AMERICANS EXPECT THE NUMBER OF PEOPLE WHO WILL NOT BE ABLE TO GET SPECIALITY CARE WHEN THEY ARE SERIOUSLY ILL WILL INCREASE IN THE NEXT FIVE YEARS. A LARGE MAJORITY EXPECTS AN INCREASE IN THE NUMBER OF PEOPLE WHO WILL NOT BE ABLE TO PAY FOR NURSING HOME CARE. NEARY EIGHT OUT OF TEN THINK THERE WILL BE AN INCREASE IN THE NUMBER OF PEOPLE WHO WILL BE UNABLE TO AFFORD MEDICAL CARE FOR A SERIOUSLY ILL CHILD. THIRTY PERCENT FEAR THAT THEIR EMPLOYERS WILL STOP PROVIDING HEALTHCARE INSURANCE OR SEVERELY LIMIT COVERAGE IN THE FUTURE. WHAT DO PHYSICIANS THINK WILL BE THE FUTURE? SEVENTY ONE PERCENT SAY THERE WILL BE GREATER LIMITATIONS ON THE SERVICES THEY PROVIDE TO PATIENTS. SIXTY TWO PERCENT SAY IT WILL BE MORE DIFFICULT TO SPEND THE CURRENT AMOUNT OF TIME WITH PATIENTS. SIXTY PERCENT BELIEVE IT WILL BE MORE DIFFICIULT KEEPING RELATIONSHIPS WITH THE SAME PATIENTS. FIFTY FIVE PERCENT SAY IT WILL BE MORE DIFFICULT TO PROVIDE CARE THAT BOTH THEY AND THEIR PATIENTS FEEL IS NECESSARY. FIFTY EIGHT PERCENT SAY IT WILL BE MORE DIFFICULT TO PROVIDE CARE THAT BOTH THEY AND THE PATIENTS FEEL IS NECESSARY. FIFTY EIGHT PERCENT SAY IT WILL BE MORE DIFFICULT TO REFER ADULT PATIENTS TO A SPECIALISTS. FORTY THREE PERCENT SAY IT WILL BE MORE DIFFICULT TO REFER CHILDREN TO A SPECIALIST. THE INSTITUTE OF THE FUTURE. GOVERNMENT LEGISLATION LEGISLATION WILL AFFECT TWO PRIMARY AREAS THERE WILL LEGISLATIVE OUTCOMES AS A RESULT OF A BACKLASH AGAINST MANAGED CARE. MEDICARE MAY LOOK DIFFERENT THAN IT DID IN THE EARLY 1990’S MANY MEDICARE RECIPIENTS WILL NOT BE IN THE TRADITIONAL FEEFOR-SERVICE PROGRAM BUT IN AN HMO OR SOME OTHER ORGANIZED HEALTH PLAN ARRANGEMENT. DEMOGRAPHICS, PATIENTS, POPULATIONS, AND NEW CONSUMERS. BY 2010 THE AVERAGE LIFE EXPECTANCY WILL BE UP TO 86 YEARS OF AGE FOR A WOMAN AND 76 YEARS FOR A MAN. THERE WILL BE 100,000 PEOPLE OVER THE AGE OF 100. AMERICA WILL BECOME MORE ETHNICALLY DIVERSE. CURRENTLY 74% OF THE POPULATION IS WHITE. IN 2010 THAT WILL DECREASE TO 64%. THE POPULATION WILL BE BETTER EDUCATED. 55 PERCENT OF THE POPULATION OVER THE AGE OF 25 WILL HAVE THE EQUIVALENT OF ONE YEAR OF COLLEGE. ACCESS TO HEALTH CARE WILL REMAIN “TIERED” AND WILL BECOME MORE EXTREME. THE TOP TIER, “THE EMPOWERED CONSUMER,” WILL HAVE CONSIDERABLE DISCRETIONARY INCOME, ARE WELL EDUCATED, AND USE TECHNOLOGY TO GET INFORMATION ABOUT THEIR HEALTH. PAYERS AND HEALTH CARE COSTS HEALTH CARE COSTS WILL CONTINUE TO GROW BUT THE DESPITE THE BEST EFFORTS OF CONGRESS PUBLIC PROGRAMS (MEDICARE, MEDICAID) WILL GROW AT A RATE OF 6% TO 9% ANNUALLY. BUSINESS AND GOVERNMENT WILL PUT IN PLACE STRATEGIES TO REPRESS LARGE COST INCREASES. BY 2005, HEALTH CARE COSTS WILL ACCOUNT FOR ABOUT 15% OF THE GROSS DOMESTIC PRODUCT (GDP). HEALTH PLANS AND INSURERS BY 2005, HMO’S WILL CAPTURE THE MAJORITY OF THE COMMERCIAL MARKET AND 25% OF THE MEDICARE MARKET, AND 60% OF THE MEDICAID MARKET. HOSPITALS AND PHYSICIANS THERE ARE 570,000 PHYSICIANS IN THE UNITED STATES AND ANOTHER 170,000 IN THE MEDICAL SCHOOL PIPELINE. THERE ARE THREE NEW PHYSICIANS FOR EVERYONE WHO RETIRES. THE NUMBER OF NURSE PRACTITIONERS (NP’S), PHYSICIAN ASSISTANTS (PA’S). AND OTHER NON-MD CLINICIANS WILL INCREASE RAPIDLY. THERE WILL BE HOSPITAL CLOSINGS AND BED REDUCTIONS, BUT HOSPITALS WILL BE DIFFICULT TO SHUT DOWN. SHOULD EXPECT A REDUCTION OF 150,000 BEDS BY 2005. MEDICAL TECHNOLOGIES THE DEVELOPMENT OF NEW TECHNOLOGIES IS UNLIKELY TO SLOW, AND THERE WILL BE AN INCREASING NUMBER OF NEW TECHNOLGIES IN THE DECADE AHEAD. NEW TECHNOLOGIES RATIONAL DRUG DESIGN ADVANCES IN IMAGING MINIMALLY INVASIVE SURGERY GENETICS MAPPING AND TESTING GENE THERAPY VACCINES ARTIFICIAL BLOOD XENOTRANPLANTATION THE TRANSPLANTATION OF ANIMAL ORGANS AND TISSUES INTO HUMANS, PRIMARILY BONE MARROW AND SOLID ORGANS MAYBE WE WILL ALL GET TO LIVE FOREVER… END OF LECTURE FOR November 28th, 2007, 7th Period. Remember…next Monday…a fascinating presentation by Mark Bowden, Physical Therapist…on research. Then..the final review…hot dog…