FUTURE OF HEALTH: NEW TECHNOLOGY WILL BRING AWSOME RESPONSIBILITY

Treating diseases on the cellular level may be the biggest breakthrough in medicine in the 21st century, but it also may produce some huge moral dilemmas.

"Genetic therapy will bring cures and a tremendous amount of suffering will be relieved," predicted Ginny Sadler, vice president of patient care at St. Francis Medical Center. "But it also will bring ethical issues we haven't faced previously."

Research is ongoing with the Human Genome Project to identify and decipher the chemical sequences of the more than 100,000 genes in human DNA. On Dec. 1, researchers announced they had completed mapping chromosome 22.

Already this has lead to being able to diagnose some hereditary diseases, said Dr. Jonathan Thomas, an obstetrician/gynecologist.

"If we know the genetic code of chromosomes, we can tell normal from abnormal," he said.

The next step, Thomas said, will be finding ways to alter abnormal sequences to correct defects and ward off diseases while the fetus is still in the uterus or even when fertilizing an egg with a sperm.

And if you can do that, you also may be able to alter DNA for non-medical reasons, like giving a child blue eyes instead of brown, an athletic build, an outgoing personality. There could even be some humans genetically engineered to be workers and others leaders as in Aldous Huxley's "Brave New World."

Thomas said none of the doctors he knows would support such use of genetic research, but he admits that if the technology is there, someone may try to abuse it.

"Doctors and researchers will be facing some major ethical issues," Thomas said.

But before science reaches that point, there are other, more beneficial uses of advances in cellular research.

Dr. Stanley Sides, a hematology/oncology specialist with Physician Associates, believes the future of health care will involve modifying the body's response to viruses, bacteria and other microorganisms. This will involve strengthening the body's immune system at the cellular level to keep infections at bay rather than trying to fight infection once it takes hold in a body.

Sides also said research is looking into altering the DNA in cancer molecules to render them harmless or to turn these foreign invaders against themselves.

Genetic engineering also has promise in fighting heart ailments, said Dr. Edward Bender, a cardiac and thoracic surgeon. This includes using heart cells to grow new heart muscle.

Other advances in health care that local doctors foresee:

Implantable artificial hearts

Bender said ventricular assist devices, the medical term for a device that pumps your blood, are now small enough that they can be worn on a belt or a vest and are getting smaller.

Bender sees them eventually becoming small enough and sophisticated enough that they will be implantable.

"I think eventually they will be used not as a bridge until a transplant is available but as the treatment instead of a transplant," Bender said.

Internet diagnosis

Dr. Scott Gibbs, a Cape Girardeau neurosurgeon and author of a medical Internet column, predicts a time when a patient can be examined by a doctor thousands of miles away using a sophisticated camera and the Internet. He doesn't see this replacing visits to the doctor's office because of the process' impersonal nature. But it could help those patients who need to see specialists that practice far away.

Gibbs also thinks doctors and medical researchers will increasingly use the Internet to collaborate on diagnosing patients and trade information, even directing surgery.

"Technology will allow people who otherwise might not have access to specialists to get the benefit of expertise," Gibbs said.

Lasers

Gibbs predicts lasers may replace scalpels in many types of surgery.

"They are already used to do delicate operations on the eye and the brain," Gibbs said. "With them, you can control the depth of the incision in a very precise way."