Rapid Advancements Evolve Health Care

Genetically modified DNA molecules
by Vice Adm. Michael Cowan, Medical Corps, U.S. Navy, Retired
September 26, 2017

It has been said that human minds are prone to see the world through the “status quo,” to accept anything current as though it has been eternal. Our minds are also designed to be critical. We see problems, flaws and deficiencies but tend to take for granted things that work, things which stick out and are different. The ability to see the “odd thing out” is likely a survival adaptation, honed throughout thousands of years. The ability to detect a predator before it detects you ensures survival of the fittest. Or, the hunter who can find the small signs of prey has the advantage over those who cannot. The hard truth is, in evolutionary terms, we are not much different from our caveman ancestors. In genetic evolution, humans have only existed for the blink of an eye. The famous biologist E.O. Wilson described our all too human perplexity with the modern world in the following manner:  “We have Paleolithic minds, with Medieval Institutions, trying to manage near God-like complexity of modern technologies.”

Our adaptions served us well over the millennia. How are they doing now? For the health care consumer or those professionals looking after the health needs of patients, families and communities, one might argue “not so well.” A famous article in the Journal of the Royal Society of Medicine in 2011 determined that the lag time between discovery of a medical advance until its full acceptance by the profession is 17 years. That is, from the time a treatment, therapy or intervention is proven scientifically until one can be sure his/her providers will be utilizing it is almost two decades – a generation. And there is “the rub” as Shakespeare said in Medicine today. We live in a world where technological innovation, engineering marvels, information access and knowledge are advancing and expanding far faster than the wildest dreams of people even short decades ago.

A brief scan of the modern scientific environment is revealing. Scientists have cracked the code to the human genome and others are working to develop individually tailored medicines and treatments for multiple diseases and conditions. A new gene splicing technology, which goes by the acronym CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats), has drastically improved our ability to modify the basic genes of any living organism – for good or ill. The CRISPR process is so simple that laboratory kits are now being sold on the Internet. But you shouldn’t try this at home, kids! A robot called “DaVinci,” which would have been the most fabulous science fiction a few years ago, is today hard at work in hospital operating rooms around the world. This “robot” can perfectly mimic a surgeon’s actions, enhancing his/her accuracy performing micro-keyhole surgical procedures and dramatically advancing the ability of surgical procedures to save lives and minimize complications.

Even the prosaic has the exotic. When I attended medical school (before most reading this were born), we had adhesive tape and gauze bandages to dress wounds. Any wound. All wounds. Gauze and tape. Now there is a tape that sticks to wet skin, tape that dissolves in place over time, gauze preparations that carry a variety of medications and others that stimulate new cell growth. The simplest of medical equipment, gauze and tape, have become a specialty of their own!

When starting my career in 1969, I remember thinking that assistive devices for people with physical conditions from amputations to spinal cord damage (crutches, wheelchairs, prosthetics) were little changed from the pictures of crutches and prosthesis that I saw in antique textbooks from the Civil War era more than 100 years before. Now we have an armamentarium of a staggering variety of options:  nerve regeneration therapies, highly functional prostheses, wheelchairs that can ascend and descend staircases, and even allographic limb transplants. Once, it was almost always better to save a badly damaged limb than to amputate and require prosthesis. Any limb, even one with minimal function, was better than anything we had to replace it. No longer. Physicians and their patients now face far more complex decisions regarding salvage or prosthesis.

Information technology has been one of the most remarkable advances. It makes virtually all information, which is not restricted in some way, not only instantly available worldwide but also easy to find. At your fingertips. Anywhere. I once stood next to a Masai warrior in the Olduvai Gorge watching him read that morning’s Nairobi newspaper, Nairobi Daily Nation, on his cell phone. Then he played a video game for awhile before herding his cattle down a hillside to water.

You may think the above is a silly example, but it illustrates that someone on a barren African hillside can keep up with his stock portfolio and market fluctuations just as easily as the high-priced broker in a three-piece suit at the Nairobi stock exchange building. The point is, in exactly the same way, ubiquitous medical information, most of it reliable, is now at everyone’s fingertips. A patient in his/her living room can learn nearly as much about any given condition as most physicians. Or more. Who has the most “skin in the game” for any given condition:  the doctor who needs to know about thousands of conditions or the patient who has an overriding lifetime interest in just one?

An old medical saying, which is advice to young doctors, is:   “Don’t be the first doctor to use a new therapy and don’t be the last.” A delicate balance exists between being too slow to drop the old and too quick to pick up the new. Not just changes in technology, but their rapid advancement, make this time not only the best time to be a medical practitioner or recipient of marvelous diagnostics and therapeutics, which did not exist short years ago, but also the most difficult, frustrating and confusing.

Medical care is a high social and political priority in America today. But if I were an alien reading newspapers and watching TV news, I would think it is all about insurance, costs, deductibles, existing conditions and Republican vs. Democrat political battles, seasoned with the occasional frightening account of a high-profile malpractice case. The spectacular, confrontational and political crowds out the reality of a profession undergoing rapid and beneficial advances. Economics and politics take the air out of the room and don’t leave enough for conversations about things that really make a difference.

Health21 magazine is a publication designed to foster these vital conversations and to develop better understandings of the world of medicine today. Within these articles, you will notice our focus is not just on the disease and treatment of an individual. Today, American medicine has recognized that treating a condition is not the end but the beginning of real health for individuals, families and communities. Health is “a complete state of physical, mental and spiritual wellbeing, not just the absence of infirmity or disease” (World Health Organization). We live in a world connected in more ways than we ever imagined – and a broad view of what it means to be healthy is a global view.

In this issue, we bring you insights from some of the most highly regarded leaders and world renowned experts in their fields. We hope to expose our readership to the length and breadth of thought leadership and advances that have changed the face of both medicine and public health. But we always want to return you to the basics because the important can easily be replaced in our imaginations by the fascinating. For example, an abundant supply of clean drinking water is the most important aspect of all public health issues. And preventable death from trauma – falls, accidents, auto crashes, violence – are the overall leading cause of deaths in America and solutions are near at hand. We hope to stir interest in all our readers for these and other issues.

Thank you for reading Health21 and enjoy the issue!


AMSUS, a non-profit, membership-based organization, was organized in 1891 as the Association of Military Surgeons of the United States. It was later renamed the “Society of Federal Health Professionals,” as its scope, membership and mission broadened. The organization’s Executive Advisory Council (EAC) consists of the Surgeons General of the Army, Navy, Air Force and Public Health Service. Additional EAC members include:  Under Secretary for Health, Department of Veterans Affairs; Assistant Secretary of Defense for Health Affairs; President of the Uniformed Services University of the Health Sciences; Department of Defense Joint Staff Surgeon; Director of Defense Health Agency and Assistant Secretary for Health Affairs, Department of Homeland Security. AMSUS supports all federal health professionals, including those in other nations, and provides professional development through a variety of platforms, including its Continuing Education Meetings and National Conference. For more information, or to become a member, go to www.amsus.org or call 301-897-8800.