Anyone who has read my scribbles knows I hail from that land over the ocean, which has advantages and, well, disadvantages. While having an English accent in America apparently imbues one with extra IQ points, as John Cleese’s character, Archie Leach, says in the movie A Fish Called Wanda, addressing the titular fish:
“Wanda, do you have any idea what it’s like being English? Being so correct all the time, being so stifled by this dread of, of doing the wrong thing...?”
In this age of “cancel culture” saying or doing something that somebody does not like can lead to being erased from society. Well, as an Englishman (and American) and as a pilot, I say phooey – we can disagree but not be disagreeable. So, I thought it might be good medicine at this time of the year to reflect on some medical retrospectives and hopes for the new year.
Every Christmas, Her Majesty, Queen Elizabeth II gives a speech on television. I reflect back to 1992, the year she called her annus horribilis, Latin for horrible year. In some ways 2021 was that, but it was also annus mirabilis, or “wonderful year,” in many ways. The horrible? Well, it is no surprise that the novel coronavirus dominated headlines. But in the interests of not poking that particular skunk, I am not going to delve further into Covid. With one exception; think about it – how many non-medics even knew what a virus looked like prior to Covid? And now everyone drops phrases like “mutations” and spike proteins with abandon and pictures of the little wretch adorn every household cleaning product.
Leaving aside other topics about Covid, there is some good news; the global medical response has been awesome with fabulous innovations and collaborations. And we must get even better at collaborating to avoid or rapidly tackle other existential threats.
To some degree at least, 2021 was a year of recovery; a year of getting industry back on its feet. It was also coined as the ‘International Year of the Healthcare Worker.’ Maybe rather than platitudes, society needs to work out if they want an integrated health system – I think many countries are debating that long and hard as the deployment and cost of services has been quite chaotic in some places and healthcare disparities have been made even more obvious.
Work and travel habits have changed over the past year and we must wonder what the future holds. Doctors seeing many patients virtually is in some cases more efficient – think of it, pediatricians are now able to build a rapport with a child talking to them in their home environment rather than having the screaming heebie-jeebies in the office, less patient travel, less crowded waiting rooms, better use of healthcare workers’ time. And one specific use of telemedicine, to make up for the lack of clinicians traveling to teach overseas, has been a wonderful development. Big shoutout to my friend Dr. Yulun Wang, whose World Telehealth Initiative (https://www.worldtelehealthinitiative.org/) has been at the forefront.
And telemedicine has taught us that many chronic conditions like diabetes can be well managed remotely but we need to get smarter to prevent backwards steps in survivability from malignancies and part of this is to do a better job educating patients to come forward, or lives lost to heart attacks, stroke and cancer will escalate.
Speaking of healthcare workers, France granted citizenship to thousands of frontline workers in September as a thank-you for all their hard work during the past year. These workers include medical professionals, cleaning staff, cashiers, sanitation workers and more. Other countries may think about that.
Twenty twenty-one also saw the first malaria shot for children being approved. Malaria is a major health issue and kills over 400,000 a year, including over a quarter of a million African children.
And along those lines, in 2021, the World Health Organization also certified that China and El Salvador had become malaria-free, El Salvador becoming the first Central American country to receive a WHO malaria elimination certificate.
In more preventative medical news, and a big headline for women’s health, a study found that cervical cancer rates are 90% lower in women immunized against HPV, human papilloma virus, the bug that causes this malignancy with 100 countries now using the injection as part of a global effort to completely eradicate cervical cancer.
Messenger RNA is the genetic means that cells use to convey information and this past year mRNA technology advanced in leaps and bounds, and will have implications to prevent or combat many potentially fatal human and animal diseases.
The American food and drug administration, FDA, approved 48 new drugs in 2021, including a new HIV drug in the form of 2 monthly shots, reducing the frequency of treatment burden on these patients.
In the United Kingdom, the contraceptive pill became available over the counter, sixty years from when it was announced as being available on the National Health Service. The Scottish government also launched the first Women’s Health Plan, which focuses on improving diagnostic efforts into endometriosis, menopause services, heart disease, and miscarriage support.
This past year saw 3D printing being deployed to address shortages of various medical equipment and, as a result of higher utilization this approach is now being explored for all sorts of medical devices. For instance, personalized surgeries have been developed over the past year creating patient-specific models of organs and anatomical models to gain a far stronger understanding of patient health. The 3D printing industry is expected to develop even more rapidly in the future, with a projected number of 4 million orthopedic implants being made by 2027.
The rise of artificial intelligence and automation within surgery is clear for all to see; “autopilot and moving maps for the human body” if you will. Just as those technologies improved navigation for aviators, applied to medicine, these technologies are improving surgical navigation, dissection precision and hopefully outcomes. And of course, the data generated is making us better at diagnosis, prognosis, personalized treatment and, hopefully, cost reduction.
Continuing an aviation theme, back in May 2021, the government of Botswana, the Botswana International University of Science and Technology, and the United Nations Population Fund debuted the Drones for Health program – with the objective of fighting maternal mortality by delivering lifesaving supplies to remote areas within Botswana with drones. Delivery times have been dramatically reduced and drones are also being used to deliver lab samples and other key medical items now. Do you want pepperoni on that prosthesis, ma’am?
However, our technological overlords didn’t quite get the hang of everything, and during 2021 there have been multiple data breaches including over 40 million American patient records – and those are just the ones reported to the Federal government!
For the coming year, I expect more of the same, human ingenuity, drive and compassion stimulating more wonderful innovation. On the horizon? Self-steering colonoscopes pulled by an external magnet? That invention is actually entering clinical trials. Non-invasive neuromodulation technologies to treat everything from obesity to physical prowess? Yup. Robots capable of delivering ever-more-precise therapies at dramatically reduced cost? Just over the horizon! And new diagnostics, therapeutics and health maintenance tools and strategies.
My three wishes for a healthier and happier 2022? My first is easy; lets ensure scientific research is funded properly so that new diagnostics, treatments and preventative measures can be introduced to ease human suffering.
The second, wide understanding of global health access concerns us all. Health is more than the absence of disease, and to see people living in abject poverty, even in so-called developed countries, is a disgrace that we must solve.
The third is that kindness makes two people feel better, so I wish for a kinder world where thoughts and deeds are all well-intentioned.
So, I hope everyone had a lovely time over the holidays and that 2022 is a healthy, happy and successful year for all. Fly well!
You can hear Dr. Sackier’s weekly podcasts on matters medical at https://www.emg-health.com/omnipresent/?category=podcasts&therapeutic_area=healthcare or wherever you get your podcasts. And you can write to him at [email protected]