2020 vision, and beyond

Pondering about a new decade on New Year’s Day, I thought to myself that not much has changed in the last 10 years. I then shifted on my couch, pointed the remote control at my large-screen TV, and tried to decide between Netflix, Crave, or Amazon. Well, maybe some things have changed. I had to admit that the 2010s included many personal life changing events—I remarried, had two grandchildren, and lost both of my parents.

But on the professional front, is my 2020 general practice so different than it was in 2010? One major change has been the rapid expansion of medications to treat type 2 diabetes. Previously it was metformin, glyburide, then insulin. Now the list is quite impressive and includes DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, and stop-stuffing-your-facers. Also notable is the expansion of insulin pump use and, more recently, cutaneous blood glucose sensors—can an external pancreas be far behind? If forced to, I would label the last 10 years as the “mab” decade. Medications using monoclonal antibody technology have exploded onto the scene and, depending which antigen is being targeted, are being used for cancer, autoimmune conditions, and inflammatory diseases. As an aside, I have to laugh at some of the American TV commercials that depict an elderly lady with rheumatoid arthritis frolicking in the sand followed by a minute explaining how grandma could die if she takes “expensivemab.”

The past decade also marked our ability to cure hepatitis C. This chronic viral disease led to many cases of cirrhosis, liver failure, and cancer, so what a gift for patients to be able to get rid of this dangerous infection. We also now have a prophylactic medication to reduce the likelihood of HIV transmission in high-risk individuals. Apparently an Ebola vaccine has also been developed and is ready for use.

On a broader scale, the exciting world of gene therapy has become a reality. CRISPR technology allows DNA to be edited by snipping off and replacing genes. The DNA of mosquitoes and mice has been tweaked looking for ways to control malaria and to treat sickle cell disease. Human applications are sure to follow. In addition, therapies using harvested genetically engineered immune cells to target certain tumors are now available. Along the same lines, drugs that release the human immune system by targeting its normal inhibitors are being developed.  

On the surgical side there has been an explosion of procedures using scopes instead of incisions. Never has more been done through less. The use of robotic surgery is also expanding. Even 3-D printing is getting in on the action with the production of artificial limbs.

An area that has changed very little, however, is the challenge of finances and costs. Many of these therapies have been priced out of reach of all but the privileged few. Socialized medicine is struggling to keep pace with an ever-expanding array of new and costly therapies.

Regardless of the challenges to be faced and the advances to be made, this decade will likely be the last of my medical career, and I look forward to seeing how medicine evolves as I accelerate over and down the hill. Here’s to the roaring ’20s!
—David Richardson, MD