2001: A Medical Odyssey

How Did Experts Do in Predicting What Medicine Would Look Like Today?

In 1987, 227 world-class scientists were asked to predict the state of medicine in the 21st Century. This was no simple survey: the full report was 203 pages of statistics and analysis, commissioned by Bristol-Myers and conducted by Louis Harris and Associates,

When I originally wrote about the predictions, my work was front-page news in medical and lay news outlets. Now, the future is here: how did the experts do?

• They predicted a 67% cancer cure rate: Pretty much right on target. Today, the 5-year survival rate for cancer overall is 66%. (The comparable cure rate when the experts made their prediction: 54%.)

• No more heart bypass: Missed it by a mile. Specifically, cardiovascular scientists predicted most of the 230,000 heart bypass surgeries being done in 1987 would be replaced by less invasive procedures. Well, there are now 1.3 million such minimally invasive heart interventions done each year; but far from being replaced, nearly twice as many heart bypass procedures are being done each year in the US today (448,000) compared to 1987. It’s partly a factor of an aging population, but mostly it’s a realization that specific types of patients still do better with open surgery.

• 61% predicted an AIDS vaccine by the year 2000: Way too optimistic. Later this year, experts will gather for the 10th annual AIDS Vaccine Conference. In their preliminary program, the chairs of the conference state that despite “encouraging progress…we remain a long way from an affordable, effective vaccine against HIV.”

• A majority predicted an AIDS cure by 2010. Nope. (To be fair, 73% of the infectious disease experts surveyed in 1987 were at complete odds with most of the other experts and saw little or no improvement in treating AIDS by 2000.)

• The death of traditional psychoanalysis. Saw this one coming and, not surprisingly, the central nervous system experts who predicted this were way over-confident. (The word cocky also comes to mind.) Granted, the percentage of patients who receive psychotherapy is about 28.9% today compared to 44.4% in 1996-97. Still, that’s far from “little or no role” for psychotherapy. Importantly, there’s one big reason for the downturn in psychotherapy: financial incentives (insurance reimbursement) favor short medication visits compared with longer psychotherapy sessions. However, given growing concern regarding the widespread use of psychotropic drugs coupled with recent research showing the benefits of cognitive therapy, reports of the death of psychotherapy are greatly exaggerated.

• The “Golden Age of Biology.” Dr. Leroy Hood, whose work revolutionized genetic engineering and biology, said, “I think we will develop every bit as revolutionary technologies in the next 10 years as we have in the past 10 years.” Frankly, if the survey were repeated today, I suspect many of our current world-class scientists would agree and say the same thing about the next 10 years in medicine.

Finally, the experts in 1987 were nearly unanimous on one point: that disease-prevention would do more than advances in either treatment or diagnosis. For example, while steady improvement was predicted for “curing cancer,” there was almost complete agreement that a smokeless society would be the most effective strategy in the prevention and treatment of lung cancer.