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World's Top Doctors Look at Crystal Ball of Medicine


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Feb. 6, 2001 -- Mirror, mirror on the wall, what will be the greatest medical advance of all? Will it be an injection-free way to treat diabetes? A cure for genetic lung diseases like emphysema? An early diagnostic test for Alzheimer's disease or osteoarthritis?

The answer depends largely on whom you ask. One thing is clear, however: The next 25 years will mark an exciting time for medical research, and no specialty or disease will be untouched by changes afoot in research labs across the country. This is the message of experts speaking at a media briefing on medical research in the 21st century, sponsored by TheJournal of the American Medical Association and the Albert and Mary Lasker Foundation.

Advances in imaging technologies and biotechnology and the mapping of the human genome have already given birth to new medical disciplines and new therapies for existing diseases. The Human Genome Project is an international research program designed to construct detailed genetic and physical maps of the human genome. In theory, this will help scientists develop new therapies to correct the genetic abnormalities that can cause disease.

Though significant challenges remain, including understanding disorders with both genetic and environmental causes, "the possibilities for progress in medical science and the opportunities for medical research have never been greater," says David G. Nathan, MD, President Emeritus of Dana-Farber Cancer Institute and the Robert A. Stranahan Distinguished Professor of Pediatrics at Harvard Medical School, both in Boston.

Here's why:

The field of neurology has been completely transformed by molecular genetics, which lets researchers understand the genes causing neurological diseases, says Eric R. Kandel, MD, the winner of last year's Nobel Prize in Medicine.

Psychiatry has been intrinsically changed by new brain imaging techniques that enable researchers to see how areas of the brain are affected by psychiatric illnesses, explains Kandel, who is University Professor at Columbia University College of Physicians and Surgeons in New York City and a senior investigator at the Howard Hughes Medical Institute.

As scientists continue identifying the genes responsible for neurological and psychiatric illnesses, they will get closer to developing new therapies that can turn a gene off like a light switch and prevent or reverse certain diseases, Kandel says. Specific genes encode proteins that, in turn, may cause disease.

And this is especially important now because "as the population ages, diseases of the nervous system are likely to become even more abundant than they are now," he says. Diseases of the nervous system include Parkinson's disease, Alzheimer's disease, and Huntington's disease.

As it stands, nearly 500,000 Americans suffer a stroke each year. Alzheimer's disease affects more than 4 million people, and about 17 million people suffer from serious depression. Millions of Americans are afflicted with other psychiatric or neurological disorders, including drug and alcohol abuse, schizophrenia, brain tumors, and epilepsy.

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