Professional Documents
Culture Documents
In World 1, life expectancies are in the ninth and sometimes tenth de-
cades. In the poorest countries, life extends to the sixth or seventh decades.
The world’s affluent have a heightened interest in maximizing human quality
of life, productivity, and achievement, along with their continuing interest in
curing and preventing disease. In World 3, the emphasis remains on prevent-
ing infectious disease and other early killers. Violence, however, continues to
claim lives in World 1 and especially World 3 countries. The contrast is shown
below:
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Affluent Destitute
Some details of these stories follow below and in case studies for the United
States, representing the affluent countries, and Pakistan, representing the poor
countries.
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Striving For Good Health
Tuberculosis Hookworm
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Key
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up up slightly
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→
→
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down unchanged
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down markedly
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For the top few killers, hopes for prevention and cure have not been
realized for several reasons:
• More people living to old age (cardiovascular diseases, acute respira-
tory infections, and cancer)
• Massive urbanization, with more people living in close proximity (tu-
berculosis, diarrheal diseases)
• Failures of sanitation systems (diarrheal diseases, amoebiasis, hook-
worm)
• Degraded environmental conditions (acute respiratory infections, cancer)
• Microbial and viral resistance and mutation (diarrheal diseases, tuber-
culosis, other diseases)
• Cultural resistance and ignorance (all diseases)
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The Genetics Revolution
The primary outcome of genetics has been the rise of drugs, foods,
diagnoses, and lifestyle health strategies based on biochemical individuality
among humans. Historically, the drug industry and medical professionals skirted
the issue and designed treatments for the widest possible application. A suc-
cessful drug needed at least 75% efficacy. Drug manufacturers usually ig-
nored the richness of alternative choices, despite their potential success in
some individuals.
Future
• Home telesurgery, requiring no professionals in attendance
• Global human gene database linked to synthesis equipment for gene insertion therapies
• Worn or implanted health monitors that automatically administer drugs or neural impulses
according to need
Health is decentralized
Health is decentralized in World 1. This is true for four reasons:
• Information technologies and communications give people unpre-
cedented access to information about health.
• Society has come to recognize that a big part of health is the re-
sponsibility of the individual.
• Regulators in the late 1990s and the 2000s changed strategies,
deregulating much of health care and letting people decide, based on
information, what technologies to use or avoid.
• Implants, sensors, and home/workplace/ recreation place diagnostic
technologies have taken health care out of hospitals and away from
administration exclusively by professionals.
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The American Longevity Curve Squares Off
Survivors from Birth to Successive Ages
Total U.S. Population, 1950, 1986, 2025
Life expectancies are similar in the affluent nations and are as much as
30 years shorter in the poor countries. Strategies to limit the effects of aging
are listed below.
... in children
• Precise diet design, involving the principle of reduced caloric intake
• Gene insertion in the blastocyst
• Prenatal and perinatal gene therapies
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From To
Doctors and institutional decision making Individual decision making
Regulators and institutions responsible Individual responsibility
Generalized approaches Finely tailored approaches
Universally indicated treatments Patient-specific treatments
Treatment Prevention
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Importantly, medicine recognizes the particular health needs of people
who were less often acknowledged by the system in the last century: women,
the aging, and people of different ethnic groups. With this, medicine has moved
its focus from the end of life to the beginning, with interventions, especially
genetic ones, for lifelong outcomes. This shift in focus necessarily places spe-
cial emphasis on children.
The following is a comprehensive look at how health is promoted and
how people use medical science and technology throughout their lives. A
central feature in the section is a look at six health histories.
Today, the smart card allows people to coordinate their food purchases in grocery stores and
restaurants, their exercise activities, their clothing purchases, and the ergonomics of home,
vehicle, and workplace. The cards start smart and get smarter as they monitor the health his-
tory of the individual and collect information.
Society began to generalize this practice late last century with move-
ments in business, self-help, education, and health to meet and exceed tradi-
tional levels of performance.
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Today we see people identifying and targeting thresholds of performance
that they want to achieve or cross. This can be the hobbyist athlete competing
against others, much the way professionals have. It can be the aging person
trying to maintain or increase physical vigor or mental acuity against his or
her own past records or an age group standard.
This trend is likely to see its full flowering in the next few decades as
more people examine their genetic potentials, decide what they want to do,
and turn to self-driven and medically supported practices to reach them. Ad-
vances in genetic interventions will also serve them.
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Donny Ambaye gets a clean bill of health
Donny Ambaye is 12. Donny is in excellent health, and plays speed tag. Because of hereditary
diseases in both parents’ families, Donny had a full genetic assay when he was a second-
month fetus. Of particular concern to Donny’s parents was sickle-cell anemia, which is present
on his mom’s, Connie’s, side. Had their fetus carried sickle cell, the Ambaye’s might have
decided to abort it in the fifth week.
If Donny were born today, his parents might have had the sickle-cell gene replaced in Connie’s
fertilized ovum in vitro at the blastocyst stage. Twelve years ago, those procedures were only
experimental.
Donny and his dad go into their techroom to use the HealthXOne system. Donny is old enough
to do his own checkup and faces the wall screen to begin. His dad, Robert, stands nearby, and
watches the monitor as Donny places a HealthXOne sensor on his earlobe. Robert chuckles as
Donny rolls his eyes at the appearance on the screen of Doctor Mastodon, who says “Hello,
Billy.” Donny’s brother Billy is five and used the system earlier. Donny says “health check” and
the system recognizes him. The image of crossball star Curtis Pangabe greets Donny: “Hello,
Champ!”
Reading Donny’s blood, the sensor picks up nothing outside the normal ranges. Then Curtis
asks Donny whether he is still playing speed tag and whether he’s going out for any new sports.
Curtis says, “Donny, since you’re going out for soccer, let me go over some food tips with you,”
and suggests how to use foods currently popular with kids.
Then the HealthXOne does a few other tests with Donny. The grip test, lung test, and eye check
all show Donny right on track for a kid his age. Curtis shows Donny a key move the pros use
in speed tag.
Finally, Curtis comes back on screen and reminds Donny to get his yearly injection of antican-
cer cocktail. At the same time the system makes an appointment at the clinic, and puts a
reminder in Connie’s video mailbox.
Curtis says, “Hey Champ, don’t forget to put your Health Card in the slot for updating.”
Donny’s health stats are stored in the system, and on his medical card. Had he had any prob-
lems, the system would have reported them to Connie, and to the family’s health plan. There
some problems are evaluated and treatments prescribed by the plan’s computers, while spe-
cial cases are reviewed by doctors.
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People who refuse to die
Medicine has established that human lives are finite. Still, it is medically possible for doctors to
extend lives indefinitely with complex treatments on old people. Only a handful of people,
typically the super rich, have had the battery of treatments needed, possible since the 2010s.
Japan’s national treasure, the poet Shinagawa, is an example.
Another is Costas Papadopoulos, the transportation trillionaire. He is now 73. His procedures
were begun in 2017. Though it is unlikely, he plans and expects to live to be at least 145.
Among the treatments he began in 2017 were:
• Fetal brain tissue therapy for maintaining mental acuity
• Marrow infusions and tissue therapies for maintaining blood cell production
• Heart, kidney, and liver transplants
• An artificial lung paired with his natural lung
• Anticancer therapies (ongoing)
• Immune system boosters (ongoing)
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Seven health histories
A female fetus (due in 2025)
• Parents chose the date of conception, gender, longevity, and hair and eye color of the child.
The genes of the blastocyst were screened for genetic disorders possible from either parent.
A several-step genetic manipulation of the preembryo, shortly after conception, replaced
the essential genes for characteristics selected.
• At the end of the first trimester, a physician corrected the fetus position in the womb and
used a multi-imager to check for any growth and development problems.
• At eight months gestation, the fetus had an immunization complex for five infectious dis-
eases.
• Ready for birth on October 27, 2025. Parents will schedule a convenient delivery time.
• Will get a blood chemistry assay and tissue sampling to catch any problems not screened at
conception or detected in utero. This follow-up is not covered by insurance, but the par-
ents want to make doubly sure the child is in and stays in perfect health.
• The child’s parents used a hormone treatment prior to conception to select a boy.
• Gene therapy in utero to “correct for” congenital short stature that is common in both
parent’s families.
• Will be 4 centimeters taller than both parents by age 13.
• Additional inoculation cocktail for other infectious diseases at five months.
• A broken radius at age four reset, with healing promoted electrically. The bone was fully
healed in six days.
• Parents use the Nutripediatm system to optimize growth and development. The system also
anticipates the problems of senescence, beginning the child on what is meant to be life-
long caloric tailoring for longevity. The system helps parents select foods according to
blood chemistry and other measures of nutrition and health that they can do at home.
• Since birth, parents monitor the child’s health using home testing and diagnostic equip-
ment. Blood testing is done without penetrating the skin, with a blood chemistry assay.
• Using a Televideo center, parents can make routine diagnoses with computer assistance, or
consult a pediatrician on line. The system updates the child’s health card for use at the
doctor’s office, pharmacy, day care, or shopping center.
• Genetic testing was well established, though genetic therapies were new. The parents
spent several months with technicians testing fertilized ova to avoid several genetic predis-
positions to disease. Tay-Sachs and compulsive disorders are present in both families.
• Regular blood tests screen for any abnormalities.
• Cancer prevention, liver, kidney, heart, and lung diseases to be watched for in annual tests
through life.
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A fifty-year-old woman (born 1975)
• Will shortly enter home hospice, with attendants around the clock. Life will be extended a
few days with a drug to counter cardiac arrest and cessation of breathing, so that family
members will be assembled. Anticipates a three-week stay.
• Will control his own pain through neural stimulus, as needed.
Other examples abound in which people follow or reject lifestyle advice based on genetic
testing. Because a person may now know, with nearer certainty, the health consequences that
will result from a behavior, more people can choose behaviors that were once thought to be
universally deadly.
Organoids
Organoids have also been successful. Their success suggests that we
are not far from growing perfect replacement organs either in the body or in
vitro. First demonstrated in animals in the late 1980s, these artificially grown
organs became effective replacements for the spleen and pancreas by 2013.
The potential for more complex systems like the heart have so far been be-
yond our reach.
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Organoids are organs induced to grow in the body on an implanted
matrix. Particular cells, such as insulin producing cells for pancreas replace-
ments, are inserted in the matrix, along with growth hormones. The body
adapts to the organoid with a blood supply, and it develops the ability to
secrete substances and govern biochemical processes. Once triggered, the
organ-forming process goes on by itself in the body. The organoids do not
only simulate or replace existing human organs. Some, such as the anticancer
organoid TNF32, become a biologically compatible implant for introducing
an enzyme, hormone, or other compound into the body. Another valuable
use is in lubricating degraded joints. Tiny hyaluronic-acid-producing organoids
placed, for example, in the knee’s synovial sac, can reduce or remove the
pain of arthritis. The acid was once obtained from the combs of roosters,
among other sources. Today, an organoid can make the body produce it.
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The artificial kidney
Membrane technology allowed the development of today’s artificial kidneys. This highly suc-
cessful technology has ended all but the occasional donor kidney replacement.
The most important changes over the past two decades have come in
donor organ handling. Immunological responses to donated organs is a thing
of the past. Tissue matching is no longer necessary, because we now control
the body’s response to foreign tissues.
Donor organs are cheaper than artificial organs. Sometimes, they work
better. However, fewer organs are available as more trauma and other acci-
dents are made survivable by medical advances. More donors today come
from outside World 1.
Emily and Carl have elected to use a more cost-effective gender-selecting enzyme, available
from the pharmacy, to prevent conception of a boy. To time things just so, they will use ovula-
tion-enhancing drugs to extend their window of opportunity to four days.
Before conceiving in mid-January next year, Emily will have a full examination to see whether
“all systems are go.” They have not had a child together before. She will get a blood scan for
hormonal levels (which she can do at home). At the clinic, a clinician will use a noninvasive
probe to give her a pelvic exam, checking her entire reproductive tract.
Emily and Carl plan to have a birthing specialist on hand at their home for delivery, if Emily’s
pregnancy goes well. They will use a drug to induce labor when everything is ready. They do
not expect any problems.
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Remaining on the reproduction agenda is the need to get 100% of
pregnant women to use the pre- and perinatal care they need for healthy
pregnancies and healthy babies. This has been a decades-long battle. The
remaining problems are social, not medical.
Contraception has benefited from decades of research in human hor-
mone biochemistry and immunity. The every-three-month male injection, for
example, relies on an extremely subtle adjustment of hormonal levels. Women
can have an induced immune response to sperm, get a five-year contracep-
tive implant, or take a regular injection. Progestin receptor-blocker based drugs
originating in France with RU-486 (Mifepristone) became legal in the United
States in 2000. Other postcoital drugs to induce menses, anticipated in the
1990s, were finally perfected in 2011.
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Pain control possibilities
Pain control has come a long way since the knock- ‘em-out drugs used last century. Greater
refinement of drug design, advances in brain science and neural stimulus mean that pain
control rarely has unpleasant side effects. The latest drug implants are implanted tissues that
produce natural narcotics for local or general pain control.
Still, the long-heralded direct brain anesthesiology has not yet arrived. Today’s electrical simu-
lators are a stopgap technology. Look for greater advances by the end of the decade. It is likely
that neurotransmitters will be blocked non-invasively to prevent sensations of pain for the
duration of a medical procedure or for routine control of headache, etc.
• Restoring hearing
• Restoring and improving taste and smell in old people
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Neural grafting cures Alzheimer’s and Parkinson’s
Particularly as more of us live to old ages, Alzheimer’s and Parkinson’s
diseases, though preventable, turn up in disturbingly high numbers in the
population. Each year, about 500,000 people in the United States are diag-
nosed with Alzheimer’s. Today’s elderly, who were born in the 1940s and
1950s, did not have today’s genetic and lifestyle therapies available to pre-
vent the disease. Many also lived most of their lives before researchers discov-
ered the lifestyle and environmental factors behind Alzheimer’s, Parkinson’s
disease, which is genetic, also afflicts a substantial portion of the population.
For both Alzheimer’s and Parkinson’s, there are cures with 60% to 80% suc-
cess rates. The treatments involve brain tissue grafting and tissue regenera-
tion. Most often, doctors patch the diseased tissues with healthy tissues from
donor brains.
Color is useful to the clinician to accent the properties of tissues analyzed and to highlight
diseased tissues and other medically relevant conditions. Artificial intelligence can interpret
most images and give the clinic professional an immediate diagnosis. Most systems are fully
integrated with molecular probes that take a closer look at the tissues of interest and report
precise biochemical findings. The ability to do all this in full motion and real time allows
computers or clinicians to make live adjustments to a condition and see how the tissues re-
spond chemically.
Most clinics are networked to the global Med-Imagebase that allows a quick match of the
image at hand to archetype images indicating diagnoses. At the same time, unique or rare
readings are reported with the patient’s consent to research organizations that have logged
standing requests for certain classes of things on the system. You could be scanned on a Tues-
day and be in a Photonic NewsFlash that afternoon, or an online medical journal two weeks
later.
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Molecular probes for gentler sensing and testing
Molecular probes are the favored technique for diagnosing disease,
particularly diseases discovered and tracked through biochemical processes.
Similarly, geneticists use gene probes on DNA, even for fetuses in utero.
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for unhealthy living conditions. Water and waste systems do not keep pace
with growing populations. Although some diseases are well-controlled, oth-
ers, such as cholera, resist control. Africa is still afflicted with river blindness,
malaria, etc. Famine exacerbates the problem.
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Health-related factors in Pakistan
Urban Rural
Percent of population with access to safe water 92 66
Most difficult in the region has been improving water quality and managing sewage and other
wastes. Overpopulation, even in Sahiwal, has led to breakdowns in basic sanitation. Cholera
hit the community in early 2010s, killing 1,700.
There are only two doctors working at the Sahiwal clinic. Nearly all the treatment there is
given by nurses and clinicians.
Most of the clinic’s work, outside of educating people in self-care, is in inoculation, contracep-
tion, and treatment of people with infectious diseases.
The Sahiwal clinic and others like it around the country have had some success in fighting
ignorance and disease, but much remains to be done. Modern treatment, such as microsur-
gery, eye surgery, and hormone therapy are most often administered in Lahore. The people of
Sahiwal are not often likely to get such treatment.
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Rural Pakistanis suffer most
The percentage of rural Pakistanis without access to safe drinking water
rose to 66% in 2023. Generally, access to basic sanitation services in Pakistan
was only 53% in 2023. New systems and services have not kept pace with
population.
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Unrealized Hopes and Fears
Event Potential Effects
Cheap human organ cloning, including Widespread treatment of damaged and diseased
commercial organ farming. organs and tissues, potential for life extension.
Donor organ “farming” in which people are the Extreme values conflict in society.
livestock, selling their organs for transplanting.
Human cloning. Extension of life through cloned organ
replacements or transfer of consciousness to
replacement body
Fast mutating viral and bacterial disease Tens or hundreds of millions lose their
pandemics. lives; extreme medical costs of chasing
down vaccines and cures.
Complete control of genetics at or before A eugenics-based society.
conception.
Life extension to the 15th decade. Uncertain.
The end of infectious disease. Greater health standards worldwide, but
concomitant growth of populations possibly
exacerbating current problems.
Elimination of all cancers. Cost savings and quality of life enhancement
across society.
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