science and technology in medicine essay

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• Published: 16 January 2023

The next generation of evidence-based medicine

• Vivek Subbiah   ORCID: orcid.org/0000-0002-6064-6837 1 , 2 , 3  

Nature Medicine volume  29 ,  pages 49–58 ( 2023 ) Cite this article

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• Adaptive clinical trial
• Drug development
• Health policy

Recently, advances in wearable technologies, data science and machine learning have begun to transform evidence-based medicine, offering a tantalizing glimpse into a future of next-generation ‘deep’ medicine. Despite stunning advances in basic science and technology, clinical translations in major areas of medicine are lagging. While the COVID-19 pandemic exposed inherent systemic limitations of the clinical trial landscape, it also spurred some positive changes, including new trial designs and a shift toward a more patient-centric and intuitive evidence-generation system. In this Perspective, I share my heuristic vision of the future of clinical trials and evidence-based medicine.

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The last 30 years have witnessed breathtaking, unparalleled advancements in scientific research—from a better understanding of the pathophysiology of basic disease processes and unraveling the cellular machinery at atomic resolution to developing therapies that alter the course and outcome of diseases in all areas of medicine. Moreover, exponential gains in genomics, immunology, proteomics, metabolomics, gut microbiomes, epigenetics and virology in parallel with big data science, computational biology and artificial intelligence (AI) have propelled these advances. In addition, the dawn of CRISPR–Cas9 technologies has opened a tantalizing array of opportunities in personalized medicine.

Despite these advances, their rapid translation from bench to bedside is lagging in most areas of medicine and clinical research remains outpaced. The drug development and clinical trial landscape continues to be expensive for all stakeholders, with a very high failure rate. In particular, the attrition rate for early-stage developmental therapeutics is quite high, as more than two-thirds of compounds succumb in the ‘valley of death’ between bench and bedside 1 , 2 . To bring a drug successfully through all phases of drug development into the clinic costs more than 1.5–2.5 billion dollars (refs. 3 , 4 ). This, combined with the inherent inefficiencies and deficiencies that plague the healthcare system, is leading to a crisis in clinical research. Therefore, innovative strategies are needed to engage patients and generate the necessary evidence to propel new advances into the clinic, so that they may improve public health. To achieve this, traditional clinical research models should make way for avant-garde ideas and trial designs.

Before the COVID-19 pandemic, the conduct of clinical research had remained almost unchanged for 30 years and some of the trial conduct norms and rules, although archaic, were unquestioned. The pandemic exposed many of the inherent systemic limitations in the conduct of trials 5 and forced the clinical trial research enterprise to reevaluate all processes—it has therefore disrupted, catalyzed and accelerated innovation in this domain 6 , 7 . The lessons learned should help researchers to design and implement next-generation ‘patient-centric’ clinical trials.

Chronic diseases continue to impact millions of lives and cause major financial strain to society 8 , but research is hampered by the fact that most of the data reside in data silos. The subspecialization of the clinical profession has led to silos within and among specialties; every major disease area seems to work completely independently. However, the best clinical care is provided in a multidisciplinary manner with all relevant information available and accessible. Better clinical research should harness the knowledge gained from each of the specialties to achieve a collaborative model enabling multidisciplinary, high-quality care and continued innovation in medicine. Because many disciplines in medicine view the same diseases differently—for example, infectious disease specialists view COVID-19 as a viral disease while cardiology experts view it as an inflammatory one—cross-discipline approaches will need to respect the approaches of other disciplines. Although a single model may not be appropriate for all diseases, cross-disciplinary collaboration will make the system more efficient to generate the best evidence.

Over the next decade, the application of machine learning, deep neural networks and multimodal biomedical AI is poised to reinvigorate clinical research from all angles, including drug discovery, image interpretation, streamlining electronic health records, improving workflow and, over time, advancing public health (Fig. 1 ). In addition, innovations in wearables, sensor technology and Internet of Medical Things (IoMT) architectures offer many opportunities (and challenges) to acquire data 9 . In this Perspective, I share my heuristic vision of the future of clinical trials and evidence generation and deliberate on the main areas that need improvement in the domains of clinical trial design, clinical trial conduct and evidence generation.

The figure represents the timeline from drug discovery to first-in-human phase 1 trials and ultimately FDA approval. Phase 4 studies occur after FDA approval and can go on for several years. There is an urgent need to reinvigorate clinical trials through drug discovery, interpreting imaging, streamlining electronic health records, and improving workflow, over time advancing public health. AI can aid in many of these aspects in all stages of drug development. DNN, deep neural network; EHR, electronic health records; IoMT, internet of medical things; ML, machine learning.

Clinical trial design

Trial design is one of the most important steps in clinical research—better protocol designs lead to better clinical trial conduct and faster ‘go/no-go’ decisions. Moreover, losses from poorly designed, failed trials are not only financial but also societal.

Challenges with randomized controlled trials

Randomized controlled trials (RCTs) have been the gold standard for evidence generation across all areas of medicine, as they allow unbiased estimates of treatment effect without confounders. Ideally, every medical treatment or intervention should be tested via a well-powered and well-controlled RCT. However, conducting RCTs is not always feasible owing to challenges in generating evidence in a timely manner, cost, design on narrow populations precluding generalizability, ethical barriers and the time taken to conduct these trials. By the time they are completed and published, RCTs become quickly outdated and, in some cases, irrelevant to the current context. In the field of cardiology alone, 30,000 RCTs have not been completed owing to recruitment challenges 10 . Moreover, trials are being designed in isolation and within silos, with many clinical questions remaining unanswered. Thus, traditional trial design paradigms must adapt to contemporary rapid advances in genomics, immunology and precision medicine 11 .

Progress in clinical trial design

High-quality evidence is needed for clinical practice, which has traditionally been achieved with RCTs 12 . In the last decade, substantial progress has been made in the design, conduct and implementation of ‘master’ protocols (overarching protocols that apply to several substudies), which has led to many practice changes that have substantially improved the stagnation of RCTs. Moreover, master protocols may involve parallel interventional studies in a single disease or multiple diseases defined by a biomarker or disease entity 12 . Four different classes of studies are included under the master protocols—the umbrella study, basket study, platform study and master observational trial (MOT) (Fig. 2 ). Each of these is a unique trial design that can include independent arms with control interventions and may be analyzed individually and/or collectively, with added flexibility 13 , 14 . The field of oncology has led these efforts more so than any other field, owing to advances in genomics (for identifying molecular alterations), discovery of therapeutics and rapid clinical translation, thus ushering in the precision oncology era.

Four different classes of studies are included under the master protocols—the basket study, umbrella study, platform study and MOT.

Umbrella study

Umbrella trials are study designs that evaluate multiple targeted therapies for the same disease entity, stratified by molecular alteration. Examples include the I-SPY (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging And Molecular Analysis) breast cancer trial and Lung-MAP (Lung Cancer Master Protocol) 15 , 16 .

Basket (or bucket) trial

Basket trials are tissue-agnostic or histology-independent studies where targeted therapy is evaluated on multiple disease types that all harbor the same underlying molecular aberration. For instance, the VE-Basket study (in which VE denotes vemurafenib) 17 , Rare Oncology Agnostic Research (ROAR) study 18 , ARROW trial 19 and LIBRETTO-001 trials 20 , 21 have led to several drug approvals in specific biomarker-driven populations in a histology-dependent and histology-independent manner.

Platform study

These are multi-arm, multistage study designs that compare several intervention groups with a common control group in the context of the same master protocol. Additionally, they can be perpetual/immortal study designs (with no defined end date) and are more efficient than traditional trials on account of the shared control arm, which ensures that a greater proportion of patients are enrolled in the interventional/experimental arms than in the control arm. The Randomised Evaluation of COVID-19 Therapy (RECOVERY) Platform Study is a prominent example; this practice-changing trial established dexamethasone as an effective treatment for COVID-19 (ref. 22 ) and also showed that hydroxychloroquine was ineffective. Platform studies are flexible by design and do not necessarily need to have a shared control arm; the main idea is that intervention arms may be added to an ongoing trial, for example, as in the The UK Plasma Based Molecular Profiling of Advanced Breast Cancer to Inform Therapeutic CHoices (plasmaMATCH) platform trial 23 . Although the aforementioned trials were designed in the context of drug development in oncology and infectious diseases, the scope of platform trials could be leveraged in other diverse areas such as clinical psychology and neurology 24 . Such trials could also be used for digital mental health interventions and could be readily implemented in resource-constrained settings 24 .

The MOT is a prospective, observational study design that broadly accepts patients independently of biomarker signature and collects comprehensive data on each participant 14 , 25 . The MOT is a combination of the master interventional trial and prospective observational trial designs and attempts to hybridize the power of biomarker-based master interventional protocols with the breadth of real-world data (RWD) 14 , 25 . This approach could be well suited to collect prospective RWD across many specialties; the Registry of Oncology Outcomes Associated with Testing and Treatment (ROOT) MOT is one example 14 .

Development of biomarkers and defining endpoints

Biomarker development has facilitated progress in clinical trial design, with unprecedented advances in genomics and immunology leading to several approvals for biomarker-based targeted therapies and immunotherapy in the last decade. In fact, human genetics evidence provided support for more than two-thirds of the drug approvals in 2021 (ref. 26 ). The fields of oncology and genetics have benefited immensely from these advances, but fields such as cardiology, nephrology and pulmonology are still lagging in biomarker-based drug approvals.

To fast-track drug development and clinical trials in every major disease, we will need to define biomarkers (whether clinical, pathological or physiological) and their context of use for every disease process and delineate clear endpoints for studies 27 . Biomarkers can be diagnostic, prognostic or predictive and can inform early drug development, dose selection and trial design. In addition, biomarkers can help to fast-track basic science and drug discovery—all with the eventual goal of improving patient health 28 . However, the level of evidence for a biomarker largely depends on the context of use.

In addition to biomarkers, every field needs to define areas of top priority for research and identify the most relevant endpoints to answer priority research questions. Endpoints are measures of health and/or disease and serve different purposes depending on the phase of the trial 28 , 29 . Beyond clinical and regulatory endpoints, patient-reported outcomes and digital endpoints are also rapidly emerging.

Digital endpoints

Digital endpoints are sensor-generated data collected outside the clinical environment in the context of patients’ routine living—such as using smartphone microphones to monitor cognitive decline in people with Alzheimer’s disease or smartwatch monitors to evaluate drug effect in people with sickle-cell anemia 29 . This is an area of considerable excitement in medicine as it could permit more realistic real-world tracking of the patient experience. Moreover, with the increase in decentralized trial conduct across many specialties, remote monitoring is poised to increase. For instance, a recent study developed an AI model to detect and track progression of Parkinson’s disease (for which there are no biomarkers) on the basis of nocturnal breathing signals using noninvasive, at-home assessment, providing evidence that AI may be useful in risk assessment before clinical diagnosis of the condition 29 , 30 . Additionally, digital atrial fibrillation screening by smart devices has been evaluated extensively in large-scale studies, including the Apple 31 , Huawei 32 and Fitbit 33 cardiac studies. Altogether, these siteless observational studies enrolled over 1 million participants, an amazing feat, and a randomized study showed the superiority of digital atrial fibrillation detection over usual care 34 .

Digital characterization and assessment of clinical status need to be standardized and harmonized, with interdisciplinary collaboration and regulatory input. Consensus is also needed to identify and characterize intermediate and surrogate endpoints for major chronic diseases. This requires specialty-specific incorporation of multiple levels of data such as genomic, proteomic and genotype–phenotype-based clinical data and disease-specific measurements, in addition to a layer of functional data 26 . The National Institutes of Health (NIH) and Food and Drug Administration (FDA) have developed BEST (Biomarkers, EndpointS and other Tools) resources to clarify the ambiguity in biomarkers and endpoints. This is a ‘living document’ that is continually updated as standards and evidence change 35 and that clarifies important definitions and describes some of the hierarchical relationships, connections and dependencies among the terms.

Clinical trial conduct

The components of clinical trial conduct are protocol implementation; patient selection, recruitment, monitoring and retention; ensuring compliance to safety reporting; and continuing review and data analysis. The pharmaceutical industry and the healthcare sector invest substantial resources into clinical trial conduct, but changes are urgently needed to make the process more seamless. Moreover, the pace at which clinical trials are conducted is too slow to match the research advances in every field; thus, a high-tech transformation of every component in a stepwise manner is needed.

One of the positive sides of the pandemic is that it forced the system to redirect clinical trials to be more patient-centric than before, thus giving more importance to the principal subject of clinical research—the patient 36 (Fig. 3 ). This has led to decentralized trials and digital, remote and ‘virtual’ trials (which allow patients access to trials regardless of their geographic location), as well as ‘hospital-at-home’ and home-based monitoring concepts 37 . Such rapid strides have been aided by guidance from regulatory authorities 38 . Adopting an AI-based approach to enhance the patient experience can further improve high-fidelity assessments and ensure compliance with protocols 39 . Although digitalization, virtualization and decentralization are not cures for clinical research crises, they can create efficiencies that may have a sizeable and long-term downstream impact.

The main constituents of the clinical trial enterprise—patients, academic centers, industry sponsors (big and small pharma), government/cooperative group sponsors, regulatory agencies, patient advocacy organizations and CROs—need to work together, with the patient as the center of this clinical trial universe. AMA, African Medicines Agency; CDSCO, Central Drugs Standard Control Organization (India); CMS, Centers for Medicare and Medicaid Services; ECA, external control arm; EMA, European Medicines Agency; HTA, Health Technology Assessment; NMPA, National Medical Products Administration (China).

Physicians, healthcare team members and clinical investigators at academic sites and other trial enrolling sites contribute immensely to patient recruitment. In addition, high-impact, high-functioning sites (as in major academic centers of excellence) often have a portfolio of trials and screen patients presenting to the system in an efficient manner. Such sites are in the minority, however, and most clinical trial sites are challenged with staffing constraints and other barriers.

Clinical trial research enterprise

Efficiency and collaboration in the clinical trial research enterprise are major components of clinical trial success. The main constituents of the clinical trial enterprise are patients, academic centers, industry sponsors (big and small pharma), government/cooperative group sponsors, regulatory agencies, patient advocacy organizations and contract research organizations (CROs), and all of these need to work together with the patient as the center of the clinical trial universe (Fig. 3 ). Moreover, this whole system needs a digital overhaul as many sites still use protocol binders, pen-and-paper diaries, faxes between sites, unstructured data and decades-old software systems. Registrational clinical trials need to be well managed on a day-to-day basis with rigorous electronic data capture and monitoring. Integration of blockchain technology into the clinical trial management system could conceivably bolster trust in the clinical trial process and facilitate regulatory oversight 40 .

Patient participation in clinical trials is key, as there can be no trials without patients. Clinical trial organizers should make it easier for patients to participate in trials. In addition, physician–patient treatment decisions for major diseases should include clinical trial options as standard. These clinical trials should be easily accessible and should ensure that no patients are unnecessarily excluded; this can be achieved with site-agnostic clinical trial matching and navigation services. In addition, clinical trial training should be a part of medical education so that a diverse pool of trained investigators and personnel from the entire healthcare enterprise can be available for clinical research.

It is about time

Clinical development timelines for drug candidates are a race against time from when patents are filed to final FDA approval 41 . Drug development timelines, on average, are approximately 10 years (Fig. 1 ). The swiftness of the development of the COVID-19 mRNA vaccines and the oral COVID-19 treatment nirmatrelvir/ritonavir tablets, both of which were developed within a year using a ‘lightspeed approach’, should not be an outlier 42 . The lessons learned should provide a model for multiple therapeutic areas of unmet need. The two small molecules that hold the record for the shortest timeline in drug development, osimertinib for EGFR -mutant non-small-cell lung cancer (NSCLC) (984 days via accelerated approval) and elexacaftor for cystic fibrosis (1,043 days via the regular path) 41 , in nonpandemic times demonstrate that this is possible.

The regulatory logjams slowing drug development necessitated the creation of programs such as the FDA’s accelerated approval pathway, which was introduced in 1992 to address the HIV and AIDS crisis and has since benefitted highly specialized areas such as precision oncology 43 . Multiple programs have been created to shorten timelines for the premarket process, including priority review, fast-track designation, breakthrough designation and orphan designation 44 . Beyond these programs, however, the timelines are still slow and there is an urgent need to address this for all diseases as drug development speed is crucial for patients, physicians and drug development stakeholders alike.

Globalizing drug development, harmonization and transportability

Although the mandate of the FDA is to the US population, their influence is global and, functionally, the FDA is the de facto regulator for the world. Other regulatory authorities such as the European Medicines Agency, the National Medical Products Administration in China and the Central Drugs Standard Control Organization in India, which in total serve more than 3 billion of the world’s population, are also evolving as key players in the global pharmaceutical sector. In addition, the newly established African Medicines Agency was set up (in 2019) to speed up timelines for vaccines and medicine approvals and to improve access to drugs, especially for emerging infectious diseases endemic to the continent 45 . All of these agencies need to be able to stand alone. In addition, there is an urgent need for global harmonization across regulatory authorities to address the substantial inequities in access to medicines. Ideally, clinical trials for new therapies should be conducted globally, for access and generalizability 46 . However, the reality is that clinical trials, including RCTs, cannot be conducted in every country to generate specific evidence for that country’s population. Evidence generation using transportability analysis is gaining traction and refers to the ability to generalize inferences from a study sample in one country to a target population in another country where the study was not conducted 47 , 48 . Transportability analyses may offer some evidence of external validity with implications for local regulatory and health technology assessments 48 .

Evidence generation in clinical research

Clinical studies of rare diseases.

As scientific advances drive clinical trials forward, trials on cancers and many rare diseases are being designed and conducted in small genetically defined or biomarker-defined subsets. Moreover, new methods to generate evidence of clinical benefit may accelerate clinical trial conduct and provide individuals with rare diseases access to new therapeutic compounds. Rare diseases affect an estimated 263 million–446 million people globally at any given time and are increasingly becoming a huge public health burden 49 . Clinical trials in this context come with their own challenges stemming from the rarity of the conditions and incomplete natural history data 50 . However, remarkable advances in molecular biology coupled with legislation to spur orphan disease developmental therapeutics have led to progress. There is increasing regulatory flexibility to use programs such as the accelerated approval program, and there are case scenarios whereby trials have used external control arms based on RWD.

As an example, the FDA granted accelerated approval to alpelisib (Vijoice, Novartis) for adults and children over 2 years of age who require systemic therapy for PIK3CA-related overgrowth spectrum, which includes a group of rare disorders linked to mutations in the PIK3CA gene 51 . Interestingly, efficacy was evaluated using a retrospective chart review of RWD from EPIK-P1 ( NCT04285723 ), a single-arm clinical study in which individuals with PIK3CA-related overgrowth spectrum received alpelisib as part of an expanded access program for compassionate use. The application for this approval used the Real-Time Oncology Review pilot program 52 , which streamlined data submission before filing of the entire clinical application, and Assessment Aid 53 , a voluntary submission from the applicant to facilitate assessment by the FDA. As a result, this application was granted priority review, breakthrough designation and orphan drug designation 51 .

N-of-1 trials

In the era of individualized genomic medicine, N-of-1 trials are emerging as a tool to study potentially fatal rare diseases. The N-of-1 trial is a single-patient clinical trial using the individual person as a unit of investigation to evaluate the efficacy and/or adverse events of different interventions through objective data-driven criteria 54 . For example, an antisense oligonucleotide therapy was designed for, and evaluated in, a single patient who had a fatal genetic neurodegenerative disorder known as CLN7 neuronal ceroid lipofuscinosis (a form of Batten’s disease) 55 . Another patient (who happened to be a physician) with idiopathic Castleman’s disease refractory to IL-6-blocking therapy identified the causative molecular alteration in his own disease to develop a personalized therapy 56 . In yet another example, rapid dose escalation with a selective RET inhibitor was evaluated in a single patient with highly refractory medullary thyroid carcinoma, to overcome a resistance mechanism specific to that patient 57 .

These sensational new drug discovery–translation paradigms raise important questions, such as what level of evidence is needed before exposing a human to a new drug, what evidence this approach might generate for the next patient and what challenges might exist with generalizability 58 . The concept of medical analog patient-specific ‘digital twins’ is an emerging area of research that has the potential to combine polynomial data (mechanistic data, medical history, with the power of AI) and may perhaps serve to enhance N-of-1 trials in the future, to further personalize medicine 37 , 59 , 60 .

RWD and real-world evidence

One of the major criticisms of all clinical trial research is that clinical trials do not represent the ‘real-world’ population; often, the restrictive criteria of clinical trials and the limited analyses framed to answer specific questions may not apply to real-world patients. A wide gap therefore exists between the trial world and the real world, and attempts have been made to close this gap 61 . Conventional trials have been designed on the basis of the misconception that regulatory bodies may not accommodate more modern and diverse evidence from RWD, which is no longer the case 61 , 62 .

It is important to distinguish between RWD, which refers to data generated from routine, standard care of patients 62 , and real-world ‘evidence’ (RWE), which is the evidence generated from RWD regarding the potential use of a product. RWE is generated by trial designs or analysis and is not restricted to randomized trials; instead, it comes from pragmatic trials and prospective and/or retrospective observational studies 62 , 63 .

In this purview of RWD and RWE, all stakeholders look to regulators for guidance. Consequently, regulators have taken a hands-on approach and provided guidance and a comprehensive framework launched through the 21st Century Cures Act 62 , 64 . Moreover, the FDA uses RWD and RWE for postmarketing safety monitoring, and insurance agencies have started to use such data for coverage decisions 62 . This has been necessitated by rapidly accelerating data input from multiple streams and layers into electronic health records, as well as wearables and biosensors, in parallel with new analytical capabilities (multimodal AI) to analyze the vast amount of data.

Evidence from synthetic or external control arms

RCTs are considered the gold standard for drug development and evidence as they allow for estimation of treatment effects that can be assigned to the experimental arm of interest. The randomization in these studies curtails the concern for confounding bias by removing systematic imbalances between arms in measured and unmeasured prognostic factors 65 . However, advances in the genomics of rare diseases and the discovery of rare oncogene-driven cancers have led to specific targeted therapies, for which evaluation in RCTs may not be feasible or ethical and may delay patient access to promising or lifesaving therapies.

In such cases, synthetic control arms are emerging as options for generating comparator arms that can ‘mimic’ the comparator arms of RCTs. Synthetic control arms are external to the study in question, and most are derived from RWD 65 . Moreover, RWD are obtained from electronic health records, administrative claims data, natural history registries and patient-generated data from many sources, including wearable devices 65 . Synthetic control arms may also be generated from previous clinical trial data (single or pooled trials). This is an emerging area primed for innovation as so much data are now available from multiple sources.

NSCLC is increasingly being divided into small oncogene-driven subsets, making it more challenging to conduct randomized trials 66 , and recent developments in the NSCLC trial landscape illustrate the utility of synthetic control arms. For instance, RET fusions are genomic drivers in 1–2% of NSCLCs, and pralsetinib is a selective RET-targeted therapy showing promising responses even in individuals with advanced disease. The ARROW study ( NCT03037385 ) was a single-arm registrational trial, conducted globally, to evaluate pralsetinib in RET fusion-positive individuals with NSCLC 67 , 68 . This trial showed a relative survival benefit with the drug when compared to an external standard-of-care control arm consisting of RWD cohorts derived from two Flatiron Health databases 66 . A template for future studies of this nature using quantitative bias analyses showed that comparisons between the external control arm and the trial arm are robust and able to withstand issues such as data missingness, potentially poorer outcomes in RWD and residual confounding 66 . Overall, the study provided evidence in favor of pralsetinib as a first-line treatment for RET fusion-positive NSCLC.

The use of synthetic control arms can accelerate drug development, and initial skepticism about them arose mainly from a lack of precedence and direction from regulatory authorities. These concerns are now being dispelled as synthetic control arms have been used recently for drug approvals for ultra-rare diseases. For example, neurofibromatosis is a rare disease seen in 1 in 3,000 births. Patients develop plexiform neurofibroma lesions that are painful and debilitating, causing motor and neuronal dysfunction. The MEK inhibitor selumetinib was approved for pediatric patients with symptomatic, inoperable plexiform neurofibromas on the basis of a dataset of 50 patients from Selumetinib in Pediatric Neurofibroma Trial (SPRINT)—a single-arm phase 2 trial showing a durable objective response rate and improvements in functional symptoms 65 , 69 , 70 . Comparator arms from two previously conducted trials provided evidence for the natural history of the disease and were submitted as an external control arm, which helped confirm that spontaneous regressions were uncommon and that the observed responses and symptom improvement represented a genuine treatment effect 69 .

Despite this progress, external control arms are still an emerging concept and they have mainly been used to investigate the natural history of disease and have not generally been included as primary evidence or in product labels. However, in the future, I can envision such comparative effectiveness analysis and comparator arms as primary evidence to support drug approval. Challenges mainly arise from data quality and data missingness, as well as uncertainty of whether external control data are fit for purpose. However, some of these concerns can be mitigated by quantitative bias analysis and other methodologies 66 , 71 .

Pediatric clinical trials

Although pediatric research has been at the forefront of major advances in medicine (extracorporeal membrane oxygenation 72 is a notable example) and has pushed the boundaries of modern oncology (for instance, in treating pediatric leukemia), innovations in new drug development are often delayed. Many rare and orphan diseases occur mainly in the pediatric population, and drug development in this population has always been operationally, ethically, statistically and methodologically challenging 73 , 74 . This is compounded by the limited understanding of basic biology, the ontology of disease manifestations, and the acute and long-term safety of products 73 , 74 . In addition, there is considerable off-label use of products in very young children, infants and neonates where clinical trials have not been feasible, and it is imperative that high-level evidence be generated by creative methods. Programs such as the Best Pharmaceuticals for Children Act (in 2002) and the Pediatric Research Equity Act (in 2003), made permanent in 2012 under the FDA Safety and Innovation Act, have incentivized and enhanced the development of pediatric therapeutics 73 . Innovative trial designs, RWD and leveraging data from other resources may help with risk–benefit assessment and drug approval, such as the approval for neurofibromatosis type 1 (NF1) 73 .

Reimagining the future of clinical trials

The landscape of AI in medicine has transformed recently, and AI is poised to become ubiquitous. Several RCTs have quantified the benefits of AI in specialties that use pattern recognition and interpretation of images, such as radiology (mammography and lung cancer screening), cardiology (interpreting electrocardiograms (EKGs), cardiac functional assessment and atrial fibrillation screening), gastroenterology (interpreting colonoscopies), pathology (cancer diagnosis), neurology (tracking disease evolution of amyotrophic lateral sclerosis and Parkinson’s disease), dermatology (diagnosing lesions) and ophthalmology (eye disease screening) 75 . However, most AI research focuses on ‘clinical care delivery’ applications and not ‘clinical trial research’ 76 .

The integration of AI into clinical trial research has been slower than expected, mainly owing to the (perceived) friction between AI versus human intelligence. Nevertheless, trials of data generation and interpretation should be conducted, and AI should be used to augment human intelligence—not seen as something to replace it 77 . Next-generation clinical trials using AI should consider AI + human rather than AI versus human scenarios 75 , 78 . The clinical trial guidelines for protocols (Standard Protocol Items: Recommendations for Interventional Trials–Artificial Intelligence (SPIRIT-AI) extension) and publications (Consolidated Standards of Reporting Trials–Artificial Intelligence (CONSORT-AI) extension) 79 , 80 are intended to achieve standardized and transparent reporting for randomized clinical trials involving AI, and these are just the beginning of a new phase of clinical research modernization.

Given the time and cost involved in developing a drug, every failed drug in the market represents a considerable loss to the drug development ecosystem. In addition, inferior trial designs, suboptimal patient recruitment, poor infrastructure to run trials, and inefficiency in trial conduct and monitoring have plagued the system for decades. AI has the potential to augment all phases of drug development, from drug design to the complete drug development cycle (Fig. 1 ).

Clinical trial conduct is still rudimentary in many ways. For instance, in oncology trials, a few aspects of two-dimensional lesions are measured and followed over time and effectiveness of the drug is evaluated by shrinkage of these lesions. Automated quantitative assessments and artificial neural networks can aid in automated rapid processing of multiple lesions 81 . In cardiology trials, vital signs are measured once a week in clinic, and, in neurology, patient questionnaires are administered in clinic. Now, these data can all be tracked dynamically in real time using wearable sensor technology. The application of AI to such areas can have a transformational near-term impact. In addition, pattern recognition using deep neural networks can help with reading scans, pathology images and EKGs, among others 37 , 78 .

The current evidence-based medicine pyramid represents the tip of the iceberg and barely provides shallow evidence to care for a generic patient (Fig. 4 ). Hence, a deep synthesis and amalgamation of all available data is needed to achieve next-generation, ‘deep’ evidence-based medicine. The main challenge in the next two decades will be to tap the potential of multidimensional evidence generation 82 by extracting, collating and mining large sets of natural history data, genomics and all other omics analysis, all published clinical studies, RWD, data from ubiquitous smart devices and amassed data from the IoMT to provide next-generation evidence for deep medicine.

The current evidence-based medicine (EBM) pyramid represents the tip of the iceberg and barely provides enough shallow evidence to care for a generic patient. Hence, a deep synthesis and amalgamation of all available data is needed to achieve next-generation, deep evidence-based medicine. The main challenge ahead in the next two decades will be extracting, collating and mining large sets of natural history data, genomics and all omics analyses, all published clinical studies, RWD and amassed data from the IoMT to provide next-generation evidence for deep medicine. PRO, patient-reported outcomes.

Partnerships in drug development

Currently, the pharma industry is the main driver of drug development, and their expenditures far exceed investments from any national agency such as the National Institutes of Health 61 . There are two domains of clinical trials. The first of these is from ‘big pharma’, which uses CROs to run trials; such trials are very often approved for registration by the FDA. The second domain encompasses academic clinical trials, which often operate on a very limited budget, do not often evaluate new compounds and, thus, rarely result in FDA registration. In this era of reduced federal funding for research, more partnerships are needed for drug development. Academic centers and community sites are crucial for patient enrollment; however, a siloed mentality has impacted drug development and delayed access to lifesaving therapies. Therefore, collaborations among specific disease organizations, academic institutions, federal agencies and patient advocacy groups are crucial for betterment of the health of populations (Fig. 3 ). Because the pharma industry is hesitant to invest huge amounts with limited financial return, especially in rare diseases, federal agencies have developed programs to incentivize rare disease drug development 1 . Moreover, disease-focused organizations have collaborated with the pharma industry, federal agencies and academia to form ‘venture philanthropy’ with risk-sharing financial models to de-risk drug development 1 . Many academic institutions are entering into risk-sharing strategic alliances with the pharma industry to collaborate across preclinical and clinical development phases. Such successful innovative partnership models have set a precedent in diseases such as cystic fibrosis, multiple myeloma, type 1 diabetes mellitus and other rare diseases 1 . These collaborations have effectively catalyzed innovation through all phases of drug development and provided a compelling reason to sustain and foster more of these sorts of programs.

Social media and online community research

Social media outlets (Twitter, Facebook and so on) can influence patient accrual in clinical trials. They can strongly influence and address historical clinical trial challenges, including the lack of awareness among patients and physicians about available trials and the lack of community engagement. More than 4.48 billion people use social media globally, and this number is projected to increase to almost 6 billion in 2027 (ref. 83 ). Over 70% of Americans are on social media, including rural dwellers and adolescent and young adult populations who have always been under-represented in clinical trials. Although many older adults do not use social media, their caregivers are likely to.

People with terminal diseases often self-experiment with drugs, and online patient communities can provide environments for sharing and monitoring such drug usage. This can allow for observational studies to be planned around quantitative, internet-based outcome data. For example, researchers developed an algorithm to dissect the data reported on the PatientsLikeMe website by people with amyotrophic lateral sclerosis who experimented with lithium carbonate treatment 84 . This analysis reached the same conclusion as an ensuing RCT, suggesting that data from online patient behavior can help accelerate drug development and evaluate the effectiveness of drugs already in use.

An increase in engagement from patients and patient advocacy groups can aid patient education and outreach and can facilitate patient-partnered research, as well as allowing for incorporation of patients’ perspectives in the design of clinical research—ultimately generating research that is driven by the needs of real people with the disease under investigation. Moreover, social media breaks open silos dividing researchers and clinicians, creating enormous potential to influence all areas of medicine 85 .

The success of future clinical trials requires a fundamental transformation in how trials are designed, conducted, monitored, adapted, reported and regulated to generate the best evidence. The status quo model is unsustainable. Instead, preventive, personalized, pragmatic and patient-participatory medicine is needed, and paradigm shifts are required to get there via sustainable growth. Silos need to be broken. Standards of care and clinical trials are currently viewed in different realms; however, the overarching goal of both is to improve health outcomes. The COVID-19 pandemic created an opportunity to observe how routine clinical care and clinical trials can work synergistically to generate evidence 86 . Pragmatic platform trials such as the RECOVERY trial should be a model and guide for trial efficiency and real-time impact.

Current paradigms must be continuously challenged by emerging technology and by all stakeholders (the new generations of scientists, physicians, the pharma industry, regulatory authorities and, most importantly, patients). Disruptive innovation should lead to every clinical site being a research site, with all necessary quality checks and research as part of the standard of care. The healthcare system should be integrated into an intuitive RWE-generation system, with clinical research and clinical care going hand in hand. Beyond an ad hoc creative flash of genius (necessitated by a pandemic), sustained momentum will be needed to leverage the knowledge gained from programs such as ‘Operation Warp Speed’ (initiated by the US government to accelerate COVID-19 vaccine development). My personal view is that every major disease needs a ‘Moonshot’ program and every rare disease should have an ‘Operation Warp Speed’—both with clearly identified, sustainable goals to improve population health and address equity, diversity and global access to therapies. Methodological advances and future AI-based analyses of all data will provide deep evidence to realize the goal of personalized medicine— that is, to offer the right treatment to the right patient at the right time.

Ramsey, B. W., Nepom, G. T. & Lonial, S. Academic, foundation, and industry collaboration in finding new therapies. N. Engl. J. Med. 376 , 1762–1769 (2017).

Article   CAS   Google Scholar  

Butler, D. Translational research: crossing the valley of death. Nature 453 , 840–842 (2008).

DiMasi, J. A., Grabowski, H. G. & Hansen, R. W. Innovation in the pharmaceutical industry: new estimates of R&D costs. J. Health Econ. 47 , 20–33 (2016).

Article   Google Scholar  

Wouters, O. J., McKee, M. & Luyten, J. Estimated research and development investment needed to bring a new medicine to market, 2009–2018. JAMA 323 , 844–853 (2020).

Subbiah, V. A global effort to understand the riddles of COVID-19 and cancer. Nat. Cancer 1 , 943–945 (2020).

Flaherty, K. T. et al. Rethinking cancer clinical trial conduct induced by COVID-19: an academic center, industry, government, and regulatory agency perspective. Cancer Discov. 11 , 1881–1885 (2021).

Samimi, G. et al. Lessons learned from the impact of COVID-19 on NCI-sponsored cancer prevention clinical trials: moving toward participant-centric study designs. Cancer Prev. Res. 15 , 279–284 (2022).

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Health and Economic Costs of Chronic Diseases https://www.cdc.gov/chronicdisease/programs-impact/pop/index.htm (2022).

Menta, A. K., Subbiah, I. M. & Subbiah, V. Bringing wearable devices into oncology practice: fitting smart technology in the clinic. Discov. Med. 26 , 261–270 (2018).

Google Scholar  

Krittanawong, C., Johnson, K. W. & Tang, W. W. How artificial intelligence could redefine clinical trials in cardiovascular medicine: lessons learned from oncology. Per. Med. 16 , 83–88 (2019).

Subbiah, V. & Kurzrock, R. Challenging standard-of-care paradigms in the precision oncology era. Trends Cancer 4 , 101–109 (2018).

Woodcock, J. & LaVange, L. M. Master protocols to study multiple therapies, multiple diseases, or both. N. Engl. J. Med. 377 , 62–70 (2017).

Park, J. J. H. et al. Systematic review of basket trials, umbrella trials, and platform trials: a landscape analysis of master protocols. Trials 20 , 572 (2019).

Dickson, D. et al. The master observational trial: a new class of master protocol to advance precision medicine. Cell 180 , 9–14 (2020).

Das, S. & Lo, A. W. Re-inventing drug development: a case study of the I-SPY 2 breast cancer clinical trials program. Contemp. Clin. Trials 62 , 168–174 (2017).

Redman, M. W. et al. Biomarker-driven therapies for previously treated squamous non-small-cell lung cancer (Lung-MAP SWOG S1400): a biomarker-driven master protocol. Lancet Oncol. 21 , 1589–1601 (2020).

Subbiah, V. et al. Pan-cancer efficacy of vemurafenib in BRAF V600 -mutant non-melanoma cancers. Cancer Discov. 10 , 657–663 (2020).

Subbiah, V. et al. Dabrafenib and trametinib treatment in patients with locally advanced or metastatic BRAF V600 -mutant anaplastic thyroid cancer. J. Clin. Oncol. 36 , 7–13 (2018).

Subbiah, V. et al. Pan-cancer efficacy of pralsetinib in patients with RET fusion-positive solid tumors from the phase 1/2 ARROW trial. Nat. Med. 28 , 1640–1645 (2022).

Drilon, A. et al. Efficacy of selpercatinib in RET fusion–positive non–small-cell lung cancer. N. Engl. J. Med. 383 , 813–824 (2020).

Subbiah, V. et al. Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): a phase 1/2, open-label, basket trial. Lancet Oncol. 23 , 1261–1273 (2022).

Normand, S.-L. T. The RECOVERY platform. N. Engl. J. Med. 384 , 757–758 (2020).

Turner, N. C. et al. Circulating tumour DNA analysis to direct therapy in advanced breast cancer (plasmaMATCH): a multicentre, multicohort, phase 2a, platform trial. Lancet Oncol. 21 , 1296–1308 (2020).

Gold, S. M. et al. Platform trials and the future of evaluating therapeutic behavioural interventions. Nat. Rev. Psychol. 1 , 7–8 (2022).

Dickson, D. et al. Snapshot: trial types in precision medicine. Cell 181 , 208 (2020).

Ochoa, D. et al. Human genetics evidence supports two-thirds of the 2021 FDA-approved drugs. Nat. Rev. Drug Discov. 21 , 551 (2022).

Wickström, K. & Moseley, J. Biomarkers and surrogate endpoints in drug development: a european regulatory view. Invest. Ophthalmol. Vis. Sci. 58 , BIO27–BIO33 (2017).

Robb, M. A., McInnes, P. M. & Califf, R. M. Biomarkers and surrogate endpoints: developing common terminology and definitions. JAMA 315 , 1107–1108 (2016).

Landers, M., Dorsey, R. & Saria, S. Digital endpoints: definition, benefits, and current barriers in accelerating development and adoption. Digit. Biomark. 5 , 216–223 (2021).

Yang, Y. et al. Artificial intelligence-enabled detection and assessment of Parkinson’s disease using nocturnal breathing signals. Nat. Med. 28 , 2207–2215 (2022).

Perez, M. V. et al. Large-scale assessment of a smartwatch to identify atrial fibrillation. N. Engl. J. Med. 381 , 1909–1917 (2019).

Guo, Y. et al. Mobile photoplethysmographic technology to detect atrial fibrillation. J. Am. Coll. Cardiol. 74 , 2365–2375 (2019).

Lubitz, S. A. et al. Rationale and design of a large population study to validate software for the assessment of atrial fibrillation from data acquired by a consumer tracker or smartwatch: the Fitbit Heart Study. Am. Heart J. 238 , 16–26 (2021).

Rizas, K. D. et al. Smartphone-based screening for atrial fibrillation: a pragmatic randomized clinical trial. Nat. Med. 28 , 1823–1830 (2022).

FDA-NIH Biomarker Working Group. BEST (Biomarkers, EndpointS, and other Tools) Resource https://www.ncbi.nlm.nih.gov/books/NBK326791/ (2016).

Desai, A. & Subbiah, V. COVID-19 pandemic and cancer clinical trial pandemonium: finding the silver lining. J. Immunother. Precis. Oncol. 4 , 64–66 (2020).

Acosta, J. N., Falcone, G. J., Rajpurkar, P. & Topol, E. J. Multimodal biomedical AI. Nat. Med. 28 , 1773–1784 (2022).

Food and Drug Administration. Digital health technologies for remote data acquisition in clinical investigations, draft guidance for industry, investigators, and other stakeholders. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/digital-health-technologies-remote-data-acquisition-clinical-investigations (2022).

Thomas, K. A. & Kidziński, Ł. Artificial intelligence can improve patients’ experience in decentralized clinical trials. Nat. Med. https://doi.org/10.1038/s41591-022-02034-4 (2022).

Wong, D. R., Bhattacharya, S. & Butte, A. J. Prototype of running clinical trials in an untrustworthy environment using blockchain. Nat. Commun. 10 , 917 (2019).

Brown, D. G., Wobst, H. J., Kapoor, A., Kenna, L. A. & Southall, N. Clinical development times for innovative drugs. Nat. Rev. Drug Discov. 21 , 793–794 (2021).

Anderson, A. S. A lightspeed approach to pandemic drug development. Nat. Med. 28 , 1538 (2022).

Subbiah, V. et al. Accelerated approvals hit the target in precision oncology. Nat. Med. 28 , 1976–1979 (2022).

Kepplinger, E. E. FDA’s expedited approval mechanisms for new drug products. Biotechnol. Law Rep. 34 , 15–37 (2015).

Ncube, B. M., Dube, A. & Ward, K. Establishment of the African Medicines Agency: progress, challenges and regulatory readiness. J. Pharm. Policy Pract. 14 , 29 (2021).

Moyers, J. T. & Subbiah, V. Think globally, act locally: globalizing precision oncology. Cancer Discov. 12 , 886–888 (2022).

Degtiar, I. & Rose, S. A review of generalizability and transportability. Annu. Rev. Stat. Appl. 10 , 1 (2023).

Ramagopalan, S. V. et al. Transportability of overall survival estimates from US to Canadian patients with advanced non–small cell lung cancer with implications for regulatory and health technology assessment. JAMA Netw. Open 5 , e2239874 (2022).

Nguengang Wakap, S. et al. Estimating cumulative point prevalence of rare diseases: analysis of the Orphanet database. Eur. J. Hum. Genet. 28 , 165–173 (2020).

Pizzamiglio, C., Vernon, H. J., Hanna, M. G. & Pitceathly, R. D. S. Designing clinical trials for rare diseases: unique challenges and opportunities. Nat. Rev. Methods Primers 2 , 13 (2022).

Food and Drug Administration. FDA approves alpelisib for PIK3CA-related overgrowth spectrum. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-alpelisib-pik3ca-related-overgrowth-spectrum (2022).

Food and Drug Administration. Real-time oncology review. https://www.fda.gov/about-fda/oncology-center-excellence/real-time-oncology-review (2022).

Food and Drug Administration. Assessment aid. https://www.fda.gov/about-fda/oncology-center-excellence/assessment-aid (2022).

Lillie, E. O. et al. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Per. Med. 8 , 161–173 (2011).

Kim, J. et al. Patient-customized oligonucleotide therapy for a rare genetic disease. N. Engl. J. Med. 381 , 1644–1652 (2019).

Fajgenbaum, D. C. et al. Identifying and targeting pathogenic PI3K/AKT/mTOR signaling in IL-6 blockade–refractory idiopathic multicentric Castleman disease. J. Clin. Investig. 129 , 4451–4463 (2019).

Subbiah, V. et al. Selective RET kinase inhibition for patients with RET -altered cancers. Ann. Oncol. 29 , 1869–1876 (2018).

Woodcock, J. & Marks, P. Drug regulation in the era of individualized therapies. N. Engl. J. Med. 381 , 1678–1680 (2019).

Björnsson, B. et al. Digital twins to personalize medicine. Genome Med. 12 , 4 (2019).

Laubenbacher, R., Sluka, J. P. & Glazier, J. A. Using digital twins in viral infection. Science 371 , 1105–1106 (2021).

Sherman, R. E., Davies, K. M., Robb, M. A., Hunter, N. L. & Califf, R. M. Accelerating development of scientific evidence for medical products within the existing US regulatory framework. Nat. Rev. Drug Discov. 16 , 297–298 (2017).

Concato, J. & Corrigan-Curay, J. Real-world evidence—where are we now? N. Engl. J. Med. 386 , 1680–1682 (2022).

Concato, J., Stein, P., Dal Pan, G. J., Ball, R. & Corrigan-Curay, J. Randomized, observational, interventional, and real-world—what’s in a name? Pharmacoepidemiol. Drug Saf. 29 , 1514–1517 (2020).

Food and Drug Administration. Real-world evidence. https://www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence (2022).

Mishra-Kalyani, P. S. et al. External control arms in oncology: current use and future directions. Ann. Oncol. 33 , 376–383 (2022).

Popat, S. et al. Addressing challenges with real-world synthetic control arms to demonstrate the comparative effectiveness of pralsetinib in non-small cell lung cancer. Nat. Commun. 13 , 3500 (2022).

Gainor, J. F. et al. Pralsetinib for RET fusion-positive non-small-cell lung cancer (ARROW): a multi-cohort, open-label, phase 1/2 study. Lancet Oncol. 22 , 959–969 (2021).

Subbiah, V. et al. Pralsetinib for patients with advanced or metastatic RET -altered thyroid cancer (ARROW): a multi-cohort, open-label, registrational, phase 1/2 study. Lancet Diabetes Endocrinol. 9 , 491–501 (2021).

Center for Drug Evaluation and Research, Food and Drug Administration. NDA multi-disciplinary review and evaluation: NDA 213756 Koselugo (selumetinib). https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/213756Orig1s000MultidisciplineR.pdf (2020).

Casey, D. et al. FDA approval summary: selumetinib for plexiform neurofibroma. Clin. Cancer Res. 27 , 4142–4146 (2021).

Wilkinson, S. et al. Assessment of alectinib vs ceritinib in ALK-positive non–small cell lung cancer in phase 2 trials and in real-world data. JAMA Netw. Open 4 , e2126306 (2021).

Bartlett, R. H. et al. Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases. Ann. Surg. 204 , 236–245 (1986).

McCune, S. & Portman, R. J. Innovation and opportunities in pediatric therapeutic development. Ther. Innov. Regul. Sci. 53 , 564–566 (2019).

Subbiah, V. Fast-tracking novel drugs in pediatric oncology. Cell Cycle 14 , 1127–1128 (2015).

Rajpurkar, P., Chen, E., Banerjee, O. & Topol, E. J. AI in health and medicine. Nat. Med. 28 , 31–38 (2022).

Weissler, E. H. et al. The role of machine learning in clinical research: transforming the future of evidence generation. Trials 22 , 537 (2021).

Adashek, J. J., Subbiah, I. M. & Subbiah, V. Artificial intelligence systems assisting oncologists? Resist and desist or enlist and coexist. Oncologist 24 , 1291–1293 (2019).

Topol, E. J. High-performance medicine: the convergence of human and artificial intelligence. Nat. Med. 25 , 44–56 (2019).

Liu, X. et al. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. Nat. Med. 26 , 1364–1374 (2020).

Cruz Rivera, S. et al. Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension. Nat. Med. 26 , 1351–1363 (2020).

Kickingereder, P. et al. Automated quantitative tumour response assessment of MRI in neuro-oncology with artificial neural networks: a multicentre, retrospective study. Lancet Oncol. 20 , 728–740 (2019).

Jarow, J. P., LaVange, L. & Woodcock, J. Multidimensional evidence generation and FDA regulatory decision making: defining and using “real-world” data. JAMA 318 , 703–704 (2017).

Dean, B. Social network usage & growth statistics: how many people use social media in 2022? Backlinko https://backlinko.com/social-media-users (2021).

Wicks, P., Vaughan, T. E., Massagli, M. P. & Heywood, J. Accelerated clinical discovery using self-reported patient data collected online and a patient-matching algorithm. Nat. Biotechnol. 29 , 411–414 (2011).

Morgan, G. et al. The (r)evolution of social media in oncology: engage, enlighten, and encourage. Cancer Discov. 12 , 1620–1624 (2022).

Pessoa-Amorim, G. et al. Making trials part of good clinical care: lessons from the RECOVERY trial. Future Healthc. J. 8 , e243–e250 (2021).

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Acknowledgements

V.S. is an Andrew Sabin Family Foundation fellow at the University of Texas MD Anderson Cancer Center. V.S. acknowledges the support of the Jacquelyn A. Brady Fund. V.S. thanks the team at Draw Impacts for figures. V.S. is supported by the US National Institutes of Health (NIH) (grants R01CA242845 and R01CA273168); the MD Anderson Cancer Center Department of Investigational Cancer Therapeutics is supported by the Cancer Prevention and Research Institute of Texas (grant RP1100584), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (grant 1U01CA180964), NCATS (Center for Clinical and Translational Sciences) (grant UL1TR000371) and the MD Anderson Cancer Center Support (grant P30CA016672).

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None relevant to the manuscript. V.S. reports research funding/grant support for clinical trials from AbbVie, Agensys, Alfasigma, Altum, Amgen, Bayer, BERG Health, Blueprint Medicines, Boston Biomedical, Boston Pharmaceuticals, Celgene, D3 Bio, Dragonfly Therapeutics, Exelixis, Fujifilm, GlaxoSmithKline, Idera Pharmaceuticals, Incyte, Inhibrx, Loxo Oncology, MedImmune, MultiVir, NanoCarrier, National Comprehensive Cancer Network, NCI-CTEP, Northwest Biotherapeutics, Novartis, PharmaMar, Pfizer, Relay Therapeutics, Roche/Genentech, Takeda, Turning Point Therapeutics, UT MD Anderson Cancer Center and Vegenics; travel support from ASCO, ESMO, Helsinn Healthcare, Incyte, Novartis and PharmaMar; consultancy/advisory board participation for Helsinn Healthcare, Jazz Pharmaceuticals, Incyte, Loxo Oncology/Eli Lilly, MedImmune, Novartis, QED Therapeutics, Relay Therapeutics, Daiichi-Sankyo and R-Pharm US; and a relationship with Medscape.

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Subbiah, V. The next generation of evidence-based medicine. Nat Med 29 , 49–58 (2023). https://doi.org/10.1038/s41591-022-02160-z

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Why Frankenstein matters

Frontiers in science, technology and medicine

By Audrey Shafer, MD

Illustration by Michael Waraksa

“Clear!” At some point during medical education and practice, every physician has heard or given this command. One person — such as a closely supervised medical student — pushes a button to deliver an electric shock and the patient’s body jerks. The code team, in complex choreography, works to restore both the patient’s cardiac rhythm and a pulse strong enough to perfuse vital organs. 

After a successful defibrillation effort, team members do not have time to dwell on the line crossed from death to life. It is even difficult to focus on the ultimate goal: to enable the patient to leave the hospital intact, perhaps to grasp a grandchild’s — or grandparent’s — hand while crossing the street to the park.

Despite these dramatic hospital scenes, many scientists, doctors and patients balk at any mention of the words Frankenstein and medicine in the same breath. Because, unlike the Victor Frankenstein of Mary Shelley’s novel, the reanimators at a hospital code have not toiled alone in a garret; assembled body parts from slaughterhouses, dissecting rooms and charnel houses; or created an entirely new being. Nonetheless, in this bicentennial commemorative year of the book’s publication, it is not only germane, but important to consider the impact of this story, including our reactions to it, on the state of scientific research today.

Shelley’s Frankenstein has captured the imaginations of generations, even for those who have never read the tale written by a brilliant 18-year-old woman while on holiday with Lord Byron, Percy Bysshe Shelley and Dr. John Polidori amid extensive storms induced by volcanic ash during the so-called year without a summer. Mary Shelley (her name was Mary Wollstonecraft Godwin at the time) was intrigued by stories of science such as galvanism, which she would have heard through her father’s scientist (then called natural philosopher) friends.

With Frankenstein , Shelley wrote the first novel to forefront science as a means to create life, and as such, she wrote the first major work in the science fiction genre. Frankenstein, a flawed, obsessed student, feverishly reads extensive tomes and refines his experiments. After he succeeds in his labors, Frankenstein rejects his creation: He is revulsed by the sight of the “monster,” whom he describes as hideous. This rejection of the monster leads to a cascade of calamities. The subtitle of the book, The Modern Prometheus , primes the reader for the theme of the dire consequences of “playing God.”

A framework for examining morality and ethics

Frankenstein  is not only the first creation story to use scientific experimentation as its method, but it also presents a framework for narratively examining the morality and ethics of the experiment and experimenter. While artistic derivations, such as films and performances, and literary references have germinated from the book for the past 200 years, the current explosion of references to  Frankenstein  in relation to ethics, science and technology deserves scrutiny.

Science is, by its very nature, an exploration of new frontiers, a means to discover and test new ideas, and an impetus for paradigm shifts. Science is equated with progress and with advances in knowledge and understanding of our world and ourselves. Although a basic tenet of science is to question, there is an underlying belief, embedded in words like “advances” and “progress,” that science will better our lives.

Safeguards, protocols and institution approvals by committees educated in the horrible and numerous examples of unethical experiments done in the name of science are used to prevent a lone wolf like Victor Frankenstein from undertaking his garret experiments. Indeed, it is amusing to think of a mock Institutional Review Board approval process for a proposal he might put forward.

But these protections can go only so far. It is impossible to predict all of the consequences of our current and future scientific and technologic advances. We do not even need to speculate on the potential repercussions of, for example, the creation of a laboratory-designed self-replicating species, as we can look to unintended consequences of therapies such as the drug thalidomide, and controversies over certain gene therapies. This tension, this acknowledgment that unintended consequences occur, is unsettling.

Science and technology have led to impressive improvements in health and health care. People I love are alive today because of cancer treatments unknown decades ago. We are incredibly grateful to the medical scientists who envisioned these drugs and who did the experiments to prove their effectiveness.

As an anesthesiologist, I care for patients at vulnerable times in their lives; I use science and technology to render them unconscious — and to enable them to emerge from an anesthetized state.

But, as the frontiers are pushed further and further, the unintended consequences of how science and technology are used could affect who we are as humans, the viability of our planet and how society evolves. In terms of health, medicine and bioengineering, Frankenstein resonates far beyond defibrillation. These resonances include genetic engineering, tissue engineering, transplantation, transfusion, artificial intelligence, robotics, bioelectronics, virtual reality, cryonics, synthetic biology and neural networks. These fields are fascinating, worthy areas of exploration.

‘Frankenstein’ is not only the first creation story to use scientific experimentation as its method, but it also presents a framework for narratively examining the morality and ethics of the experiment and experimenter.

We, as physicians, health care providers, scientists and people who deeply value what life and health mean, cannot shy away from discussions of the potential implications of science, technology and the social contexts which give new capabilities and interventions even greater complexity. Not much is clear, but that makes the discussion more imperative.

Even the call “Clear!” and the ritual removal of physical contact with a patient just about to receive a shock is not so “clear,” as researchers scrutinize whether interruptions to chest compressions are necessary for occupational safety — that is, it may be deemed safe in the future for shocks and manual compressions to occur simultaneously.

We need to discuss the big questions surrounding what is human, and the implications of those questions. What do we think about the possibility of sentient nonhumans, enhanced beyond our limits, more sapient than Homo sapiens? Who or what will our great-grandchildren be competing against to gain entrance to medical school?

Studying and discussing works of art and imagination such as Frankenstein , and exchanging ideas and perspectives with those whose expertise lies outside the clinic and laboratory, such as artists, humanists and social scientists, can contribute not just to an awareness of our histories and cultures, but also can help us probe, examine and discover our understanding of what it means to be human. That much is clear.

Audrey Shafer, MD

Audrey Shafer, MD, is a Stanford professor of anesthesiology, perioperative and pain medicine, the director of the Medicine and the Muse program and the co-director of the Biomedical Ethics and Medical Humanities Scholarly Concentration. She is an anesthesiologist at the Veterans Affairs Palo Alto Health Care System.

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Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Co-published by Oxford University Press, New York.

Disease Control Priorities in Developing Countries. 2nd edition.

Chapter 5 science and technology for disease control: past, present, and future.

David Weatherall , Brian Greenwood , Heng Leng Chee , and Prawase Wasi .

As we move into the new millennium it is becoming increasingly clear that the biomedical sciences are entering the most exciting phase of their development. Paradoxically, medical practice is also passing through a phase of increasing uncertainty, in both industrial and developing countries. Industrial countries have not been able to solve the problem of the spiraling costs of health care resulting from technological development, public expectations, and—in particular—the rapidly increasing size of their elderly populations. The people of many developing countries are still living in dire poverty with dysfunctional health care systems and extremely limited access to basic medical care.

Against this complex background, this chapter examines the role of science and technology for disease control in the past and present and assesses the potential of the remarkable developments in the basic biomedical sciences for global health care.

• Medicine Before the 20th Century

From the earliest documentary evidence surviving from the ancient civilizations of Babylonia, China, Egypt, and India, it is clear that longevity, disease, and death are among humanity's oldest preoccupations. From ancient times to the Renaissance, knowledge of the living world changed little, the distinction between animate and inanimate objects was blurred, and speculations about living things were based on prevailing ideas about the nature of matter.

Advances in science and philosophy throughout the 16th and 17th centuries led to equally momentous changes in medical sciences. The elegant anatomical dissections of Andreas Vesalius swept away centuries of misconceptions about the relationship between structure and function of the human body; the work of Isaac Newton, Robert Boyle, and Robert Hooke disposed of the basic Aristotelian elements of earth, air, fire, and water; and Hooke, through his development of the microscope, showed a hitherto invisible world to explore. In 1628, William Harvey described the circulation of the blood, a discovery that, because it was based on careful experiments and measurement, signaled the beginnings of modern scientific medicine.

After steady progress during the 18th century, the biological and medical sciences began to advance at a remarkable rate during the 19th century, which saw the genuine beginnings of modern scientific medicine. Charles Darwin changed the whole course of biological thinking, and Gregor Mendel laid the ground for the new science of genetics, which was used later to describe how Darwinian evolution came about. Louis Pasteur and Robert Koch founded modern microbiology, and Claude Bernard and his followers enunciated the seminal principle of the constancy of the internal environment of the body, a notion that profoundly influenced the development of physiology and biochemistry. With the birth of cell theory, modern pathology was established. These advances in the biological sciences were accompanied by practical developments at the bedside, including the invention of the stethoscope and an instrument for measuring blood pressure, the first use of x-rays, the development of anesthesia, and early attempts at the classification of psychiatric disease as well as a more humane approach to its management. The early development of the use of statistics for analyzing data obtained in medical practice also occurred in the 19th century, and the slow evolution of public health and preventive medicine began.

Significant advances in public health occurred on both sides of the Atlantic. After the cholera epidemics of the mid 19th century, public health boards were established in many European and American cities. The Public Health Act, passed in the United Kingdom in 1848, provided for the improvement of streets, construction of drains and sewers, collection of refuse, and procurement of clean domestic water supplies. Equally important, the first attempts were made to record basic health statistics. For example, the first recorded figures for the United States showed that life expectancy at birth for those who lived in Massachusetts in 1870 was 43 years; the number of deaths per 1,000 live births in the same population was 188. At the same time, because it was becoming increasingly clear that communicable diseases were greatly depleting the workforce required to generate the potential rewards of colonization, considerable efforts were channeled into controlling infectious diseases, particularly hookworm and malaria, in many countries under colonial domination.

However, until the 19th century, curative medical technology had little effect on the health of society, and many of the improvements over the centuries resulted from higher standards of living, improved nutrition, better hygiene, and other environmental modifications. The groundwork was laid for a dramatic change during the second half of the 20th century, although considerable controversy remains over how much we owe to the effect of scientific medicine and how much to continued improvements in our environment ( Porter 1997 ).

This balance between the potential of the basic biological sciences and simpler public health measures for affecting the health of our societies in both industrial and developing countries remains controversial and is one of the major issues to be faced by those who plan the development of health care services for the future.

• Science, Technology, and Medicine in the 20th Century

Although rapid gains in life expectancy followed social change and public health measures, progress in the other medical sciences was slow during the first half of the 20th century, possibly because of the debilitating effect of two major world wars. The position changed dramatically after World War II, a time that many still believe was the period of major achievement in the biomedical sciences for improving the health of society. This section outlines some of these developments and the effect they have had on medical practice in both industrial and developing countries. More extensive treatments of this topic are available in several monographs ( Cooter and Pickstone 2000 ; Porter 1997 ; Weatherall 1995 ).

Epidemiology and Public Health

Modern epidemiology came into its own after World War II, when increasingly sophisticated statistical methods were first applied to the study of noninfectious disease to analyze the patterns and associations of diseases in large populations. The emergence of clinical epidemiology marked one of the most important successes of the medical sciences in the 20th century.

Up to the 1950s, conditions such as heart attacks, stroke, cancer, and diabetes were bundled together as degenerative disorders, implying that they might be the natural result of wear and tear and the inevitable consequence of aging. However, information about their frequency and distribution, plus, in particular, the speed with which their frequency increased in association with environmental change, provided excellent evidence that many of them have a major environmental component. For example, death certificate rates for cancers of the stomach and lung rose so sharply between 1950 and 1973 that major environmental factors must have been at work generating these diseases in different populations.

The first major success of clinical epidemiology was the demonstration of the relationship between cigarette smoking and lung cancer by Austin Bradford Hill and Richard Doll in the United Kingdom. This work was later replicated in many studies, currently, tobacco is estimated to cause about 8.8 percent of deaths (4.9 million) and 4.1 percent of disability-adjusted life years (59.1 million) ( WHO 2002c ). Despite this information, the tobacco epidemic continues, with at least 1 million more deaths attributable to tobacco in 2000 than in 1990, mainly in developing countries.

The application of epidemiological approaches to the study of large populations over a long period has provided further invaluable information about environmental factors and disease. One of the most thorough—involving the follow-up of more than 50,000 males in Framingham, Massachusetts—showed unequivocally that a number of factors seem to be linked with the likelihood of developing heart disease ( Castelli and Anderson 1986 ). Such work led to the concept of risk factors, among them smoking, diet (especially the intake of animal fats), blood cholesterol levels, obesity, lack of exercise, and elevated blood pressure. The appreciation by epidemiologists that focusing attention on interventions against low risk factors that involve large numbers of people, as opposed to focusing on the small number of people at high risk, was an important advance. Later, it led to the definition of how important environmental agents may interact with one another—the increased risk of death from tuberculosis in smokers in India, for example.

A substantial amount of work has gone into identifying risk factors for other diseases, such as hypertension , obesity and its accompaniments, and other forms of cancer. Risk factors defined in this way, and from similar analyses of the pathological role of environmental agents such as unsafe water, poor sanitation and hygiene, pollution, and others, form the basis of The World Health Report 2002 ( WHO 2002c ), which sets out a program for controlling disease globally by reducing 10 conditions: underweight status; unsafe sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water, sanitation, and hygiene; iron deficiency; indoor smoke from solid fuels; high cholesterol; and obesity. These conditions are calculated to account for more than one-third of all deaths worldwide.

The epidemiological approach has its limitations, however. Where risk factors seem likely to be heterogeneous or of only limited importance, even studies involving large populations continue to give equivocal or contradictory results. Furthermore, a major lack of understanding, on the part not just of the general public but also of those who administer health services, still exists about the precise meaning and interpretation of risk . The confusing messages have led to a certain amount of public cynicism about risk factors, thus diminishing the effect of information about those risk factors that have been established on a solid basis. Why so many people in both industrial and developing countries ignore risk factors that are based on solid data is still not clear; much remains to be learned about social, cultural, psychological, and ethnic differences with respect to education about important risk factors for disease. Finally, little work has been done regarding the perception of risk factors in the developing countries ( WHO 2002c ).

A more recent development in the field of clinical epidemiology—one that may have major implications for developing countries—stems from the work of Barker (2001) and his colleagues, who obtained evidence suggesting that death rates from cardiovascular disease fell progressively with increasing birthweight, head circumference, and other measures of increased development at birth. Further work has suggested that the development of obesity and type 2 diabetes, which constitute part of the metabolic syndrome, is also associated with low birthweight. The notion that early fetal development may have important consequences for disease in later life is still under evaluation, but its implications, particularly for developing countries, may be far reaching.

The other major development that arose from the application of statistics to medical research was the development of the randomized controlled trial. The principles of numerically based experimental design were set out in the 1920s by the geneticist Ronald Fisher and applied with increasing success after World War II, starting with the work of Hill, Doll, and Cochrane (see Chalmers 1993 ; Doll 1985 ). Variations on this theme have become central to every aspect of clinical research involving the assessment of different forms of treatment. More recently, this approach has been extended to provide broad-scale research syntheses to help inform health care and research. Increasing the numbers of patients involved in trials and applying meta-analysis and electronic technology for updating results have made it possible to provide broad-scale analyses combining the results of many different trials. Although meta-analysis has its problems—notably the lack of publication of negative trial data—and although many potential sources of bias exist in the reporting of clinical trials, these difficulties are gradually being addressed ( Egger, Davey-Smith, and Altman 2001 ).

More recent developments in this field come under the general heading of evidence-based medicine (EBM) ( Sackett and others 1996 ). Although it is self-evident that the medical profession should base its work on the best available evidence, the rise of EBM as a way of thinking has been a valuable addition to the development of good clinical practice over the years. It covers certain skills that are not always self-evident, including finding and appraising evidence and, particularly, implementation—that is, actually getting research into practice. Its principles are equally germane to industrial and developing countries, and the skills required, particularly numerical, will have to become part of the education of physicians of the future. To this end, the EBM Toolbox was established (Web site: http://www.ish.ox.ac.uk/ebh.html ). However, evidence for best practice obtained from large clinical trials may not always apply to particular patients; obtaining a balance between better EBM and the kind of individualized patient care that forms the basis for good clinical practice will be a major challenge for medical education.

Partial Control of Infectious Disease

The control of communicable disease has been the major advance of the 20th century in scientific medicine. It reflects the combination of improved environmental conditions and public health together with the development of immunization, antimicrobial chemotherapy, and the increasing ability to identify new pathogenic organisms. Currently, live or killed viral or bacterial vaccines—or those based on bacterial polysaccharides or bacterial toxoids—are licensed for the control of 29 common communicable diseases worldwide. The highlight of the field was the eradication of smallpox by 1977. The next target of the World Health Organization (WHO) is the global eradication of poliomyelitis. In 1998, the disease was endemic in more than 125 countries. After a resurgence in 2002, when the number of cases rose to 1,918, the numbers dropped again in 2003 to 748; by March 2004, only 32 cases had been confirmed ( Roberts 2004 ).

The Expanded Program on Immunization (EPI), launched in 1974, which has been taken up by many countries with slight modification, includes Bacillus Calmette-Guérin (BCG) and oral polio vaccine at birth; diphtheria, tetanus, and pertussis at 6, 10, and 14 weeks; measles; and, where relevant, yellow fever at 9 months. Hepatitis B is added at different times in different communities. By 1998, hepatitis B vaccine had been incorporated into the national programs of 90 countries, but an estimated 70 percent of the world's hepatitis B carriers still live in countries without programs ( Nossal 1999 ). Indeed, among 12 million childhood deaths analyzed in 1998, almost 4 million were the result of diseases for which adequate vaccines are available ( WHO 2002a ).

The development of sulfonamides and penicillin in the period preceding World War II was followed by a remarkable period of progress in the discovery of antimicrobial agents effective against bacteria, fungi, viruses, protozoa, and helminths. Overall, knowledge of the pharmacological mode of action of these agents is best established for antibacterial and antiviral drugs. Antibacterial agents may affect cell wall or protein synthesis, nucleic acid formation, or critical metabolic pathways. Because viruses live and replicate in host cells, antiviral chemotherapy has presented a much greater challenge. However, particularly with the challenge posed by HIV/AIDS, a wide range of antiviral agents has been developed, most of which are nucleoside analogues, nucleoside or nonnucleoside reverse-transcriptase inhibitors, or protease inhibitors. Essentially, those agents interfere with critical self-copying or assembly functions of viruses or retroviruses. Knowledge of the modes of action of antifungal and antiparasitic agents is increasing as well.

Resistance to antimicrobial agents has been recognized since the introduction of effective antibiotics; within a few years, penicillin-resistant strains of Staphylococcus aureus became widespread and penicillin-susceptible strains are now very uncommon ( Finch and Williams 1999 ). At least in part caused by the indiscriminate use of antibiotics in medical practice, animal husbandry, and agriculture, multiple-antibiotic-resistant bacteria are now widespread. Resistance to antiviral agents is also occurring with increasing frequency ( Perrin and Telenti 1998 ), and drug resistance to malaria has gradually increased in frequency and distribution across continents ( Noedl, Wongsrichanalai, and Wernsdorfer 2003 ). The critical issue of drug resistance to infectious agents is covered in detail in chapter 55 .

In summary, although the 20th century witnessed remarkable advances in the control of communicable disease, the current position is uncertain. The emergence of new infectious agents, as evidenced by the severe acute respiratory syndrome (SARS) epidemic in 2002, is a reminder of the constant danger posed by the appearance of novel organisms; more than 30 new infective agents have been identified since 1970. Effective vaccines have not yet been developed for some of the most common infections—notably tuberculosis, malaria, and HIV—and rapidly increasing populations of organisms are resistant to antibacterial and antiviral agents. Furthermore, development of new antibiotics and effective antiviral agents with which to control such agents has declined. The indiscriminate use of antibiotics, both in the community and in the hospital populations of the industrial countries, has encouraged the emergence of resistance, a phenomenon exacerbated in some of the developing countries by the use of single antimicrobial agents when combinations would have been less likely to produce resistant strains. Finally, public health measures have been hampered by the rapid movement of populations and by war, famine, and similar social disruptions in developing countries. In short, the war against communicable disease is far from over.

Pathogenesis, Control, and Management of Non-communicable Disease

The second half of the 20th century also yielded major advances in understanding pathophysiology and in managing many common noncommunicable diseases. This phase of development of the medical sciences has been characterized by a remarkable increase in the acquisition of knowledge about the biochemical and physiological basis of disease, information that, combined with some remarkable developments in the pharmaceutical industry, has led to a situation in which few noncommunicable diseases exist for which there is no treatment and many, although not curable, can be controlled over long periods of time.

Many of these advances have stemmed from medical research rather than improved environmental conditions. In 1980, Beeson published an analysis of the changes that occurred in the management of important diseases between the years 1927 and 1975, based on a comparison of methods for treating these conditions in the 1st and 14th editions of a leading American medical textbook. He found that of 181 conditions for which little effective prevention or treatment had existed in 1927, at least 50 had been managed satisfactorily by 1975. Furthermore, most of these advances seem to have stemmed from the fruits of basic and clinical research directed at the understanding of disease mechanisms ( Beeson 1980 ; Comroe and Dripps 1976 ).

Modern cardiology is a good example of the evolution of scientific medicine. The major technical advances leading to a better appreciation of the physiology and pathology of the heart and circulation included studies of its electrical activity by electrocardiography; the ability to catheterize both sides of the heart; the development of echocardiography; and, more recently, the development of sophisticated ways of visualizing the heart by computerized axial tomography, nuclear magnetic resonance, and isotope scanning. These valuable tools and the development of specialized units to use them have led to a much better understanding of the physiology of the failing heart and of the effects of coronary artery disease and have revolutionized the management of congenital heart disease. Those advances have been backed by the development of effective drugs for the management of heart disease, including diuretics, beta-blockers , a wide variety of antihypertensive agents, calcium-channel blockers, and anticoagulants.

By the late 1960s, surgical techniques were developed to relieve obstruction of the coronary arteries. Coronary bypass surgery and, later, balloon angioplasty became major tools. Progress also occurred in treatment of abnormalities of cardiac rhythm, both pharmacologically and by the implantation of artificial pacemakers. More recently, the development of microelectronic circuits has made it possible to construct implantable pacemakers. Following the success of renal transplantation, cardiac transplantation and, later, heart and lung transplantation also became feasible.

Much of this work has been backed up by large-scale controlled clinical trials. These studies, for example, showed that the early use of clot-dissolving drugs together with aspirin had a major effect on reducing the likelihood of recurrences after an episode of myocardial infarction ( figure 5.1 ). The large number of trials and observational studies of the effects of coronary bypass surgery and dilatation of the coronary arteries with balloons have given somewhat mixed results, although overall little doubt exists that, at least in some forms of coronary artery disease, surgery is able to reduce pain from angina and probably prolong life. Similar positive results have been obtained in trials that set out to evaluate the effect of the control of hypertension ( Warrell and others 2003 ).

Effects of a One-Hour Streptokinase Infusion Together with Aspirin for One Month on the 35-Day Mortality in the Second International Study of Infarct Survival Trial among 17,187 Patients with Acute Myocardial Infarction Who Would Not Normally Have Received (more...)

The management of other chronic diseases, notably those of the gastrointestinal tract, lung, and blood has followed along similar lines. Advances in the understanding of their pathophysiology, combined with advances in analysis at the structural and biochemical levels, have enabled many of these diseases to be managed much more effectively. The pharmaceutical industry has helped enormously by developing agents such as the H2-receptor antagonists and a wide range of drugs directed at bronchospasm. There have been some surprises—the discovery that peptic ulceration is almost certainly caused by a bacterial agent has transformed the management of this disease, dramatically reducing the frequency of surgical intervention. Neurology has benefited greatly from modern diagnostic tools, while psychiatry, though little has been learned about the cause of the major psychoses, has also benefited enormously from the development of drugs for the control of both schizophrenia and the depressive disorders and from the emergence of cognitive-behavior therapy and dynamic psychotherapy.

The second half of the 20th century has witnessed major progress in the diagnosis and management of cancer (reviewed by Souhami and others 2001 ). Again, this progress has followed from more sophisticated diagnostic technology combined with improvements in radiotherapy and the development of powerful anticancer drugs. This approach has led to remarkable improvements in the outlook for particular cancers, including childhood leukemia, some forms of lymphoma, testicular tumors, and—more recently—tumors of the breast. Progress in managing other cancers has been slower and reflects the results of more accurate staging and assessment of the extent and spread of the tumor; the management of many common cancers still remains unsatisfactory, however. Similarly, although much progress has been made toward the prevention of common cancers—cervix and breast, for example—by population screening programs, the cost-effectiveness of screening for other common cancers—prostate, for example—remains controversial.

Many aspects of maternal and child health have improved significantly. A better understanding of the physiology and disorders of pregnancy together with improved prenatal care and obstetric skills has led to a steady reduction in maternal mortality. In an industrial country, few children now die of childhood infection; the major pediatric problems are genetic and congenital disorders, which account for about 40 percent of admissions in pediatric wards, and behavioral problems ( Scriver and others 1973 ). Until the advent of the molecular era, little progress was made toward an understanding of the cause of these conditions. It is now known that a considerable proportion of cases of mental retardation result from definable chromosomal abnormalities or monogenic diseases, although at least 30 percent of cases remain unexplained. Major improvements have occurred in the surgical management of congenital malformation, but only limited progress has been made toward the treatment of genetic disease. Although a few factors, such as parental age and folate deficiency, have been incriminated, little is known about the reasons for the occurrence of congenital abnormalities.

In summary, the development of scientific medical practice in the 20th century led to a much greater understanding of deranged physiology and has enabled many of the common killers in Western society to be controlled, though few to be cured. However, although epidemiological studies of these conditions have defined a number of risk factors and although a great deal is understood about the pathophysiology of established disease, a major gap remains in our knowledge about how environmental factors actually cause these diseases at the cellular and molecular levels ( Weatherall 1995 ).

Consequences of the Demographic and Epidemiological Transitions of the 20th Century

The period of development of modern scientific medicine has been accompanied by major demographic change ( Chen 1996 ; Feachem and others 1992 ). The results of increasing urbanization, war and political unrest, famine, massive population movements, and similar issues must have had a major effect on the health of communities during the 20th century, but there has been a steady fall in childhood mortality throughout the New World, Europe, the Middle East, the Indian subcontinent, and many parts of Asia during this period, although unfortunately there has been much less progress in many parts of Sub-Saharan Africa. Although much of the improvement can be ascribed to improving public health and social conditions, the advent of scientific medicine—particularly the control of many infectious diseases of childhood—seems likely to be playing an increasingly important part in this epidemiological transition. Although surveys of the health of adults in the developing world carried out in the 1980s suggested that many people between the ages of 20 and 50 were still suffering mainly from diseases of poverty, many countries have now gone through an epidemiological transition such that the global pattern of disease will change dramatically by 2020, with cardiorespiratory disease, depression, and the results of accidents replacing communicable disease as their major health problems.

Countries undergoing the epidemiological transition are increasingly caught between the two worlds of malnutrition and infectious disease on the one hand and the diseases of industrial countries, particularly cardiac disease, obesity, and diabetes, on the other. The increasing epidemic of tobacco-related diseases in developing countries exacerbates this problem. The global epidemic of obesity and type 2 diabetes is a prime example of this problem ( Alberti 2001 ). An estimated 150 million people are affected with diabetes worldwide, and that number is expected to double by 2025. Furthermore, diabetes is associated with greatly increased risk of cardiovascular disease and hypertension ; in some developing countries the rate of stroke is already four to five times that in industrial countries. These frightening figures raise the questions whether, when developing countries have gone through the epidemiological transition, they may face the same pattern of diseases that are affecting industrial countries and whether such diseases may occur much more frequently and be more difficult to control.

Partly because of advances in scientific medicine, industrial countries have to face another large drain on health resources in the new millennium (Olshansky , Carnes, and Cassel 1990). In the United Kingdom, for example, between 1981 and 1989, the number of people ages 75 to 84 rose by 16 percent, and that of people age 85 and over by 39 percent; the current population of males age 85 or over is expected to reach nearly 0.5 million by 2026, at which time close to 1 million females will be in this age group. Those figures reflect the situation for many industrial countries, and a similar trend will occur in every country that passes through the epidemiological transition. Although data about the quality of life of the aged are limited, studies such as the 1986 General Household Survey in the United States indicate that restricted activity per year among people over the age of 65 was 43 days in men and 53 days in women; those data say little about the loneliness and isolation of old age. It is estimated that 20 percent of all people over age 80 will suffer from some degree of dementia, a loss of intellectual function sufficient to render it impossible for them to care for themselves. Scientific medicine in the 20th century has provided highly effective technology for partially correcting the diseases of aging while, at the same time, making little progress toward understanding the biological basis of the aging process. Furthermore, the problems of aging and its effect on health care have received little attention from the international public health community; these problems are not restricted to industrial countries but are becoming increasingly important in middle-income and, to a lesser extent, some low-income countries.

Although dire poverty is self-evident as one of the major causes of ill health in developing countries, this phenomenon is emphatically not confined to those populations. For example, in the United Kingdom, where health care is available to all through a government health service, a major discrepancy in morbidity and mortality exists between different social classes ( Black 1980 ). Clearly this phenomenon is not related to the accessibility of care, and more detailed analyses indicate that it cannot be ascribed wholly to different exposure to risk factors. Undoubtedly social strain, isolation, mild depression, and lack of social support play a role. However, the reasons for these important discrepancies, which occur in every industrial country, remain unclear.

Economic Consequences of High-Technology Medicine

The current high-technology medical practice based on modern scientific medicine must steadily increase health expenditures. Regardless of the mechanisms for the provision of health care, its spiraling costs caused by ever more sophisticated technology and the ability to control most chronic illnesses, combined with greater public awareness and demand for medical care, are resulting in a situation in which most industrial countries are finding it impossible to control the costs of providing health care services.

The U.K. National Health Service (NHS) offers an interesting example of the steady switch to high-technology hospital practice since its inception 50 years ago ( Webster 1998 ). Over that period, the NHS's overall expenditure on health has increased fivefold, even though health expenditure in the United Kingdom absorbs a smaller proportion of gross domestic product than in many neighboring European countries. At the start of the NHS, 48,000 doctors were practicing in the United Kingdom; by 1995 there were 106,845, of whom 61,050 were in hospital practice and 34,594 in general (primary care) practice. Although the number of hospital beds halved over the first 50 years of the NHS, the throughput of the hospital service increased from 3 million to 10 million inpatients per year, over a time when the general population growth was only 19 percent. Similarly, outpatient activity doubled, and total outpatient visits grew from 26 million to 40 million. Because many industrial countries do not have the kind of primary care referral program that is traditional in the United Kingdom, this large skew toward hospital medicine seems likely to be even greater.

The same trends are clearly shown in countries such as Malaysia, which have been rapidly passing through the epidemiological transition and in which health care is provided on a mixed public-private basis. In Malaysia, hospitalization rates have steadily increased since the 1970s, reflecting that use is slowly outstripping population growth. The number of private hospitals and institutions rose phenomenally—more than 300 percent—in the same period. In 1996, the second National Health and Morbidity Survey in Malaysia showed that the median charge per day in private hospitals was 100 times higher than that in Ministry of Health hospitals. Those figures reflect, at least in part, the acquisition of expensive medical technology that in some cases has led to inefficient use of societal resources. As in many countries, the Malaysian government has now established a Health Technology Assessment Unit to provide a mechanism for evaluating the cost-effectiveness of new technology.

Those brief examples of the effect of high-technology practice against completely different backgrounds of the provision of health care reflect the emerging pattern of medical practice in the 20th century. In particular, they emphasize how the rapid developments in high-technology medical practice and the huge costs that have accrued may have dwarfed expenditure on preventive medicine, certainly in some industrial countries and others that have gone through the epidemiological transition.

A central question for medical research and health care planning is whether the reduction in exposure to risk factors that is the current top priority for the control of common diseases in both industrial and developing countries will have a major effect on this continuing rise of high-technology hospital medical practice. The potential of this approach has been discussed in detail recently ( WHO 2002c ). Although the claims for the benefits of reducing either single or multiple risk factors are impressive, no way exists of knowing to what extent they are attainable. Furthermore, if, as seems likely, they will reduce morbidity and mortality in middle life, what of later? The WHO report admits that it has ignored the problem of competing risks—that is, somebody saved from a stroke in 2001 is then "available" to die from other diseases in ensuing years. Solid information about the role of risk factors exists only for a limited number of noncommunicable diseases; little is known about musculoskeletal disease, the major psychoses, dementia, and many other major causes of morbidity and mortality.

The problems of health care systems and improving performance in health care delivery have been reviewed in World Health Report 2000—Health Systems: Improving Performance ( WHO 2000 ). Relating different systems of health care to outcomes is extremely complex, but this report emphasizes the critical nature of research directed at health care delivery. As a response to the spiraling costs of health care, many governments are introducing repeated reforms of their health care programs without pilot studies or any other scientific indication for their likely success. This vital area of medical research has tended to be neglected in many countries over the later years of the 20th century.

Summary of Scientific Medicine in the 20th Century

The two major achievements of scientific medicine in the 20th century—the development of clinical epidemiology and the partial control of infectious disease—have made only a limited contribution to the health of developing countries. Although in part this limited effect is simply a reflection of poverty and dysfunctional health care systems, it is not the whole story. As exemplified by the fact that of 1,233 new drugs that were marketed between 1975 and 1999, only 13 were approved specifically for tropical diseases, the problem goes much deeper, reflecting neglect by industrial countries of the specific medical problems of developing countries.

For those countries that have gone through the epidemiological transition and for industrial countries, the central problem is quite different. Although the application of public health measures for the control of risk factors appears to have made a major effect on the frequency of some major killers, those gains have been balanced by an increase in the frequency of other common chronic diseases and the problems of an increasingly elderly population. At the same time, remarkable developments in scientific medicine have allowed industrial countries to develop an increasingly effective high-technology, patch-up form of medical practice. None of these countries has worked out a way to control the spiraling costs of health care, and because of their increasing aged populations, little sign exists that things will improve. Although some of the diseases that produce this enormous burden may be at least partially preventable by the more effective control of risk factors, to what extent such control will be achievable is unclear, and for many diseases these factors have not been identified. In short, scientific medicine in the 20th century, for all its successes, has left a major gap in the understanding of the pathogenesis of disease between the action of environmental risk factors and the basic disease processes that follow from exposure to them and that produce the now well-defined deranged physiology that characterizes them.

These problems are reflected, at least in some countries, by increasing public disillusion with conventional medical practice that is rooted in the belief that if modern medicine could control infectious diseases, then it would be equally effective in managing the more chronic diseases that took their place. When this improvement did not happen—and when a mood of increasing frustration about what medicine could achieve had developed—a natural move occurred toward trying to find an alternative answer to these problems. Hence, many countries have seen a major migration toward complementary medicine.

It is against this rather uncertain background that the role of science and technology for medical care in the future has to be examined.

• Science, Technology, and Medicine in the Future

Before considering the remarkable potential of recent developments in basic biological research for improvements in health care, we must define priorities for their application.

Priorities for Biomedical Research in the Future

In the setting of priorities for biomedical research in the future, the central objective is to restore the balance of research between industrial and developing countries so that a far greater proportion is directed at the needs of the latter. In the 1990s, it was estimated that even though 85 percent of the global burden of disability and premature mortality occurs in the developing world, less than 4 percent of global research funding was devoted to communicable, maternal, perinatal, and nutritional disorders that constitute the major burden of disease in developing countries ( WHO 2002b ).

The second priority is to analyze in much more detail methods of delivery of those aspects of health care that have already been shown to be both clinically effective and cost-effective. It is vital that the delivery of health care be based on well-designed, evidence-based pilot studies rather than on current fashion or political guesswork. It is essential to understand why there are such wide discrepancies in morbidity and mortality between different socioeconomic groups in many industrial countries and to define the most effective approaches to educating the public about the whole concept of risk and what is meant by risk factors. In addition, a great deal more work is required on mechanisms for assessing overall performance of health care systems.

The third priority must be to focus research on the important diseases that the biomedical sciences have yet to control, including common communicable diseases such as malaria, AIDS, and tuberculosis; cardiovascular disease; many forms of cancer; all varieties of diabetes; musculoskeletal disease; the major psychoses; and the dementias. Of equal importance is gaining a better understanding of both the biology and pathophysiology of aging, together with trying to define its social and cultural aspects.

In the fields of child and maternal health, the requirements for research differ widely in industrial and developing countries. Industrial countries need more research into the mechanisms of congenital malformation and the better control and treatment of monogenic disease and behavioral disorders of childhood. In developing countries, both child and maternal health pose different problems, mainly relating to health education and the control of communicable disease and nutrition. In many developing countries, some of the common monogenic diseases, notably the hemoglobin disorders, also require urgent attention.

In short, our priorities for health care research come under two main heads: first, apply knowledge that we already have more effectively; second, apply a multidisciplinary attack on diseases about which we have little or no understanding. These issues are developed further in chapter 4 .

New Technologies

The sections that follow briefly outline some examples of the new technologies that should help achieve these aims.

Genomics, Proteomics, and Cell Biology

Without question the fields of molecular and cell biology were the major developments in the biological sciences in the second half of the 20th century. The announcement of the partial completion of the human genome project in 2001 was accompanied by claims that knowledge gained from this field would revolutionize medical practice over the next 20 years. After further reflection, some doubts have been raised about this claim, not in the least the time involved; nevertheless, considerable reason for optimism still exists. Although the majority of common diseases clearly do not result from the dysfunction of a single gene, most diseases can ultimately be defined at the biochemical level; because genes regulate an organism's biochemical pathways, their study must ultimately tell us a great deal about pathological mechanisms.

The genome project is not restricted to the human genome but encompasses many infectious agents, animals that are extremely valuable models of human disease, disease vectors, and a wide variety of plants. However, obtaining a complete nucleotide sequence is one thing; working out the regulation and function of all the genes that it contains and how they interact with each other at the level of cells and complete organisms presents a much greater challenge. The human genome, for example, will require the identification and determination of the function of the protein products of 25,000 genes ( proteomics ) and the mechanisms whereby genes are maintained in active or inactive states during development ( methylomics ). It will also involve the exploration of the roles of the family of regulatory ribonucleic acid (RNA) molecules that have been discovered recently ( Mattick 2003 ). All this information will have to be integrated by developments in information technology and systems biology. These tasks may take the rest of this century to carry out. In the process, however, valuable fallout from this field is likely to occur for a wide variety of medical applications. Many of these are outlined in a recent WHO report, Genomics and World Health 2002 ( WHO 2002a ).

The first applications of DNA technology in clinical practice were for isolating the genes for monogenic diseases. Either by using the candidate gene approach or by using DNA markers for linkage studies, researchers have defined the genes for many monogenic diseases. This information is being used in clinical practice for carrier detection, for prenatal diagnosis, and for defining of the mechanisms of phenotypic variability. It has been particularly successful in the case of the commonest monogenic diseases, the inherited disorders of hemoglobin, which affect hundreds of thousands of children in developing countries ( Weatherall and Clegg 2001a , 2001b ). Through North-South collaborations, it has been possible to set up screening and prenatal diagnosis programs for these conditions in many countries, resulting in a marked decline in their frequency, particularly in Mediterranean populations ( figure 5.2 ). Gene therapy, that is, the specific correction of monogenic diseases, has been fraught with difficulties, but these are slowly being overcome and this approach seems likely to be successful for at least some genetic diseases in the future.

Decline in Serious Forms of Thalassemia in Different Populations after the Initiation of Prenatal Diagnosis in 1972 following the Development of North-South Partnerships.

From the global perspective, one of the most exciting prospects for the medical applications of DNA technology is in the field of communicable disease. Remarkable progress has been made in sequencing the genomes of bacteria, viruses, and other infective agents, and it will not be long before the genome sequence of most of the major infectious agents is available. Information obtained in this way should provide opportunities for the development of new forms of chemotherapy ( Joët and others 2003 ) and will be a major aid to vaccine development ( Letvin, Bloom, and Hoffman 2001 ). In the latter case, DNA technology will be combined with studies of the basic immune mechanisms involved in individual infections in an attempt to find the most effective and economic approach. Recombinant DNA technology was used years ago to produce pure antigens of hepatitis B in other organisms for the development of safe vaccines. More recently, and with knowledge obtained from the various genome projects, interest has centered on the utility of DNA itself as a vaccine antigen. This interest is based on the chance observation that the direct injection of DNA into mammalian cells could induce them to manufacture—that is, to express—the protein encoded by a particular gene that had been injected. Early experiences have been disappointing, but a variety of techniques are being developed to improve the antigens of potential DNA-based vaccines.

The clinical applications of genomics for the control of communicable disease are not restricted to infective agents. Recently, the mosquito genome was sequenced, leading to the notion that it may be possible to genetically engineer disease vectors to make them unable to transmit particular organisms ( Land 2003 ). A great deal is also being learned about genetic resistance to particular infections in human beings ( Weatherall and Clegg 2002 ), information that will become increasingly important when potential vaccines go to trial in populations with a high frequency of genetically resistant individuals.

The other extremely important application of DNA technology for the control of communicable disease—one of particular importance to developing countries—is its increasing place in diagnostics. Rapid diagnostic methods are being developed that are based on the polymerase chain reaction (PCR) technique to identify pathogen sequences in blood or tissues. These approaches are being further refined for identifying organisms that exhibit drug resistance and also for subtyping many classes of bacteria and viruses. Although much remains to be learned about the cost-effectiveness of these approaches compared with more conventional diagnostic procedures, some promising results have already been obtained, particularly for identification of organisms that are difficult to grow or in cases that require a very early diagnosis ( Harris and Tanner 2000 ). This type of technology is being widely applied for the identification of new organisms and is gaining a place in monitoring vaccine trials ( Felger and others 2003 ). The remarkable speed with which a new corona virus and its different subtypes were identified as the causative agent of SARS and the way this information could be applied to tracing the putative origins of the infection are an example of the power of this technology ( Ruan and others 2003 ).

Genomics is likely to play an increasingly important role in the control and management of cancer ( Livingston and Shivdasani 2001 ). It is now well established that malignant transformation of cell populations usually results from acquired mutations in two main classes of genes:

• First are oncogenes —genes that are involved in the major regulatory processes whereby cells interact with one another, respond to environmental signals, regulate how and when they will divide, and control the other intricate processes of cell biology ( box 5.1 ).
• Second are tumor suppressor genes; loss of function by mutation may lead to a neoplastic phenotype.

Chronic Myeloid Leukemia: The Path from Basic Science to the Clinic. 1960 An abnormal chromosome, named the Philadelphia chromosome, was found in the white cells of most patients with chronic myeloid leukemia (CML). 1973 By the use of specific dyes to (more...)

In the rare familial cancers, individuals are born with one defective gene of this type, but in the vast majority of cases, cancer seems to result from the acquisition during a person's lifetime of one or more mutations of oncogenes. For example, in the case of the common colon cancers, perhaps up to six different mutations are required to produce a metastasizing tumor. The likelihood of the occurrence of these mutations is increased by the action of environmental or endogenous carcinogens.

Array technology, which examines the pattern of expression of many different genes at the same time, is already providing valuable prognostic data for cancers of the breast, blood, and lymphatic system. This technology will become an integral part of diagnostic pathology in the future, and genomic approaches to the early diagnosis of cancer and to the identification of high-risk individuals will become part of clinical practice. It is also becoming possible to interfere with the function or products of oncogenes as a more direct approach to the treatment of cancer ( box 5.1 ), although early experience indicates that drug resistance may be caused by mutation, as it is in more conventional forms of cancer therapy.

The genomic approach to the study of common diseases of middle life—coronary artery disease, hypertension , diabetes, and the major psychoses, for example—has been widely publicized ( Collins and McKusick 2001 ). Except in rare cases, none of them is caused by a defective single gene; rather, they appear to be the result of multiple environmental factors combined with variation in individual susceptibility attributable to the action of several different genes. The hope is that if these susceptibility genes can be identified, an analysis of their products will lead to a better understanding of the pathology of these diseases and will offer the possibility of producing more definitive therapeutic agents. Better still, this research could provide the opportunity to focus public health measures for prevention on genetically defined subsets of populations.

Pharmacogenomics is another potential development from the genomics revolution ( Bumol and Watanabe 2001 ) ( table 5.1 ). Considerable individual variability exists in the metabolism of drugs; hence, clinical medicine could reach a stage at which every person's genetic profile for the metabolism of common drugs will be worked out and become part of their physicians' toolkit. This information will also be of considerable value to the pharmaceutical industry for designing more effective and safer therapeutic agents.

Pharmacogenomics.

A word of caution is necessary: Although well-defined genetic variation is responsible for unwanted side effects of drugs, this information is still rarely used in clinical practice; a possible exception is screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency for primaquine sensitivity, though the costs preclude its application in many developing countries. Furthermore, plasma levels after the administration of most common drugs follow a normal distribution, indicating that if genetic variation exists, a number of different genes must be involved. Hence, although the idea of all people having their genetic profile for handling drugs as part of their standard medical care will take a long time to achieve, if it ever happens, no doubt exists that this field will gradually impinge on medical research and clinical practice.

Many other potential applications of genomic research for medical practice wait to be developed. The role of DNA array technology for the analysis of gene expression in tumors has already been mentioned. Advances in bioengineering, with the development of biomicroelectromechanical systems, microlevel pumping, and reaction circuit systems, will revolutionize chip technology and enable routine analysis of thousands of molecules simultaneously from a single sample ( Griffith and Grodzinsky 2001 ), with application in many other fields of research. Although somatic cell gene therapy—that is, the correction of genetic diseases by direct attack on the defective gene—has gone through long periods of slow progress and many setbacks, the signs are that it will be successful for at least a limited number of monogenic diseases in the long term (Kaji and Leiden 2001). It is also likely to play a role for shorter-term objectives—in the management of coronary artery disease and some forms of cancer, for example. DNA technology has already revolutionized forensic medicine and will play an increasingly important role in this field. Although it is too early to assess to what extent the application of DNA technology to the studies of the biology of aging will produce information of clinical value, considering the massive problem of our aging populations and the contribution of the aging process to their illnesses, expanding work in this field is vital. Current work in the field of evolution using DNA technology seems a long way from clinical practice; however, it has considerable possibilities for helping us understand the lack of adaptation of present day communities to the new environments that they have created.

Stem Cell and Organ Therapy

Stem cell therapy, or, to use its more popular if entirely inappropriate title, therapeutic cloning, is an area of research in cellular biology that is raising great expectations and bitter controversies. Transplant surgery has its limitations, and the possibility of a ready supply of cells to replace diseased tissues, even parts of the brain, is particularly exciting. Stem cells can be obtained from early embryos, from some adult and fetal tissues, and (at least theoretically) from other adult cells.

Embryonic stem cells, which retain the greatest plasticity, are present at an early stage of the developing embryo, from about the fourth to seventh day after fertilization. Although some progress has been made in persuading them to produce specific cell types, much of the potential for this field so far has come from similar studies of mouse embryonic stem cells. For example, mouse stem cells have been transplanted into mice with a similar condition to human Parkinson's disease with some therapeutic success, and they have also been used to try to restore neural function after spinal cord injuries.

Many adult tissues retain stem cell populations. Bone marrow transplantation has been applied to the treatment of a wide range of blood diseases, and human marrow clearly contains stem cells capable of differentiating into the full complement of cell types found in the blood. Preliminary evidence indicates that they can also differentiate into other cell types if given the appropriate environment; they may, for example, be a source of heart muscle or blood vessel cell populations. Although stem cells have also been found in brain, muscle, skin, and other organs in the mouse, research into characterizing similar cell populations from humans is still at a very early stage.

One of the major obstacles to stem cell therapy with cells derived from embryos or adult sources is that, unless they come from a compatible donor, they may be treated as "foreign" and rejected by a patient's immune system. Thus, much research is directed at trying to transfer cell nuclei from adult sources into an egg from which the nucleus has been removed, after which the newly created "embryo" would be used as a source of embryonic stem cells for regenerative therapy for the particular donor of the adult cells. Because this technique, called somatic cell nuclear transfer, follows similar lines to those that would be required for human reproductive cloning, this field has raised a number of controversies. Major ethical issues have also been raised because, to learn more about the regulation of differentiation of cells of this type, a great deal of work needs to be carried out on human embryonic stem cells.

If some of the formidable technical problems of this field can be overcome and, even more important, if society is able to come to terms with the ethical issues involved, this field holds considerable promise for correction of a number of different intractable human diseases, particularly those involving the nervous system ( Institute of Medicine 2002 ).

Information Technology

The explosion in information technology has important implications for all forms of biomedical research, clinical practice, and teaching. The admirable desire on the part of publicly funded groups in the genomics field to make their data available to the scientific community at large is of enormous value for the medical application of genomic research. This goal has been achieved by the trio of public databases established in Europe, the United States, and Japan (European Bioinformatics Institute, GenBank, and DNA Data Bank of Japan, respectively). The entire data set is securely held in triplicate on three continents. The continued development and expansion of accessible databases will be of inestimable value to scientists, in both industrial and developing countries.

Electronic publishing of high-quality journals and related projects and the further development of telepathology will help link scientists in industrial and developing countries. The increasing availability of telemedicine education packages will help disseminate good practices. Realizing even these few examples of the huge potential of this field will require a major drive to train and recruit young information technology scientists, particularly in developing countries, and the financial support to obtain the basic equipment required.

Minimally Invasive Diagnostics and Surgery: Changes in Hospital Practice

Given the spiraling costs of hospital care in industrial countries and the likelihood of similar problems for developing countries in the future, reviewing aspects of diagnostics and treatment that may help reduce these costs in the future is important. Changes in clinical practice in the latter half of the 20th century have already made some headway on this problem. In the U.K. NHS, the number of hospital beds occupied daily halved between 1950 and 1990 even though the throughput of the service, after allowance for change of definition, increased from 3 million to 10 million inpatients per year. Remarkably, by 1996, of 11.3 million finished consultant episodes, 22 percent were single-day cases. How can this efficient trend be continued? A major development with this potential is the application of minimally invasive and robotic surgery ( Mack 2001 ). Advances in imaging, endoscopic technology, and instrumentation have made it possible to convert many surgical procedures from an open to an endoscopic route. These procedures are now used routinely for gall bladder surgery, treatment of adhesions, removal of fibroids, nephrectomy, and many minor pediatric urological procedures. The recent announcement of successful hip replacement surgery using an endoscopic approach offers an outstanding example of its future potential. Although progress has been slower, a number of promising approaches exist for the use of these techniques in cardiac surgery and for their augmentation by the introduction of robotics into surgical practice. Transplant surgery will also become more efficient by advances in the development of selective immune tolerance ( Niklason and Langer 2001 ).

These trends, and those in many other branches of medicine, will be greatly augmented by advances in biomedical imaging ( Tempany and McNeil 2001 ). Major progress has already been made in the development of noninvasive diagnostic methods by the use of MRI, computer tomography, positron imaging tomography, and improved ultrasonography. Image-guided therapy and related noninvasive treatment methods are also showing considerable promise.

Human Development and Child and Maternal Health

Among the future developments in molecular and cell biology, a better understanding of the mechanisms of human development and the evolution of functions of the nervous system offer some of the most exciting, if distant, prospects ( Goldenberg and Jobe 2001 ). In the long term, this field may well have important implications for reproductive health and birth outcomes. The role of a better understanding of the monogenic causes of congenital malformation and mental retardation was mentioned earlier in this chapter. Already thoughts are turning to the possibility of the isolation and clinical use of factors that promote plasticity of brain development, and specific modulators of lung and gut development are predicted to start to play an increasing role in obstetric practice. A better understanding of the mechanisms leading to vasoconstriction and vascular damage as a cause of preeclampsia has the potential for reducing its frequency and thus for allowing better management of this common condition. Similarly, an increasing appreciation of the different genetic and metabolic pathways that are involved in spontaneous preterm births should lead to effective prevention and treatment, targeting specific components of these pathways and leading to reduction in the frequency of premature births. An increasing knowledge of the mode of action of different growth factors and promoters of gut function will enhance growth and development of preterm infants.

Neuropsychiatry

Particularly because depression and related psychiatric conditions are predicted to be a major cause of ill health by 2020 and because of the increasing problem of dementia in the elderly, neuropsychiatry will be of increasing importance in the future ( Cowan and Kandel 2001 ). Developments in the basic biomedical sciences will play a major role in the better diagnosis and management of these disorders. Furthermore, the application of new technologies promises to lead to increasing cooperation between neurology and psychiatry, especially for the treatment of illnesses such as mental retardation and cognitive disorders associated with Alzheimer's and Parkinson's diseases that overlap the two disciplines.

The increasing application of functional imaging, together with a better understanding of biochemical function in the brain, is likely to lead to major advances in our understanding of many neuropsychiatric disorders and, hence, provide opportunities for their better management. Early experience with fetally derived dopaminergic neurons to treat parkinsonism has already proved to be successful in some patients and has raised the possibility that genetically manipulated stem cell treatment for this and other chronic neurological disorders may become a reality. Promising methods are being developed for limiting brain damage after stroke, and there is increasing optimism in the field of neuronal repair based on the identification of brain-derived neuronotrophic growth factors. Similarly, a combination of molecular genetic and immunological approaches is aiding progress toward an understanding of common demyelinating diseases—notably multiple sclerosis.

Strong evidence exists for a major genetic component to the common psychotic illnesses—notably bipolar depression and schizophrenia. Total genome searches should identify some of the genes involved. Although progress has been slow, there are reasonable expectations for success. If some of these genes can be identified, they should provide targets for completely new approaches to the management of these diseases by the pharmaceutical industry. Recent successes in discovering the genes involved in such critical functions as speech indicate the extraordinary potential of this field. Similarly, lessons learned from the identification of the several genes involved in familial forms of early-onset Alzheimer's disease have provided invaluable information about some of the pathophysiological mechanisms involved, work that is having a major effect on studies directed at the pathophysiology and management of the much commoner forms of the disease that occur with increasing frequency in aged populations.

Nutrition and Genetically Modified Crops

By 2030, the world's population is likely to increase by approximately 2.5 billion people, with much of this projected growth occurring in developing countries. As a consequence, food requirements are expected to double by 2025. However, the annual rate of increase in cereal production has declined; the present yield is well below the rate of population increase. About 40 percent of potential productivity in parts of Africa and Asia and about 20 percent in the industrial world are estimated to be lost to pathogens.

Given these considerations, the genetic modification (GM) of plants has considerable potential for improving the world's food supplies and, hence, the health of its communities. The main aims of GM plant technologies are to enhance the nutritional value of crop species and to confer resistance to pathogens. GM technology has already recorded several successes in both these objectives.

Controversy surrounds the relative effectiveness of GM crops as compared with those produced by conventional means, particularly with respect to economic issues of farming in the developing world. Concerns are also expressed about the safety of GM crops, and a great deal more research is required in this field. The results of biosafety trials in Europe raise some issues about the effects of GM on biodiversity ( Giles 2003 ).

Plant genetics also has more direct potential for the control of disease in humans. By genetically modifying plants, researchers hope it will be possible to produce molecules toxic to disease-carrying insects and to produce edible vaccines that are cheaper than conventional vaccines and that can be grown or freeze dried and shipped anywhere in the world. A promising example is the production of hepatitis B surface antigen in transgenic plants for oral immunization. Work is also well advanced for the production of other vaccines by this approach ( WHO 2002a ).

Social and Behavioral Sciences, Health Systems, and Health Economics

As well as the mainstream biomedical sciences, research into providing health care for the future will require a major input from the social and behavioral sciences and health economics. These issues are discussed in more detail in chapter 4 .

The World Health Report 2002 ( WHO 2002c ) emphasizes the major gaps in public perception of what is meant by health and, in particular, risk factors, in both industrial and developing countries. Epidemiological studies have indicated that morbidity and mortality may be delayed among populations that are socially integrated. Increasing evidence of this kind underlines the importance of psychosocial factors in the development of a more positive approach to human health, clearly a valuable new direction for research on the part of the social sciences.

Neither developing nor industrial countries have come to grips with the problems of the organization and delivery of health care. Learning more about how to build effective health delivery strategies for developing countries is vital. Similarly, the continuous reorganization of the U.K. NHS, based on short-term political motivation and rarely on carefully designed pilot studies, is a good example of the requirement for research into the optimal approaches to the provision of health care in industrial countries. Indeed, across the entire field of health provision and the education of health care professionals, an urgent requirement exists for research into both methodology and, in particular, development of more robust endpoints for its assessment.

Similar problems exist with respect to research in health economics. Many of the parameters for assessing the burden of disease and the cost-effectiveness of different parameters for the provision of health care are still extremely crude and controversial, and they require a great deal more research and development. These problems are particularly relevant to the health problems of the developing countries.

One of the main barriers to progress in these fields is the relative isolation of the social sciences and health care economics from the mainstreams of medical research and practice. Better integration of these fields will be a major challenge for universities and national and international health care agencies.

Integration of the Medical Sciences: Organizational Priorities for the Future

From these brief examples of the likely direction of biomedical research in the future, some tentative conclusions can be drawn about its effects on the pattern of global health care.

The control of communicable disease will remain the top priority. Although this goal can be achieved in part by improving nutrition and sanitation and applying related public health measures in developing countries, the search for vaccines or better chemotherapeutic agents must also remain a high priority. However, although optimism that new vaccines will become available is well founded, many uncertainties still exist, particularly in the case of biologically complex diseases like malaria. It is vital that a balance be struck between the basic biomedical science approach and the continued application of methods to control these diseases by more conventional and well-tried methods.

For the bulk of common noncommunicable diseases, the situation is even less clear. Although much more humane, cost-effective, and clinically effective approaches to their management seem certain to be developed, mainly by high-technology and expensive procedures, the position regarding prevention and a definitive cure is much less certain. Hence, the program for reducing risk factors, as outlined in the World Health Report 2002 ( WHO 2002c ), clearly should be followed. However, a strong case exists for a partnership of the public health, epidemiological, and genomic sciences to develop pilot studies to define whether focusing these programs on high-risk subsets of populations will be both cost-effective and more efficient. For those many chronic diseases for which no risk factors have been defined, strategies of the same type should be established to define potential environmental factors that may be involved. Although surprises may arise along the way, such as the discovery of the infective basis for peptic ulceration, the multilayered environmental and genetic complexity of these diseases, combined with the ill-understood effects of aging, suggests that no quick or easy answers to these problems will present themselves; future planning for global health services must take this factor into consideration.

Given these uncertainties, an important place exists for the involvement and integration of the social sciences and health economics into future planning for biomedical research. Major gaps in knowledge about public perceptions and understanding of risk factors, a lack of information about the social and medical problems of aging populations, and widespread uncertainty about the most cost-effective and efficient ways of administering health care—both in developing countries and in those that have gone through the epidemiological transition and already have advanced health care systems—still exist.

In short, the emerging picture shows reasonable grounds for optimism that better and more definitive ways of preventing or curing communicable diseases will gradually become available; only the time frame is uncertain. Although there will be major improvements in management based on extensive and increasingly high-technology practice, the outlook for the prevention and definitive cure of the bulk of noncommunicable diseases is much less certain. Hence, it is vital that research in the basic biomedical sciences be directed at both the cause and the prevention of noncommunicable diseases, and that work in the fields of public health and epidemiology continues to be directed toward better use of what is known already about their prevention and management in a more cost-effective and efficient manner.

New Technologies and Developing Countries

The role of genomics and related high-technology research and practice in developing countries is discussed in detail in Genomics and World Health 2002 ( WHO 2002a ). The central question addressed by the report was, given the current economic, social, and health care problems of developing countries, is it too early to be applying the rather limited clinical applications of genomic and related technology to their health care programs? The report concluded that it is not too early, and subsequent discussion has suggested that this decision was right. Where DNA technology has already proven cost-effective, it should be introduced as soon as possible ( Weatherall 2003 ). Important examples include the common inherited disorders of hemoglobin (see chapter 34 ) and, in particular, the use of DNA diagnostics for communicable disease. The advantage of this approach is that it offers a technical base on which further applications can be built as they become available. It also provides the impetus to develop the training required, to initiate discussions on the many ethical issues that work of this type may involve, and to establish the appropriate regulatory bodies. The way this type of program should be organized—through North-South collaboration, local networking, and related structures, monitored by WHO—was clearly defined in the report.

For the full benefits of genomics to be made available to developing countries—and for these advances not to widen the gap in health care provision between North and South—the most pressing and potentially exciting developments from the new technologies of science and medicine will have to be exploited by current scientific research in the industrial countries.

This need is particularly pressing in the case of the major communicable killers: malaria, tuberculosis, and AIDS. Similarly—and equally important—if developing countries are to make the best use of this new technology for their own particular disease problems, partnerships will have to be established between both academia and the pharmaceutical industries of the North and South.

Although this approach should be followed as a matter of urgency, that developing countries build up their own research capacity is equally important. Genomics and World Health 2002 ( WHO 2002a ) includes some encouraging accounts of how this capacity is being achieved in Brazil, China, and India. The establishment of the Asian-Pacific International Molecular Biology Network is a good example.

It is important that work start now to apply the advances stemming from the basic biological sciences for the health of the developing world. This beginning will form a platform for the integration of future advances into health care programs for these countries. However, because of uncertainties of the time involved, more conventional public health approaches to medical care must not be neglected, and a balance should be struck between research in this area and research in the emerging biomedical sciences.

Economic Issues for Future Medical Research

The central economic issues regarding medical research in the future are how it is to be financed and how its benefits are to be used in the most cost-effective way in both industrial and developing countries. Currently, research is carried out in both private and public sectors ( table 5.2 ). Work in the private sector is based mainly in the pharmaceutical industry and, increasingly, in the many large biotechnology companies that evolved rapidly following the genomic revolution. In the public sector, the major sites of research are universities, government research institutes, and centers—either within the universities or freestanding—that are funded through a variety of philanthropic sources. The input of philanthropic sources varies greatly between countries. In the United Kingdom, the Wellcome Trust provides a portion of funding for clinical and basic biomedical research that approaches that of the government, and in the United States, the Howard Hughes organization also plays a major, though proportionally less important, role in supporting medical research. Similarly, the Bill & Melinda Gates Foundation and other large international philanthropic foundations are contributing a significant amount of funding for medical research. In developing countries, such research funding as is available comes from government sources. For example, Thailand and Malaysia spend US$15.7 million and US$6.9 million each year, representing 0.9 percent and 0.6 percent of their health budgets, respectively ( WHO 2002b ).

Estimated Global Health Research and Development Funding for 1998.

As examined in the report of the WHO Commission on Macroeconomics and Health ( WHO 2001 ), considerable discussion is taking place about how to mobilize skills and resources of the industrial countries for the benefit of the health of the developing world. However, how this international effort should be organized or, even more important, funded is still far from clear. A number of models have been proposed, including the creation of a new global institute for health research and a global fund for health research with an independent, streamlined secretariat analogous to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Recently, a number of large donations have been given—either by governments or by philanthropic bodies—to tackle some of the major health problems of the developing world. Although many of these approaches are admirable, those that involve single donations raise the critical problem of sustainability. People with experience in developing interactions between the North and South will have no doubts about the long period of sustained work that is often required for a successful outcome.

Because of the uncertainties about sustainability and the efficiency of large international bodies, it has been suggested that a virtual global network for health research be established in which the leading research agencies of the North and South take part, together with a coordinating council ( Keusch and Medlin 2003 ). In this scheme or in a modified form ( Pang 2003 ), both government funding agencies and philanthropic bodies would retain their autonomy and mechanisms of funding while at the same time their individual programs would be better integrated and directed toward the problems of global health.

A central problem of both private and public patterns of funding for medical research is that industrial countries have tended to focus their research on their own diseases and have, with a few exceptions, tended to ignore the broader problems of developing countries, a trend that has resulted in the well-known 10/90 gap in which more than 90 percent of the world's expenditure on health research is directed at diseases that, numerically, affect a relatively small proportion of the world's population. If the enormous potential of modern biomedical research is not to result in a widening of the gap in health care between North and South, this situation must be corrected. The governments of industrial countries may be able to encourage a more global view of research activity on the part of their pharmaceutical and biotechnology industries by various tax advantages and other mutually beneficial approaches. Progress in this direction seems likely to be slow, however. For this reason, moving quickly toward a virtual global network for research that would bring together the research agencies of the North and South holds many attractions. Although those of the North that rely on government and charitable funding may find it equally difficult to convince their governments that more of their budget should be spent on work in the developing world, they vitally need to move in this direction, possibly by turning at least some proportion of their overseas aid to this highly effective approach to developing North-South partnerships.

In short, to produce the funding required for medical research in the future and to ensure that it takes on a much more global view of its objectives, a complete change in attitude is called for on the part of the industrial countries. This transformation, in turn, will require a similar change of outlook on the part of those who educate doctors and medical scientists. The introduction of considerable sums of research monies into the international scene by governments or philanthropic bodies as single, large donations, while welcome, will not form the basis for the kind of sustainable research program that is required. Rather, the attitudes of both government funding agencies and charitable bodies in industrial countries will have to change, with a greater proportion of their funding being directed at diseases of the developing world in the future. Achieving this end will require a major program of education on the global problems of disease at every level, including governments, industry, universities, charitable organizations, and every other body that is involved in the medical research endeavor.

Issues requiring the assessment of the economic value of medical research are discussed in chapter 4 .

The central theme of the previous sections is that the potential fruits of the exciting developments in the biomedical sciences will be achieved only if a complete change in attitude occurs on the part of industrial countries, with the evolution of a much more global attitude to the problems of medical research and health care. Change will have to start in the universities of the industrial countries, which will need to incorporate a more global perspective in medical education so that the next generation of young people is more motivated to develop research careers that take a more international view of the problems of medical research. A major change of emphasis in education will be required and will be difficult to achieve unless those who control the university education and research programs can be convinced that funding is available for further development in these new directions ( Weatherall 2003 ). Excellent examples of the value of the development of North-South partnerships between universities and other academic institutions do already exist.

An effective approach to increasing global funding for internationally based research is through virtual global networks involving the leading research agencies in the North and South. Hence, a similar effort will be required to educate these agencies and their governments that this approach to improving the level of health globally is cost-effective. In particular, it will be vital to persuade them that this approach may constitute an effective use of their programs of aid for developing countries. Carrying out a number of pilot studies showing the economic value of North-South partnerships in specific areas of medical research may be necessary. Indeed, a number of these partnerships have already been formed in several countries and information of this type almost certainly exists ( WHO 2002a ).

Of course, much broader issues involving education need to be resolved for the better exploitation of medical research. The problems of educating the public so that developing countries can partake in the advancements of the genome revolution were set out in detail in Genomics and World Health 2002 ( WHO 2002a ), but a great deal of work along these lines is also required for industrial countries. People are increasingly suspicious of modern biological science and of modern high-technology medicine, a factor that, together with concerns over the pastoral skills of today's doctors, is probably playing a role in driving many communities in industrial countries toward complementary medicine (see Horton 2003 ). These trends undoubtedly are attributable to inadequacies of medical education and the way that science is taught in schools—reflected by the lack of scientific literacy both in the general public and in governments. If trust is to be restored between the biomedical sciences and the public, significant efforts will have to be made to improve the level of scientific literacy, and a much more open dialogue will need to be developed between scientists and the community. This requirement will be increasingly important as work on basic biomedical sciences impinges on areas such as gene therapy, stem cell research, and the collection of large DNA databases to be used for both research and therapeutic purposes in the future.

The difficulties in achieving a more global view of medical research and health care on the part of industrial countries for the future should not be underestimated. Without a major attempt to solve these difficulties, the potential of modern biomedical sciences seems certain to simply widen the gap in health care between North and South.

Ethical Issues

Few advances in scientific medicine have not raised new ethical issues for society. The genomics era has encountered many problems in this respect, and although many of the initial fears and concerns have been put to rest by sensible debate and the development of effective control bodies, new problems continue to appear ( WHO 2002a ). The ill-named field of therapeutic cloning is still full of unresolved issues regarding human embryo research, the creation of embryos for research purposes, and other uncertainties, but these questions should not be overemphasized at a time when most societies face even more onerous ethical issues. For example, as the size of our aging population increases, many societies may have to face the extremely difficult problem of rationing medical care. The theme recurring throughout both industrial and developing countries is how to provide an adequate level of health care equally to every income group.

Many developing countries still lack the basic structure for the application of ethical practices in research and clinical care, including the development of institutional ethics committees, governmental regulatory bodies, and independent bioethical research bodies. Every country requires a completely independent bioethics council that can debate the issues uninhibited by pressures from government, commerce, or pressure groups of any kind. Our approaches to developing a more adequate ethical framework for much of medical decision making, whether it involves preventive medicine, clinical practice, or research, constitute another neglected area that requires research input from many different disciplines.

The important question of the ethical conduct of research in the developing countries by outside agencies has been reviewed in detail recently ( Nuffield Council on Bioethics 2002 ).

Why Do We Need Research?

It is important to appreciate that considerable public suspicion exists about both the activities and the value of biomedical research. Suspicion has been generated in part by the field's exaggerated claims over recent years, an uneasy feeling that research is venturing into areas that would best be avoided, and a lack of understanding about the complexity of many of the problems that it is attempting to solve. At the same time, many government departments that run national health care programs, the private sector (with the exception of the pharmaceutical industry), and many nongovernmental organizations set aside extremely small fractions of their overall expenditure for research. For many of those organizations, research seems irrelevant as they deal with the stresses of daily provision of programs of health care and with crisis-management scenarios that have to follow rapid change or major failures in providing health care.

One of the major challenges for the biomedical research community will be to better educate the public about its activities and to restore their faith in and support for the medical research endeavor. Educating many governments and nongovernmental organizations about the critical importance of decision making based on scientifically derived evidence will be vital. Medical care will only get more complex and expensive in the future; its problems will not be solved by short-term, politically driven activity. The need for good science, ranging from studies of molecules to communities, has never been greater.

Clearly, the most important priorities for medical research are development of more effective health delivery strategies for developing countries and control of the common and intractable communicable diseases. In this context, the argument has been that much of the medical research that has been carried out in industrial countries, with its focus on noncommunicable disease and its outcomes in high-technology practice, is completely irrelevant to the needs of developing countries. This view of the medical scene, however, is short term. Although some redistribution of effort is required, every country that passes through the epidemiological transition is now encountering the major killers of industrial countries. Learning more about those killers' basic causes, prevention, and management is crucial. Although the initial costs of providing the benefits of this research are often extremely high, they tend to fall as particular forms of treatment become more widely applied. Hence, because we cannot completely rely on our current preventive measures to control these diseases, medical research must continue.

Research in basic human biology and the biomedical sciences is entering the most exciting phase of its development. However, it is difficult to anticipate when the gains of this explosion in scientific knowledge will become available for the prevention and treatment of the major killers of mankind. Thus, medical research must strike a balance between the well-tried approaches of epidemiology, public health, and clinical investigation at the bedside with the application of discoveries in the completely new fields of science that have arisen from the genome revolution.

If this balanced approach toward the future provision of health care is not to continue to worsen the gap between North and South, however, a complete change of attitude is necessary toward health care research and practice on the part of the industrial countries. A major effort will be required to educate all parties—international nongovernmental organizations, governments, universities, and the private sector—in global health problems ( Weatherall 2003 ). Equally important will be a major change of emphasis in the universities of industrial countries toward education programs in science and medicine to provide medical scientists of the future with a more global perspective of health and disease. If this transformation can be achieved—if it can form the basis for the establishment of networks for sustainable research programs between universities and related bodies in the North and South—much progress will be made toward distributing the benefits of biomedical research and good practice among the populations of the world. However, the great potential of advances in the biomedical sciences for global health will not come to full fruition without much closer interaction between the fields of basic and clinical research and the fields of public health, health economics, and the social sciences.

• Alberti G. Noncommunicable Diseases: Tomorrow's Pandemics. Bulletin of the World Health Organization. 2001; 79 (10):907. [ PMC free article : PMC2566675 ] [ PubMed : 11693971 ]
• Barker, D., ed. 2001. Fetal Origins of Cardiovascular and Lung Disease . New York: Marcel Dekker.
• Bartram C. R., deKlein A., Hagemeijer A., van Agthoven T., Geurts van Kessel A., Bootsma D. et al. Translocation of c -Abl Oncogene Correlates with the Presence of a Philadelphia Chromosome in Chronic Myelocytic Leukemia. Nature. 1983; 306 (5940):277–80. [ PubMed : 6580527 ]
• Beeson P. B. Changes in Medical Therapy during the Past Half Century. Medicine (Baltimore). 1980; 59 (2):79–99. [ PubMed : 7360043 ]
• Black, D. 1980. Inequalities in Health: Report of a Working Party, Department of Health and Society Security . London: Her Majesty's Stationery Office.
• Bumol T. F., Watanabe A. M. Genetic Information, Genomic Technologies, and the Future of Drug Discovery. Journal of the American Medical Association. 2001; 285 (5):551–55. [ PubMed : 11176857 ]
• Castelli W. P., Anderson K. Population at Risk: Prevalence of High Cholesterol Levels in Hypertensive Patients in the Framingham Study. American Journal of Medicine. 1986; 80 (Suppl. 2A):23. [ PubMed : 3946458 ]
• Chalmers I. The Cochrane Collaboration: Preparing, Maintaining, and Disseminating Systematic Reviews of the Effects of Health Care. Annals of the New York Academy of Science. 1993; 703 :156–63. ; discussion 163–165. [ PubMed : 8192293 ]
• Chen, L. C. 1996."World Population and Health." In 2020 Vision: Health in the 21st Century . Washington, DC: National Academy Press.
• Collins F. S., McKusick V. A. Implications of the Human Genome Project for Medical Science. Journal of the American Medical Association. 2001; 285 (5):540–44. [ PubMed : 11176855 ]
• Comroe J. H. Jr., Dripps R. D. Scientific Basis for the Support of Biomedical Science. Science. 1976; 192 (4235):105–11. [ PubMed : 769161 ]
• Cooter, R., and J. Pickstone. 2000. Medicine in the Twentieth Century . Amersterdam: Harwood.
• Cowan W. M., Kandel E. R. Prospects for Neurology and Psychiatry. Journal of the American Medical Association. 2001; 285 (5):594–600. [ PubMed : 11176865 ]
• Doll R. Preventive Medicine: The Objectives. Ciba Foundation Symposium. 1985; 110 :3–21. [ PubMed : 3845884 ]
• Druker B. J., Tamura S., Buchdunger E., Ohno S., Segal G. M., Fanning S. et al. Effects of a Selective Inhibitor of the Abl tyrosine kinase on the Growth of Bcr-Abl Positive Cells. Nature Medicine. 1996; 2 (5):561–66. [ PubMed : 8616716 ]
• Egger, M., G. Davey-Smith, and D. G. Altman. 2001. Systematic Reviews in Health Care: Meta-Analysis in Context . London: BMJ Publications.
• Feachem, R. G. A., T. Kjellstrom, C. J. L. Murray, M. Over, and M. A. Phillips. 1992. The Health of Adults in the Developing World . Oxford, U.K.: Oxford University Press.
• Felger I., Genton B., Smith T., Tanner M., Beck H. P. Molecular Monitoring in Malaria Vaccine Trials. Trends in Parasitology. 2003; 19 (2):60–63. [ PubMed : 12586469 ]
• Finch, R. G., and R. J. Williams. 1999. Antibiotic Resistance . London: Baillière Tindall.
• Giles J. Biosafety Trials Darken Outlook for Transgenic Crops in Europe. Nature. 2003; 425 (6960):751. [ PubMed : 14574368 ]
• Goldenberg R. L., Jobe A. H. Prospects for Research in Reproductive Health and Birth Outcomes. Journal of the American Medical Association. 2001; 285 (5):633–39. [ PubMed : 11176872 ]
• Griffith L. G., Grodzinsky A. J. Advances in Biomedical Engineering. Journal of the American Medical Association. 2001; 285 (5):556–61. [ PubMed : 11176858 ]
• Harris E., Tanner M. Health Technology Transfer. British Medical Journal. 2000; 321 (7264):817–20. [ PMC free article : PMC1118623 ] [ PubMed : 11009526 ]
• Horton, R. 2003. Second Opinion: Doctors, Diseases and Decisions in Modern Medicine . London: Grant Books.
• Institute of Medicine. 2002. Stem Cells and the Future of Regenerative Medicine . Washington, DC: National Academy Press.
• ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised Trial of Intravenous Streptokinase, Oral Aspirin, Both, or Neither among 17,187 Cases of Suspected Acute Myocardial Infarction: ISIS-2. Lancet. 1988; 2 (8607):349–60. [ PubMed : 2899772 ]
• Joët T, Eckstein-Ludwig M. U., Morin C., Krishna S. Validation of the Hexose Transporter of Plasmodium falciparum as a Novel Drug Target. Proceedings of the National Academy of Sciences of the U.S.A. 2003; 100 (13):7476–79. [ PMC free article : PMC164611 ] [ PubMed : 12792024 ]
• Kaji E. H., Leiden J. M. Gene and Stem Cell Therapies. Journal of the American Medical Association. 2001; 285 (5):545–50. [ PubMed : 11176856 ]
• Keusch G. T., Medlin C. A. Tapping the Power of Small Institutions. Nature. 2003; 422 (6932):561–62. [ PubMed : 12686973 ]
• Klein A., van Kessel A. G., Grosveld G., Bartram C. R., Hagemeijer A., Bootsma D. et al. A Cellular Oncogene Is Translocated to the Philadelphia Chromosome in Chronic Myelocytic Leukaemia. Nature. 1982; 300 (5894):765–67. [ PubMed : 6960256 ]
• Land K. M. The Mosquito Genome: Perspectives and Possibilities. Trends in Parasitology. 2003; 19 (3):103–5. [ PubMed : 12643988 ]
• Letvin N. L., Bloom B. R., Hoffman S. L. Prospects for Vaccines to Protect against AIDS, Tuberculosis, and Malaria. Journal of the American Medical Association. 2001; 285 (5):606–11. [ PubMed : 11176867 ]
• Livingston D. M., Shivdasani R. Toward Mechanism-based Cancer Care. Journal of the American Medical Association. 2001; 285 (5):588–93. [ PubMed : 11176864 ]
• Mack M. J. Minimally Invasive and Robotic Surgery. Journal of the American Medical Assocation. 2001; 285 (5):568–72. [ PubMed : 11176860 ]
• Mattick J. S. Challenging the Dogma: The Hidden Layer of Non-Protein-Coding RNAs in Complex Organisms. Bioessays. 2003; 25 (10):930–39. [ PubMed : 14505360 ]
• Modell B., Bulyzhenkov V. Distribution and Control of Some Genetic Disorders. World Health Statistics Quarterly. 1998; 41 :209–18. [ PubMed : 3232409 ]
• Niklason L. E., Langer R. Prospects for Organ and Tissue Replacement. Journal of the American Medical Association. 2001; 285 (5):573–76. [ PubMed : 11176861 ]
• Noedl H., Wongsrichanalai C., Wernsdorfer W. H. Malaria Drug-Sensitivity Testing: New Assays, New Perspectives. Trends in Parasitology. 2003; 19 (4):175–81. [ PubMed : 12689648 ]
• Nossal, G. J. V. 1999. "Vaccines." In Fundamental Immunology , ed. W. E. Paul. Philadelphia: Lippincott-Raven.
• Nowell P. C., Hungerford D. A. A Minute Chromosome in Human Chronic Granulocytic Leukemia. Science. 1960; 132 :1497–501.
• Nuffield Council on Bioethics. 2002. The Ethics of Research Related to Healthcare in the Developing Countries . London: Nuffield Council on Bioethics.
• Olshansky S. J., Carnes B. A., Cassel C. In Search of Methuselah: Estimating the Upper Limits to Human Longevity. Science. 1990; 250 (4981):634–40. [ PubMed : 2237414 ]
• Pang T. Complementary Strategies for Efficient Use of Knowledge for Better Health. Lancet. 2003; 361 (9359):716. [ PubMed : 12620734 ]
• Perrin L., Telenti A. HIV Treatment Failure: Testing for HIVResistance in Clinical Practice. Science. 1998; 280 (5371):1871–73. [ PubMed : 9669946 ]
• Porter, R. 1997. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present . London: Harper Collins.
• Roberts L. Polio: The Final Assault? Science. 2004; 303 (5666):1960–68. [ PubMed : 15044779 ]
• Rowley J. D. A New Consistent Chromosomal Abnormality in Chronic Myelogenous Leukemia Identified by Quinacrine Fluorescence and Giemsa Staining. Nature. 1973; 243 (5405):290–93. [ PubMed : 4126434 ]
• Ruan Y. J., Wei C. L., Ee A. L., Vega V. B., Thoreau H., Su S. T. et al. Comparative Full-Length Genome Sequence Analysis of 14 SARS Coronavirus Isolates and Common Mutations Associated with Putative Origins of Infection. Lancet. 2003; 361 (9371):1779–85. [ PMC free article : PMC7140172 ] [ PubMed : 12781537 ]
• Sackett D. L., Rosenberg W. M., Gray J. A., Haynes R. B., Richardson W. S. Evidence Based Medicine: What It Is and What It Isn't. British Medical Journal. 1996; 312 (7023):71–72. [ PMC free article : PMC2349778 ] [ PubMed : 8555924 ]
• Scriver C. R., Neal J. L., Saginur R., Clow A. The Frequency of Genetic Disease and Congenital Malformation among Patients in a Pediatric Hospital. Canadian Medical Association Journal. 1973; 108 (9):1111–15. [ PMC free article : PMC1941389 ] [ PubMed : 4704890 ]
• Souhami, R. L. , I. Tannock, P. Hohenberger, and J. C. Horiot, eds. 2001. The Oxford Textbook of Oncology . 2nd ed. Oxford, U.K.: Oxford University Press.
• Tempany C. M., McNeil B. J. Advances in Biomedical Imaging. Journal of the American Medical Association. 2001; 285 (5):562–67. [ PubMed : 11176859 ]
• Warrell, D. A., T. M. Cox, J. D. Firth, and E. J. Benz, eds. 2003. Oxford Textbook of Medicine . 4th ed. Oxford, U.K.: Oxford University Press.
• Weatherall, D. J. 1995. Science and the Quiet Art: The Role of Research in Medicine . New York: Rockefeller University, W. W. Norton, and Oxford University Press.
• ———2003 Genomics and Global Health: Time for a Reappraisal Science 302(5645):597–99. [ PubMed : 14576421 ]
• Weatherall D. J., Clegg J. B. Inherited Haemoglobin Disorders: An Increasing Global Health Problem. Bulletin of the World Health Organization. 2001a; 79 (8):704–12. [ PMC free article : PMC2566499 ] [ PubMed : 11545326 ]
• ———. 2001b. The Thalassaemia Syndromes . 4th ed. Oxford, U.K.: Blackwell Scientific Publications.
• ———2002 Genetic Variability in Response to Infection: Malaria and After Genes and Immunity 3(6):331–37. [ PubMed : 12209359 ]
• Webster, C. 1998. The National Health Service: A Political History . Oxford, U.K.: Oxford University Press.
• WHO (World Health Organization). 2000. World Health Report 2000—Health Systems: Improving Performance . Geneva: WHO.
• ———. 2001. Macroeconomics and Health: Investing in Health for Economic Development: Report of the Commission on Macroeconomics and Health . Geneva: WHO.
• ———. 2002a. Genomics and World Health 2002 . Geneva: WHO.
• ———. 2002b. Global Forum for Health Research: The 10/90 Report on Health Research 2001–2002 . Geneva: WHO.
• ———. 2002c. The World Health Report 2002: Reducing Risks, Promoting Healthy Life . Geneva: WHO. [ PubMed : 14741909 ]
• Cite this Page Weatherall D, Greenwood B, Chee HL, et al. Science and Technology for Disease Control: Past, Present, and Future. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 5. Co-published by Oxford University Press, New York.
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Science and Technology in Medicine

An Illustrated Account Based on Ninety-Nine Landmark Publications from Five Centuries

• © 2006
• Andras Gedeon

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A rare glimpse at historic contributions to the medical literature throughout the past five centuries, Science and Technology in Medicine beautifully documents the origins of some of the most significant scientific and technologic discoveries

Explains their impact on the practice and advancement of medicine

Includes supplementary material: sn.pub/extras

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Table of contents (5 chapters)

Front matter, introduction by jeremy m. norman, ninety-nine landmark publications at a glance, ninety-nine landmark publications, timeline and topics at a glance, the network of interrelationships, back matter.

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Book Title : Science and Technology in Medicine

Book Subtitle : An Illustrated Account Based on Ninety-Nine Landmark Publications from Five Centuries

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DOI : https://doi.org/10.1007/0-387-27875-3

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AI-powered medicine

Asu researchers are using artificial intelligence to improve health.

August Hays-Ekeland’s research with the Neural Engineering Lab focuses on the part of the brain responsible for speech output. Photo by Jeff Newton

Editor's note:  This story originally appeared in the summer 2024 issue of  ASU Thrive  magazine.

The human body is dripping in data, from the steady beat of the heart to electrical impulses shooting through the brain, to the myriad ways we walk and talk.

Tapping into that information to treat patients is one of the great challenges faced by doctors all over the world — but it’s being made easier thanks to advances in artificial intelligence.

ASU researchers are at the forefront of this new wave of medical research. Here are just some of the ways they are exploring how AI and machine learning can be used to speed up diagnosis, unlock new treatments and access new data sources that could shed light on the mysteries inside us all.

Assessing treatments for neurological conditions

Speech demands precise choreography — tongue, lips and jaw moving in harmony. But in neurological conditions like Alzheimer’s, Parkinson’s and ALS, those movements break down. 

Breaking new ground

Learn more about AI at ASU at ai.asu.edu .

Sufferers may experience slurred and slowed speech, difficulties in recalling words, and instances of incoherent speech, says Visar Berisha, associate dean and professor in ASU’s Ira A. Fulton Schools of Engineering and professor in the College of Health Solutions. Berisha and Julie Liss are developing AI models that analyze both the content of someone’s words and the way they sound to “reverse engineer” what’s happening. 

“The speech signal is very rich and has a lot of information about the state of a person and their health and emotions,” says Liss, an associate dean and professor in the College of Health Solutions.

In 2015, Liss and Berisha co-founded a spinout company to bring the insights to patient care. While some startups are trying to use speech to diagnose conditions like Alzheimer’s, Liss and Berisha are taking a more conservative approach with potential for immediate impact. 

Across many neurodegenerative conditions, there is a high failure rate in clinical trials. This is because the tools used to evaluate whether patients are improving from treatments are coarse and subjective. To solve this, Berisha and Liss use their AI model to evaluate whether patients are responding to treatment in clinical trials, with success already demonstrated in prospective trials in ALS. 

These and other successes have led to breakthrough device designation status from the Food and Drug Administration, device registration with the FDA and global adoption by pharmaceutical companies and health care providers to track patient health.

“Speech analytics provide objective, interpretable, clinically meaningful measures that allow for clinical decision-making,” says Berisha. The hope is that AI will be able to pick up subtle changes in speech that a clinician might have missed.

Standardizing brain scans

Inside the brain, Alzheimer’s is characterized by the growth of amyloid plaques, clumps of abnormal proteins that form in the gaps between neurons. New treatments such as lecanemab target these plaques. To track how these drugs are working, subjects in clinical trials are injected with a radioactive tracer that sticks to the amyloid so that it shows up on a PET scanner.

There are five different FDA-approved tracers, all with different properties, and different clinics use different tracers, making it hard for researchers to compare data. AI can help. 

Teresa Wu, a professor in ASU’s School of Computing and Augmented Intelligence and health solutions ambassador in the College of Health Solutions, uses AI to harmonize PET scans taken with different types of tracers. 

Wu’s model generates what a brain scan taken using one type of tracer would look like if it had been taken with a different one, enabling easier comparison and research. 

“If you want to make use of imaging data to support medical decisions, there is a hurdle to overcome,” she says. “You cannot just take the data from different sources and dump it in your deep-learning model. You have to make sure it’s clinically relevant and usable.”

Doing that opens a wealth of new opportunities for using AI to improve diagnosis. 

Another project uses AI and deep learning to predict a person’s biological age from MRI brain scans. 

“With healthy subjects you expect their biological age and their true age to be similar,” Wu says.

If it’s not, that could be an early sign of neurodegenerative disease. 

Plugging into the brain

Locked-in syndrome, caused by damage to the brainstem, stops signals from the brain from reaching the rest of the body. The person can see and hear, but they’re robbed of their ability to move, speak and communicate through anything but eye movements and blinking. 

Bradley Greger, an associate professor in ASU’s School of Biological and Health Systems Engineering, is using artificial intelligence and machine learning to translate what’s happening in the brain in the hope of helping people with locked-in syndrome communicate more fluidly.

“It’s about tapping into those areas of the brain that process language and speech, recording the neural activity, and then using machine learning algorithms to figure out how that neural signal maps to the word they’re trying to speak,” he explains. 

The research piggybacks on patients who are already having surgery to place electrodes in their brain to treat conditions such as epilepsy. Greger says this is the only way to get the detailed level of information needed — noninvasive brain scanning techniques like EEG and fMRI aren’t precise enough. 

Machine learning really helps with processing the huge amount of data that’s generated. Bradley Greger Associate professor in ASU’s School of Biological and Health Systems Engineering

That information then can be used to train a model to predict what a person is trying to say.

Greger also notes that the brain is active while listening to speech — even in patients who are locked in.

“Ultimately, we’ll be able to understand not only what the patient is saying, we’ll also be able to confirm cognitive understanding when listening to speech,” he says.

Greger hopes to use this research for other applications: enabling paralyzed people to control a robotic limb, for instance, or blind people to see with the aid of a camera connected to the retina, optic nerve or visual processing areas of the brain. 

“For somebody who’s blind or paralyzed, it can be really life-changing for millions of people,” he says.

“Machine learning really helps with processing the huge amount of data that’s generated — terabytes of data,” Greger continues. “And then you have to map that onto the person’s behavior and what they’re saying.” 

Training therapists

How do you train a therapist? You start by hiring actors. Right now, practice patients played by budding TV and movie stars are one of the best ways to re-create scenarios a therapist might face in sessions. 

But there are problems with that approach. First, how do you get the training to people in remote areas who don’t have a supply of actors? How do you make sure the actors provide the same experience? 

Psychologist Thomas Parsons, the Grace Center Professor of Innovation in Clinical Education, Simulation Science and Immersive Technology, is using AI to create virtual standardized patients that he hopes will solve some of 9these problems. 

Parsons, an Air Force veteran, is particularly interested in helping clinicians better treat ex-military patients with blast injuries, combat stress symptoms and insomnia.

He’s the lead investigator on a more than $5.2 million project supported by the Department of Defense Congressionally Directed Medical Research Programs The work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, in the amount of $5,072,397.00, through the Congressionally Directed Medical Research Programs Peer Reviewed Medical Research Program under Award No. HT9425-23-1-1080. Interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Assistant Secretary of Defense for Health Affairs or the Department of Defense. that trains an AI virtual patient using transcripts and video recordings of sessions between real patients and doctors. That will be combined with digitized recordings of actors to create realistic virtual patients who can say what a real patient would say. 

Eventually, Parsons says, the system will be able to assess the clinicians’ performance and adapt.

“There are specific things that you’re supposed to ask in a structured clinical interview, and we can look at how the human is deviating from that,” he says. “And then there’s six sessions. So, over six sessions you want to see this virtual patient get better.”

Mapping cancer cells

In the early days of biology, scientists would dissect and examine, peer through microscopes and draw sketches of what they saw. 

“It was easy for them to keep in their heads how things work,” says Christopher Plaisier, an assistant professor in ASU’s School of Biological and Health Systems Engineering in the Fulton Schools of Engineering. 

Today that’s impossible. We now know there are 25,000 genes in the human genome, and 9,000 of them are expressed in any given cell. The only way to understand the relationships between those genes and how they interact with diseases like cancer is with the help of AI.

Plaisier is trying to build what he calls “intelligible systems.” These AI models will classify different types of cells and help scientists understand the underlying biology better. 

Techniques like unsupervised learning can find similarities between different cell types and map out the complex genetic pathways that govern their growth. That can unlock exciting opportunities for medicine. 

In one strand of work, Plaisier used AI to analyze tumor cells from malignant pleural mesothelioma, a type of lung cancer. By tapping into databases of existing drugs, his team found 15 FDA-approved drugs that could potentially be repurposed to treat this condition.

Another project looks at quiescent cancer cells, which are in a dormant, nonreplicating state but could start growing again at any time. Plaisier is using neural network-based classifiers to map the cell cycle of these cells, in the hope of finding ways to knock tumors into quiescence so they stop growing, or out of quiescence so they’re more susceptible to chemotherapy.

AI will help researchers make medical discoveries that weren’t possible before, Plaiser says. 

“We’re trying to understand how biological systems work, and that’s going to lead us to a place where we can actually start to make decisions intelligently,” Plaisier says. “That’s where machine learning methods can really help us dig in.” 

Preventing falls in seniors

For seniors, falls pose a risk that can derail their ability to live on their own. To try to help, ASU Professor Thurmon Lockhart in the School of Biological and Health Systems Engineering has added AI to his biomechanics research. 

“Traditional fall-risk assessments for seniors don’t always target specific types of risk, like muscle weakness or gait stability,” Lockhart says.

He’s developed a wearable device that goes across a patient’s sternum. It measures body posture and arm and leg movements in real time to monitor fall risk at home. When the risk is deemed to be high, a smartphone app called the Lockhart Monitor can alert the user or a caregiver before someone actually falls. 

“This integration allows for real-time customization of individual patient-care pathways, all tracked through a centralized data system and reported to a clinical team to enhance the ability to improve patient outcomes and target high-risk patients to reduce avoidable injuries,” Lockhart says. 

We’re trying to understand how biological systems work, and that’s going to lead us to a place where we can actually start to make decisions intelligently. Christopher Plaisier Assistant professor in ASU’s School of Biological and Health Systems Engineering

Revolutionizing medicine

These projects represent only some of ASU’s work using AI to make medical breakthroughs.

As sensors get cheaper to make and artificial intelligence tools become easier to use, more medical fields will be able to unlock the power of big data. AI is already helping people receive better care. In the future, it could unlock a golden era of medicine for all.

Story by Amit Katwala. An editor and writer at WIRED, Amit Katwala works on features, science and culture. His latest book is “Tremors in the Blood: Murder, Obsession and the Birth of the Lie Detector.”

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Essay on Science and Technology for Students and Children

500+ words essay on science and technology.

Essay on Science and Technology: Science and technology are important parts of our day to day life. We get up in the morning from the ringing of our alarm clocks and go to bed at night after switching our lights off. All these luxuries that we are able to afford are a resultant of science and technology . Most importantly, how we can do all this in a short time are because of the advancement of science and technology only. It is hard to imagine our life now without science and technology. Indeed our existence itself depends on it now. Every day new technologies are coming up which are making human life easier and more comfortable. Thus, we live in an era of science and technology.

Essentially, Science and Technology have introduced us to the establishment of modern civilization . This development contributes greatly to almost every aspect of our daily life. Hence, people get the chance to enjoy these results, which make our lives more relaxed and pleasurable.

Benefits of Science and Technology

If we think about it, there are numerous benefits of science and technology. They range from the little things to the big ones. For instance, the morning paper which we read that delivers us reliable information is a result of scientific progress. In addition, the electrical devices without which life is hard to imagine like a refrigerator, AC, microwave and more are a result of technological advancement.

Furthermore, if we look at the transport scenario, we notice how science and technology play a major role here as well. We can quickly reach the other part of the earth within hours, all thanks to advancing technology.

In addition, science and technology have enabled man to look further than our planet. The discovery of new planets and the establishment of satellites in space is because of the very same science and technology. Similarly, science and technology have also made an impact on the medical and agricultural fields. The various cures being discovered for diseases have saved millions of lives through science. Moreover, technology has enhanced the production of different crops benefitting the farmers largely.

Get the huge list of more than 500 Essay Topics and Ideas

India and Science and Technology

Ever since British rule, India has been in talks all over the world. After gaining independence, it is science and technology which helped India advance through times. Now, it has become an essential source of creative and foundational scientific developments all over the world. In other words, all the incredible scientific and technological advancements of our country have enhanced the Indian economy.

Looking at the most recent achievement, India successfully launched Chandrayaan 2. This lunar exploration of India has earned critical acclaim from all over the world. Once again, this achievement was made possible due to science and technology.

In conclusion, we must admit that science and technology have led human civilization to achieve perfection in living. However, we must utilize everything in wise perspectives and to limited extents. Misuse of science and technology can produce harmful consequences. Therefore, we must monitor the use and be wise in our actions.

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The Future of Technology in Health Care

Alyson diaz , julia englebert , and carson turner.

Scholars discuss the need for federal regulations to combat risks associated with technology in health care.

Most U.S. adults use technology to improve their health—nearly 60 percent browse the Internet for medical information, and over 40 percent obtain care through telemedicine .  Despite technology’s health care potential, however, six out of ten Americans are uncomfortable with their health care provider relying on AI to diagnose diseases and recommend treatments.

AI can enhance quality of care by helping physicians verify their diagnoses and detect diseases earlier. For example, researchers have found that AI technology can help predict a patient’s risk of breast cancer. Similarly, a combination of physician expertise and AI algorithms can increase the accuracy of diagnoses.

Yet, AI systems can fail, and if humans rely too much on software, an underlying problem in one algorithm can injure more patients than a single physician’s error. In addition, AI algorithms incorporate biases from available data. For example, Black patients receive , on average, less pain medication than white patients. An algorithm trained to recommend pain treatment from these health records could suggest lower doses of painkillers for Black patients, irrespective of biological needs.

At the same time, technology can help underserved communities gain access to health care. These communities often experience shortages of trained practitioners and standard health care facilities, resulting in higher risk of disease and misdiagnoses. Telehealth, as one example, increases access to quality care by allowing patients to meet with doctors online or have their vitals monitored remotely.

Currently, no federal law regulates the use of AI in health care. Although the U.S. Food and Drug Administration (FDA) reviews most products using technology or AI software on patients, it does not currently make determinations as to whether uses of AI in health care are safe for patients. Instead, FDA approves AI-enabled devices through a process known as 510(k) review . During a 510(k) review, a manufacturer must show that its technology is “substantially equivalent” to a product already available in the market. The process allows AI-enabled devices to be approved without clinical trials proving their safety or accuracy.

Last year, the Biden Administration pledged to oversee the responsible development of AI, including in health-related fields. President Joseph R. Biden’s executive order on the subject includes requirements for health care providers to inform users when the content they provide is AI-generated and not reviewed by a physician. In addition, providers are responsible for mitigating potential risks posed by the technology and ensuring that it expands access to care.

Health professionals have also expressed concern about adolescents self-diagnosing medical conditions discussed by influencers who promote telemedicine on social media. Currently, FDA does not require telemedicine companies to disclose information about potential risks of services, and companies receive free speech protections as “advertisers.”

Advocates for stricter regulation of technology in health care point out that telehealth providers escape regulation by classifying themselves as communication platforms that connect patients with doctors, and not as providers of medical services. Telehealth companies maintain their independence from medical providers, allowing them to avoid legal liability for those providers’ actions.

In this week’s Saturday Seminar, scholars offer varying suggestions on regulating the use of technology in health care.

• AI algorithms are inherently biased, yet no federal regulation addresses the risk of biased diagnostics when AI is used in health care, recent Seattle University School of Law graduate Natalie Shen argues in an article in the Seattle Journal of Technology, Environmental & Innovation Law . Shen explains that in the absence of federal action, states have taken the lead in passing laws to address automated decision systems such as AI in health care. By analyzing New Jersey’s and California’s approaches, Shen recommends improvements to future state legislation, including extending any future law’s coverage to the private health insurance sector, and imposing continuous assessment requirements as AI technology evolves.
• In an article for the Virginia Law Review , Berkeley Law Schools Khiara M. Bridges argues that educating patients about the risk of race-based algorithmic bias should be a prerequisite before using AI in health care. Bridges explains that people of color are more likely to distrust physicians and health care institutions and thus, are likely to be skeptical of medical AI. Furthermore, medical algorithms are developed based on a primarily white “general population,” reducing their predictive accuracy for communities of color, Bridges notes . She argues that disclosure of AI-related risks would foster patient-physician dialogue in communities of color, encouraging more patients of color to use the technology and ultimately remedying existing algorithmic biases.
• Regulation of AI-enabled health tools must include pre-market authorization and continued performance monitoring processes, urge Joana Gonçalves-Sá of Complexity Science Hub and Flávio Pinheiro of NOVA Information Management School in an chapter in Multidisciplinary Perspectives on Artificial Intelligence and the Law . Gonçalves-Sá and Pinheiro propose improvements to FDA’s pilot program, Total Product Lifecycle , which tracks the safety risks of AI. Under the program, an AI company can achieve “precertified status” if it can demonstrate that it develops high quality algorithms and continues to monitor their effectiveness after market entry, Gonçalves-Sá and Pinheiro explain . FDA should also investigate the reliability of datasets and engineers that train AI tools, Gonçalves-Sá and Pinheiro recommend .
• Regulators should lower legal barriers that prevent community organizations such as Black churches from helping poor and marginalized people to gain access to telehealth services, argues Meighan Parker of the University of Chicago Law School in a recent article in the Columbia Science and Technology Law Review . Parker notes that although community organizations such as Black churches could help some people to overcome mistrust of health care providers, involving them could cause conflicts between the churches’ beliefs and patients’ medical needs, or open the churches to malpractice liability. In response, Parker proposes softening or adjusting regulatory barriers to ensure that churches will not face ethical conflict or legal liability for connecting people with needed telehealth services.
• In a note in the Washington Journal of Law, Technology & Arts , Kaitlin Campanini , a student at Pace University Elisabeth Haub School of Law , argues that the U.S. Drug Enforcement Administration’s lax regulation of telehealth providers has worsened inadequate mental health treatment and increased excessive drug prescriptions. Although telehealth providers’ business models can render treatment more convenient and affordable, the expedited treatment model they offer “blurs the line between offering health care to patients and selling controlled substances to customers.” This is because such companies fall into a regulatory gray area. They disclaim providing medical services by maintaining that they are independent from providers. Yet they aggressively market stimulants to consumers and facilitate questionable prescriptions after short, virtual evaluations.
• In a recent note in the Belmont Law Review , J.D. candidate Nora Klein argues that regulators should close legal loopholes that allow direct-to-consumer (DTC) pharmaceutical companies to unfairly influence social media users. Klein notes that DTC pharmaceutical companies have avoided FDA advertising regulations in part by labeling themselves as entities over which FDA has no regulatory authority. Accordingly, these entities are only subject to FTC advertising regulations, which are difficult to enforce, Klein observes . She argues that the DTC model is harmful because it leads to misdiagnoses and patient complications more often than traditional health care services. To address the problem, Klein proposes that FDA require DTC pharmaceutical companies to disclose important drug information to consumers.

The Saturday Seminar is a weekly feature that aims to put into written form the kind of content that would be conveyed in a live seminar involving regulatory experts. Each week,  The Regulatory Review  publishes a brief overview of a selected regulatory topic and then distills recent research and scholarly writing on that topic.

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The Information Technology in Medicine Essay

Modern healthcare, being primarily focused on providing quality patient care, cannot exist apart from information technology. For this reason, medical employees are now obliged to learn how to beneficially use technology as well as practice proper communication with patients on the subject of its use in the process of treatment. The discipline, which will be analyzed in the course of the paper, is aimed at defining major tools necessary for providing quality healthcare to the community. Thus, the most significant insight acquired during the course is the high necessity of learning how to convey the importance of information technology to the patients in the simplest way possible.

To begin with, it is necessary to dwell upon the notions that should be processed by the students throughout the course. The subject’s primary goal was to introduce the most common technologies now used in healthcare and their significance to the sphere. Another part of the course was dedicated to the nuance of proper communication with patients using both technology and interpersonal communication.

Before the course enrollment, I considered information technology to be more of an arbitrary helping tool rather than part and parcel of medical practice. However, by the end of the course, I have discovered that the proper use of technology tools can potentially help save hundreds of human lives. Researchers claim that such tools as the Clinical Decision Support System (CDSS) prevent doctors from making false diagnoses due to cognitive overload (Ancker et al., 2017). Besides helping medicals focus more on the treatment process, it is also a key tool for the precise statistical data, crucial for the further development of healthcare across the state.

Another crucial aspect obtained during the course is the ability to assess personal strengths and weaknesses when it comes to cooperation with information systems. As a result, I have discovered that my major strength is the ability to adapt to technology use quite quickly. This benefit also concerns almost all young specialists who are used to information technology from an early age. Such knowledge puts more adolescent specialists at a serious advantage in terms of healthcare system development. However, the skills of fast learning do not concern some patients who are to be educated on the use of technology tools during their treatment process.

According to the researchers, effective patient education is the key to successful treatment due to the patient’s willingness to collaborate (Jimenez & Lewis, 2018). Hence, I believe my major weakness to be the ability to communicate with patients in a way beneficial for their desire to be educated. Despite various already existing methods on patient education, there is still a strong need to develop further research on the topic in order to make it more productive.

In my opinion, the development of healthcare informatics is now rapidly moving towards its zenith due to the beneficial environment. The strategies of further researches are now being planned for the next decades. However, automatized systems of clinical history have introduced the issue of privacy for both patients and medical employees (Iyengar et al., 2018). For this reason, I believe sustaining privacy while maintaining technological advancements in the medical sphere to be one of the most significant topics for further investigation. Moreover, the field of healthcare informatics develops too fast for educators to adapt to the process.

As a result, many specialized educational establishments fail to provide proper students’ preparation on the subject (Ashrafi et al., 2019). Hence, another subject of further investigation should be the methods in which students could be informed of the information technologies used in the field.

Speaking of my personal evaluation of the competencies aligned to the course, the progress is definitely visible by the end of the course, but there are still a lot of details requiring reconsideration. My understanding of the outlines introduced in the course syllabus, including the ability to analyze major programs and methods of computer-human interaction critically is clear and exhaustive. However, in order to maintain the obtained knowledge and skills, there should be more practical tasks, which may help build on the progress. The most valuable output I realized throughout the course is the fact that subjects concerning medicine and technology require constant and comprehensive learning in order to remain relevant in the field.

Taking everything into consideration, it may be concluded that the course of healthcare informatics is an integral part of medical education in the context of the 21st century. In the following reflection of the course, some of its major constituents and outputs were introduced and analyzed. When it comes to personal knowledge and skills gained, the most significant discoveries are the necessity to continually improve on the subject in order to realize how to convey the information to the patients. Even the most advanced technology may be of no help if the patients are not willing to collaborate. Further research on the subject includes more methods for patient education and examination of privacy maintenance.

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC medical informatics and decision making , 17 (1), 36.

Ashrafi, N., Kuilboer, J. P., Joshi, C., Ran, I., & Pande, P. (2019). Health informatics in the classroom: An empirical study to investigate higher education’s response to healthcare transformation. Journal of Information Systems Education , 25 (4), 5.

Iyengar, A., Kundu, A., & Pallis, G. (2018). Healthcare informatics and privacy. IEEE Internet Computing , 22 (2), 29-31.

Jimenez, Y. A., & Lewis, S. J. (2018). Radiation therapy patient education using VERT: a combination of technology with human care. Journal of medical radiation sciences , 65 (2), 158-162.

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Essay on Impact Of Science And Technology On Society

Students are often asked to write an essay on Impact Of Science And Technology On Society in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Impact Of Science And Technology On Society

Changes in daily life.

Science and technology have changed how we live every day. We use smartphones to talk, get information, and have fun. Washing machines clean our clothes, and microwaves cook food fast. Life is easier and we can do more things in a day.

Health Improvements

Doctors use new tools to treat sickness. Medicine helps us live longer and healthier. Vaccines stop diseases from spreading. We can fix hearts and even replace some body parts. People are healthier now than ever before.

Education and Learning

Learning is different now. Children use computers and the internet for homework and research. They can watch videos to understand tough subjects. Teachers can reach students far away through online classes.

Work and Jobs

Robots and computers do many jobs that people used to do. This can make things faster and cheaper, but some people may lose their jobs. New jobs in technology are created too, so people need to learn new skills.

Environment and Challenges

Science helps us know about pollution and climate change. We can make clean energy like solar and wind power. But technology can also harm the environment. We must be careful and protect our planet.

250 Words Essay on Impact Of Science And Technology On Society

Science and technology have changed the way we live every day. Long ago, people had to do everything by hand. Now, we have machines that wash our clothes and dishwashers that clean our plates. We can talk to someone far away by using a phone or a computer. These tools save us time and make life easier.

Thanks to science, we are healthier and live longer. Doctors use new tools to find out what is wrong with us and have better ways to treat illnesses. We have medicines for diseases that once had no cure. This means fewer people get sick and can enjoy their lives more.

Learning has changed a lot because of technology. Students can find information on the internet and learn from videos and games. They don’t have to go to a library to read about things; they can learn from anywhere with a computer or a tablet.

Environment and Energy

Science helps us understand our planet and how to take care of it. We know more about how to save energy and use less water. There are also new types of energy that don’t harm the earth, like solar and wind power.

Jobs and the Economy

Technology creates new jobs and helps the economy grow. People can work with computers and robots, and there are jobs that didn’t exist before, like designing apps for phones. This means more people can work and have money to buy things they need.

In conclusion, science and technology have a big impact on our society. They make our lives better, help us stay healthy, change the way we learn, protect our planet, and give us new jobs. The world keeps changing, and science and technology will continue to be a big part of that change.

500 Words Essay on Impact Of Science And Technology On Society

Introduction to science and technology.

Science and technology are like two sides of the same coin. They both help us understand the world and make our lives better. Science is about discovering new things and understanding how everything works. Technology uses science to solve problems and create tools that make our lives easier. Together, they have a big effect on how we live every day.

Communication and Information

One of the biggest changes science and technology have brought is the way we talk to each other. Long ago, sending a message to someone far away could take days or even months. Now, with computers and phones, we can talk to anyone around the world instantly. The internet lets us find information about anything in seconds. This has made learning and sharing ideas much easier and faster.

Health and Medicine

Science and technology have also changed how we stay healthy. Doctors use new tools to find out what’s wrong with us and to help us get better. We have medicines for illnesses that once had no cure. Because of this, people are living longer and healthier lives. Even in places that are hard to reach, mobile health services can give medical care to those who need it.

Travel and Transportation

Think about how we move from one place to another. Cars, buses, trains, planes, and ships have all become faster and safer thanks to technology. We can travel long distances in a short time, which has made the world feel smaller. It’s easier to go to new places, meet new people, and learn about different cultures.

Work and Industry

Robots and machines are now doing many jobs that were once done by people. This can be good because it means products can be made quickly and without mistakes. But it also means that some jobs are not needed anymore, and people have to learn new skills to work with these machines. This change is a big challenge for society.

Science and technology can help protect our planet too. We have learned how to make energy from the sun, wind, and water, which are cleaner than burning coal or oil. Scientists are also working on ways to reduce trash and pollution. Still, technology can harm the environment if we use it without thinking about the consequences.

In the end, science and technology have both good and bad effects on our lives. They make many things easier and better, but they can also cause problems if we’re not careful. It’s important for everyone, not just scientists and engineers, to think about how we use technology. By working together, we can make sure that science and technology help make a better world for all of us.

That’s it! I hope the essay helped you.

If you’re looking for more, here are essays on other interesting topics:

• Essay on Impact Of Science And Technology On Human Life
• Essay on Impact Of Poverty On Education
• Essay on Impact Of Music On Human Life

Apart from these, you can look at all the essays by clicking here .

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Essay on Science and Technology for Students: 100, 200, 350 Words

• Updated on  
• Sep 20, 2023

Writing an essay on science and technology requires you to keep yourself updated with the recent developments in this field. Science is a field which has no limits. It is the most potent of all the fields and when combined with technology, then even the sky doesn’t remain a limit. Science is everywhere from the minute microscopic organisms to the gigantic celestial bodies. It’s the very essence of our existence. Let’s learn about Science and Technology in an essay format.

Also Read – Essay on Corruption

Essay on Science and Technology in 100 Words

Everything we do, every breath we take, every move we make, every interaction with any object, and even the thoughts we have, and the dreams we see, all involve science. Similarly, as the world is progressing, technology is getting intertwined with even the basic aspects of our lives. Be it education, sports, entertainment, talking to our loved ones, etc. Everything is inclusive of Technology nowadays. It is safe to say that Science and Technology go hand-in-hand. They are mutually inclusive of each other. Although from a broader perspective, Technology is a branch of Science, but still, each of these fields cannot be sustained without the other.

Essay on Science and Technology in 200 Words

Science and Technology are important aspects of life from the very beginning of the day to the end of it. We wake up in the morning because of the sound of our alarm clocks and go to bed at night after switching off our lights. Most importantly, it helps us save time is one of the results of advancements in science and technology. Each day new Technologies are being developed that are making human life easier and much more convenient.Advantages of Science and Technology

If we were to name the advantages of science and technology, then we would fall short of words because they are numerous. These range from the very little things to the very big ones.

Science and Technology are the fields that have enabled man to look beyond our own planet and hence, discover new planets and much more. And the most recent of the Project of India, The successful landing of Chandrayaan-3 on the south pole of the moon proves that the potential of Science and Technology cannot be fathomed via any means. The potential it holds is immense. 

In conclusion, we can confidently say that Science and Technology have led us to achieve an absolutely amazing life. However, it is extremely important to make use of the same in a judicious way so as to ensure its sustenance. 

Also Read – Essay on Noise Pollution

Essay on Science and Technology in 350 Words

Science and Technology include everything, from the smallest of the microbes to the most complex of the mechanisms. Our world cannot exist without Science and Technology. It is hard to imagine our lives without science and technology now. 

Impact of Science & Technology 

The impact of science and technology is so massive that it incorporates almost each and every field of science and even others. The cures to various diseases are being made due to the advancement in Science and Technology only. Also, technology has enhanced the production of crops and other agricultural practices also rely on Science and Technology for their own advancement. All of the luxuries that we have on a day-to-day basis in our lives are because of Science and Technology. Subsequently, the fields of Science and Technology have also assisted in the development of other fields as well such as, Mathematics , Astrophysics , Nuclear Energy , etc. Hence, we can say that we live in the era of Science and Technology. 

Safety Measures

Although the field of Science and Technology has provided the world with innumerable advancements and benefits that are carrying the world forward, there are a lot of aspects of the same that have a negative impact too. The negative impact of these is primarily on nature and wildlife and hence, indirectly and directly on humans as well.

The large factories that are associated with manufacturing or other developmental processes release large amounts of waste which may or may not be toxic in nature. This waste gets deposited in nature and water bodies and causes pollution. The animals marine or terrestrial living in their respective ecosystems may even ingest plastic or other toxic waste and that leads to their death. There are a lot of other negative aspects of the same.

Hence, it becomes our responsibility to use Science and Technology judiciously and prevent the degradation of nature and wildlife so as to sustain our planet, along with all its ecosystems, which will eventually ensure our existence in a healthy ecosystem leading to healthy and long life.

Science is something that is limitless. It is the most potent of all the fields and when combined with technology, then even the sky doesn’t remain a limit. Science is everywhere from the minute microscopic organisms to the most gigantic ones. It’s the very essence of our existence.

Science and Technology are important aspects of life. All of the luxuries that we have on a day-to-day basis in our lives are because of Science and Technology. Most importantly, it helps us save time is one of the results of advancements in science and technology. It is hard to imagine our lives without science and technology now. 

In any nation, science and technology holds a crucial part in its development in all aspect. The progress of the nation is dependent upon science and technology. It holds the to economic growth, changing the quality of life, and transformation of the society.

We hope this blog of ours on Essay on Science and Technology has helped you gain a deeper knowledge of the same. For more such informative and educational essays please visit our site:- Leverage Edu Essay Writing .

Deepansh Gautam

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413 Science and Technology Essay Topics to Write About [2024]

Would you always go for Bill Nye the Science Guy instead of Power Rangers as a child? Were you ready to spend sleepless nights perfecting your science fair project? Or maybe you dream of a career in science?

Then this guide by Custom-Writing.org is perfect for you. Here, you’ll find the following:

• lists of excellent science and technology topics;
• essay prompts;
• scientific essay outline;
• bonus tips.
• 🔝 Top 10 Science & Technology Topics
• 🔬 Scope of Research
• 🤖 Modern Technology Topics
• 🧪 Science Essay Topics
• 🔭 Space Exploration Topics
• 💡 Other Topics
• 📝 Essay Prompt
• ✍️ Step-by-Step Guide

🔍 References

🔝 top 10 science and technology topics.

• ICT use in healthcare
• Consent in biobanking
• Pros and cons of NFTs
• Fintech and healthcare accessibility
• Widening of the global digital skills gap
• Ways to identify gaps in health research
• Changes in Mid-Atlantic regional climate
• Transforming public health data systems
• Workings of the online extremist ecosystem
• Ways of improving statistical computing practices

🔬 Science and Technology: Scope of Research

Now you can start looking for an essay idea in our topics list. But first, have a look at the following fields of research in science and technology that our topics cover:

• Modern technology includes the newest advances in engineering, hardware, systems, and organization methods. You can write about robotics, computer science, and more.
• Science is knowledge about the universe in the form of testable explanations. In your paper, you can cover different areas of science such as biology, physics, etc. For more ideas, check out our list of topics in science .
• Space explorations began in the ancient world and eventually allowed people to build a spaceship, arrange the first space trip, and step on the Moon.
• In a technology essay on space exploration , you may write about the most up-to-date technologies in the sphere of space traveling and exploration.
• Space exploration essays can also be devoted to the period of the Cold War . One of its aspects was a space race between the United States and the USSR.
• Finally, you can assess the importance of various space innovations . Many people tend to condemn spending vast sums of money on space exploration. You may give your viewpoint on this question in an essay. Check out our list of topics in astrophysics for more ideas.

🤖 Modern Technology Essay Topics

• Increasingly powerful 3D computer chips
• Technology and the rise of the leisure class
• Luddism as the most radical opposition to the use of technology
• Technological inventions that have a destructive power
• How does nuclear technology affect the global economy?
• Mobile video communication from any mountaintop
• Using technology to reinvent identification documents
• The history of the computer viruses and their current examples
• Does technology provide for a better life, or is it a bane?
• Did people reinvent texting to express the full range of emotions?
• How did pop-up advertisements appear and evolve on the Internet?
• The technology behind the most famous instances of hacking in history
• The future privacy risks in the world fully connected to the Internet
• What are the possible future developments in cloud storage ?
• Dancing robots : why is it important to teach robots to dance?
• Should there be censorship on the Internet?
• What self-driving cars can and cannot do at present
• Which features can increase the popularity of self-driving cars among people?
• 19 th -century discoveries versus recent technological developments
• The positive and negative impacts of communication technology
• The printing press , the telephone, and the Internet: their contribution to global communications
• Philosophical debates about the present and future use of nuclear technology
• The potential dangers of virtual reality replacing real-life experiences
• Transhumanism and techno-progressivism and their positive views of technology
• The history, benefits, and drawbacks of cloud technology
• Voice-commanded robot wheelchair (that will bring you to any location stored in its memory)
• Cameras that can determine your age just by looking at your face: how do they work?
• Innovative technologies in Antarctica that are speeding up polar research
• Technology and the development of daily living aids for chronic diseases. People who have chronic diseases always need to monitor their well-being. However, science has moved towards developing special devices that help people in their daily lives. For instance, you can write about stairlifts, wheelchairs, or other appliances.
• The history and technological evolution of prosthetics. People have been using prosthetic limbs from ancient times. Now, these items are much more functional, and their innovation continues. Wood and metal have been replaced by novel materials such as carbon fiber. Robotics also allows controlling prosthetic limbs better.
• Disability technology: how science invented hearing aids , text-to-speech programs, and more. Today, disabled people can get access to aids that enhance their living. For example, hearing aids were developed as far as 1898. But they became small only after World War II. Now they are enhanced by the technology of Bluetooth .
• How has the clothing industry evolved with the development of new technology? In the past, all clothes were hand-made. After the sewing machine was introduced, people’s fashion also changed. Now, technology can create items of clothing that a human cannot produce. But many people still seek hand-made items and see the automatization of manufacturing process as a disadvantage.
• Gardening for the 21st century: vertical gardening for tiny city spaces. As the world population grows, people have much less room for farming and recreational gardening. New concepts such as vertical gardening are innovative and environmentally conscious. They create small green spaces in urban areas and bring humans back to nature.
• Hydroponic systems and other approaches to agriculture without soil. It can be hard to find enough place for soil planting in big crowded cities. Hydroponic gardening is a way to get fresh local vegetables that can be grown indoors. Such approaches, nonetheless, have their advantages and disadvantages.
• The importance of sustainable farming for the environment. Food production is a vital part of people’s lives. Science has shown that agriculture contributes to pollution. Now, climate change concerns raise the question—how can humans grow food without damaging the environment? Sustainable principles may be the answer to this question.
• Genetically modified foods: history, benefits and drawbacks, and common misconceptions. Many discussions surround the topic of genetically modified organisms (GMOs). GMOs are crops whose DNA was changed artificially. Some people believe that bioengineered fruits and vegetables pose risks to people’s health. Others say that genetic engineering improves harvest and food quality.
• Can GMOs solve world hunger? Food shortage is among the biggest problems in the world. Genetic modification may introduce crops that ripen faster, stay fresh longer, and yield a better harvest. However, these GMOs may not grow as well as natural plants. These issues are at the center of the debate around bioengineering.

🧪 Science Topics to Write About

Science Essay Topics for Middle School

• How did humans learn to measure speed and velocity?
• Everyday life examples of Newton’s 2 nd law of motion
• Current differences in various measurements of distance
• How and why are miles different from nautical miles?
• The concept of time from antiquity to modern clocks
• How were measurements of distance developed?
• How gravity explains most of the natural phenomena on Earth
• The history of Einstein’s theory of gravity and people who opposed it
• The history of the 3 different systems of measuring temperature
• Which temperature unit is easier to use in daily life: Fahrenheit or Celsius?
• How can Newton’s laws of motion be explained by using household objects?
• Experimental design : how to improve the results of an experiment
• Is safety important in scientific experimentation, or does it get in the way of discovery?
• How the Earth was shaped: tectonic plates’ movement. A long time ago, the continents used to be shaped differently. Their shape depended on the direction of tectonic plates. It is believed that they once formed Pangaea—a supercontinent that broke into many pieces and created the modern continents.
• Can humans create new continents and change the existing ones? Humans contribute to shaping the planet in many ways. Agriculture and the search for resources change the terrain, while urban development leads to climate change. Also, various islands are constructed by people from natural and artificial materials.
• What is the air that we breathe made out of? The air in the Earth’s atmosphere is unique. It allows nature to thrive and live. Air contains more than just various gases. It also holds water and particles that affect pollution, climate, and nature’s health.
• The layers of the atmosphere : why mountain air is different. The Earth is surrounded by an atmosphere with layers. Each of them has a different composition and pressure level. That is why people say that the air on the top of a mountain feels different. This variety affects many aspects of the natural world.
• How the Earth is shaped today: volcanoes, earthquakes, and tsunamis. Different natural phenomena contribute to changing the shape of the planet. For example, volcanic eruptions make lava spill onto land and water. Over time, this lava hardens and turns into rock. These events can create whole new landforms or destroy existing ones.
• Which animals can live in the outer layers of the atmosphere? Almost all living beings on Earth require oxygen to survive. However, some of them may need less oxygen than others. Interestingly, a small group of creatures needs almost no air. Various microorganisms can even be found as high as the troposphere.
• The dangers of oxygen. Everybody knows that oxygen is a source of life on Earth . But it is also a part of many dangerous chemical reactions. For example, breathing in pure oxygen is harmful for the body.
• The internal layers of Earth: their chemical composition and state. Earth’s inner structure is as layered as its atmosphere. Each component has unique properties and a different physical state. The movement of one layer can result in volcanic eruptions and earthquakes .
• What are the purpose and special status of navigational stars? Celestial navigation means finding one’s location using stars. It is an ancient practice that is still used today. Some stars, however, play a more important role than others. They serve as marks for easy navigation. The most well-known navigational star is the Polaris, but there are many more.
• The history of weather forecasting in ancient cultures. Today, people can look at a weather forecast for weeks ahead. In ancient times, different cultures searched for the best ways of predicting the weather . Some interesting sources of information were the stars, the color of the sky, the lunar phases, and animal behavior.

Science Essay Topics for High School Students

• Printing food: will you be able to download a pizza?
• Why are there so many programming languages ?
• Can computers create meaningful and original art?
• The place of creative professions in an AI-powered future
• Is distance learning effective, or does it hinder studying?
• Are there any alternatives to plastic that benefit the environment?
• Can everyone stay inside forever with the help of technology?
• The common mistakes that AI continues to make to this day
• Enhancing the quality of school education with virtual reality
• The effect of social media on building relationships and making friends
• The research of artificially produced foods and its environmental impact
• Which devices do students and teachers need to introduce into the classroom ?
• The rise of distance learning : the best methods of studying remotely
• Is translation software equally developed for all languages of the world?
• How people in small communities can find each other with social media
• The impact of unrecyclable materials on oceans. Pollution is on the minds of many scientists today. Ocean animals are often injured or killed by plastic debris. Coral reefs and vegetation also struggle with materials that cannot be recycled. You may suggest ways of cleaning the ocean and making it a better environment for its flora and fauna.
• The use of big data in predicting people’s everyday choices. Big data refers to collecting enormous amounts of information. The data is taken from open online sources. It is then analyzed for different industries to use. How can companies use big data to predict what people need?
• How does marketing use Internet-of-Things? Marketing specialists are always searching for new technologies to explore. They want to surprise their clients and make them interested in their company’s product. The Internet-of-Things connects devices and saves valuable data. Advertisements may use this interconnectedness to their advantage.
• The differences between traditional and digital art . Many of today’s artists are skilled in using software to create art. They use digital painting programs to produce unique works. But how does digital art differ from traditional methods? What negative and positive sides does it have?
• Why do search engines show different results for the same search term? When entering a keyword into Google , Bing, or other search engines, one can get an array of different responses. This essay can explore different companies’ strategies to provide the best answers to their users’ queries.
• What are the disadvantages of clean energy sources ? With the issue of climate change on the rise, many scientists suggest using eco-friendly energy sources . Such options have many benefits for the world. However, they also pose some risks.
• The history of global nuclear energy development. Nuclear energy is a controversial topic among scientists. On the one hand, it is an alternative to fossil fuel use. On the other, the devastating effects of nuclear plant catastrophes expose many risks of this option. This energy source is an excellent topic for an exploratory or argumentative science essay.
• Benefits and drawbacks of wind and solar power for everyday use. Comparisons between solar and wind power are at the center of many debates about clean energy. Both options are considered environmentally friendly, but they are very different. A compare-and-contrast essay on this topic is sure to provide many points of discussion.
• Is it possible for people to produce more freshwater than there currently is? The freshwater supply is limited, and science searches for new ways to produce it. Some organizations collect rainwater and make it safe for consumption. Others try to invent more effective seawater filters. The goal of this search is to support the growing water demand.
• Can science prolong our lives or even let us live forever? Many people think about mortality and try to prolong their lives. Some researchers may believe that there are ways to make people live longer by slowing down aging. A scientific essay can explore people’s search for life extension strategies.

🔭 Space Exploration Essay Topics: Science and Technology

Science and Technology Topics in Space Studies

• What is the role of NASA in space research?
• How relevant is the problem of space debris?
• Describe the dynamics of space flights
• What is the role of dogs in space travel ?
• History and evolution of space research
• What is the purpose of planetary science?
• The first man to travel into space
• Top 10 interesting facts about space
• Explain the concept of wormholes
• Ecological problems of space exploration
• Exploration and effects of dark matter
• Discuss the process of human adaptation to space conditions
• What have we learned from space research over the last decade?
• How do you understand and define spacetime?
• How does the James Webb Space Telescope work?
• What are some of the most prominent contributors to space research?
• Discuss possibilities of manned trips to other planets
• The evidence that proves the existence of black holes
• What is significant about the Solar System?
• What are gravitational waves , and how can we measure them?
• Describe the first 50 years of the space age
• Compare and contrast different space exploration techniques
• Discuss Space Exploration Day, its origin, and relevance
• The effect of space weather on the planet Earth
• Current trends and news about space exploration
• Who are the most famous American astronauts and researchers?
• What are the benefits of space research for society?
• The use of standard candles in measuring distance in space
• What are the economic benefits of space exploration?
• What are the space programs of major countries ?
• The history of non-human animals in spacecraft testing. Before the first human was sent into space, many animals were used to test spacecraft. Some of them successfully reached their goals and returned home. Countries such as the US and USSR sent various animals into space, ranging from dogs to chimpanzees.
• What is the connection between a planet and its moons ? Many planets, including the Earth, have one or several moons. In total, there are more than 200 moons in the Solar System. These natural satellites orbit their planets and influence their weather. Although Earth has only one natural satellite, the Moon , it plays a significant role in its climate.
• The biological effects of space travel and its long-term outcomes. Astronauts who spend time in space report changes in their behavior. For example, they get accustomed to the lack of gravity on the spaceship. Their health is also affected—even a short trip leads to “space adaptation syndrome.”
• What are the prospects of exploring space beyond the Solar System? Currently, human-led expeditions aim for nearby space segments. However, robotic spacecraft and powerful telescopes help people see beyond the Solar System. Voyagers 1 and 2 are the only NASA’s spacecraft that can cross interstellar limits. They still have enough power to collect more data.
• Gravity on Earth and in the Solar System. The role of gravity on Earth is vital for every system and occurrence. A gravitational pull that keeps planets in their orbits, but gravity can do much more—it creates stars, moves matter, and heats planetary cores.
• How far have the scientists reached in their exploration of space? People’s view of the universe has expanded dramatically since the first theories about space. Now, it appears endless, and people use the best technology to see its remotest corners. The Solar System is no longer the limit of exploration, and many vital discoveries contributed to this knowledge.
• The history of exoplanet research. Extrasolar planets (or exoplanets) move through space outside the Solar System. The first evidence of their existence appeared as early as the 1910s. However, it was confirmed scientifically only in the 1980s. Since then, researchers have discovered more than 4000 exoplanets.
• Why is Mars the primary goal of many missions? Mars is the center of space exploration news. Since 1933, NASA has led the Mars Exploration Program (MEP) to investigate the planet’s resources. It also has a solid surface that allows exploration robots to roam Mars in search of life.
• The international legacy of space exploration. During the Cold War, space exploration was a part of the US and the USSR competition. Since then, astronauts from many countries have participated in missions. Space programs have a national purpose, but cooperation between countries leads to better results.

Technology Essay Topics about Space Exploration

• History of space telescopes
• How is a sub-orbital rocket constructed?
• Describe any type of modern spacecraft
• How does a rocket engine work?
• Discuss the relevance of space weapons
• How does an artificial satellite work?
• The Cassini mission and its legacy
• The cultural impact of Curiosity rover
• What are safety measures on spacecrafts?
• What are the modern targets of space exploration?
• What are the advantages and disadvantages of uncrewed spacecraft?
• Can space technology help to combat the avian influenza virus?
• How long will it take for a spaceship to get to a nearby planet?
• Prospects for the development of space technologies
• Who are the pioneers of rocket and space technology?
• Spacecraft classification according to their missions
• What happens at the International Space Station ?
• Can space technology solve the energy crisis?
• Project Orion: origin, challenges, and its impact
• The journeys of NASA’s robotic spacecraft around and beyond Earth’s atmosphere. NASA’s history of space exploration includes many exciting expeditions. Human-led missions were grand and are remembered in history. However, unmanned probes have brought lots of information about space to NASA. They were able to collect samples for investigation and photograph remote planets.
• Why is gravity important in space explorations? Everyone knows that astronauts live in space with no gravity . Weightlessness is an issue that affects the human body. Some space objects have gravity, but it is different from Earth’s. Understanding this aspect of space exploration is vital for designing future missions.
• Elon Musk’s dream of building a rocket. The whole world follows the news of how scientists at Space X tried to reinvent spacecraft. They failed many times, but only to succeed and partner with NASA. Explore the timeline of their innovations in your essay.
• What is the role of experimentation in space travel improvement? Space exploration is a complicated field where a slight miscalculation can lead to dangerous results. Many space ships and probes have failed in decades of testing. That is why experimentation is a core part of exploration. Without failure, success cannot be achieved.
• How did the safety of spacecraft evolve over the years? Human spaceflights pose many dangers to the ship’s crew. People cannot survive in outer space, so the spacecraft must be safe from radiation and hostile environments. Moreover, astronauts who go into outer space or step on the surface of other planets have to be equipped to handle the harsh conditions.
• The history of communication in space. Communication between astronauts and Earth is crucial for all space missions. It is also a remedy for space travelers’ isolation from their families and loved ones. A special Space Network was developed to connect the researchers on Earth with the astronauts.
• The successes and failures of “space gardens.” Aboard the International Space Station , astronauts have entire gardens for various vegetables and flowers. However, the process of finding how to grow these plants was long. Space researchers had to solve problems with gravity, water delivery, fertilizer intake, and much more.
• Which technologies allowed people to mimic their daily activities in space? Even in space, people have to eat, sleep, and keep up with their hygiene. However, the lack of gravity turns these simple daily tasks into a challenge. Much of the space-related research was dedicated to creating freeze-dried food, no-rinse shampoo, and other interesting inventions to resolve this issue.
• The differences and similarities between types of spacecraft. Robotic spacecraft have unique characteristics that correspond with their missions. For example, flyby spacecraft explores the Solar System without landing. Some probes are designed to land on a planet and send data back to Earth. Others are made to penetrate the surface of a comet to measure its properties.
• How did crewless spacecraft evolve? The creation of uncrewed spacecraft has changed with the world’s technological advancement . At first, spacecraft only left the Earth’s atmosphere to observe space. Robots and rovers were eventually designed to land on other planets . These machines need to survive harsh environments to collect data.

Space Race Essay: Scientific Topics

• Cold War , space research, and diplomacy
• What were the consequences of the space race?
• Was the space race a result of the Cold War ?
• The failures and successes of the US in the space race
• Soviet vs. American rocket development
• Compare and contrast Sputnik and Explorer satellites
• How were space discoveries affected by the Cold War
• Timeline of space investigation during the Cold War
• How did the space race affect other spheres of scientific development?
• The state of US and USSR’s space programs after the end of the Cold War
• Why was the Moon chosen as the destination for both nations during the space race?
• The role of US/Soviet spacecraft cooperation in reducing Cold War tensions
• Planned trips to other planets of the Solar System during the space race
• What are the positive and negative consequences of the space race for the countries?
• How did the competition between the US and the USSR start? In the early 20 th century, the tensions between the United States and the USSR were combat-based. However, the arms race after World War II transformed it into a space race. Both nations wanted to be the first in achieving space exploration milestones.
• Was the creation of NASA a consequence of the Cold War? NASA was established in 1958. Its earlier projects show that the space race influenced the organization. For instance, the operation Man in Space Soonest (MISS) name reveals the competitive nature of early space exploration.
• The influence of the USSR’s space exploration achievements on American politics . The US was the first country to put a man on the Moon. Nevertheless, the USSR made several important discoveries as well. This fact undoubtedly affected American politics during and after the Cold War. It inspired political ideas rooted in scientific superiority and academic achievement.
• What did the Apollo missions achieve? The Apollo program lasted from 1968 until 1972, including six successful missions. Some spacecraft were launched to orbit the Moon and photograph its surface. During the Apollo 11 mission, two astronauts landed and walked on the Moon.

• Did the space race contribute to other tensions between the US and USSR ? The competition surrounding space exploration led to many domestic and foreign political changes. Both countries set ambitious goals and cultivated a sense of pride in their achievements. It may be argued that the space race was a continuation of a long tradition of seeking leadership in technology.
• The first woman in space and the history of female astronauts. The story of the first man in space is well-known to most people. However, the USSR also sent the first woman, Valentina Tereshkova, into space in 1963. After that, no flights included women up until the 1980s. Nowadays, female astronauts come from many countries, but men on spacecraft crews still outnumber them.
• The role of Germany in the advancement of rocket technology in World War II . The space race usually mentions two key players—the US and the USSR. However, Germany also affected this competition during and after World War II. Missiles created in Nazi Germany showed that sub-orbital spaceflight was possible. Soviet and American rocket engineers used their military knowledge and transferred it into spacecraft design.
• The Apollo-Soyuz Test Project. In 1972, the US and USSR leaders decided to push for cooperation rather than competition in the space race. As a result, the Apollo-Soyuz Test Project (ASTP) began its development. It was the first international mission; in 1975, two spacecraft docked in space to symbolize unity.
• How did the first men in space contribute to space exploration? Both the US and the USSR were able to send people to space. In 1961, Yuri Gagarin was the first human to fly in Earth’s orbit. In 1969, Buzz Aldrin and Neil Armstrong landed on the Moon. Both events significantly contributed to the countries’ national development and interest in space exploration.

Science and Technology Essay Ideas in Space Innovations

• Why should we continue space exploration ?
• How much money is spent on space research today?
• What are the future perspectives of space investigation?
• What are the major challenges in geodesy?
• The main types of space telescopes
• Is colonization of the Solar System possible?
• Should more money be invested in spacecraft innovations?
• What space innovations do you think will be invented in the future?
• Do you think humanity can survive an asteroid impact?
• Compare and contrast the colonization of outer space planets in 2 science fiction novels
• What can the previous crashes of spacecraft teach engineers? Many of the space missions failed across the globe. Crewless probes, drones , and spacecraft with a crew can fail at any stage of the flight. However, previous unsuccessful efforts are very useful for scientists.
• The potential for recreational space travel. Millions of people dream of going into space, but the astronaut profession is not for everyone. Recreational travel is a chance for tourists to experience space. It is a question of whether it will be possible.
• Key participants in space exploration innovations in the 21st century. In the last century, the US and USSR were the key countries in space exploration. Now, many nations contribute to innovations and develop new technologies. For example, the International Space Station (ISS) program includes Japan, Canada, Germany, and other countries.
• Elon Musk’s reusable rockets. Currently, most spacecraft cannot be reused for space missions. Many factors lead to aircraft degradation, making it dangerous for second use. One of the goals of Space X, created by Elon Musk , is to develop fully-reusable spacecraft.
• The ideas of space colonization in movies: are any of them realistic? Films such as The Martian , Interstellar , and Alien introduce exciting ideas about space travel. Although they are fictional, they may depict certain devices or scenarios that will be real in the future.
• What are the reasons behind people’s renewed interest in space travel? The end of the Cold War also marked diminished interest in space exploration. For some years, people didn’t pay much attention to it. However, now it appears that the passion for exploration has been sparked again. Many countries are currently working on their own spacecraft, and people see Mars as the new destination to conquer.
• Space drones and other crewless spacecraft for interplanetary exploration. Scientists were able to create various spacecraft to go beyond the limits of the Solar System. One of the latest ideas is to make interplanetary drones that will leave the Earth and gather information in a new way.
• Does the Moon present any potential for travel and colonization? Historically, the Moon landings are considered to be outstanding achievements. Now, the Moon is again the center of discussions. You can explore interesting concepts for colonizing the Moon.
• Technological advancements in creating safe and comfortable spacesuits for different environments. Space travel requires scientists to develop spacesuits that protect people from various harsh environments. For example, landing on Mars would require a suit that withstands great and rapid temperature changes.

💡 Science and Technology Essay Topics: Other Ideas

• The new Face ID technology: is it a revolutionary invention?
• What will technical schools look like in the future?
• Is the human brain more productive than a computer?
• The temperature on the surface of exoplanets
• Thomas Edison’s contribution to technological advancements
• How do sun rays affect people’s health?
• Revolutionary technologies and famous inventions from Japan
• Technologies that make driving safer
• How will people study exact sciences in the future?
• New technologies in modern architecture
• Stephen Hawking’s black holes hypothesis
• Is there a possibility that people’s manual labor might not be necessary for any manufacturing processes in the future?
• Do new technologies influence people’s appearance ? How do they do it?
• What would today’s world be like without cellphones and computers?
• What could Leonardo da Vinci possibly invent in the 21 st century?
• Will professions that don’t require the human factor remain in demand in several decades?
• What impact do new technologies have on people’s beliefs and personal philosophies ?
• New technologies and equipment that helps farmers during the wheat harvest
• Will hover drones replace helicopters in the future?
• What are the top 5 alternative energy sources?
• What technologies should be implemented to stop pollution on Earth?
• Social media’s  impact on the populations of different countries
• If people colonize Mars , what means of communication between two planets might be fast enough to share information?
• How can the problem of lack of Internet connection in some parts of the world be solved?
• A scientific approach to the problem of alcoholism
• NASA’s space projects that will be realized in the next decade
• Spheres in which computer technologies cannot replace human workers
• The history of computers: how was the first computer invented?
• A scientific approach to global warming: the most efficient methods of the catastrophe prevention
• Useful features in the new generation of computers and smartphones
• Ernest Rutherford’s scientific career and achievements
• The most technologically advanced country in the world
• Technologies implemented for cleaning the oceans from garbage
• Innovative methods of charging electronic devices
• Scientific research in spaceships: are travels at light speed possible?
• Modern automobiles and technologies that help drivers control their vehicles
• The furthest object that humanity managed to observe with the help of a telescope
• Is teleportation possible, or should people stop spending money on its development?
• The most ridiculous and useless scientific experiments
• The human brain and a  computer : differences and  similarities
• Gravity, temperature, and living conditions on the Moon
• What can be possibly found at the bottom of the Pacific Ocean? Will humanity ever reach its deepest point?
• Technologies used in nursing for delivering appropriate medication to patients in hospital settings
• Scientific research on the topic of protecting nature and the environment: ecologic technologies and policies
• Does the popular minimalist movement contribute to new technologies in any way?
• The tallest plants on Earth and where they grow
• Innovative technologies in  producing and reserving electricity  all over the world
• New technologies that prevent ships from falling over during storms
• Apple’s approach to the safety of their clients’ personal data
• How will the Solar System’s planets’ orbits change in the next century?
• The universe: how big can it possibly be?
• Nanotechnologies used in medicine to heal people with AIDS and cancer
• Earth’s collision with an asteroid in approximately 600 years: actual threat or a hoax?
• Is it ever going to be possible for humanity to travel outside the limits of our galaxy?
• Will humans terraform Mars instead of saving the Earth from an ecological catastrophe?
• Use of nanotechnologies in reducing the amount of garbage on the planet
• New technologies in sports and how will they influence people’s health
• Modern bicycles with reduced risk of accidents on the roads
• The safest means of transport in the world
• Virtual reality  and its use in art
• Can disabled people live a full life with the help of virtual reality?
• The best way to travel across the universe and galaxies
• Robots and their use in the mining industry
• Is there a possibility of human clones’ production?
• The most impressive innovations that people expect scientists to develop in the next century
• Nanotechnologies in biology: Is it possible that people might install microchips in their heads to record every memory and valuable data?
• Is it necessary to support human brain activities with the help of technology?
• Social media vs. television: will people stop watching TV altogether?
• New technologies in education: what new methods of teaching and studying might be helpful in colleges and universities?
• How does the world of electronic devices influence people’s relationships with one another?
• A new trend in Japan: marriages with virtual characters
• The effectiveness of physical exercises supported by new technologies
• How long does it take scientists to develop a vaccine against a virus that emerged unexpectedly?
• The diffusion of the Ebola virus and various methods of its prevention in healthy people
• Benefits of the 3D printing technology in healthcare
• In what ways did computers change people’s lives?
• Products that make people’s night rests healthier and their daily activities more productive
• The  environmental pollution’s impact on people’s health: toxic gases, dirty water, and GMO foods
• New technologies that help pilots control and land the aircrafts
• The role of drones in the modern world: how can people use this technology to save finances and prevent traffic jams?
• Vehicles of the future: how will people travel in several decades?
• What technologies should scientists develop for people to survive on Mars ?
• New technologies’ impact on people’s health, lifestyle, and values
• The technology of controlling computers and mobile phones using only brain activity
• New technologies that balance people’s nervous systems and prevent stresses
• Nanotechnologies in ophthalmology: helping children with visual impairments
• People’s mental health and how modern devices influence it
• New technologies in sustainability: recycling methods
• China’s rapid development: technologies that the country uses for its economic system’s growth
• Ways of producing oxygen on Mars in the future

• Technologies that filter water and make it suitable for consumption
• Apps and programs for effective remote work
• Oil drilling technologies and their impact on the environment
• How will the Internet change in 100 years, and what technology might replace the World Wide Web in the future?
• Apps and programs that help students in accomplishing and organizing scientific research
• The advantages of using the cloning technologies in household cares
• Undesirable outcomes of people’s dependency on their electronic devices: computers, mobile phones, and gaming consoles
• New technologies in language learning: innovative methods to expand one’s vocabulary
• New technologies used for transplanting vital organs
• The role of video games in people’s lives
• The possible harm that robots might cause to humanity
• Is it possible to travel through time, and what technologies might help develop a time machine ?
• How ecological fuel that might replace  natural gas , petrol, and diesel
• Perpetual motion machine: attempts of different scientists to create an engine with endless resources of energy
• Technologies that Americans use daily
• Scientific inventions or decisions that might save the world from an ecological catastrophe
• How far can people travel from Earth in outer space ?
• Automobiles’ aerodynamic qualities and how they have changed since the 1950s
• How do technologies change people’s mentalities and cultures?
• What is the purpose of inventing new warfare technologies if some countries have enough power to destroy our planet?
• The impact of new technologies on military establishment and relationships among countries
• Does the Internet make people more intelligent, or is it the other way round?
• Technologies restricted by law in the territory of the Democratic People’s Republic of Korea
• Do Internet search engines such as Google , Ask, and Bing make people less attentive to what they learn?
• If new software requires more memory space on computers, how many terabytes will an average user need to work online in 20 years?
• How can robots help humanity to increase people’s daily productivity?
• New Apple devices that can change people’s lives
• Alternative ways of finding and sharing necessary information in the future
• Will robots coexist with people in 100 years?
• Will translation software ever be able to replace professional interpreters?
• How can robots and other programmed machines provide medical treatment to hospital patients?
• New technologies in the taxi business
• Is technological progress a good thing, or should we deliberately slow it down?
• What technologies cause harm to the environment, Earth’s population, and the oceans?
• Technologies in the tattoo business: the most effective methods of putting colored pigments under the skin
• Does the US government use any technologies that allow them to wiretap people’s private calls? Is it ethical?
• What technologies should be implemented to create wireless access to the Internet worldwide?
• Do values of contemporary people focus on new technologies more than on everything else?
• What technologies should be implemented to reduce the possibility of overpopulation on Earth?
• Are  electric cars  more cost-effective and productive than vehicles that run on gasoline, diesel, and natural gas?
• Do Face ID and Touch ID technologies protect people’s data from hackers?
• Can any technology reduce the time required for night rests?
• How intelligent are dolphins and whales ?
• Newly emerged research areas and branches of science
• The role of synthetic biology in medicine
• Bionics: the main principles and purposes of the new science
• Nutrigenomics: food values and other factors that influence people’s health
• The main principles and objectives of the memetics study
• Neuroeconomics: the ability of the human brain to make wise decisions
• Sonocytology: the study of the sounds and impulses that the human cells make
• Technologies that help people socialize and rehabilitate after long-term
• How can zero gravity in outer space be used for people’s benefit?
• Which countries are known for their achievements in the sphere of chemistry ?
• Leading countries in the sphere of technology.
• How long will it take Earth to restore all its resources and energy consumed by humanity?
• Machine learning in restaurant and hotel businesses: Improved methods of cooperating with clients
• The ethics of implanting microchips in animals
• AI in online shopping : is it cost-efficient regarding both time and money?
• New technologies that reduce various health risks in polluted areas
• Innovative methods of completing medical operations are more accurate and reduce the possibilities of unfortunate outcomes
• Process automation aimed at cleaning eggs and removing bacteria from the natural products’ surfaces
• How can the implantation of microchips in the human brain help paralyzed individuals?
• Autopilot installed in heavy trucks
• Payment systems that require people’s eye or face scans: is this technology safer than ordinary passwords?
• Camera options that allow people to film in the 360-degree mode
• Solar batteries and their significance in the modern age
• Smart computers that don’t require a person’s intervention to complete tasks or collect information
• Robotic chefs: the device’s functions and other options that make cooking easier
• The technology of modular phones: why did the idea of creating a phone that consists of multiple blocks fail?
• VR technology that might allow people to feel and touch virtual objects
• Water recycling technology that filters the water people use for showering
• Advanced fishing technologies: sensors, drones, and artificial intelligence
• Gyroscope and various devices based on its working principle
• New technologies in web design
• Newton circle and its spheres of use
• Scientific facts that prove the existence of other life forms in the outer space
• Active volcanoes that can erupt at any moment: preventative technologies and safety measures
• Technologies that make people healthy and fit without effort: are they possible?
• Augmented reality use in the cosmetics business
• Potential branches of science that might lead to the creation of new occupations in the future
• The most valuable resource on Earth and technological methods of its extraction
• Internet-of-Things: how is it used in agriculture?
• Synthetic foods: do they contain any nutritional components?
• What technologies can help people reduce the cost of utilities ?
• Entertainment: how will VR technologies influence people’s hobbies in the future?
• How long will it take people to travel between Earth and Mars?
• The temperature on Mars: is it possible for humans to survive on the Red Planet without additional heating devices?
• What will people eat on Mars, and how will they get their food?
• Professions that humanity might need on Mars during colonization
• Messages sent by society in outer space: will they ever be answered?
• If there are other forms of life in different galaxies, how will humans understand and contact them?
• Satellites on our planet’s orbit: what do these devices do, and why are they important for people?
• Is it possible for a human being to stay in a deep freeze for an extended period?
• What do cosmonauts research and observe in the orbit of Earth?
• The main problems of modern science: what issues are scientists trying to solve?
• How dangerous can new technologies be for our environment?
• How do different professions change and improve due to technological development?
• Ethical aspects of genetic engineering for humans
• Egyptian pyramids : technologies that ancient Egyptians used to build their pharaohs’ graves
• Contemporary achievements in genetics
• How have helicopters developed since the 1950s?
• Controversial issues of stem cell research
• German technologies in road building: how is it possible to build a high-quality road for decades?
• Wireless technologies that maternity hospitals use
• What is antimatter, and how can it be used in the medical field?
• How has  technology changed our lives compared to people living a century ago?
• The technology you cannot live without
• What are  the advantages  and disadvantages of genetic engineering?
• Experiments on humans: can they be justified for the sake of science development?
• Can alternative energy technologies provide humanity with sustainable energy resources?
• What technologies can limit the adverse human impact on the environment ?
• Smart devices that can help you reduce your carbon footprint
• Is there a connection between human activity and natural disasters ?
• Military technology advancement: a way to safety or a global threat?
• Robot army: a scene from a movie or our near future?
• Science and technology for personal safety
• Advances in science and technology for  cybersecurity
• Development of technologies for safe online purchases

📝 Science and Technology Essay Prompts

Writing science and technology essays might be a challenging task. Our essay prompts are here to inspire you. Keep reading to make your essay writing even more effortless.

Science in Everyday Life Essay Prompt

Every day we are surrounded by marvelous inventions that can be described in your paper:

• Anything made of plastic. Today numerous industries rely on the production of plastic, from packaging and electronics to aerospace and industrial engineering.
• Anything charged with electricity. The work of people like Alessandro Volta or Andre-Marie Ampere lies at the foundation of the electrical industry.
• Any food item in front of you. Science has revolutionized our approach to food cultivation and raised agricultural productivity to a new level.
• Any modern medicine. At the end of the 18th century, scientist Edward Jenner established that vaccination works. And in the 19th century, the germ theory of disease emerged, which saved millions of lives over two hundred years.

Technology in the Future Essay Prompt

If you choose to write a paper about technology in the future, you can consider describing the following technologies:

• Vision-improving technology . Artificial cornea or iris can provide vision to people with impairments.
• Small living robots . These robots can deliver medicine to different body parts or collect microplastic from the oceans.
• Internet everywhere . Companies such as Google or Facebook use helium balloons, drones, microsatellites, and other technology to provide the Internet to inaccessible areas.
• Dairy products made in a lab . Biotech companies are searching for a way to make dairy products more available and less damaging to the environment. There are already some lab-made dairy products available in the US.

Interest in Science Essay Prompt

If you wish to tell about your interest in science or make your reader interested in it, take a look at these ideas:

• Factors that influence one’s attitude towards science. You can analyze reasons for students’ interest or indifference towards science.
• Parents’ role in children’s attitude towards science. Discuss how parents, their social status, or education level affect their children’s interests.
• How does one’s faith affect their perception of science? Some religious beliefs don’t support scientific ideas about life and the universe.

Importance of Science Essay Prompt

Science is essential for our society, environment, and many other parts of our lives. In your essay about the importance of science, you can include the following points:

• Science is solving the mysteries of our universe. One of the main goals of science is to gain knowledge about the world. It helps us understand different phenomena and find solutions to numerous problems.
• How science benefits society . Science is also used to improve our life quality. Education and knowledge allow us to make our lives easier and more enjoyable.
• The way science helps solve global challenges . Health, agriculture, and other spheres rely on science. Governments also use science to combat issues, such as climate change.

✍️ How to Write a Scientific Essay

To achieve academic prowess in science and technology studies, you will need to get good at writing scientific essays. Here are the general principles of essay writing:

Essay on Science and Technology Outline

The structure of a science and technology essay remains the same as basically any other essay type. It includes the following points:

Science & Technology Essay Introduction

In your introduction, you should make your reader interested in your topic. Start with a hook, and don’t forget to include some background information. You can consult our article about writing a good introduction for more info.

An introduction of a science and technology essay about the disadvantages of space exploration can look like that:

Space exploration’s contribution to environmental science is impossible to deny. However, it might also be damaging to the environment itself. Space exploration produces hydrochloric acid and carbon dioxide that contribute to global warming.

Thesis Statement about Technology & Science

Close your introduction with a thesis to state the main point of your essay. Make sure to support your point with evidence throughout the text.

There should be ways to make space exploration less damaging to the environment since the pollution caused by it is getting worse every year.

Science and Technology Essay Body

The body paragraphs are the central part of your essay. There you show your investigation results and support them with solid arguments. Don’t forget to open each of the paragraphs with a topic sentence that can let your reader know the main idea of the passage (you can learn more from this article about topic sentences by Rochester Institute of Technology.)

Aluminum oxide particles produced during rocket launches absorb the radiation and contribute to global warming. NASA uses fuel that consists of aluminum powder and ammonium perchlorate in their solid booster rockets. They form aluminum oxide when combined. As a result, these rocket launches are damaging to the environment and are one of the causes of climate change and global warming.

Science and Technology Essay Conclusion

The conclusion closes your essay by restating your thesis statement and making your reader want to dive further into your topic. Keep in mind that just saying that “more research on the subject is required” is not what the conclusion should be about. Make sure to include plenty of details in addition to summarizing the articles.

To sum up, although space exploration allows us to know more about our universe and makes our life easier, it also negatively affects the environment. Less damaging ways are needed in order for us to continue gaining knowledge and improving our life quality without hurting our planet.

Choosing Topics Related to Science and Technology

The field of science and technology is so broad that it is not very easy to decide on good science and technology topics right away. That is why we will explain the main issues to pay attention to while picking out a topic for your scientific essay:

• It must be interesting for you as a writer;
• It should be of current importance for readers;
• It has to shed light on some scientific innovations.

If you consider these three points, you’ll have an excellent opportunity to succeed in writing your essays on science and technology.

If you feel lost and unsure what is a worthy topic, try thinking about something down-to-earth and present in our daily lives. For more tips on choosing good topics, check out some brainstorming techniques in our Guide to Academic Writing or use our topic generator .

Scientific Essay: Bonus Tips

• Be sure you correctly understand the chosen problem.
• Formulate your sentences well.
• Use linking phrases within paragraphs and the text as a whole.
• Ensure that your text is cohesive and logical.
• Write in a language that would be clear even to an audience of non-professionals.
• Mind the tone and wording of your technology essay.
• Be careful not to make mistakes in spelling, grammar, style, and format.
• Sound formal but not moralizing.
• Foresee possible questions from your readers and answer them beforehand.
• Call your readers to action and push them toward an adequate response.

Although essays might be one of the most common writing assignments, our free tips are here to make your studies even more enjoyable! We hope the information presented here will help you create an excellent scientific essay. Let us know what you think about our guide in the comments below!

Further reading:

• Funny Informative Speech Topics and Ideas for Presentation
• A List of Informative Speech Topics: Best Creative Topic Ideas
• Good Informative Speech Topics: How to Get Thunders of Applause
• Social Studies Topics for Your Research Project
• Satirical Essay Examples and Best Satire Essay Topics
• Evidence: UNC Writing Center
• What Is STS: Harvard University
• An Introduction to Science and Technology Studies: London’s Global University
• What is the Study of STS? Stanford University
• Science and Technology: Gale
• Essay Structure: Ashford Writing Center
• 100 Technology Topics for Research Papers: Owlcation
• A CS Research Topic Generator: Purdue University
• Research Topics List: NASA
• 11 of The Biggest Innovations Shaping The Future of Spaceflight Today: Insider
• Space Exploration Timeline: ALIC
• Science and Technology: Academia
• Modern Technology: ScienceDirect
• Are Space Launches Bad for the Environment?: Science Focus
• The Future of Space Exploration: University of Central Florida
• The Space Race: Digital History
• Sputnik, 1957: United States Department of State
• Space Exploration and Innovation: UNOOSA
• Benefits of Science: University of California, Berkeley
• Technology in Space Exploration and Beyond: Experimental College
• US Views of Technology and the Future: Pew Research Center
• The Development of Interest in Science: NCBI
• Science for Society: UNESCO
• Science and Technology: RAND
• The Relationship between Science and Technology: ScienceDirect
• Science, Technology, and Innovation (STI) and Culture for Sustainable Development and The MDGs: United Nations
• Religion and Science: The Atlantic
• Writing the Scientific Paper: Colorado State University
• International Space Station: Facts, History & Tracking: Space.com: NASA, Space Exploration and Astronomy News
• Screaming Yeast: Sonocytology, Cytoplasmic Milieus, and Cellular Subjectivities: University of Chicago
• What is Nanotechnology?: University of Wisconsin–Madison
• 5 Influential NASA Inventions: Ohio University
• GMO Crops, Animal Food, and Beyond: US Food and Drug Administration
• Hydroponics: Oklahoma State University
• The Science of Virtual Reality: The Franklin Institute
• How Important Is Technology in Education? Benefits, Challenges, and Impact on Students: American University, Washington, DC.
• What was Pangea?: USGS
• Renewable Energy Explained: US Energy Information Administration
• Deep Space Communication and Navigation: European Space Agency
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• Science and Technology Essay

Essay on Science and Technology

Science and technology is the ultimate need of an hour that changes the overall perspective of the human towards life. Over the centuries, there have been new inventions in the field of science and technology that help in modernizing. Right from connecting with people to using digital products, everything involves science and technology. In other words, it has made life easy and simple. Moreover, humans now have to live a simple life. There is modern equipment explored by tech experts to find something new for the future.

Science and technology have now expanded their wings to medical, education, manufacturing and other areas. Moreover, they are not limited to cities, but also rural areas for educational purposes. Every day new technologies keep coming, making life easier and more comfortable.

Brief about Science

Throughout history, science has come a long way. The evolution of the person is the contribution to science. Science helped humans to find vaccines, potions, medicines and scientific aids. Over the centuries, humans have faced many diseases and illnesses taking many lives. With the help of science, medicines are invented to bring down the effect or element of these illnesses.

Brief of Technology

The mobile, desktop or laptop which you are using for reading this essay, mobile you use for connectivity or communication or the smart technology which we use in our daily life, are a part of technology. From the machinery used in the factory to the robots created all fall under tech invention. In simpler words, technology has made life more comfortable.

Advancement in science and technology has changed the modern culture and the way we live our daily life.

Advantages and Disadvantages of Science and Technology

Science and technology have changed this world. From TV to planes, cars to mobile, the list keeps on going how these two inventions have changed the world we see through. For instance, the virtual talks we do use our mobile, which was not possible earlier. Similarly, there are electrical devices that have made life easier.

Furthermore, the transportation process we use has also seen the contribution of science and technology. We can reach our destination quickly to any part of the world.

Science and technology are not limited to this earth. It has now reached mars. NASA and ISRO have used science and technology to reach mars. Both organizations have witnessed success in sending astronauts and technologies to explore life in the mars.

Other Benefits

Life is much simpler with science and technology

Interaction is more comfortable and faster

Human is more sophisticated

Disadvantages

With the progress in science and technology, we humans have become lazier. This is affecting the human mind and health. Moreover, several semi-automatic rifles are created using the latest technology, which takes maximum life. There is no doubt that the third world war will be fought with missiles created using technology.

Man has misused the tech and used it for destructive purposes.

 Man uses them to do illegal stuff.

Technology such as a smartphone, etc. hurts children.

Terrorists use modern technology for damaging work.

Science and Technology in India

India is not behind when it comes to science and technology. Over the centuries, the country has witnessed reliable technology updates giving its people a better life. The Indian economy is widely boosted with science and technology in the field of astronomy, astrophysics, space exploration, nuclear power and more. India is becoming more innovative and progressive to improve the economic condition of the nation.

The implementation of technology in the research work promotes a better life ahead. Similarly, medical science in India is progressing rapidly, making life healthy and careful. Indian scientists are using the latest technology to introduce new medical products for people and offer them at the lowest price.

The Bottom Line

The main aim of writing this essay on science and technology is to showcase how humans have evolved over the years. Since we are advancing, the science and technology industry is also advancing at a faster pace. Although there are challenges, the road ahead is exciting. From interaction to transportation and healthcare in every sector, we will witness profitable growth in science and technology.

FAQs on Science and Technology Essay

1. How technology changed humans?

Technology has certainly changed the way we live our lives. Not a single piece of technology has failed and is continuously progressing. Be it the small industry or large, technology is a boom to your society. Technology can encompass ancient technologies like calculators, calendars, batteries and others. In future, the technology worlds include Blockchain technologies, smart cities, more advanced intelligent devices, quantum computers, quantum encryption, and others. Humans are updated with technology. This is a good sign for the coming generation.

2. What are the top technologies?

In the last few years, there has been a massive update in technology. From individuals to companies, everywhere, the use of technology is required. Some of the top technologies we are witnessing are

 Data Science

 Internet of Things

 Blockchain

 Robotic Process Automation (RPA)

 Virtual Reality

 Edge Computing

Intelligent apps

Artificial Intelligence

Each of these technologies is in the use of daily life and even in making products. However, to use this technology, there is a requirement of skilled professionals and they need proper training to use them.

3. Is the topic Science and Technology an appropriate topic for students?

Yes, Science and Technology are one of the most important topics every student should know in their schooling. The world is growing rapidly at an increasing rate where one should be equipped with minimum knowledge about these concepts. Science and technology have become a part of everyone’s life today. Therefore understanding them is definitely important.

4. Does writing essays improve English?

Yes, of course it does. Writing is absolutely fundamental to language learning. As with anything, however, it is important to learn when and what you write. If you do it all the time, your writing might sound forced. If you only do it when you don't have anything better to do, you might find yourself procrastinating, and not do it at all. It's also a lot more effective to compose essays when you are in that mindset of an essay. So, to answer your question, yes.

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International Edition

Home / Features / IAVI recognizes HIV Vaccine Awareness Day as new papers are published

May 17, 2024

IAVI recognizes HIV Vaccine Awareness Day as new papers are published

Additional evidence advances germline targeting strategy for hiv vaccine development.

Every year on May 18, the global HIV community observes HIV Vaccine Awareness Day, a day to recognize the long quest to produce one of the holy grails of public health tools: an effective vaccine that could bring an end to HIV.

There are many reasons why an HIV vaccine remains necessary, even in a world where new, long-acting pre-exposure prophylactic drugs (PrEP) are becoming available. There are simply too many new and existing cases of HIV—with 1.3 million people contracting HIV in 2022 alone, and 39 million people living with HIV globally—for our current set of preventive and treatment tools to bring an end to HIV as a public health threat. Tragically, increased uncertainty around continued donor funding, especially in the United States, creates additional risk to an HIV prevention and treatment strategy that rests on the expansion of donor-funded ARV treatment and PrEP access. 

For this reason, HIV vaccine development remains an essential undertaking. This effort has so far failed to bear fruit, with all vaccine candidates taken into efficacy trials failing to date. But IAVI’s current approach to HIV vaccine design offers particular reason to hope.

IAVI’s germline targeting strategy of vaccine development is the first attempt to create an HIV vaccine based on rational vaccine design. Our colleagues are using an iterative process to test immune system responses to carefully sequenced immunogens with the goal of coaching the immune system to produce broadly neutralizing antibodies (bnAbs) that can offer protection against HIV. It was incredible to see the results of the IAVI G001 study demonstrating proof-of-principle for this approach when they were announced in 2021. 

Today, it’s very exciting to see a new set of papers published in Science and Science Translational Medicine led by our colleagues at the NAC, Scripps Research, and the Ragon Institute adding to evidence base supporting the germline targeting approach for HIV vaccine development. Among a set of notable findings, it is a great step forward to see proof-of-principle for HCDR3-dominant bnAb-precursor priming in animals established. The papers in Science are available here and here , and a paper in Science Translational Medicine is available here . A press release will be published imminently. 

IAVI’s work in HIV prevention goes beyond vaccine development, however. We are also deeply optimistic about the potential offered by the use of bnAbs for prevention. IAVI has spent years developing potent antibodies against HIV , that, when infused, may offer protection against HIV for a period of time. We see a special utility for this technology to protect infants in the peri- and post-natal periods from contracting HIV, and we are excited to have a planned set of trials in adults and infants that will begin at the end of 2024 and in early 2025. We are advancing not only the science for this approach but are working to catalyze the policy and funding decisions that would pave the way to access for this technology. 

To commemorate HVAD this year, IAVI has planned a research literacy workshop in Nairobi, Kenya, and a virtual conference: 

• HVAD Webinar: Mapping Routes to Success in HIV Vaccine Development  

On May 29, 2024, IAVI will host an HVAD Webinar themed ‘Mapping Routes to Success in HIV Vaccine Development.’ The discussions will focus on strategies to advance the most promising HIV vaccine candidates toward clinical trials, emphasizing the shift toward localized research and development. It will also delve into the progression of experimental medicine vaccine trials for the germline targeting strategy and other innovative approaches, from initial trials to gaining regulatory approval and community acceptance. To register, visit: https://bit.ly/HVAD2024  

• HVAD Research Literacy Workshop  

IAVI will host a two-day workshop in Nairobi, Kenya, targeting advocates from across Africa, for a deep-dive into the importance of vaccine advocacy, understanding vaccine mechanisms, and exploring different vaccine platforms. Participants will gain insights into the HIV vaccine pipeline, funding strategies, and current prevention approaches like broadly neutralizing antibodies.