Today, the practice of medicine mainly involves treating medical conditions after symptoms of the medical condition become obvious (e.g., setting a fracture or treating pneumonia), or preventing disease for a population of patients using a preventative that has few side effects (e.g., vaccinations, mammograms).

In the future, medicine will be more predictive and proactive. Medicine will be better able to predict that a disease will occur for an individual before there are obvious symptoms and treat the disease before there are obvious symptoms, either stopping the disease or lessening the effects of the disease in the future. I call such diseases early treatment diseases.

A current example of an early treatment disease is colon cancer. During a colonoscopy, polyps, which could later turn into cancers, can be removed.

Another current example of an early treatment disease is BRCA1 or BRCA2 related breast cancer or ovarian cancer. Mutations in a woman’s BRCA1 or BRCA2 genes can result in a greater than 80 percent chance of a woman having breast or ovarian cancer in her lifetime. Treatment to decrease the chances of these cancers’ chances are a double mastectomy and salpingo-oophorectomy.

Some diseases are devastating even if they start to occur, such as Alzheimer’s disease, so it would be highly beneficial if such a disease could be made an early treatment disease, able to be predicted and treated before there are symptoms.

One hope for a disease such as Alzheimer’s is molecular biology. Molecular biology potentially allows a diagnostic test to look into cells and identify disease pathways that could eventually result in the disease and possibly allows a treatment that modifies the disease pathway, thus slowing or arresting the progression to the disease.

I expect in the coming years that there will be many research breakthroughs for diseases showing how to predict the disease before it occurs, together with how to successfully stop the occurrence of the disease or mitigate the disease if it occurs. Let us assume this is the case.
Medical care and the teaching of medical care will then have to change significantly. Patients will need to come in for care before they are sick. Preventative care will now be done individually rather than for a group.

There are also the following considerations in treating early treatment diseases:

1. Selection. There must be a strong criterion to select patients who have a high likelihood of getting the disease.

2. Psychological. The individual may not want to know the possibility that he will get the disease, and therefore the early treatment process will not occur.

3. Process. A diagnostic test will be done to determine the likelihood of the disease occurring. If the test is positive, the patient would then be considered for treatment to stop or mitigate the future occurrence of the disease.

4. Timing. The timing of the diagnostic test and treatment may be critical for their success; for example, if the diagnostic test is done too early, then it may be impossible to predict the likely future occurrence of the disease, while if the diagnostic test is done too late, then the treatment may be too late to be successful.

5. Diagnostic test complications. The diagnostic test might cause complications. The diagnostic test might produce a false-positive result, and an unnecessary treatment might then be done, in itself causing harm.

6. Treatment complications. The treatment may cause complications.

7. Insurance considerations. Insurance companies may be reluctant to pay for early treatments as the disease has not yet obviously occurred. They may be especially reluctant to pay for expensive diagnostics or treatments or ones that may cause harm.

Principle differences in medical care are that a patient must be convinced to come in for care when not sick. The patient must be scheduled for diagnosis and treatment within given time frames before the onset of disease symptoms. Further, the process could cause harm or discomfort to the patient, although it has a chance of providing a much greater long-term benefit for the patient.

Michael R. McGuire is the author of A Blueprint for Medicine.

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