FUTURE FORECASTS for 2000
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Dr. Philip Lanzkowsky, M.D., FRCP, DCH, Sc.D., vice president of the Children's Health Network of North Shore Long Island Jewish Health System, chairman of the department of pediatrics and chief of staff at Schneider Children's Hospital, believes that the new millennium will bring many exciting advances in pediatric medicine. He is particularly optimistic about the development of new immunizations, including one for rotavirus, the most common cause of severe gastroenteritis and diarrhea in infants and young children. Although the Rotashield vaccine was recently withdrawn from the market due to concerns about its link to a painful and potentially fatal bowel obstruction, the National Institute of Allergy and Infectious Diseases reports that eight other vaccines to fight rotavirus are in various stages of development, and Dr. Lanzkowsky is hopeful that a safe and effective one will be available in the not-too-distant future. He also expects that within the next few years we will see the development of vaccines which can prevent pneumococcal illnesses, middle ear infections and other common childhood diseases, as well as the emergence of medications to treat other disorders.
Dr. Lanzkowsky, an expert in childhood leukemia and other pediatric malignancies, anticipates breakthroughs in the treatment of childhood cancers - such as the development of powerful new chemotherapeutic agents. He points out that when he started practicing medicine about 40 years ago, childhood leukemia was 100 percent fatal, while today there is a 70 percent cure rate, and many of the remaining 30 percent do well with continued treatment. The cure rates for other childhood cancers, such as Wilms tumor and Hodgkin's disease, have also greatly improved.
Dr. Lanzkowsky is excited by new possibilities for the use of gene therapy, believing "it holds great promise for the future." The National Cancer Institute concurs, pointing out that "gene therapy could redefine the practice of medicine in the next century." Potential applications include replacing missing genes which are responsible for genetic disorders such as cystic fibrosis, or injecting genes into target cancer cells to either kill the cells directly or make them more receptive to anti-cancer drugs. Dr. Lanzkowsky, who also expects great strides in the area of organ transplantation, believes that "research will help us to overcome immunological barriers to the use of animal organs," and also predicts we will be able to use mechanical hearts and other technologically-sophisticated devices to sustain life until an organ is available for transplant.
One cause for concern is the antibiotic dilemma. While new ones will be developed, according to Dr. George Post, chief scientific officer of SmithKline Beecham, the British pharmaceutical giant, "As more and more bugs become resistant to more and more antibiotics, we will have a definite window of vulnerability before new antibiotics begin to be introduced to overcome the (super)bugs which are resistant to today's antibiotics... We're not going to see those new antibiotics until at least 2007 in any significant numbers."
Recently, the American Health Foundation announced the formation of its Pediatric Task Force, an advisory group of experts which will examine in depth the health status of our nation's children. According to chairperson Myron Winick, M.D., New York City pediatric specialist in nutrition, "As we embark on the 21st century, pediatrics is about to introduce a new concept - the concept that many of the most serious diseases in adulthood may begin in early childhood or even before (in utero) and that with proper management early in life, some of the leading causes of death in adults (i.e., cardiovascular disease, diabetes, and obesity) may be prevented or at least delayed...
"A very important new dimension is entering into the care of children. No longer is it sufficient to treat them only when they are sick. No longer is it sufficient to prevent the usual diseases of childhood. Now a healthy childhood must also encompass maximal protection against many diseases that will become overt 30, 40 or even 50 years later. Thus, anyone concerned with child health in the 21st century will be concerned with recognizing and eliminating 'pediatric antecedents of adult disease.'"
A healthy childhood and a long, healthy adulthood. As we prepare to don our party hats and celebrate the beginning of a brave new century, this is certainly a wonderful wish for the children of America.
- Barbra Williams Cosentino RN, LCSW is a writer in Queens, NY