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White Coat Notes

A glimpse of what’s ahead in medicine

Plenty has been written this year about the history of medicine through the lens of the New England Journal of Medicine, which celebrated its 200th anniversary.

The journal created a website chronicling medical advancements through the past two centuries, many of which were highlighted during a symposium held in June.

In an editorial published Thursday on the journal’s website, two top editors join Dr. Isaac Kohane of Boston Children’s Hospital in looking at what medicine might look like in the next 100 years. Here are a few highlights:

■  We’ll know more about ourselves.

“The state of an individual person will be characterized with increasing precision from the molecular level to the genomic level to the organ level and by interactions with medications, nutrients, the microbiome, therapeutic devices, and the environment,” the authors write.


Many of us will become study subjects as our medical information, entered into­ electronic health records, is mined for information. Study groups will include millions, they say. That research will give doctors new tools for predicting health problems and discerning which treatments will work best for each us.

■  We’ll know more about our health care.

Transparency is a buzz word. But the authors say patients, health insurers, and government programs will demand more information about the kinds of treatments they’re paying for and more proof they are worth the money. Regulators and providers will become more accountable.

■  More may not be better.

“Biomedical research, data technologies, and clinical care all require resources, but the era of shifting more and more economic resources toward health care is going to end,” they write.

Medicine must focus on preventing disease and on treatments that deliver the best value to people who need them.

■  Medicine as peacemaker.

Reducing disparities in health care, especially between rich countries and poor ones, is essential, they write. That goal may provide opportunities for everyone.


“Research-rich countries may come to see that achieving basic health care throughout the world is a strategy to promote stability and peace,” they write.

Pediatricins renew call for gun safety counseling

Two Boston pediatricians, in a New England Journal piece, call on their colleagues to focus on gun safety, following the tragedy in Connecticut, where a gunman killed 20 children and six adults.

“It is time to act for these families and for those who continue to lose children to gun violence,” write Drs. Judith and Sean Palfrey , pediatricians at Boston Children’s Hospital and Boston Medical Center.

Gun injuries are a leading cause of death for US children and young adults, the Palfreys write. They caused twice as many deaths in 2010 as cancer did among people ages 1 to 24.

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