Taurine Levels in Human Aqueous Humour MEDICAL SCIENCES (2000), 2, 1-2 © 2000 SULTAN QABOOS UNIVERSITY *Department of Pharmacology, College of Medicine, Sultan Qaboos University, P O Box 35, Al-Khod, Muscat 123, Sultanate of Oman. 1 Thoughts for the future *Tanira M O M رؤى للمستقبل تنيرة. م he three most significant health-related issues raised in the past year were, presumably, the introduction of drugs for ‘lifestyle improve- ment’, certain new medical interventions and a re- newed interest in utilizing alternative medicine in medical care. These issues are expected to significantly influence medical practice in the future and contribute to modify its present pattern. ‘LIFE-STYLE IMPROVEMENT’ DRUGS This category of drugs is well represented by Viagra (sildenafil citrate), about which little needs to be said. After little more than a year of its approval by the US Food and Drug Administration (FDA) in March 1998, it is difficult to find someone who does not know the name. In September 1998, less than six months of Viagra’s approval, the FDA cleared another drug called Preven , indicated for emergency contra- ception in case of contraceptive failure or unprotected intercourse. Nicknamed ‘morning-after kit’, Preven consists of a patient information booklet, a urine preg- nancy test and four emergency contraceptive pills, each containing a standard oral contraceptive combi- nation (250 µg levonorgestrel and 50 µg ethinylo- estradiol). The drug reduces the risk of pregnancy by about 75%.1 The public response generated by Preven was similar to that of Viagra, though this time con- fined to the West. Preven and similar emergency contraception methods, were available for years.2 However, the FDA approval and probably the opportune marketing of Viagra, brought it in the spotlight. The implications of drugs such as Viagra and Preven may be two-fold. First, they represent a recent tendency to introduce more and more drugs to improve ‘lifestyle’ or quality of life. In the past (up to 1997), new drugs were introduced to make people live healthier. In the future, new drugs could be introduced also to make people live or look better and feel happier. Second, the introduction of these drugs could be a response to public demand rather than to medical need. With either or both explanations, it is becoming likely that the patient would have a stronger say in de- ciding the pattern of future medical practice. NEW MEDICAL INTERVENTIONS The new medical interventions may be symbol- ised by more than one achievement. One is the approval of the first gene-based drug Herceptin (trastuzumab; a humanised anti-HER-2 monoclonal antibody).3 The second is the successful application of a chromosome-based technique of sperm separation that enables parents to choose the gender of their future child.4 These two achievements are harbingers of genetic applications in medical practice. Expectedly, more genetics-based applications would be introduced in the near future. Another advance is the successful culturing of embryonic stem cells from human blastocytes.5 Em- bryonic stem cells can give rise to essentially all cell types in the body. This makes ‘cell and tissue replace- ment therapy’ a likely tool of the future with great potential applications in organ transplant, gene therapy and treating diseases such as diabetes mellitus, AIDS and neurodegenerative conditions such as Parkinson’s disease. If the envisioned potential of this technique is materialised, then it would break new ground in medi- cal practice.6 ALTERNATIVE MEDICINE At the other extreme, ‘alternative medicine’, a collection of non-allopathic methods such as herbal medicine, acupuncture, homoeopathy and chiroprac- tic, appears to pose as a healthcare frontier of the future. The popularity of alternative medicine in the developing countries is well known. It does not seem to be much different in the developed countries. In T T A N I R A M O M 2 the UK about 10% of the population visit alternative medicine practitioners and about 30% of the country’s general practices offer their patients access to alter- native medicine services through the national health service.7 The Journal of American Medical Association (JAMA) devoted almost all of its November 1998 issue to alternative medicine. One study in that issue estimated that 629 million visits worth US$ 27 billion were made in 1997 to alternative medicine practition- ers in the US, a number that exceeded the total visits made to all primary care physicians.8 It also repre- sented a 47.3% increase over the 1990 figure of 427 million. The study attributed this increase to a rise in the proportion of the population seeking alternative therapies, rather than to increased visits per patient. With these results, it is difficult to ignore that people want to use—and are using—alternative medi- cal interventions alone or concurrently with allopathic medicine. The mainstream medical profession might eventually accept this shift and incorporate some ‘useful’ procedures from alternative medicine in their practice. CONCLUSION If the above three issues progress as predicted, the present pattern of clinical practice might gradually be replaced with a future pattern, so far not fully envi- sioned. Perhaps, with more technological applications and greater role for patients in health matters, the role of medical practitioner would also be redefined. In one scenario it was postulated that general practition- ers of the future would be “highly skilled medical generalists and information specialists”.9 The author of this view expects that “general practitioners will have a key role in helping patients make complex decisions about diagnosis and treatment” and that everything else “will be done by nurses, technicians and robots”. Those who are at present medical students (or just graduated) and in their early twenties are expected to practice more than 40 years in the new millennium. The above issues would probably be daily aspects of their practice. REFERENCES 1. Trussell J, Rodriguez G, Ellertson C. New estimates of the effectiveness of the Yuzpe regimen of emergency contraception. Contraception 1998, 57, 363–9. 2. Yuzpe AA, Lancee WJ. Ethinyloestradiol and dl– norgestrel as a postcoital contraceptive. Fertil Steril 1977, 28, 932–6. 3. Tanira MOM. Viagra is not the last call: Pharmacotherapy in the new millennium. (Editorial) Em Med J 1998, 16, 77–9. 4. Fugger EF, Black SH, Keyvanfar K, Schulamn JD. Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in–vitro fertilisation and intracytoplasmic sperm injection. Hum Reprod 1998, 13, 2367–70. 5. Thosmon JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, Fwiergiel JJ, Marshall VS, Jones JM. Embryonic stem cell lines derived from human blastocytes. Science 1998, 282, 1145–7. 6. Pedersen RA. Embryonic stem cells for therapy. Sci Am April 1999, 68–73. 7. Vickers A. Use of complementary therapies. Evidence-Based Medicine 1998, 3, 168–169. 8. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990–1997: results of follow–up national survey. JAMA 1998, 280, 1569–75. 9. Lipman T. Is there a clinical future for the general practitioner? BMJ 1999, 318, 1420. Thoughts for the future *Tanira M O M ??? ???????? ‘LIFE-STYLE IMPROVEMENT’ DRUGS NEW MEDICAL INTERVENTIONS ALTERNATIVE MEDICINE CONCLUSION REFERENCES