Recently, I had the privilege of attending a course on Balancing Technology and Humanism in Medicine at the School of Medicine University of California San Francisco. The objective of the course was to review the teaching of technology and humanism to the medical students, future leader physicians for the year's 2020 - 20030. To achieve this goal, several hours were dedicated to predict how medicine will be practiced in the third decade of the 21^st century. I would like to share with my ALASBIMN friends and colleagues the most important ideas discussed in the course.

Virtual libraries and virtual hospitals. The course was given as part of the grand opening gala of the new building of the UCSF School of Medicine Fresno Medical Education Program. The building consists of a virtual library and a virtual hospital. The library has no books. Students and faculty go to the virtual library with their own wireless PDAs or laptops and navigate through the different cybernetic libraries and banks of data. Faculties are continuously and objectively assessed by the school's deans for promotions and renewal of appointments by the number of times their publication sites are visited by students, colleagues and investigators. Students, interns, residents, and community physicians are trained in virtual hospitals as aviation pilots are training on virtual airplanes.

Globalization. Medicine is a science and it will be practiced all over the world following the same patterns. These patterns will consist of flow-charts based on results of well planned, well implemented and well analyzed unbiased trials. These flow-charts as well the results of the trials will be part of the public domain. Most of the time that patients and/or their relatives consult the internet, they will be as well informed as their physicians. Images will be interpreted by intelligent machines and complex invasive procedures performed by robots.

Genomic preventive medicine. In the third decade of the 21^st century, the main function of primary care physicians will be to review the genomic maps of their patients. Based on this data, they will plan and implement care plans to decrease the phenotypic manifestations of undesirable genes, as well as to avoid bad environmental influences. The electronic health record (EHR) will contain all the information of a patient, from birth to death, including the genomic map. This information will be in an implanted device smaller and more sophisticated than a chip. Primary care physicians will communicate with the device wireless via satellite.

Electro-neurology. We will have a better understanding of the following issues: a) how the brain works, b) what is human intelligence, c) the nature of human memory, and d) the methods used by the brain for long-term and short term retention of memory. We will have very large computers, with a number of memories equal to the total number of synapses of a human brain. Radiologists will be able to scan the human brain with a resolution such that information about all the recorded memories of the individual will be displayed and stored in the machine's computer. As today electro-cardiologists can stimulate and arrest the heart using appropriate electrodes and pacemakers; in the third decade of the 21^st century, electro-neurologists using appropriate electrodes will stimulate the brain, will stop and re-start it, and will supplement and complement its memories. Diseases like Alzheimer's disease will not be treated only with coarse pharmacological intervention on the synaptic receptors. They will also be treated by stimulating specific sites and implanting memories in the sites that were destroyed. These memories will be obtained using nanotechnology and stem cell technology.

To those interested in this subject, I strongly recommend that you read the book: The Age of Spiritual Machines. When Computers Exceed Human Intelligence, by Ray Kurzweil, Published by Penguin Books New York, USA, 2000.

Juan J. Touya MD, PhD
Historian officer of ALASBIMN
Clinical Professor of Radiology, UCSF
Adjunct Professor of Biology, CSUF
E-mail: JTouya@Aol.com