Real Lives: Just what the doctor e-mailed

The normally sedate `British Medical Journal' raised eyebrows with its hi-tech vision of the future. JOHN HARRIS reports

It's a Wednesday morning some time in the future. Having woken with a head-rattling hangover, you stumble into the bathroom to have a much-needed pee. No sooner have you started than a box mounted on the cistern emits a series of bleeps. "Low blood sugar!" says the read-out. "Hypoglycaemia imminent."

Suitably chastened, you hobble downstairs for two bottles of Purdey's health drink and a look at your e-mails. And that's where the fun really starts. The first message is from your local Medical Service Provider: rather alarmingly, your latest gene mapping suggests that you've inherited a propensity for the development of Crohn's disease. You're advised to make your first preventive appointment forthwith.

As if that weren't enough, your parents have written to tell you that grandma has been put in isolation at the local hospital. She blundered into casualty with a suspected broken finger, only for air sensors to discover that she was carrying a virulent strain of flu.

It's a terribly paranoid vision, but this bleak prognosis is founded on the ideas of people who should know. In a pre-millennial special, the British Medical Journal has cajoled countless medical brains into turning their attentions to the future of healthcare; they're doing so in partnership with similar titles the world over. The result is a refreshingly populist read, made yet more resonant by the possibilities some of its predictions suggest.

According to Dr Abi Berger, who put the issue together, the BMJ made a conscious decision to step outside its usual elevated, academic style and deliver something pitched at the public. The idea marks the perfect synthesis of medium and message - because, as diagnostic expertise increases and access to medical information becomes available to all, this kind of accessible enterprise will find an ever-growing market.

"Initially, it wasn't popular with some of our subscribers," she says, "but things have quietened down since. I think people realise that this kind of approach is increasingly what's needed. People will need accessible information more and more -- chiefly on the web. And in the future, I wouldn't mind doing something that's even more aimed at the patient."

Hypochondria, after all, lurks within everybody. And the key need in the imagined world the BMJ has evoked will be the desire for reliable information. If genetic scanning (accomplished via the study of DNA "microarrays") will enable your doctor to inform you about the possible development of, say, cancer, Alzheimer's or diabetes, you'll need hourly access to the kind of voice that can allay your fears. Thankfully, the advent of "telemedicine" will allow it. "Fear not," your PC will boom. "Environmental factors are as important, and the importance of diet cannot be overstated. So run off to www.branmuffin.com and stop worrying."

In fact, the time between the onset of any ailment and one's treatment may be so short that blinking - let alone worrying - isn't an option. By 2010, claims an article by one Charles B Wilson (a big noise within the ludicrously named Institute For The Future), ubiquitous sensors in hospitals will allow for instant detection of any dangerous biological presence.

He portrays the reality in suitably clinical terms. "The vent in the [hospital] lobby is an air monitor that detects and reports any visitor who might transmit an airborne infection to a patient. Other sensors are located in sinks for staff and visitors, who are required to wash their hands before and after going into a patient's room. Any identified carrier of pathogens is swept with a hand-held biosensor that identifies the specific organism and its sensitivity pattern."

Up to a point, the issue's authors would concur with some of the anxiety prompted by such scenarios. "Certainly," says Dr Berger, "there's a real danger of hospitals becoming even more intimidating to people. At the moment, you have that usual worry about people in white coats and a loss of your self-determination, but we could end up with a fear of medical technology as well."

In fairness, the BMJ has a few more agreeable visions: designs for wheelchairs that finally incorporate robotics technology, using gene therapy to fight Aids, and a new, "non-invasive alternative to investigative colonoscopy". So that's that sorted, then.

Most refreshing of all, however, is news from the US about that most easily jettisoned of medical treasures: the foreskin. "An American bioengineering firm is using foreskins to manufacture tissue-engineered skin grafts," runs a piece brimming with optimism. "There have been reports of a dramatic recovery in cases of neonatal epidermolysis bullosa treated with them."

So, fear and paranoia can at least be offset by one source of comfort: "waste not, want not", it seems, will be an incantation repeated long into the next century.

Visit www.bmj.com for more details.