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The world 25 years from now: Where will neurosurgery be?
ELSEVIER
Editorial
THE WORLD 25 YEARS FROM WHERE WILL NEUROSURGERY
Surgical Neurology is interested in helping neurosurgeons prepare for the future. I found an article which summarizes a viewpoint of the future, and thought that our readers would enjoy its perspective. Joseph Coates, writing for The Futurist, published a collection of 83 assumptions about the year 2025 [ 11. These predictions were developed for “Project 2025: Anticipating Developments in Science and Technology and their Implications for the Corporation.” This work was sponsored by “18 large organizations in the United States and Europe . . . to explore how science and technology are likely to reshape society over the next three decades.” Se lections from this list of assumptions about the future are reproduced below.* All human diseases and disorders will have their linkages, if any, to the human genome identified . . . The intermediate biochemical processes leading to the expression of the disease. , . and its interaction with the person’s environment. . . will also have been explicated. The chemical, physiological, and genetic bases of human behavior will be generally understood. Direct, targeted interventions for disease control and individual human enhancement will be commonplace. Brain-mind manipulation technologies to control or influence emotions, learning, sensory, acuity, memory, and other psychological states will be available and in widespread use. More people in advanced countries will be living to their mid-SOS while enjoying a healthier, fuller life. Prosthesis (synthetic body parts or replacements) with more targeted drug treatments will lead to radical improvements for people who are injured [or] impaired. *Reproduced with permission from the World Future Society, 7910 Woodmont Avenue, Suite 450, Bethesda, Maryland 20814. ph: 301-656 8274; fax: 301-951-0394. 0090-3019/97/$17.00 PI1 SOO90-3019(96)00522-X
Now: BE?
5. Foods for human consumption will be more diverse as a result of agricultural genetics . . . A variety of factors will bring vegetarianism to the fore, including health, environmental, and ethical trends. 6. Genetically engineered microorganisms . . . will be used in production of. . . medicines, vaccines, drugs and in agriculture, . . . waste management, and environmental cleanup. 7. Many natural disasters, such as floods, earthquakes, and landslides, will be mitigated, controlled, or prevented. 8. There will be a worldwide, broadband network of networks based on fiber optics; other techniques, such as communications satellites, cellular, and microwave will be ancillary. Throughout the advanced nations and the middle class and prosperous crust of the developing world, face-to-face, voice-to-voice, person-to-data, and data-to-data communication will be available to any place at any time from anywhere. 9. Robots and other automated machinery will be commonplace. . . . 10. There will be universal, on-line surveys and voting in all the advanced nations. 11. Ubiquitous availability of computers will facilitate automated control and make continuing performance monitoring and evaluations of physical systems routine. 12. Totally automated factories will be common but not universal. . . . 13. Virtual-reality technologies will be commonplace for training and recreation. . . . 14. Factory-manufactured housing will be the norm in advanced nations. . , . 15. World population will be about 8.4 billion pea ple [double the present number]. 16. Birth-control technologies will be universally accepted and widely employed. . . . 17. The population of advanced nations will be older, with an average age of 41. 655 Avenue
0 1997 by Elsevier Science Inc. of the Americas, New York, NY 10010
Editorial
18. The less-developed world will be substantially younger, but will have made spotty but significant progress in reducing birth rates. However, the population of these countries will not stop growing until sometime after 2025. 19. The majority of the world’s population will be metropolitan, including people living in satellite cities clustered around metropolitan centers. 20. A worldwide middle class will emerge. Its growth [in the developing countries] will be a powerful force for political and economic stability and for some forms of democracy. 2 1. Widespread contamination by a nuclear device will have occurred either accidentally or as an act of political/military violence. 22. Despite technological advances, epidemics and mass starvation will be common occurrences [in the developing world] because of strained resources in some areas and politically motivated disruptions in others. 23. Migration throughout the world will be regulated under new international law. 24. Terrorist activity that crosses international borders will continue to be a problem. 25. A global currency will be in use. 26. English will remain the global language in business, science, technology, and entertainment. 27. In the advanced nations, life-long learning will be effectively institutionalized in schools and businesses. 28. There will be substantial, radical changes in the U.S. government. National decisions will be influenced by electronically assisted referenda. 29. . . . People will be computer literate and computer dependent. 30. Worldwide, there will be countless virtual communities based on electronic linkages. 31. Within the United States there will be a national, universal health-care system. 32. In the United States, the collapse of the Social Security system will have led to a new form of old-age security such as one based on needonly criteria. 33. Genetic screening and counseling will be universally available and its use encouraged. . . . These 33 of the 83 predictions presented by Mr. Coates represent a general projection into the future. From this abbreviated list, it is apparent that two of the major forces shaping the world’s development in the next century will be computers and genetics. How will these forces change neurosurgery? In countries all over the world, I find
Surg Neurol 1997;47:92-4
93
large numbers of neurosurgeons who are not thinking about the future but are clinging desperately to the present-which is daily becoming the past. There is a denial that change is occurring and a hope that everything will return to the comfortable past. In 1968, 28 years ago, microsurgical techniques were just being introduced to neurosurgery. The advanced imaging systems of CT and MR had not been developed. Interventional techniques to treat aneurysms and malformations were primitive; the survival of patients with medulloblastoma and glioblastoma was one-half of what it is today. Radiosurgery and endoscopic approaches to central nervous system diseases were virtually unknown. Computer-directed surgery was only a recent development. If all of these changes have occurred within the past 28 years, what might happen in the next 28? Will you be approaching diseases of the central nervous system in the future as you do now? Obviously not! Neurosurgeons are trained to deal with multiple crises, to make decisions objectively and efficiently, and to withstand many hours of this process continually while performing intellectually and technically demanding work. This training produces a conservative, risk-adverse personality, and an ego which supports a belief that the course of action taken is correct. These characteristics, which typify neurosurgeons around the world because of similar training and experiences, have also handicapped the neurosurgeon in adapting to the rapidly changing world around him. The neurosurgeon who has been trained to be selfdependent finds it difficult to surrender some individual freedom to work with others in a group practice, or even in local or national societies. The world has already been consumed by trends towards larger groups, corporations, mergers, international cooperation in business and other affairs, while the neurosurgeon is still fighting battle to maintain his or her local store. In its pages, Surgical Neurologyhas offered suggestions for dealing with the changing world scientifically and socioeconomically. Knowledge of both of these areas will be critical to neurosurgery in the future. SurgicalNeurologyhas published papers and comments from around the world on advances in specialty areas of neurosurgery from spine, pediatrics, and cerebrovascular to stereotactic and peripheral nerve surgery. Surgical Neurology has reported on the changing health care scene in many countries so that you may gain a perspective on your own problems from the problems and solu-
94
Editorial
Surg Neurol 1997:47:92-4
tions others have offered. As you approach the new year, the question you need to ask yourself as you devote your life’s work to neurosurgery and commit your family to its outcome is, “Where will neurosurgery be in the future and what will my place be in it?” To answer this question, you need to know more than what is new in neurosurgery; you need to know what is happening in the world around you.
Providing this information Surgical Neurology’s goal.
is and will continue to be
James I. Ausmau,
Editor REFERENCE 1. Coates JF. The highly probable future: 83 assumptions about the year 2025. The Futurist: July-August 1994.
I
WOULD SUM UP MY FEAR ABOUT THE FUTURE IN ONE WORD: “BORING.” AND THAT’S MY ONE FEAR: THAT EVERYTHING HAS HAPPENED; NOTHING EXCITING OR NEW OR INTERESTING IS EVER GOING TO HAPIS JUST GOING TO BE A PEN AGAIN . . . THE FUTURE VAST, CONFORMING “SUBURB OF THE SOUL.” -J.
M.D., Ph.D.
G. BALLARD (B. 1930), BRITISH AUTHOR INTERVIEW, OCTOBER 30, 1982 IN “REISEARCH,” NO. 8/9, 1984
T
HE PAST IS OF NO IMPORTANCE. THE PRESENT IS OF NO IMPORTANCE. IT IS WITH THE FUTURE THAT WE HAVE TO DEAL. FOR THE PAST IS WHAT MAN SHOULD NOT HAVE BEEN. THE PRESENT IS WHAT MAN OUGHT NOT TO BE. THE FUTURE IS WHAT ARTISTS ARE. “THE SOUL “FORTNIGHTLY
-OSCAR WILDE (1854-l 900) OF MAN UNDER SOCIALISM” REVIEW,” FEBRUARY 189 1
Editorial
THE WORLD 25 YEARS FROM WHERE WILL NEUROSURGERY
Surgical Neurology is interested in helping neurosurgeons prepare for the future. I found an article which summarizes a viewpoint of the future, and thought that our readers would enjoy its perspective. Joseph Coates, writing for The Futurist, published a collection of 83 assumptions about the year 2025 [ 11. These predictions were developed for “Project 2025: Anticipating Developments in Science and Technology and their Implications for the Corporation.” This work was sponsored by “18 large organizations in the United States and Europe . . . to explore how science and technology are likely to reshape society over the next three decades.” Se lections from this list of assumptions about the future are reproduced below.* All human diseases and disorders will have their linkages, if any, to the human genome identified . . . The intermediate biochemical processes leading to the expression of the disease. , . and its interaction with the person’s environment. . . will also have been explicated. The chemical, physiological, and genetic bases of human behavior will be generally understood. Direct, targeted interventions for disease control and individual human enhancement will be commonplace. Brain-mind manipulation technologies to control or influence emotions, learning, sensory, acuity, memory, and other psychological states will be available and in widespread use. More people in advanced countries will be living to their mid-SOS while enjoying a healthier, fuller life. Prosthesis (synthetic body parts or replacements) with more targeted drug treatments will lead to radical improvements for people who are injured [or] impaired. *Reproduced with permission from the World Future Society, 7910 Woodmont Avenue, Suite 450, Bethesda, Maryland 20814. ph: 301-656 8274; fax: 301-951-0394. 0090-3019/97/$17.00 PI1 SOO90-3019(96)00522-X
Now: BE?
5. Foods for human consumption will be more diverse as a result of agricultural genetics . . . A variety of factors will bring vegetarianism to the fore, including health, environmental, and ethical trends. 6. Genetically engineered microorganisms . . . will be used in production of. . . medicines, vaccines, drugs and in agriculture, . . . waste management, and environmental cleanup. 7. Many natural disasters, such as floods, earthquakes, and landslides, will be mitigated, controlled, or prevented. 8. There will be a worldwide, broadband network of networks based on fiber optics; other techniques, such as communications satellites, cellular, and microwave will be ancillary. Throughout the advanced nations and the middle class and prosperous crust of the developing world, face-to-face, voice-to-voice, person-to-data, and data-to-data communication will be available to any place at any time from anywhere. 9. Robots and other automated machinery will be commonplace. . . . 10. There will be universal, on-line surveys and voting in all the advanced nations. 11. Ubiquitous availability of computers will facilitate automated control and make continuing performance monitoring and evaluations of physical systems routine. 12. Totally automated factories will be common but not universal. . . . 13. Virtual-reality technologies will be commonplace for training and recreation. . . . 14. Factory-manufactured housing will be the norm in advanced nations. . , . 15. World population will be about 8.4 billion pea ple [double the present number]. 16. Birth-control technologies will be universally accepted and widely employed. . . . 17. The population of advanced nations will be older, with an average age of 41. 655 Avenue
0 1997 by Elsevier Science Inc. of the Americas, New York, NY 10010
Editorial
18. The less-developed world will be substantially younger, but will have made spotty but significant progress in reducing birth rates. However, the population of these countries will not stop growing until sometime after 2025. 19. The majority of the world’s population will be metropolitan, including people living in satellite cities clustered around metropolitan centers. 20. A worldwide middle class will emerge. Its growth [in the developing countries] will be a powerful force for political and economic stability and for some forms of democracy. 2 1. Widespread contamination by a nuclear device will have occurred either accidentally or as an act of political/military violence. 22. Despite technological advances, epidemics and mass starvation will be common occurrences [in the developing world] because of strained resources in some areas and politically motivated disruptions in others. 23. Migration throughout the world will be regulated under new international law. 24. Terrorist activity that crosses international borders will continue to be a problem. 25. A global currency will be in use. 26. English will remain the global language in business, science, technology, and entertainment. 27. In the advanced nations, life-long learning will be effectively institutionalized in schools and businesses. 28. There will be substantial, radical changes in the U.S. government. National decisions will be influenced by electronically assisted referenda. 29. . . . People will be computer literate and computer dependent. 30. Worldwide, there will be countless virtual communities based on electronic linkages. 31. Within the United States there will be a national, universal health-care system. 32. In the United States, the collapse of the Social Security system will have led to a new form of old-age security such as one based on needonly criteria. 33. Genetic screening and counseling will be universally available and its use encouraged. . . . These 33 of the 83 predictions presented by Mr. Coates represent a general projection into the future. From this abbreviated list, it is apparent that two of the major forces shaping the world’s development in the next century will be computers and genetics. How will these forces change neurosurgery? In countries all over the world, I find
Surg Neurol 1997;47:92-4
93
large numbers of neurosurgeons who are not thinking about the future but are clinging desperately to the present-which is daily becoming the past. There is a denial that change is occurring and a hope that everything will return to the comfortable past. In 1968, 28 years ago, microsurgical techniques were just being introduced to neurosurgery. The advanced imaging systems of CT and MR had not been developed. Interventional techniques to treat aneurysms and malformations were primitive; the survival of patients with medulloblastoma and glioblastoma was one-half of what it is today. Radiosurgery and endoscopic approaches to central nervous system diseases were virtually unknown. Computer-directed surgery was only a recent development. If all of these changes have occurred within the past 28 years, what might happen in the next 28? Will you be approaching diseases of the central nervous system in the future as you do now? Obviously not! Neurosurgeons are trained to deal with multiple crises, to make decisions objectively and efficiently, and to withstand many hours of this process continually while performing intellectually and technically demanding work. This training produces a conservative, risk-adverse personality, and an ego which supports a belief that the course of action taken is correct. These characteristics, which typify neurosurgeons around the world because of similar training and experiences, have also handicapped the neurosurgeon in adapting to the rapidly changing world around him. The neurosurgeon who has been trained to be selfdependent finds it difficult to surrender some individual freedom to work with others in a group practice, or even in local or national societies. The world has already been consumed by trends towards larger groups, corporations, mergers, international cooperation in business and other affairs, while the neurosurgeon is still fighting battle to maintain his or her local store. In its pages, Surgical Neurologyhas offered suggestions for dealing with the changing world scientifically and socioeconomically. Knowledge of both of these areas will be critical to neurosurgery in the future. SurgicalNeurologyhas published papers and comments from around the world on advances in specialty areas of neurosurgery from spine, pediatrics, and cerebrovascular to stereotactic and peripheral nerve surgery. Surgical Neurology has reported on the changing health care scene in many countries so that you may gain a perspective on your own problems from the problems and solu-
94
Editorial
Surg Neurol 1997:47:92-4
tions others have offered. As you approach the new year, the question you need to ask yourself as you devote your life’s work to neurosurgery and commit your family to its outcome is, “Where will neurosurgery be in the future and what will my place be in it?” To answer this question, you need to know more than what is new in neurosurgery; you need to know what is happening in the world around you.
Providing this information Surgical Neurology’s goal.
is and will continue to be
James I. Ausmau,
Editor REFERENCE 1. Coates JF. The highly probable future: 83 assumptions about the year 2025. The Futurist: July-August 1994.
I
WOULD SUM UP MY FEAR ABOUT THE FUTURE IN ONE WORD: “BORING.” AND THAT’S MY ONE FEAR: THAT EVERYTHING HAS HAPPENED; NOTHING EXCITING OR NEW OR INTERESTING IS EVER GOING TO HAPIS JUST GOING TO BE A PEN AGAIN . . . THE FUTURE VAST, CONFORMING “SUBURB OF THE SOUL.” -J.
M.D., Ph.D.
G. BALLARD (B. 1930), BRITISH AUTHOR INTERVIEW, OCTOBER 30, 1982 IN “REISEARCH,” NO. 8/9, 1984
T
HE PAST IS OF NO IMPORTANCE. THE PRESENT IS OF NO IMPORTANCE. IT IS WITH THE FUTURE THAT WE HAVE TO DEAL. FOR THE PAST IS WHAT MAN SHOULD NOT HAVE BEEN. THE PRESENT IS WHAT MAN OUGHT NOT TO BE. THE FUTURE IS WHAT ARTISTS ARE. “THE SOUL “FORTNIGHTLY
-OSCAR WILDE (1854-l 900) OF MAN UNDER SOCIALISM” REVIEW,” FEBRUARY 189 1