10 important medical problems with no easy solution
1. Ageing
Aging is extremely bad for people (!). Not only is it a cause of suffering, it is degrading to people who feel they are dependent on others for their basic day-to-day needs.
Sick elderly people are also extremely costly to governments. And therefore keeping them active and well, by the most cost-effective means, will reduce the burden of the elderly on society generally.
Another issue is that, in some developed countries (such as Japan), there is a falling population. Hence the number of people available for work – and thus to pay tax to fund the needs of the elderly – is rapidly declining.
If people did not suffer the declining years of old age, their healthcare (and the economy) would benefit very significantly.
2. Chronic pain
Many individuals with chronic pain conditions (like osteo- and rheumatoid arthritis) are often poorly managed; due to a lack of effective treatments and the complexities of pain perception.
3. Mental health stigma
Despite increased awareness, stigma surrounding mental health issues still prevents many from seeking help. Access to mental health services remains a challenge (being especially poor for children).
4. Heart attacks and strokes
Prevention. Despite some advances (treatment of BP and hyperlipidaemia), heart attacks (myocardial infarctions, MIs) and strokes (cerebrovascular accidents, CVAs) still occur; and are still the cause of 2/3rd of deaths in the developed world
Treatment. The modern treatment of an MI (percutaneous coronary intervention, PCI) only improves mortality 5%; and then only if carried out in the first 2 hours of the illness. Thrombolysis in stroke has no effect on mortality.
5. Cancer (some)
For some cancers – lung, oesophagus/stomach, pancreas/gall bladder, primary brain tumours, some haematological tumours – there has been little progress in modern times.
6. Antibiotic resistance
The rise of antibiotic-resistant bacteria is a significant public health concern. Efforts to address this issue through better prescribing practices and public awareness are ongoing but insufficient.
7. Socioeconomic healthcare disparities – i.e. making healthcare fairer
Significant disparities in health outcomes persist amongst different socioeconomic and racial groups; with big differences in longevity in areas near to each other (‘postcode lottery’). Addressing these disparities requires system changes that have yet to be fully realised.
Preventive care
Many individuals do not receive adequate preventive care, such as vaccinations and screenings, due to lack of awareness, education, access, or resources. This is more common in lower socioeconomic groups.
8. Chronic disease management (obesity, BP, lipids, diabetes, sleep)
While obesity is a major risk factor for various diseases, effective long-term management strategies remain elusive for many individuals.
Conditions like diabetes, hypertension and hyperlipidaemia, require ongoing management; but many patients struggle with adherence to treatment plans and lifestyle changes. Also we still do not know basic things about the causation of many chronic diseases like these. For example, we still do not know exactly what causes diabetes, why a high glucose in the blood is bad for you, or how it damages the body.
Conditions like insomnia and sleep apnoea are often underdiagnosed and undertreated, despite their significant impact on overall health.
9. Chronic degenerative neurological diseases
There are no really effective treatments for most common chronic degenerative neurological diseases.
- Dementia, including Alzheimer’s disease
- Stroke (treatment or prevention)
- Multiple sclerosis
- Motor neurone disease
- Huntington’s disease
- Muscular dystrophies.
10. Use of IT – e.g. integration of systems
Whilst telemedicine and the use of the NHS app are on the rise, there are still huge gaps in the seamless integration of IT into everyday healthcare practice. Few NHS computers link up (GP, hospital, mental health, pharmacy etc). Poor IT has a major effect on patient engagement, who get fed up with our excuses [“they are right. Amazon does it” MyHSN Ed]; and causes significant morbidity and mortality.
Other medical problems with no easy solution
- Transplantation. Despite advances in immunosuppression, most transplants have a finite life and have to be repeated. For example, deceased donor kidney transplants last only about 10 years
- Preventable medical errors. One study suggested that there are over 200,000 preventable deaths a year in the USA through medical error (Rodziewicz, 2024)). Medical errors negatively impact the patient, their family, involved clinicians and support staff, the healthcare facility, and the community. Despite a focus on patient safety, medical error was (and is) too common; and it seems to be hard to reduce the number of them. We (doctors) still find it hard to learn from error, and often repeat mistakes. Healthcare professionals also may experience profound psychological effects (e.g. anger, guilt, inadequacy, depression, and suicidal ideation) due to actual or perceived errors, which the threat of impending legal action may compound.
- Preparing for epidemics and pandemics. Airborne viruses or diseases transferred by mosquito bite can spread quickly, with potentially devastating consequences. Currently, more time and resources are spent reacting to a new strain of influenza or an outbreak of yellow fever, rather than preparing for future outbreaks. But it’s not a question of if a dangerous virus will come about – but when.
- Social care. Even though this is not a medical problem, the UK’s poor social care service has two huge effects on health of the nation:
- 20% of patients in hospital are ‘medically fit for discharge’ but unable to leave because of a lack of social care. This contributes to the well-known gridlock in UK hospitals, causing many surgical procedures to be cancelled
- It leads to poor health indirectly (poor housing, heating etc).
Summary
Other resource
Unsolved problems in medicine (wiki)
