Dawn of the New Millennium

Health care and research are advancing at an unprecedented pace as the new millennium begins. It boggles the mind to think how much has changed since 1968, when the Health Science Center's Medical School opened its doors.

In every field, researchers have added to the understanding of diseases and conditions. Babies born in 2001 are likely to enjoy healthier lives than those born in 1968 because of the remarkable science that has changed the clinical landscape. But the sky isn't completely sunny ­ some clouds, such as AIDS, spot the horizon.

Transplantation
Surgeons performed the first human heart transplant in South Africa in 1967, the year before the Health Science Center opened. A major problem with early transplants was the tendency of the body to reject the grafted organ. In the last three decades, vastly improved anti-rejection medicines have revolutionized transplantation. "The UTHSCSA transplant program has developed into a multidisciplinary transplant facility capable of caring for patients from birth to their mid-seventies," said Dr. Glenn Halff, associate professor of surgery and director of organ transplantation programs. "Our greatest limitation is no longer rejection but the scarcity of organs, which has resulted in our successful use of laparoscopic living related kidney transplants and living related liver and split-liver transplants."

Hospital care
Another sign of the times: Hospital stays have fallen dramatically over the last 30 years. "The reasons involve a combination of scientific advances and health care economics," said Dr. Steven Wartman, executive vice president for academic and health affairs and dean of the Medical School. "For example, it was typical for a patient with an uncomplicated heart attack in the 1960s to spend four weeks in the hospital, two of which were at total bed rest. Today, such patients stay less than one week and resume full activity much quicker. Also, there are many more options today for care to be given outside of the hospital setting. Based on scientific progress and the continuing need for health care costs to be contained, the future will bring, in my opinion, an exciting redesign of the hospital as we know it."

Emergency medicine
The approach to emergency medicine was different in 1968. Ambulances of that era offered less on-board care compared to today's advanced cardiac life support and other advanced strategies for treating patients soon after their need arises. "Advanced cardiac life support consensus began in 1974 and changed in 1979, 1985, 1992 and again in 2000 when it became an international agreement," said Dr. Donald Gordon, professor and chairman of the department of emergency medical technology. "The practice has evolved from empirical to evidence-based. Life saving is still dependent on prevention and time to defibrillation. In earlier days, only physicians could shock a cardiac arrest victim; now we are encouraging lay people to use Automated External Defibrillators (AED's) and have passed laws to encourage this treatment. CPR mass training is encouraged and the Health Science Center has sponsored and encouraged this training to more than 10,000 San Antonians. The goal of the American Heart Association is to decrease, by 2010, death from heart attack and stroke by 25 percent of what it was in 1999." New clot-busting drugs provide therapy to stroke patients who might have died or been severely diminished in 1968. The quicker the drugs are administered after the attack, the more chance the debilitating effects of the stroke can be reversed or minimized.

What they said 10 years ago

HIV/AIDS
When the Health Science Center opened in 1968, faculty and students had no idea they would someday be working on research that would help to control and eradicate the deadly AIDS/HIV virus. It wasn't until 1983 that the virus was first identified. By the 1990s, millions of people worldwide had been infected, and AIDS/HIV had become one of the leading causes of death in the United States. "Today, advances in research and medicine have provided physicians with powerful drugs to treat this infection. The scientific community also has made rapid advances with respect to understanding how HIV enters the cell, and this information is being used toward developing novel ways to develop vaccines," said Dr. Sunil Ahuja, associate professor in the division of infectious diseases. "We no longer view AIDS/HIV as the death sentence it once was thought to be. Now we treat it as a chronic disease like diabetes," he said.

Craniofacial implants
In the years since the Dental School opened its doors, and in fact just in the past few years, the U.S. Food and Drug Administration has approved the use of craniofacial implants that hold artificial parts of the head and neck in place. The many patients in need of artificial noses, ears and other segments of their facial structure because of accidents, birth defects and disease now rely on something better than glue.

"We have experimented for a long time with implants, but now patients are beginning to see insurance reimbursement and other advantages from FDA approval," said Dr. Mark Pigno, director of the maxillofacial prosthetics tertiary care clinic in prosthodontics. "That's probably the biggest advance in our field to date, and the next big advance will be when we are able to actually grow a new ear or nose in a patient. We can already use bone from another part of the body, thanks to advances in microvascular surgery. We can use a flap from the arm to help rebuild a tongue. Those tissues act as grafts and grow where needed. There is research to regrow teeth or other structures in animal models, but I believe it will be several years before we actually see facial parts being regrown in humans."

Schizophrenia
As the new millennium begins, three of the top ten disabling illnesses worldwide are psychiatric. And although schizophrenia still accounts for more hospital stays than almost any other diagnosis, the psychiatry and pharmacology departments here have helped bring about major improvements in treatment for schizophrenia and several other disorders including bipolar disorder and substance abuse since the departments began in 1968.

"There have been four new drugs for schizophrenia approved during the 1990s and another one is just around the corner," reported Dr. Alexander Miller, professor of psychiatry. "This university is a major player in those and other developments. Research is under way on multiple fronts including genetics, which will help us learn not only who is vulnerable to a certain illness, but who might respond to which medication. Major advances in treating schizophrenia in the future may well be earlier intervention and the development of strategies to treat negative symptoms and cognitive deficits such as lack of motivation."

Prevention
In 1968, there was no national focus on prevention and little systematic attention given to changing personal health behaviors as a way to prevent future disease, despite the fact that more than 50 percent of deaths from diseases such as lung cancer, diabetes, hypertension, heart disease and HIV/AIDS are linked to unhealthy lifestyles. Dr. Janet Allan, dean of the School of Nursing, noted that today there is a major focus both in research and in clinical practice on health behavior and lifestyle change. "Of critical importance in focusing the nation on health was the 1979 landmark report, Healthy People, The Surgeon General's Report on Health Promotion and Disease Prevention, which introduced a set of broad national goals for improving the health of Americans by 1990. Just this year, Healthy People 2010 was published," she said.

Genetics
The Human Genome Project, started in the 1990s, has almost come to fruition. It is one of the most visible products of a technological revolution in science. "Recombinant DNA techniques, including the polymerase chain reaction (PCR), have permitted advances that were heretofore impossible," said Dr. Bettie Sue Masters, professor in the department of biochemistry. "The technologies allowing rapid and accurate sequencing of genes and proteins have been key in the Human Genome Project and are essential ingredients in the proteomics era, in which the proteins for which these genes encode are identified and characterized."

Techniques such as high-resolution nuclear magnetic resonance spectroscopy (NMR) and x-ray crystallography are the tools used for three-dimensional structural determination, she said. This work is necessary for understanding mechanisms and for designing drugs for specific protein and enzyme targets. "We have these capabilities as of the past year on this campus," Dr. Masters added. Indeed, the knowledge generated by the Human Genome Project is certain to have a profound impact on future generations. "Advances in genetic analysis now make it likely that within a decade we will be able to generate unique DNA fingerprints that will provide comprehensive pictures of all the variant genes unique for an individual, with the accompanying information with respect to health and disease," said Dr. Jan Vijg, professor of physiology.

Neuroscience
Brain imaging was in its infancy 30 years ago, but today researchers employing instruments such as PET and MRI are gleaning important kernels of knowledge about disorders as varied as stuttering, epilepsy, depression and Parkinson's disease. "Thirty years ago, non-invasive imaging of the brain of a live human was limited to computer-assisted tomography (CAT) scans for anatomy and to the electroencephalograph (EEG) for function," said Dr. Lawrence Parsons, assistant professor at UTHSC's Research Imaging Center. "Much more powerful methods have since emerged, including positron emission tomography (PET), functional and anatomical magnetic resonance imaging (MRI), magnetoencephalography (MEG), and event-related electrical potentials (ERP). Brain images now provide much finer, more comprehensive information about brain function and anatomy, with little or no known associated health risk during image acquisition. These new methods are combined with current techniques in neurophysiology, cognitive psychology, pharmacology, neurology, biochemistry, molecular biology, psychiatry and medicine. The result has been a revolution in the basic understanding of the brain and in clinical neuroscience, one heralded by the founding on January 1, 2001, of a new institute in the National Institutes of Health dedicated to biomedical imaging." [Editor's note: Dr. Parsons is referring to the National Institute of Biomedical Imaging and Bioengineering.]

Health informatics
In 1968, most health reference information was contained in textbooks and libraries were contained in bricks and mortar with collections on shelves. But an electronic explosion has taken place. Technology and the information superhighway have changed the way information is provided and accessed. "The information available to health providers and consumers via the Internet has increased significantly," said Dr. Virginia Bowden, Briscoe Library director. "By licensing as many electronic journals and databases as possible, libraries are adapting with the times to provide the most current information where it is needed, in offices and homes. In addition to reference materials, the ability to transmit patient data will continue to improve until it is a common occurrence for care providers to share charts and diagnostic images even over hundreds of miles."

Aging
With the march of time and as the American population statistically grows older, greater emphasis has been placed on studies of conditions linked with aging. Since 1968, the number of elderly people (65 years and older) in the United States has increased 75 percent, from 20 million to 35 million. Dr. Arlan Richardson, director of the Aging Research and Education Center and career research scientist at the South Texas Veterans Health Care System, said: "This increase in the number of elderly will be even more dramatic during the next 30 years when the number of elderly in the United States will double to 70 million. In Texas, the number of elderly is expected to almost triple. This projected increase in the number of elderly citizens makes it imperative that we find experimental strategies to retard aging and improve the quality of life for our senior citizens."