Читать книгу Fundamentals of Treatment Planning - Lino Calvani - Страница 13
ОглавлениеPast, present, and future of treatment planning
“Those who do not learn from history are doomed to repeat it.”
George Santayana (1863–1952)
“The past should be read with the eyes of present time.”
Charles Darwin (1809–1882)
“The past is never dead. It’s not even past.”
William Faulkner (1897–1962)
The author believes it is important to understand history not so much as a chronicle of events but in terms of the value we attach to and derive from these events. In this way, we arrive at the significance of the events. When we look back, we understand that for long millennia our civilization was not able to conceive or understand much about science, as we know it today. Certainly, in the distant past, people had absolutely no idea what they were doing when treating physical disease and illness.1-4 But once in a while, a gifted individual with a ‘beautiful mind’ sensed something new, and in this way our knowledge was carried a step or two forward. Slowly there developed the understanding and acknowledgment that the causes of illness and disease were not so much ‘divine’ as they were natural or human-made, and this understanding was the route to healing them. Of course, the first medical treatments were simple natural herbal remedies, primitive bandages and cream prototypes, coupled with attempts of a philosophical or religious nature to explain and justify all incomprehensible events by relating them to the will of a moody God.5-7
In more recent history, after the ‘static’ middle ages (from a medical point of view), an increasing awareness of scientific evidence over the past five centuries has allowed for a better understanding of the mechanics of our nature and of the ‘innate consciousness’ and ‘self-awareness’ that distinguishes us as a species.8-10 However, compared with other sciences, the development of medicine, including dental medicine, was more difficult because those bright-minded individuals who became involved had to face not only the extreme complexity and difficulty of the subject matter of the human body and mind, but also the limitations imposed by the endless short-sighted and ignorant doctrines of the time.11-13 The intelligent nature of humans means that we need to trust in order to understand; trusting in science means that in time science will explain everything, whereas trusting in a religious sense (having faith) means believing that God will take care of everything. Historically, the development of medical treatment planning has been strongly influenced by this.14,15 Nevertheless, over the last two centuries, science finally gained its autonomy from religion, and today the two areas of human endeavor are separate, to the obvious advantage of medicine.
An important aspect of the renaissance of medical science was the contribution scientists made to laying the anatomical foundations for the understanding of the cause-and-effect relationship that exists in the human body, and how the various parts of the body function and malfunction in relation to each other. This had profound implications for the development of clinical and surgical therapies. This cause-and-effect relationship can be seen as the initial basis for the current treatment planning rationale. Nevertheless, despite all efforts, ignorance about medicine among the general public was rife because society was disconnected and disorganized, and it was difficult and often impossible to teach and impart new medical knowledge and trends. At that time, medical treatment planning was largely unknown, and to the extent that it did exist, it was very primitive and poorly understood. Therefore, due to almost no true medical understanding, epidemics, traumas, infections, and cancers indiscriminately killed hundreds of millions of people. It took other two centuries before anatomy, physiology, and pathology became actual sciences, and the word ‘treatment’ became a medical term.
So, regardless of all the clever minds, poor transport and communication meant that people were isolated and led an insular way of life. Medicine itself was still largely based on old, inaccurate, and often imaginary notions. Medical practitioners were on the whole pompously dressed, incapable ignoramuses, trying to describe nonexistent diseases with useless Latin words. Original paintings of this medical class show images of fantastic methods and therapies full of enemas, leeches, ointments, and draught potions that were invented and concocted to ‘cure’ all ailments and diseases.4,16
Only during the 17th and 18th centuries did physicists and chemists boost the curiosity of many people, so that people started to believe that they could follow in the footsteps of these scientists in all scientific matters, driven by their then brand-new practice of scientific research methods and the pursuit of evidence of reality theories. This indirectly contributed to the speeding up of the understanding of medical science and treatment planning. Indeed, probably without realizing it, physicists and chemists at that time were changing the way people thought about medical science.
It can therefore be said that medical treatment planning has its origins in scientists attempting to prove that formulas could explain all scientific elements and, indeed, the world. Over time, it became clear that signs and symptoms were useful and necessary to make a correct diagnosis of illness and disease. In fact, medical treatment planning is entirely based on scientific methodology and evidence. However, while physics, astronomy, mathematics, and biology were progressing at a rapid pace, scarce technologies and immature methods limited people’s knowledge of the human body, no matter how curious they were. Also, the slow pace of life and very limited social contact meant that it was difficult to spread news, which created many problems.4,16,17
During the 19th century, medical scientists looking for scientific evidence and using the new scientific instruments of the time discovered more ways to heal and cure, which were perfected with time and passion, although many essential notions were lacking, and there was still no precise understanding of treatment planning.13,18 Universities and medical and dental medical schools began to open and flourish in the USA and in other parts of the developed world, for example, the Baltimore College of Dental Surgery was founded in 1840, the Philadelphia College of Dental Surgery in 1842, Tufts Dental School in 1852, Harvard Dental School in 1867, and the University of Michigan in 1875. Passionate researchers and clinicians started to create the basis of actual medical and dental medical scientific treatments.19 So, by the turn of the 20th century, official medical and dental medical science was starting to be oriented toward what we know today as ‘assessed methodology.’ The study of anatomy was acknowledged as the basis for understanding medicine, and investigations into the body’s functions and malfunctions started to drive more organized and critical laboratory research and clinical practice.18,20 Scientists’ curiosity and eagerness for clarification drove them to begin to look for ‘evidence’ as the starting point. The worst of the religious influence on medicine was part of the past.
While the 20th century gifted us with geniuses such as Albert Einstein (1879–1955), it also plagued us with two devastating world wars, which had a significant influence on the development of treatment planning in the west. About 20 million lives were lost in the First World War (1914–1918), and about 68 million in the Second World War (1939–1945). Apart from the death toll, war means all kinds of terrible injuries, physical and psychologic, created by all types of weapons. It means traumas, wounds, burns, disfigurements, and epidemics.
The world wars profoundly changed the lives of our grandparents and parents, and forced medical science to find surgical, clinical, and pharmacological solutions to address the sudden, terrible, and urgent traumas they caused. The wide range of injuries and infections, many of them never seen before, meant that the understanding about how to plan the treatment of patients accelerated, both during emergencies on the battlefields and in the clinic.
In addition, the 1918 influenza epidemic (known as the Spanish Flu), largely brought on by the unhygienic conditions of the First World War, left roughly 50 million dead worldwide. Therefore, the total death toll in the almost 50-year period spanning both world wars was about 125 million people, not to mention the millions more who were seriously injured in these wars and who died prematurely later on. On top of this, other local wars and epidemics followed, bringing the death toll to some 13% to 14% of the entire world population at that time.21,22-24
Due to these events, and thanks to the increased number of dedicated medical scientists and facilities, improved communication and media, and the growing body of scientific and medical knowledge that had been slowly accumulating over centuries, medical science made a great leap forward in the first part of the 20th century. The level of awareness and consciousness regarding medical treatment and its planning increased rapidly during that time, bringing a deeper understanding of the importance of knowledge about medical procedures and being well organized in the planning of treatment (this includes dental medicine and prosthodontic treatment planning, even though the latter is not always that well defined).25-27
Population growth is another important factor in the development of treatment planning. Over the last three millennia, the human population has increased from about 50 million to 7.5 billion people. Parallel to this is the increase in the number of scientists and thinkers who have dedicated their lives to solving medical problems, which has escalated the number of possibilities for furthering medical and dental medical science.28,29 Inventions and discoveries that make possible the forward movement of science and medicine are not made so much by specific individuals as by the collective knowledge and awareness that accumulates over time.30-34 This is known as ‘collective intelligence,’ which expands exponentially all the time, thereby increasing the possibility of more and more discoveries that lead to better medical understanding. For instance, about a century ago there would have been few, if any, physicists who properly understood Einstein’s theories. Today, hundreds of thousands of students easily do, and thanks largely to the internet, their contributions to science are easily and quickly spread throughout the world. Just a century ago, only a few physicians knew what an antibiotic was, and thousands of people died of bacterial infections. Today, most people know about antibiotics and millions of people take them, often autonomously and without careful prescription (which has unfortunately also resulted in an alarming and increasing physiologic resistance to them).
This ties in with another important factor in the understanding of the development of treatment planning, which is communication and the media, particularly the internet and smart phones.17,35-37 Since the two world wars (and therefore in less than a century), information about medical science has rapidly increased, and has been shared among millions of medical and dental professionals. This means that the panorama of clinical planning and treatment is continually changing and evolving.
‘Hyper-science’ and the future
When the famous physicist Niels Bohr (1885–1962) was asked to make predictions about the future, he said humorously: “Predictions are very difficult, especially about the future.” Every small scientific step forward changes our understanding of how to plan and treat medical conditions. However, despite how technology today allows for easy online access for most people to medical research, data, literature, and information, human endeavor remains crucial and necessary.
Currently, data acquisition and processing speeds seem to depend on a number of disruptive ‘innovation platforms’ that cut across sectors and markets and converge on each other on the medical stage, such as:
1. 5G and 6G internet connections.
2. Micro and macro energy storage for industry, farming, transportation, cities, etc.
3. Plasma and quantum computers; liquid, nano-magnetic, and graphene transistors.
4. Artificial intelligence (AI), artificial narrow intelligence (ANI), artificial general intelligence (AGI), deep-learning software (DLS), and self-learning software (SLS).
5. Collaborative robotics and humanoids.
6. Computer-aided design/computer-aided manufacturing (CAD/CAM) and 3D printing.
7. DNA sequencing and CRISPR therapeutic genome editing.
8. Nanotechnologies.
‘Hyper-science’ (author’s own word) seems an appropriate composite word for these revolutionary technologies and the current rapid growth of scientific knowledge. As never before, the progress of science is accelerating, and capabilities and possibilities are increasingly opening up. Which is why the medical progress indicators predict that medical and dental schools will structurally change in the near future under the pressure of digital innovations.38-44
A clear example of the above is the new, cheaper DNA sequencing and CRISPR genome editing that is enabling scientists to develop new types of diagnostic screens, tests, and therapies. Computational techniques are changing our schools and educational programs constantly, with the three-dimensional resources of virtual reality (VR) and augmented reality (AR) changing the way students and faculty interact, including the interaction with robots.45-54 Nanotechnology is increasingly being used to treat patients. Predictions made on solid scientific bases foresee that, two or three decades from now, well-programmed super-intelligent ANI, and well-instructed human-dependent or independent AGI machines as well as AGI humanoid robotized digital doctors and caregivers will clinically treat patients suffering from an increasing variety of diseases and will also feature in the laboratory. These machines will be able to handle programmable and injectable chemotherapeutical nanorobots and nanocarriers. They will be much faster and, in many ways, more capable than humans to do the job of medical care providers.25,41,55-58 We will refer to them with trust when we are ill or wounded.
Knowledge, consciousness, and indeed our entire way of living and working are being revolutionized. One only has to attend medical and dental medical meetings, conferences, and expos all over the world to see where the market is now and where it is heading, and how much money is involved. Human history has always demonstrated that whatever we are capable of imagining, we are capable of achieving. Digital science has come a long way, being completely free today of any religious constraints that might prevent it from progressing.
Currently, there is much hyper-scientific intelligent curiosity and imagination at work.59 An exciting example is the newest IBM Watson Machine Learning, which harnesses machine learning and deep learning in a way that enables the management of an infinite amount of data. It gives flexible answers, insights, and possible solutions in many different fields of human endeavor, and is already useful to medical professionals in various fields of health care. For treatment planning, for instance, it can be used for collecting and reading scientific literature published in many languages. When asked about a specific disease or illness, it can promptly give one or more answers, propose a fitting diagnosis, and suggest various treatment options according to clinical facts, scientific evidence, and statistics. It can also design program interventions.60
However, despite all future AI digital capabilities and skills, the logic of treatment planning, with its basic and complex algorithms, will always constitute the common scientific foundation of medical, dental medical, and prosthodontic treatment and its planning.
Fig 1-1 The birth and growth of medical examination, diagnosis, and treatment planning in western civilization. The first real scientific impulse occurred in 1500, with curiosity for the unknown and for medicine following until the end of 1700, when scientific evidence changed the schools and universities and gave birth to empirical knowledge and scientific research.
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