The Intensive Care Unit of the Future

The ultimate future of critical care medicine is surprisingly easy to predict with certainty. The difference between a healthy person and ill one can be reduced to the difference in the way their atoms are arranged. From a broken bone to a broken strand of DNA, illness is ultimately reducible to how the structures that embody life are configured and interact with each other. Today's clinicians can only affect events going on in their patients at the molecular level mostly in indirect ways. We have a little specificity, but no precision. We can introduce molecules (drugs) that turn or on or off certain genes, activate certain molecular mechanisms, or derange or shut down others. Antibiotics do this to flora we consider undesirable or out of control in the patient. Steroids and many other drugs signal genes or, like the pressors, more immediately act on cell machinery. We can poison metabolism and disrupt DNA with chemotherapy and radiation, but we lack the ability, at least clinically, to reset the DNA of a neoplastic cell to its healthy state.