Dr. William Hanson has harnessed the innate love of the future in The Edge of Medicine: The Technology That Will Change Our Lives. The book is an upbeat review of technologies and scientific breakthroughs that are transforming medical care.

An interesting example is the growing phenomenon of hospital ICU telemedicine. The possibilities of improved patient outcomes through what Hanson refers to as the “eye in the sky” are significant. Telemedicine means that a specialist in a small area of medicine, such as treatment of a rare inherited disease, could be contacted, evaluate a patient with the help of local physicians, recommend treatment approaches, then perform the same service for patients on two or three other continents.

Similarly, nanotechnology works on the principle that as machines decrease in size, they can perform tasks that would have been impossible otherwise. A machine that is the size of a single cell can interact with an individual cell, or the machine may function like a cell. This might result in a “mechanical” replacement for blood, or a complex, but specific, delivery system to parts of the body. Many diseases could be treated with such a system depending on which functions such small machines could fulfill. The book also describes discoveries in microbiology and other areas that could be combined with such small machines to create “organic machines” with great capabilities.

Hanson also gives examples of how discoveries and discoverers became the “parents” of a particular device or approach. Literary and historical references are also sprinkled about and make the discussion more entertaining, interesting and easily understood. Many of the disease descriptions are written for non-medical readers, but there is a meandering quality to some chapters that detracts from their readability.

The tone of the book is a positive look into “health care’s promises.” As a futurist work it resembles the movies and futurist science fiction stories of the late 19th and early 20th centuries in being sanguine about technology and its application by humans. Hanson is not pollyannaish about the world, however, there are some factors that will heavily shape health care’s future that are not explored or are only referenced in passing.

Perhaps the biggest of these is the economics of medicine. Even if the government doesn’t take over health care in the U.S., large businesses plan to. The growth of larger and larger insurance, physician, and hospital-physician groups continues unabated. That consolidation is a driving force behind technological change. Personnel costs drive businesses toward standardization, mechanization, specialization and centralization. These topics are explored by many other writers. Discussion of them would have made this book much longer, but they may cause more changes than any others mentioned. The economics and politics of medicine may set arbitrary boundaries that may alternately constrain or promote certain technologies.

Ethics and spirituality make brief visits to the book. Hanson’s description of the status of stem cells accurately reflects the current science, but takes no position per se about the larger questions of life and its meaning. It is interesting to see how Hanson makes standard references to evolution, but also seems to endow it with intelligent design characteristics in his descriptions. In keeping with his positive outlook, he assures us that medical data can be kept private – just as banking information is kept private. Cynics can be excused a laugh, considering the rise of identity theft. A greater concern may be sophisticated use of personal medical data in ways that benefit commercial companies, but would be hard to trace to individuals.

In summary, Hanson has produced a most interesting and positive book about medical science’s possible future. I would recommend it to individuals outside of health care trying to understand the impact of science and technology on health care today and tomorrow.

Dr. Ronald Halbrooks is a doctor of internal medicine and geriatrics at the Duke University Health System in Durham, NC. Dr. John Willis is a doctor of internal medicine and rheumatology at the Doctors Hospital At White Rock Lake in Dallas, TX.