The Sixth Form Purvis Society’s new academic year took off on Thursday 17th of September by welcoming back to the School Professor Alistair Chesser. Professor Chesser, an old boy of the School, is currently a consultant kidney specialist at Barts and he chose for his title ‘The Future of Healthcare’.

Professor Chesser had his audience in the palm of his hand from the outset. He began by revealing a small part of his family tree, informing us that, as far as he could determine, he was the fifth DSC00005generation of medical doctors in his family; he had traced his medical ancestry back to 1872. Picking a great grandmother, Dr Elizabeth Sloan Chesser, who was working just over 100 years ago (and whose obituary he produced), he told us of her predictions for the next 100 years. These included the abolition of all drugs; the use of paper sheets for sleeping; the recycling of crockery; the abolition of domestic drudgery, and the use of silk underwear which was changed twice a day! He hinted that he would be building towards his own predictions for the next 100 years…

Pointing out that the world population had reached a ‘scary’ level, and adding that with more people had come greater riches, he took us back to 1000BC when life expectancy was about 25 years and he commented on how this had changed; in the future it is almost certain that the current Fourth Form can expect to live longer than the current Upper Sixth. ‘An Epidemiologic Transition’ has taken place, he told us, over the last hundred years or so with an extraordinary decline in the incidence of infectious diseases almost mirrored by a significant increase in non-infectious disease.

Visiting the well-known example of John Snow and the Broad Street pump handle affair (removed in 1854, thereby stemming a cholera epidemic), Professor Chesser suggested that advances in theDSC00006 world of epidemiology and antibiotics were responsible for the decline in infectious diseases (including TB), although he acknowledged the enormous contribution from Public Health (and, by implication, education). Vaccination had also produced extraordinary results and apparently there have been no new cases of polio in Africa over the last year… There is a darker side to the use of antibiotics, however, and he expanded on the growth of antibiotic-resistant strains of several diseases which are now presenting the health services with some serious problems: India has recently reported more than two million new cases of TB in a year. Finishing his trip through infection with a brief consideration of Ebola (”we were very lucky”), and Swine ‘Flu, he now turned his attention to what he described as the ‘Diseases of the West’.

Much to the surprise of the audience he informed us that the incidence of Coronary Heart Disease had actually fallen in the last 50 years as treatments have improved, but he was not soDSC00004 encouraging about diabetes which, he said, has increased massively. Inevitably a whole raft of associated diseases accompanies this condition. His own specialism, the kidney, was benefiting from huge advances in transplantation surgery, with his own unit carrying out about 250 procedures a year. Inevitably there is a chronic shortage of suitable donors, although there is a heartening number of altruistic donations, and anti-rejection drugs have improved so significantly that unrelated people are contributing to successful outcomes in this area. Xeno-transplants seem to be the way forward with genetically altered pigs supplying suitable material which will not be rejected by the recipient. He acknowledged that there were unforeseen viral implications, but seemed confident that these could be overcome. He also discussed the use of stem-cell therapy, illustrating this with the treatment of heart disease and the growth, in vitro, of tissues ready for implantation. Supplied with a suitable skeleton it is possible to grow replacement ears and tracheas, for example. Gene therapy and stem cells may also hold the key to the treatment of some cancers and certainly gene therapy in the treatment of Haemophilia looks very exciting.

He began to wind up his talk by suggesting that we live a long time and that the future of healthcare has to involve a massive investment in the management of dementia. Wondering about the quality of life beyond a certain stage, he floated the idea that life expectancy could, eventually, reach 200 years… Clearly healthcare has lot to look forward to.

Dr Christopher Mann