Can we expect to live longer?

The international research community can look back over a twentieth century of enormous progress in health and medicine. Today, sciences such as molecular biology, immunology and pharmacology provide a sophisticated understanding of the human body and how it works in health and disease. We have acquired powerful tools to diagnose, treat and prevent disease. Most infectious diseases are amenable to treatment or prevention. Effective treatments are available for many diseases that were previously fatal or caused life long disability. Chronic kidney disease is treated by transplantation; many forms of leukaemia are amenable to chemotherapy; mental illness is largely treated in the community. The situation is in striking contrast with that of the early 1900s, when infectious diseases such as typhoid fever, tuberculosis, infant diarrhoea and pneumonia were major causes of death, chronic psychiatric illness meant a lifetime of custodial care, and a diagnosis of chronic kidney disease or leukaemia was a death sentence.

Australia has been a major contributor to the growth of global scientific knowledge and to its application to human welfare. It provides a case study in what has been achieved, as well as in what remains to be achieved.

Australians overall are by world standards a healthy lot: their expectation of life at birth exceeds 75 years for women and approaches it for men; fewer than ten infants die in the first month of life for every thousand live births. These and other health statistics compare favourably with those of other countries, and stand in striking contrast with Australian figures from earlier in this century.

Why have these improvements occurred? The reasons are complex. Changes in the standard of living have clearly been important, especially those factors involving nutrition, hygiene, accommodation and transport. Better organisation and delivery of health care certainly played a role. Much, however, must be related to progress in medical science and technology, to such developments as the discovery of antibiotics and of vaccines for immunisation.

In each of these aspects, Australia has played a prominent role. The Royal Flying Doctor Service, for example, led the world in its innovative approach to health care of remote and scattered communities. In medical research, Australian researchers have made outstanding contributions to world knowledge, to an extent quite out of proportion to the volume of research effort. Australians have reaped a double benefit, from the findings of that research and from the early knowledge and application of overseas advances that is made possible by the international networks and local influence of a strong research community.

The Australian commitment to research has a long history. A Brisbane physician, Joseph Bancroft, discovered the parasite that causes filariasis in 1876. The nation moved early to set up structures for the support of medical research. The Australian Institute of Tropical Medicine, the first institute of medical research in Australia, was established in Townsville in 1909, and the Walter and Eliza Hall Institute of Medical Research, established in 1916, became the premier institution in the nation. In 1936 the government set up the National Health and Medical Research Council which has become the major founding body for medical, dental and health research in Australian universities and institutes of medical research. In 1989, the Council supported 1,100 individual research grants, several institutes, numerous programs, fellows and scholars from a budget of 100 million Australian dollars.

Australian medical research has had its high points. Two Australian scientists, Sir Frank Macfarlane Burnet and Sir John Eccles, were awarded the Nobel Prize. Other scientists have earned international recognition, as for example in the important contribution made by Fenner to perhaps the most exciting development of the last twenty years, the global eradication of smallpox. The elucidation of infectious diseases indigenous to Australia led to some notable discoveries. For example, the description of Q fever by Derrick, the identification of its causative agent by Burnet and the development of an effective vaccine by Marmion. The science of immunology owes many of its insights to Australian researchers and research institutes. Indeed, it stands on an Australian hypothesis Burnet's clonal selection theory of immunity, which is recognised as one of the corner stones of modern biology.

Australians have made many discoveries of great practical importance. Early in the century, Queensland physicians proved that lead poisoning from paint was the cause of a disturbingly high prevalence of chronic kidney disease. Sir Norman Gregg discovered how infection of a pregnant mother with rubella (german measles) could cause congenital defects in the infant. Cade pioneered the use of lithium for the serious mental illness manic psychosis. Dr Kate Campbell recognised the causal association of the blinding disease retrolental fibroplasia with overuse of oxygen in the resuscitation of premature babies. More recently, Australian scientists and clinicians have contributed to technological developments in microsurgery and transplantation, and in the treatment of infertility and deafness (the "bionic ear").

This proud tradition continues in research on the very substantial challenges that remain. Cancer and heart disease account for more than half the deaths in our society. Australia shares the world's concerns with an epidemic disease unknown before 1980, and its researchers contribute more than their share of new findings about HIV and AIDS. Australia's population is ageing, and senile and pre senile dementia syndromes such as Alzheimer's disease have emerged as major problems, and therefore as major targets for research.

The progress of medicine and medical science has its disappointments. Still, in some countries, daunting problems of infectious and parasitic disease, malnutrition and overpopulation remain. In Australia, the Aboriginal population has levels of mortality and morbidity comparable with those seen in the so called developing world.

Exciting progress is, however, being made in some areas. Australia leads the world in some aspects of the search for a vaccine against malaria, still a major scourge in much of the tropical world. The technology and insights of molecular biology are being applied aggressively to all fields of medical research, with revolutionary advances in our understanding of such fields as genetics and cancer. Physiologists and bio engineers collaborate in studies of vision and hearing, and new and better tools to help the disadvantaged are on the horizon. Australian epidemiologists are taking advantage of modern computer technology to study disease in populations, and to measure subtle effects of the environment on health and disease. Australians, with the highest incidence in the world of skin cancer including melanoma, have cause to see those studies as important. Physicians, other health professionals, scientists and engineers are collaborating to produce new approaches to rehabilitation through better prostheses. Australian researchers are collaborating with industry to bring their discoveries to commercial development. A current example relates to acclaimed basic studies by Professor Don Metcalfe of the Walter and Eliza Hall Institute, of factors which stimulate the multiplication of blood cells, and to the application of those factors in the treatment of currently intractable haematological diseases.

It is not difficult to predict that this level of productive activity will continue into the future, and that the results will mean important gains for the health of Australians. It is not so easy to be specific about details. There is certainly one important direction for progress, to bring the benefits of modern medicine to all communities throughout the world. Can we or our successors expect to live longer? There may well be natural limits to the extension of the human lifespan, but gains are clearly still possible for some parts of our community, and there is room for all to live more effectively and die with greater dignity. At the other end of life, we have clearly not exhausted possibilities of assisting or controlling fertility, and of predicting, diagnosing, preventing or remedying genetic defects. We come closer each year to understanding our major enemies, heart disease and cancer, and to being able to intervene effectively to prevent or treat them. There are tempting horizons towards which we can extend the advances already made with the high technology of organ transplantation and body imaging. Perhaps even more exciting may be the advancer that we cannot predict. Just as some of the most important discoveries in the last 30 years could not have been predicted at the beginning of that time, so students graduating in the 1990s will see progress that their teachers could not imagine.

World medical research now has the tools to tackle scientific questions that were previously insoluble or indeed could not be formulated at all. The solutions to those questions will, in turn, revolutionise our capacity to treat and prevent disease. There is every reason for medical researchers to view the future with confidence, ambition and excitement. Australia is well placed to play a major part in that ambitious future. It has an established network of research units, and it has a well developed national system for their support. The basic necessities are there for a scientific thrust into the 21st century that will yield great benefits for people all over the world.

World first products and technologies in health and medicine

Public Notice: Due to an unresolved dispute with the Australian Trade Commission (Austrade), who copied and adopted as their own certain material from Tomorrow's World, the Australian Initiative, and published the material in their Australia Open for Business website, without remorse or recompense, access by Australian Government servers to this online edition has been blocked indefinitely.

Print Edition: ISBN 0646252119 - Paperback - 224 pages - 350 illustrations - $55.00 incl. GST.

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