Several trends have dominated health care in the years since the 23rd edition of Taber’s was published. These have included advances in our understanding of aging, cancer care, epidemics, informatics, and nutrition, among many others.
The most prominent mega-trend affecting health care might well be that world populations are growing older every year. The consequences of an aging society are diverse—and they clearly make better geroscience and the development of senolytics important emphases of future research. Older societies are sicker than young ones, making health care for patients and professionals more complex each year. Older people have more severe impairments, and regrettably, longer disabled lifespans. Impaired speech perception, dementias (including the newly identified type 3 diabetes, limbic-predominant age-related encephalopathy, and prodromal dementia), late-life, treatment-resistant depression, and vascular depression are increasing concerns in older people. As we learn more about these conditions our ability to provide better practical care for older individuals improves. Home modifications, group exercise, and functional fitness training help with many of the musculoskeletal difficulties encountered in aging, as may other rehabilitative approaches to improving balance and walking speed (the next vital sign?).
Technological achievements have also profoundly altered the environment of care in the last several years, and they are likely to impact its immediate future. Wearable technologies like smart watches now aid in the diagnosis and monitoring of cardiac rhythm disturbances. Superhuman computer processing speeds have given birth to startling advances in computer-aided diagnosis, for example in complex image interpretation in radiomics. But will chatbots, e-consults, machine learning, and remote access ultimately make us feel more connected to our health, or will they undermine the social identity of caregivers? Have we fallen prey to automation bias? Technology in the health care workplace burns brightly, but it also burns many people out. Among its unwanted effects: health care professionals now bury their faces in noctilucent screens reading bloated notes, dreading computer downtimes and programmed hard stops, complaining they now practice desktop medicine, instead of bedside medicine.
The search for better nutritional is another care concern. Is the best way to eat a fasting-mimicking diet? A heritage diet? A plant-based diet? A flexitarian or a sustainable diet? At least two facts about how we nourish ourselves seem clear: Pro-inflammatory diets should be avoided, and to reverse the impact of obesity on heart, liver, lung, and endocrine function (e.g. by achieving diabetic remission) millions of people need to eat less, eat healthier, and exercise more.
International defenses against biohazards and epidemics regularly leap to the forefront of our ecoanxious consciousnesses. As the novel coronavirus that was first identified in Wuhan, China demonstrated, pre-positioning of public health resources is often inadequate when spillover events from animals to humans occur. Hot spots may require urgent medical countermeasures especially when the relative infectivity and virulence of pathogens prove immediately dangerous to life and health.
Finally, the field of oncology (cancerology) has experienced remarkable changes in the last several years, owing in large part to better understanding of the molecular biology of cancers. Many new agents inhibit the growth of cancers, including bcl-2 inhibitors, and histone deacetylase, immune check point, JAK, PD-L1 and 2, and PI3K inhibitors. These treatments, and chimeric antigen receptor (CAR) T-cell therapies are succinctly explained in this edition. Will tumor evasion someday be overcome? Can treatments that are both well-tolerated and tissue agnostic be developed? Will genetic engineering techniques such as CRISPR/cas9 help us evade the propensity for serious illnesses like cancer?
The terms highlighted in italics in this introduction are a very small sampling of the new entries added to this 24th edition of Taber’s Cyclopedic Medical Dictionary. Our true north is to provide a reference you can use to improve both your knowledge and patient care skills. We try to edit out the bulk and misinformation of Internet-based references, limit myside bias, and advance your continuing professional development. To do this we rely on your feedback. Please let us know how we can make Taber’s ever better suited to your educational, lexical, and professional needs.
Donald Venes, M.D., M.S.J., F.A.C.P.
Thank you, April!