2050 look-ahead: Same diseases, new approaches mostly ahead for health care sector

Editor’s note: Almost one-fourth of the way through this century, TribLive is looking ahead to the next 25 years, using the events of the past 25 as a road map of what possibly is to come. This installment of the occasional series looks at health.

Pam Surano knew it would be a tough — or even nearly impossible — road ahead when her 13-year-old daughter, Mary Maloney, suffered a rare spinal stroke following a trampoline accident in 2020.

“The past four years have been indescribably difficult, and at other times, an exciting journey of faith that continues to unfold,” Surano said. “The most difficult part was not knowing what in the world we were going to do to help Mary walk again.

“There weren’t many options locally, and some of the options that were available were far away.”

But the aid of a new robotic exoskeleton, available at Allegheny Health Network Suburban in Bellevue, is giving Mary, and other patients, another opportunity to be mobile.

The equipment, called EksoNR, is the first FDA-cleared robotic exoskeleton for patients with stroke and spinal cord injury, and the only one cleared for acquired brain injury and multiple sclerosis patients, AHN officials say.

The suit is adjustable and can fit people’s limb lengths and hip widths, said Andy McGuigan, director of strategic accounts for the California-based EksoBionics. The equipment is the first of its kind in the Pittsburgh area, and only 240 exist nationwide.

Putting one foot in front of the other, and with the assistance of hospital therapists, Mary demonstrated the equipment during a news event Friday at AHN Suburban.

“The software is dynamically adjusting automatically” to the patient, McGuigan said. The smart technology supplements the work a therapist does and, more importantly, assists the patient’s needs, McGuigan said.

The community and EksoBionics rallied around Mary and her family to get the equipment to Pittsburgh.

“It’s giving them another thera­peutic tool to allow them to do standing exercises, walking exercises, other things that would not have been possible before, locally,” said AHN’s Dr. Gary Hoover. “It’s exciting that patients will not have to travel throughout the country in search of therapeutic tools such as this.”

Hoover said the exoskeleton not only helps people walk, it also helps strengthen their lower extremities, manages spasms and helps with range of motion, and prevents other complications from acute or chronic neurological diagnoses.

Mary, 18, of Cranberry said she’s been blessed to receive support from the community to be able to rehab with the exoskeleton. She started using it in December.

“It’s so mind-blowing and strong, and it’s smart, and it works with you,” Mary said of the equipment. “You just feel this glimmer of hope, and it gives you the strength you need, and it compensates for you until you learn how to do it yourself. It was just incredible.”

McGuigan said his company plans to expand the types of patients the equipment could assist, as well as its availability in the country.

“The sky’s the limit,” he said.

What does the future hold?

The past few decades were a sobering reminder, at least for Americans, that health and longevity do not inevitably improve with time.

Even as medical care spending ballooned from $1.4 trillion at the turn of the millennium to $4.9 trillion in 2023, life expectancy in the U.S. failed to keep pace with that of other high-income countries.

The rates of fatal drug overdoses, suicides and similar causes of death became so pervasive that a new term, “deaths of despair,” emerged.

And covid-19 not only killed more than 1.2 million Americans, it accelerated the rise of mis- and disinformation that, in turn, undermined confidence in medical professionals and their expertise.

By several key measures, Americans didn’t get a whole lot healthier over the past 25 years.

Conversations with medical experts reveal some wariness about what the next 25 years have in store. The upcoming quarter-century, they say, could bring new diseases, disorienting technologies and the ever-present profit motive squeezing more out of patients and providers.

But it’s not all doom and gloom. More effective, accessible treatment also could be on the horizon. Optimism, after all, is a trick of the trade.

“We don’t have a choice in public health — I am always hopeful,” said Maureen Lichtveld, dean of the University of Pittsburgh’s School of Public Health. “My hope is strengthened because of the realization that we cannot do it alone.”

Technology and communication

For better or worse, many health workers and researchers foresee an increasingly interconnected world. That could result in technological innovations or new communication tools as well as shared burdens, such as climate change or global pandemics.

Beth Hoffman, also of Pitt’s School of Public Health, studies how health misinformation can take root on social media.

“Health communication used to be putting up billboards, putting out pamphlets. And now there’s a whole field of social media communication, website creation, TikTok videos,” Hoffman said. “It can be great to have information transmitted so rapidly, but it becomes challenging to sift out what’s true information from false information.”

Social media, often blamed for zapping attention spans with scrolling and quick-hit videos, also has changed patients’ perspective, according to Kristen Sandel, president of the Pennsylvania Medical Society, a group advocating for the state’s doctors.

“We live in a society that is very fast moving,” Sandel said. “People want information, and they want treatment as fast as possible … whereas some of these medical workups and the treatment take a significantly longer period of time.”

Some medical visits can now be conducted without patients ever having to get face-to-face with a doctor. Telehealth, popularized during the pandemic, has stuck around even as the health risks of in-person visits have diminished.

Research from consulting firm McKinsey found that up to 17% of medical visits were conducted virtually in 2023.

Artificial intelligence chatbots also have been used to handle basic communication with patients, while algorithms are tasked with suggesting diagnoses before doctors could ever spot the signs, Sandel noted.

Remote nursing also is being tested at some hospitals, such as AHN Forbes Hospital in Monroeville.

These nurses handle simple tasks, like monitoring vitals or admitting patients, to free up the limited number of nurses on a given floor.

Industry trends

As exciting as these innovations may be, they do expose the degree to which hospitals, in particular, have struggled to fill all kinds of positions.

Frustrations have long simmered among hospital employees in the Pittsburgh area.

As of early December, more than 1,000 UPMC nurses signed an open letter to executives demanding better staffing, pay raises and additional paid time off.

Nurses are fleeing these roles, said Wayne Reich Jr., CEO of the Pennsylvania State Nurses Association, in favor of advanced degrees or jobs away from the bedside because of overwhelming patient loads.

Reich is hopeful for a few solutions: One, ordinary people will pressure health care networks to improve patient-to-provider ratios; and two, younger nurses won’t put up with these staffing woes.

“If we had all the nurses we needed, I still don’t think hospitals would staff appropriately,” he said.

Reich’s comment reflects Americans’ generally dismal view of their health care system.

Gallup polls have found every year since 2000 that more respondents have a negative view of the sector than a positive one — except for 2020, when the onset of widespread covid-19 transmission gave rise to health care hero rhetoric.

Sprawling conglomerates, such as UPMC and Allegheny Health Network, and the related struggles of independent hospitals could be contributing to these unfavorable sentiments.

Just this week, Sharon Regional Medical Center shuttered after multiple acquisition attempts fell through, leaving Mercer County without around-the-clock emergency heart care. Several hospitals in Butler and Clarion counties likely avoided that fate in 2022 by combining into Independence Health System.

Another 360 or so rural hospitals nationwide are teetering, according to an August report from the Center for Healthcare Quality and Payment Reform.

Andrew Simpson, a history professor at Duquesne University who studies the health care system, expects consolidation and the uncertain landscape he believes is driving this trend to continue in the coming years.

The passage of the American Care Act in 2010 injected uneasiness into the market, he said, leading to defensive mergers and acquisitions among hospitals. With a second Trump administration likely to go after “Obamacare,” networks could take that as another sign to find a buyer or purchase a competitor.

“At least in the short run, I think you’ll see continued merger activity, not just within hospitals, but within the larger health care sector in the U.S.,” he said. “I think you’ll continue to see Pittsburgh’s largest health systems … look toward ways to continue growing, but also ways to control expenses and ensure solid revenue streams.”

Caring for patients

Many of the same diseases that plagued Americans in 2000 have stubbornly stuck around.

In no particular order, heart disease, cancer, stroke, chronic respiratory disease and unintentional injury were the top five killers of Americans in 2000 and again in 2023, according to the Centers for Disease Control and Prevention.

Unintentional injuries, including overdoses, rose from the fifth- to the third-leading cause of death over than span.

Covid-19 briefly broke into the top five before falling to the No. 10 spot in the latest report.

Lichtveld, the public health dean at Pitt, is concerned that infectious diseases could surge as the climate warms and extends the range of disease vectors, such as mosquitoes. Dengue, a hemorrhagic fever historically found in tropical countries, was reported in three states as well as Puerto Rico and the U.S. Virgin Islands last year.

“People ask me what’s the biggest public health threat that’s facing us,” she said. “I don’t have to think. It’s climate.”

As for obesity, another public health crisis of the 21st century, Lichtveld is a believer in GLP-1 drugs, like Ozempic, to help with weight loss. But addressing social determinants of health will be what truly combats obesity and other chronic diseases in the coming years, she said.

“A medication can drop my weight by 30 pounds, but can I then afford to eat healthy? Can I then afford to walk more often? Will I stop going to fast food companies?” she said. “The reason why we have so many chronic diseases is we don’t pay attention to the risk factors.”