The Intensive Care Unit of the Future

  • Mike Darwin
  • Brian Wowk

The ultimate future of critical care medicine is surprisingly easy to predict with certainty. The difference between a healthy person and ill one can be reduced to the difference in the way their atoms are arranged. From a broken bone to a broken strand of DNA, illness is ultimately reducible to how the structures that embody life are configured and interact with each other. Today's clinicians can only affect events going on in their patients at the molecular level mostly in indirect ways. We have a little specificity, but no precision. We can introduce molecules (drugs) that turn or on or off certain genes, activate certain molecular mechanisms, or derange or shut down others. Antibiotics do this to flora we consider undesirable or out of control in the patient. Steroids and many other drugs signal genes or, like the pressors, more immediately act on cell machinery. We can poison metabolism and disrupt DNA with chemotherapy and radiation, but we lack the ability, at least clinically, to reset the DNA of a neoplastic cell to its healthy state.


Intensive Care Unit Sensor Array Zhongshan Hospital Cowpea Mosaic Virus Image Courtesy 
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  1. 1.
    Drexler KE. Engines of creation. New York: Doubleday; 1986. Available at:
  2. 2.
    Binnig G, Rohrer H, et al. Tunneling through a controllable vacuum gap. Appl Phys Lett 1982;40:178–180.CrossRefGoogle Scholar
  3. 3.
    Drexler KE. Nanosystems: molecular machinery, manufacturing, and computation. New York: Wiley Interscience; 1992.Google Scholar
  4. 4.
    Sapsford KE, Soto CM, et al. A cowpea mosaic virus nanoscaffold for multiplexed antibody conjugation: application as an immunoassay tracer. Biosens Bioelectron 2005;21:1668–1673.CrossRefPubMedGoogle Scholar
  5. 5.
    Lin T, Johnson, JE, et al. Structure-based engineering of an icosahedral virus for nanomedicine and nanotechnology. The Scripps Institute Scientific Report. La Jolla, CA: Scripps Institute; 2004.Google Scholar
  6. 6.
    Clarke AC. Peacetime uses for V-2; V-2 for ionosphere research? Wireless World. February1945:58.Google Scholar
  7. 7.
    Thomas L. Lives of a cell. New York: Viking Press; 1974:299.Google Scholar
  8. 8.
    Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004;32:1408–1409.CrossRefGoogle Scholar
  9. 9.
    Chalfin DB, Cohen IL, Lanken PN. The economics and cost-effectiveness of critical care medicine. Intensive Care Med 1995;21:952–961.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee R, Tuljapurkar S. Death and taxes: longer life, consumption, and social security. Demography 1997;34:67–81.CrossRefPubMedGoogle Scholar
  11. 11.
    de Grey ADNJ, Ames BN, et al. Time to talk SENS: critiquing the immutability of human aging. Ann N Y Acad Sci 2002;959:452–462.PubMedGoogle Scholar
  12. 12.
    Hayflick L. How and why we age. Westminister, MD: Ballantine Books; 1996.Google Scholar
  13. 13.
    Holmes OW. The one horse shay and its companion poems. Cambridge, MA: Houghton, Mifflin and Company, The Riverside Press; 1892.Google Scholar
  14. 14.
    Kurzweil R. The law of accelerating returns. Available at:
  15. 15.
    Becker GS. Get the FDA out of the way, and drug prices will drop. Business Week. September 16, 2002:16.Google Scholar
  16. 16.
    The Cato Institute Handbook for the 105th Congress. Section 32. Washington, DC: Cato Institute; 1997. Available at:–32.html.
  17. 17.
    Smith P. Arrows of mercy. Toronto: Doubleday; 1969:178.Google Scholar
  18. 18.
    Lindsay J. Harold Griffiths and the introduction of curare. J Can Med Assoc 1991;144:588–589.Google Scholar
  19. 19.
    Meyer JA. Werner Forssman and cardiac catherterization of the heart. Ann Thorac Surg 1990;49:497–499.PubMedCrossRefGoogle Scholar
  20. 20.
    Gott VL. King of hearts: the true story of the maverick who pioneered open heart surgery. New York: Crown Publishers; 2000.Google Scholar
  21. 21.
    Pietzman SJ. Chronic dialysis and dialysis doctors in the United States: a nephrologist-historian’s perspective. Semin Dialysis 2001;14:200–208.CrossRefGoogle Scholar
  22. 22.
    Dialysis Corporation of America Annual Report (10-K) for Dec 31, 2004.Google Scholar
  23. 23.
    Committee on Metabolic Monitoring for Military Field Applications, Standing Committee on Military Nutrition Research. Monitoring metabolic status: predicting decrements in physiological and cognitive performance. Washington, DC: National Academy Press; 2004.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Mike Darwin
    • 1
  • Brian Wowk
    • 2
  1. 1.Independent Critical Care ConsultantAsh ForkUSA
  2. 2.Senior Scientist, 21st Century Medicine, Inc.Rancho CucamongaUSA

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