Future of Neurology

[Dr Linta]

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What do you guys think is in store for the future of Neruology?
Considering the technological and medical research advances we've had within the last decade, do you think neurology will be one of the top and most desired specialities within the medical field?
Alzheimer's, parkinson's, MS, etc. I feel as though we are one breakthrough away from being able to cure these diseases. I also think that there is so much more about the human brain that is unknown. It wasn't until recently that we discovered serotonin, norepinephrine, phenylethylamine etc.
I also believe that neurology will be one of the top paid professions in the world by 2030 or so. I've seen some research projects involving chip implantations and being able to control a keyboard and mouse with ones own brain. Surely, neurology would play a huge part in this role as well.


On a sub-topic, does anyone else believe that in the near future Psychiatry and Neurology will be combined within one practice?

 

[typhoonegator]

If we knew what the future would hold, I'd be off making money selling futures on it.

The concept that we are "one step away" from "curing" these diseases is unfortunately way off. I spend most of my time doing research, and I can tell you that it is far more evolutionary than revolutionary. My work overlaps with and involves AD research from a systems biology standpoint, and the amount we still don't understand is staggering and humbling.

Projects like BrainGate (which you mentioned) are very interesting, and the PI is, in fact, a neurologist. However, it remains very preliminary at this point, and advancement relies as much on advances in engineering and software/hardware development as neurology.

Equating the fascinating research and advances in neurology to future remuneration in the field is tricky. Salaries are much more derived by the payment structure endorsed by Medicare and insurance companies, which care little these days for advances in pathobiology. Unless the cure for Alzheimer disease comes with the need for weekly infusions or other procedures, it's hard to see how it will change our position with respect to reimbursement. Yes, the population is aging, and yes, many will develop neurodegerative diseases of some sort, but it is hard to see how those returning-patient office visits will translate to our rise to a top salaried specialty.

Truth is, as physicians we are already way outside the first standard deviation for salaries within the United States. So I suppose your statement is actually correct from that standpoint.

Neurology and Psychiatry share much overlap in some areas of clinical practice, and remarkably little in others. Beyond that, in most universities, they are fully separate departments, with separate faculties, research budgets, and physical spaces. They receive NIH funding from different sources. Their labs occupy separate spaces. It would be very difficult to put that genie back in the bottle at this point, because someone would have to make extreme sacrifices to make it happen, for no discernible advantage. Also, from a training standpoint it would be a nightmare, as I don't know many psychiatrists that are interested in doing acute stroke care, and I wouldn't be caught dead doing a 3AM capacity evaluation.

I'm pleased that you are enthusiastic about the field, and I'm not here to pour water on you (although it seems I just did). I would encourage you to remain optimistic and interested in neurology, but do it because you love the questions, the advances, and the uncertainty; not because you think we might be on the brink of monetization or a rise in desirability. These things vary with time, and are subject to market whims that lack consistency, particularly in today's world.

 

[Dr Linta]

Great post!
I agree with pretty much everything you said and value your opinion higher considering your association with medical research.

Besides BrainGate, what's your opinion on Dr. Keirsteads spinal-cord research
with stem-cell rehabilitation?

I agree that we are still far from curing many of these diseases; however, it wasn't until last week that we found out there is a sub-particle of a neuron that is faster than the speed of light which brings up the notion of the existence and possibility of time travel as well as opening our views to other aspects of physics and astronomy. So, in reality, it really does take one big discovery to cure multiple if not even just one disease. I believe within the next 10 or so years we will find a cure to one of the diseases mentioned in the first post.


By the way, I had a couple of questions with regards to neurology.
I hear neurology is the hardest of all medical specialities in terms of memorization. How many terms does a neurologist actually have to know? Also, which organ systems, muscles and bones do neurologists have to know?
I saw this site and was mind-boggled:

http://www.strokecenter.org/education/glossary.html#w

 

[soulofmpatel]

Dr. Linda:

1) I agree with typhoonegator in that we are not close to "curing" the neurological diseases you mention. Medical knowledge increases exponentially with time, but this does not necessarily correlate with health outcomes.

For instance, in the field of interventional cardiology, there has been extensive developement in the fields of bioprosthetics, advanced imaging techniques, and evidence based practice, but I can still confidently make the following two claims:

a) aspirin has saved more lives and myocardial tissue than cardiac catheterization ever has or ever will

b) Good diet and regular exercise is more beneficial to the health of the average person than having access to a cardiologist.

The media gives the average person a warped sense of the medical advancements and tends to exaggerate medical progress in a myopic and unpragmatic way.

I do believe that there may be significant advancements in multiple sclerosis and possibly parkinsonism, but I'm not so optimistic about dementia.

In alzheimer disease, there are multiple degenerative processes ocurring simultaneously at the cellular level. Current treatments are relatively ineffective, and attempts to combat the actual etiology of the disease like amyloid vaccines have failed misreably. Even if we had a perfect understanding of alzheimer disease (which I'm sure typhoonegator is much closer to than myself), how do we intend on intevening effectively.

If we had the power to alter everything that we could understand, we could potentially treat down syndrome and duchenne muscular dystrophy (good luck with that).

I am more optimistic about diseases like amyotrophic lateral sclerosis where the etiology is less clear.

Personally, I don't think we can count on a significant lengthening of the human lifespan due to medical advances in the next 100-200 years (though it's difficult to predict).

2) I don't think that neurology and psychiatry will join together. The overall trend is towards specialization and subspecialization. I do believe that we may gain greater understanding of psychiatric diseases in terms of neuroanatomy/neurophysiology/neuromicrobiology.

3) I wouldn't say that learning neurology is harder than learning other medical specialties in terms of memorization.

4) Do you have a link to an article about the subatomic particle in neurons that travels faster than the speed of light?

 

[neuroint]

I disagree with the previous posts about memorization in neurology being particularly onerous. I find is similar to the surgical specialities which require an understanding of the anatomy. Like any medical speciality, the information is continually refreshed and by mid career one looks like a guru.

Regarding the future, some of the new endovascular technology is pretty cool! Check it out here.

http://youtu.be/1wx9fj-R-0s

 

[danielmd06]

I hear neurology is the hardest of all medical specialities in terms of memorization. How many terms does a neurologist actually have to know? Also, which organ systems, muscles and bones do neurologists have to know?
I saw this site and was mind-boggled:

http://www.strokecenter.org/education/glossary.html#w

Neurology is sometimes considered "harder" by people who didn't really have good neurology and neuroanatomy lectures in medical school, but it's no more difficult than most specialties.

I personally found the kindey to be the most difficult organ to try and understand (and still do).

Regardless, do it for the love of the subject matter and it will always be fun no matter what specialty you pick.