Inaugural lecture by prof. Wojciech Witkiewicz “Where is medicine going?”

Ladies and gentlemen,

today I think of the academic community of Wrocław, because medicine is an important part of that community – a very important part. This is clearly marked where we are, by the presence of sculptures located at the four corners of the terrace where three-metre-high sculptures representing allegories of the faculties stand law, medicine, philosophy and theology.

Ladies and gentlemen,

the walls of the Vatican palace are decorated with a painting entitled “The School of Athens” by Raphael Santi. The painting shows a dispute between philosophers – the greatest minds of the time. Today, people of science too – argue and draw on each other’s discoveries in the sciences, natural sciences, 2iological sciences, medical sciences and humanities.

So let me take a moment to reflect and seek an answer to the question: where is medicine going? “Quo vadis, medicina?”

For millennia, the laws of nature have been shrouded in an impenetrable shroud of mystery, fear and superstition. In the 19th century, processes of extraordinary and profound transformation began – the development of science and technology – reaching their apogee in the 20th century. It would not have succeeded if it had not been for basic science. We are in a place where science, mathematics, physics, chemistry are being developed, which are fundamentally geared towards a better understanding of the world. And meanwhile, alongside the countless human sufferings, the mad courage of the pioneer doctors, it was the development of basic science that was the main driving force behind the development of what we have in our hands today as the tools of modern medicine. Such extensive involvement in clinical practice began only 100 years ago, but the fascinating relationship between physics and medicine has a much longer history. Since ancient times, we have used physical phenomena such as heat or light to diagnose and treat illness and since the Middle Ages, thanks to an Iraqi polymath with the Latin name Alhazen, we have had science, based on experimentation. He laid the foundations for the physiology of vision. A Polish scientist of versatile abilities, the Legnica-born Wittelon, born in the early thirteenth century, also made enormous progress in this field. Although not as recognised as Alhazen, his achievements have been “rediscovered” and appreciated. In one issue of Lancent magazine, he is even portrayed as the father of vision physiology and optics, on a par with Alhazen. During the Renaissance, the first physicist and biomedical engineer appears, who is undoubtedly Leonardo da Vinci. He used physical principles to begin the quest to understand the function of the body. The result of this work was the construction of the first robotic mechanical knight. After the scientific revolution in the 17th century, some pioneers of medical physics developed a purely mechanistic approach to physiology, while others applied ideas derived from physics to understand the nature of life itself. Andreas Vesalius discovers that the heart acts as a pump, and William Harvey that blood is transported by a circulatory system driven by the heart.

At the end of the nineteenth century, the revolutionary discoveries, by Roentgen, Becquerale and Mr. and Mrs. Curie, of radiation and radioactivity ushered in a new era of radiation-based medical diagnosis and treatment. This discovery, honoured with the first Nobel Prize in Physics, led to the subsequent discovery of the helical structure of DNA, the invention of CT scans or radiotherapy for the treatment of cancer. The discovery of antimatter in 1932 led to the development of a very unique medical imaging technique, Positron Emission Tomography (PET), which today can detect cancer, Alzheimer’s disease or cardiovascular conditions at an early stage. Quantum physics and the discovery of superconductivity led to the development of magnetic resonance imaging technology, through which we obtain images of the internal structures of the human body and, more recently, of brain function. The riddle of the atom was solved, the molecule of life – DNA – was discovered and a computer was constructed. The basic laws governing matter, life and information were learned.

More information has been gathered in recent decades than in the entire history of mankind. The internet is enveloping the whole earth becoming a source and treasure trove of information. Its importance is compared to the invention of Gutenberg. The internet has transformed society into a global civilisation.

For all eternity, man has been a spectator. He could stand back and watch nature. He was adapting to its laws. Will he be its creator in the 21st century anymore?

Today, advances in medicine like never before are only possible thanks to the interaction between scientists from different fields of science. As a doctor, since the beginning of my work, I have witnessed the enormous dependence of medical progress on integrated, interdisciplinary collaboration between different scientific disciplines.

It amazes me how yesterday’s unrealistic dreams today become reality. My ideas about the future were shaped by Stanisław Lem’s science fiction literature. I dreamt of great and modern surgery. “Nothing creates the future like dreams.” I have to confess to you that my “Robot Tales” are coming true today. Surgery – once the trade of barbers and barber surgeons – has undergone an amazing transformation in the last 100 years. For more than 12 years, I have been operating with the Da Vinci robot – the most modern surgical robot in the world, which allows us doctors to operate precisely, minimally invasively, almost pushing the limits imposed by the anatomy of the human body and the limitations of our own hand. I am sure that the operating table commands of ‘Nurse, scalpel’, bloody gloves and open wounds will soon be a thing of the past. Using mechanical robotic arms equipped with surgical instruments and cameras responsible for transmitting images from inside the body, the surgeon is already able to operate from up to several hundred kilometres away from the operating table. The predictions for the use of artificial intelligence (AI) in medical robotics are also very interesting. Machine learning provides an opportunity to identify patterns that are not understood by humans. A video image of the surgical field during a robotic operation contains gigabytes of data that can be analysed using machine learning technology. The prospects for using AI in surgical training are equally interesting. The use of algorithms to assess a trainee surgeon’s progress, the quality of surgical execution and predict the risk of surgical success and failure could, in the near future, change the training system for surgeons beyond robotics. With the application of AI, the opportunity to create autonomous robots is increasing. Using machine learning, it will be possible to interpret images of the surgical field, identify and classify anatomical structures and, in the future, perform repetitive tasks autonomously.

The breakthrough in medicine and other life sciences came on 25 April 1953. This date has gone down in human history with one of the most important discoveries of science. English biochemists Crick and Watson deciphered the structure of DNA giving rise to the Central Dogma of Biology. They have climbed into the encyclopaedia of life. We know that hidden in every cell is a recipe for the restoration of the whole organism. We know, but we don’t understand, how it happens that at certain times of life, or in certain organs – some regulations are triggered and others remain dormant. This issue is dealt with by epigenetics, which looks for links between environmental impulses and the mechanisms responsible for selecting and reading genes. Today, the central dogma of biology and epigenetics are no longer questions of basic research. These disciplines combined with metabolomics are changing our perception of the human body and, as a consequence, new medical tools are being developed that are dramatically changing the concept of medical intervention. An expression of this transformation is therapies based on manipulation of nucleic acids, an example of which is the planning and production of a vaccine against COVID-19.

In 2001, 3 billion characters of human DNA – the human genome – were read and published. But it turns out that we have only just stood on the threshold of a new era, as the map of our genes reveals vast differences between humans that are greater than expected. It proves how unique we are.

By reading the genome of not only humans, but also bacteria, plants and animals, scientists have gained access to the genetic record of many species. The riddle of the evolution of life on Earth is likely to be solved soon. Genetics will allow us to better understand the origins of our species and determine our place in the animal kingdom. The more genes in common, the closer together on the evolutionary tree the organisms are. Is it any wonder that we share 40% of genes with the earthworm, 75% with the mouse, and with our closest genetic relative, the chimpanzee, we share as much as 98.4% of genes? There is a 0.05% genetic difference between parents and children, and only a 0.1% difference with one’s own wife or husband. You yourself will admit, from experience, that a small difference all too often turns out to be significant in practice. The difference between a woman and a man is only 490 bits or half a kilobyte.

A number of genetic diseases caused by the mutation of a single gene are already known. However, mankind will have to deal with diseases caused by spontaneous mutations and multi-gene inherited diseases, which will be extremely difficult, if not impossible. The guiding principle will be to detect genetic susceptibility to disease as soon as possible. Medicine will be a science focused not on treatment, but largely on prevention. The most effective and safest – and, incidentally, the cheapest – way to fight disease is always prevention. In the context of the challenges posed by the pandemic, perhaps those who are unvaccinated will look at their decision from this perspective in the absence of doctors, emergency nurses. In other words, if you don’t get sick or avoid hospitalisation thanks to the vaccine then you are realistically helping yourself and others. It will remain in the hands of the patient, who is aware of this fact, to decide how to prevent the occurrence of the disease in the future.

However, perhaps the scenario will not be so optimistic. Man uses the information he has accumulated, changes the world around him, evolves. And what is taking shape in the surrounding nature during this time? In the 1970s, due to the huge development of antibiotic treatment, the imminent end of infectious diseases was heralded. In reality, the opposite happened. Nature is also evolving, new diseases are emerging. Bacteria and viruses mutate, they evolve. Perhaps this war will continue indefinitely. Man is therefore disturbing the stable natural system, and this step can have serious consequences. Albert Einstein said: “The fate of humanity will be what it deserves”. When teaching budding doctors and students, Hippocrates warned them not to pretend infallibility. And I humbly realise today the limitations of my own knowledge. I may be very wrong about the future of medicine, but I do know one thing: Somewhere in all of us lies the dream, the myth of the philosopher’s stone, the elixir of life. Something to restore youth and give health. Medicine is certainly not giving up on this myth.

It can be said that modern medicine is a hybrid combining basic science and engineering supported by a complex and constantly evolving technical infrastructure. Ever-improving equipment and the increasing use of electronics in medicine are moving the patient further away from the doctor. This concerns me – as a doctor, as a practitioner and as an ordinary person who has experienced what illness is. Is there still a place for doctors in this integrated, hybridised world of future medicine? Can you imagine a world without doctors? Of course, many people don’t like doctor’s appointments, but perhaps there will come a time when we will long for such an appointment? The future probably belongs to ‘virtual doctors’ – automated computer programmes that will be able to correctly diagnose 95% of all common ailments. Equipped with a full record of our genes, the programme will order a course of treatment that takes into account genetic risk factors, and our health will be quietly and effortlessly monitored several times a day without inconveniencing us. The patient’s reactions, feelings, fears and anxieties have not changed, however. The patient needs personal contact with the doctor, his cordiality, his gaze and, above all, his conversation. This is because, in addition to the bodily dimension, man has a spiritual, mental and social dimension. Already Hippocrates recognised that it was necessary to treat the sick person as a whole and not just the specific disease. The doctor also needs contact with the patient. I have felt this need throughout my years of work. I felt it extremely intensely as a patient. I therefore cry out for humanism in medicine, so that the human being is not lost in this admiration and enthusiasm for the possibilities that technology brings. Because whether we use a computer, a robot or a scalpel does not change the fact that we are always treating a flesh-and-blood human being, with their spiritual and mental needs.

Ladies and gentlemen, it amazes me how yesterday’s dreams are becoming reality today. I grew up in a generation curious about technology, proud of its development and convinced of the desirability of technological progress. At a time when there were no open-access journals, no Philadelphia list or Hirsch index and the only goal behind discovery was the diligent search for truth. The pursuit of truth, passion and dedication that guided people of science at the time was the reason why a university professor, together with a doctor, occupied the first place in the rankings of prestigious professions, mainly as professions of public trust. Edith Stein, a native of Wrocław, saint, and student at this very university, said: “he who seeks the truth seeks God, even if he does not even know it, even if he does not even believe in it. An academic community according to medieval Latin – universitas – is a community of people in search of truth, which is the essence of science and, consequently, of progress. It was and is a community of individualists, but these individual paths of research have and must have a common goal, and that is the good of man. It is puzzling that today, with much greater technical, financial and human resources, 70 per cent of scientific results are not reproducible, as can be read in the journal Nature. This directly translates into slower progress in the fight against cancer and lifestyle diseases. Do we not today, in the face of such facts, lose the very meaning of science.

With regard to science, and in particular medicine, science knows what it is, but it does not always know what it should be, which is why the truths contained in Saint John Paul’s encyclicals “Fides et ratio” and “Veritatis splendor” place a wannabe thinking man’s guideposts of conscience at the crossroads of reason and faith.

In the encyclical “Fides et ratio”, Saint John Paul II addresses words of admiration and encouragement to the pioneers of science, but also calls on scientists, and I quote, “to continue their efforts without ever losing sight of the horizon of wisdom, in which scientific and technical achievements are joined by philosophical and ethical values, which are the characteristic and indispensable expression of the identity of the human person”.

Today, this human context is of particular relevance, as almost limitless perspectives, hitherto unheard of, are opening up before our eyes for medicine. Science was faced with the most difficult possible choices, which touch upon the deepest ethical and moral values that escape the legal definitions and customary practices in place to date. Moreover, choices that come dangerously close to the realm of the sacred itself.

In this race for a prolonged, well-maintained life, it is essential to skilfully balance all the needs of soul, mind and body. This is the secret to longevity in health and happiness. This sustainable development of medicine is only achievable through interdisciplinary and integrated collaboration.

So the future of medicine is also, ladies and gentlemen, in your hands, that is, in our joint efforts.