Positive prognosis: nanoterminators that destroy cancer at its root, prosthetics controlled by our brains, personalized drugs and high-tech house calls will transform how we heal and stay well.

• Author: Martin, Edward
• Position: The Future of North Carolina: HEALTH CARE

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They shudder at the sight of him, even the seasoned surgeons. Long delayed, the bridge over the Haw River north of Greensboro, which had been scheduled for completion four years earlier in 2022, was nearly finished when an accident brutally mangled a worker's face. Only from family photographs could the team of doctors determine what he had looked like. Days later, the worker lies anesthetized in a cocoon-like operating room. His images have been mapped by computers vastly more powerful than those 11 years earlier in 2015 when Wake Forest University's Institute for Regenerative Medicine, as part of a $75 million military project, began researching how to re-create skin, cartilage, bone and muscle of the faces of soldiers who suffered devastating combat wounds. 3-D printers have used cells from his body to replicate the worker's features. Now, the surgeons transplant his face. Dramas of similar scale unfold elsewhere. Microscopic robots course through bodies, seeking hidden cancer. Soon, doctors expect to use technology similar to that of re-creating the worker's face to print out whole, implantable hearts.

Only then, in year 2026, will a soul-wrenching and often futile medical chapter common a decade earlier finally have been closed. Hearts regenerated from patients' own tissue will "eliminate the need for donors and the need to take anti-rejection drugs," says Sanjeev Gulati, medical director of heart failure and transplant services of Carolinas Healthcare System's Sanger Heart & Vascular Institute in Charlotte.

A preview of Tar Heel health care a decade in the future is not science fiction. Pioneers at Wake Forest Baptist Medical Center have grown and implanted bladders, vaginas, male urethras and other organs and body parts, says spokeswoman Karen Richardson. Personalized drugs that can target an individual's particular genetic makeup, developed by GlaxoSmithKline PLC and other Tar Heel pharmaceutical companies, are already in use but will be multiple times more precise. Even research will be revolutionized, with "body on a chip," miniaturized human organs, enabling scientists to test new drugs more accurately than using laboratory animals. In medicine, a decade is like an eternity.

"If you turn back the clock 10 years, the technologies we see today would be hard to imagine," says Terry Akin, CEO of Greensboro-based Cone Health. In 2026, Carolinians might simply pass through scanners that determine if they're predisposed to diseases such as diabetes long before there are symptoms. "We're not that far away now," says Robert Seligson, CEO of the North Carolina Medical Society, which represents more than 12,000 state doctors. "At least, certainly not for those of us who grew up on Dick Tracy with his wrist TV and The Jetsons."

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It is by no means a cloudless future. As the amazing becomes routine, many physicians, insurers and others expect magnified conflicts between dazzling possibilities of technology and sobering realities of cost, access and ethics. By 2026, more than 2.1 million North Carolinians will be at least 65, an increase of 36% from present, predicts state demographer Jennifer Song. They're the focus of nearly universal agreement: Geriatrics will be the single most profound factor confronting health care.

"One prediction I'll make with 100% certainty," says Jonathan Oberlander, professor of social medicine and health policy and management at UNC Chapel Hill. "Ten years from now, there will be much, much more care and attention to the medical needs of elderly Americans. We have a long-term care system that's a mess, a nursing-home system that's a mess, and we're not doing a good enough job preparing doctors to go into...