Headlines in medicine have been daunting in recent years: a global pandemic, physician shortages, and research funding cuts. But many experienced practitioners know that these headlines don’t reflect a hidden truth: we are experiencing one of the most exciting eras ever for medical advancements and patient care. My specialty, dermatology, is indicative of what is occurring across health care: thanks to dedicated practitioners, ongoing research, and technological advancements, patients who once had very limited options now have access to treatments that dramatically improve their function, comfort, health, and quality of life. For those who are still waiting for better answers, meaningful progress is underway.
Like many specialties, dermatology has changed dramatically over the past quarter century, and those changes matter deeply for anyone living with a skin condition. Going back 25 years or so, options for many inflammatory and immune-related skin diseases were limited, treatments were often only partially effective, and researchers had very little data to guide new therapies. It was not long ago that we hospitalized patients for skin diseases — indeed some centers, including one in NYC that I visited in the '90s, had wards and beds full of severely ill people suffering greatly, as many as 30 beds full in some places. Today, that rarely happens — and the field is full of momentum, innovation, and real optimism.
The newest generation of biologic medicines has sped research progress across many diseases. We may have psoriasis to thank for that: the disease can be easily seen and measured, which helped researchers understand how well these new biologic treatments worked, paving the way for advances in other skin conditions. What started as early steps in psoriasis eventually helped open doors for better therapies in eczema, hidradenitis suppurativa (HS), alopecia areata, vitiligo, and acne — and other complex conditions are beginning to benefit too. Melanoma is a special and extraordinary story — after decades of advanced disease being a death sentence, we have seen patients come back from the brink, and now we can treat even disease that has spread effectively in many cases. Biologic therapies, mostly antibodies or receptors targeted to discrete components of the immune system, have been particularly important in creating new levels of efficacy with reassuring levels of safety.
One of the clearest examples of how far we’ve come is HS. For more than a century, doctors debated what caused this painful, debilitating condition. Real progress took time, but in the past decade, the field has finally begun to move quickly, with multiple new treatments approved and more promising options in late-stage trials. For patients who have lived for years without good choices, this new wave of research represents a major shift — proof that investment, persistence, and scientific curiosity can change lives.
Across medicine, researchers are now looking for the next breakthroughs: exploring rare inflammatory diseases, pediatric conditions, and disorders where the immune system plays an unexpected role. Families affected by genetic conditions or chronic inflammatory diseases may see more options in the years ahead as researchers uncover new pathways and rethink old assumptions. At the same time, the way clinical trials are conducted is improving. While early in adoption still, remote visits and digital tools make it possible for some patients to participate for the first time, and make things easier for all patients who may no longer have to leave their house or office to participate in trials. EHRs help identify people who may benefit from joining a study on a scale never before possible. And researchers are also finding smarter ways to analyze results so studies can be more efficient and require fewer unnecessary procedures. These behind-the-scenes changes help bring treatments to patients faster, and often with lower costs and less burden.
Of course, there are still challenges. Research funding in the U.S. has been cut, in some places drastically. The number of research sites and investigators is limited. Some regulations can be complicated for patients and investigators to navigate. And early trials can struggle to include enough participants to answer key questions. But awareness of these issues has led to new collaborative efforts to streamline studies and make participation more patient-friendly.
Looking ahead, technology will play a growing role. Artificial intelligence may help design better drugs, understand images more precisely, and simplify the paperwork that has long slowed research. Better imaging tools and point-of-care testing will likely allow faster diagnosis and more personalized treatment decisions. And real-world data — information collected from everyday medical care — may soon help doctors understand how well treatments work outside of clinical trials.
This is an extraordinary time for patients, and continued collaboration among doctors, scientists, industry partners, and patient communities will keep pushing the field forward. The future of patient health is brighter than ever — and one thing that hasn’t changed is that we all have an eye on the prize: progress for patients.
What do you consider the most important medical innovation of the past 25 years? Share in the comments!
Alexa B. Kimball, MD, MPH, is president and CEO, Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center.
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Collage by April Brust
