Dr. Amogh Nadkarni

Grant Government Medical College, Mumbai


The cult classic TV show, Black Mirror, described the world of San Junipero, a virtual reality dreamland aimed at giving the elderly, bed bound patients a chance of experiencing the vigor of youth once again.

As the camera pans over the last scene of the episode, the flickering chips represent the once dying residents of San Junipero trapped in a state of constant immortality, free from the bounds of life and death.

However, if researchers are to be believed, fantasy sci-fi TV shows such as Black Mirror may no longer exist in the genre of fiction.

Viarama, a Scottish company founded in 2015, aims to do just that. Armed with HTC Vive headsets and cutting edge Google VR software, the company aims to change the lives of those with Alzheimer’s disease and dementia.

Further, doctors are exploring options that might help soldiers experiencing PTSD and drug resistant schizophrenic patients to better control their hallucinations.

Foraying into the field of medicine, the FDA, by a 10-3 vote, approved the use of Sufentanil, an intranasal/sub-lingual opiod, touted by mainstream media such as Rolling Stones Magazine to be 10 times stronger than Fentanyl, or a 100 times stronger than morphine, for use in the field of moderate to severe pain following outpatient abdominal surgery. There is evidence for the efficacy of sufentanil in pain management, but evidence specific to the context of palliative care is limited. Sufentanil has been observed in small non-randomized studies and case studies to improve breakthrough pain in patients (primarily with cancer) receiving palliative care. Thus, the current use in end of life care remains off label with a need to develop and research guidelines aimed at standardizing care in that context.

Further, palliative radiotherapy, an emerging field, remains the gold standard of supportive cancer therapy, offering a viable means of management of pain and symptoms commonly associated with metastases. In the age of rising incidence of cancer due to better detection as well as environmental risk factors, radiotherapy will find prominence in radiation oncology. Not only serving as an effective diagnostic tool, palliative radiotherapy can quickly predict outcomes and tumours targeted to prevent the emergence of symptoms. Increased communication and co-ordination amongst members of a cancer care team, will go a long way in reducing the symptoms of the dreaded disease.

Ultimately, clinical technology towards the benefit of palliative care would target three avenues that form the cornerstone of any successful hospice program. Not only do predictive analytics target the right patients, but current and projected health helps in identifying the length of hospital stay and reduce treatment costs. Further, randomized studies have demonstrated a whopping 54 percent lowering of costs due to clinical technology in the field of palliation.


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