Telemedicine (in progress)

I have looked at how technology is changing the way physicians deal with the most common killers, the costs associated with these advances, ethical concerns, cotton candy, and a rethinking of how drugs are introduced into our systems, but telemedicine is a recent, if not a cutting-edge, flashy breakthrough, that could change the relationship, that many of us take for granted, between a doctor and a patient. According to the Journal of Postgraduate Medicine [1] “The purpose for which telemedicine is used may be categorised as one or a combination of the following: clinical, educational and administrative,” but for the purposes of my treatment-oriented thesis, I will examine only the clinical aspects of telemedicine. Telemedicine was born off advancements in communications technologies, and there are a several reasons why we never think about it. There are two hospitals and a handful of private clinics within a twenty minute drive from my house, and likely many of my classmates, but in many parts of the country and world, this is not the case.

[1] Smith AC, Bensink M, Armfield N, Stillman J, Caffery L. Telemedicine and rural health care applications. J Postgrad Med 2005;51:286-93

Cotton Candy

Now I could use some input.

My original intent was to explore “to what extent, (will) 21st century medicine be defined by increasingly sophisticated technology?”

I’ve hit a few major specific applications with surgery emphasis and coronary artery disease, but I don’t want my paper to simply go down the list of diseases, although I guess I could do that. Also,  I’ve looked at some cost and ethics, but where should I go now? Perhaps deeper into treatment/economics/ethics or somewhere new?

Maybe cotton candy? This might make it into my paper, as it could be great introductory material.  You are witnessing my thought process typed out. It helps. Please still advise me, but I have an idea where I could go: Here. By looking into “telemedicine” I could look into the changing relationship between patients and their doctors and applications in rural areas.  I’m feeling better about this again.

Post Blog: I didn’t watch the entire video yet, I can hardly expect you to, and in fact I discourage being too curious until I look into it more. There appeared to be some  flesh-cutting in the beginning so skip over that if you are eating.

Personal Source

Hopefully soon I will be able to post content from someone with more experience in the medical field, such as Dr. Yount. I want to know how technology has changed his work, and where it’s going from here. I know he’s a busy guy though, so I may have to move on to something else temporarily.

Goals and TMR

My intent with the focus on coronary heart disease is to examine how technology is changing how we deal with the “big players” as far as health hazards. My original intent, to examine to what degree 21^st century medicine will be defined by technology will be hard to measure, so instead of simply saying “ a lot” I’m hoping to show how it is changing different steps of the treatment process and how it is changing things that affect many of us. Ethical concerns will also be given some consideration in my paper, because as with nanotechnology which we’ve looked at, there are some new questions out there.

I’ll now continue with the treatment of coronary artery disease.  In addition to new medications that are being used to treat coronary artery disease, new transmyocardial revascularization laser technology being tested at Cornell University Medical College may brighten the outlook for those with the disease. Researchers studying the hearts of alligators and snakes were inspired by what they witnessed with blood from the ventricles proceeding directly to the heart without traveling through the coronary arteries. Such as we saw in diagnosis, sometimes patients aren’t up to invasive procedures or will experience minimal effectiveness such as patients with diabetes. TMR lasers that are currently employed are limited by the need for mirrors and other rigid procedures to carefully craft passageways for blood to flow in the heart, but the new technology is changing that with fiberoptics. Not only does the new manner of laser direction ease the difficulty of procedure on surgeons it also reduces the occurrence of air embolism, in which air enters into the bloodstream, and stroke. According to the American Heart Association, “how TMR reduces angina still isn’t fully understood” (angina being chest pain caused by lack of sufficient blood flow through the heart muscle), and the process has been FDA approved only for those with “no other treatment options”. I was left wondering why that is with its high success rate (80-90% incidence of pain reduction) and seemingly less invasive incision into the chest, but coronary artery bypass surgery is simply still the most systemic treatment of the condition. While it cannot be the solution to coronary artery disease, TMR is able to reduce the pain that the diseased must deal with. Because it is not completely understood, naturally there are skeptics who believe that the success of the procedure is no more than a placebo effect, but so far in the short-term things are looking up for treating pain associated with this widespread condition.

http://nyp.org/news/hospital/tmr-laser.html

http://www.texasheartinstitute.org/hic/topics/proced/tmlrs.cfm

http://www.americanheart.org/presenter.jhtml?identifier=4782

Coronary Heart Disease Part 1:diagnosis

Heart disease is the leading cause of death in the U.S. and coronary artery disease its most prevalent form. I would like to investigate how advances in medical technology are changing the way medical professionals approach diagnosing and treating this all to common killer. It is interesting to note in progress we have made diagnosing coronary artery the disease the story that seems to run through all medicine and indeed much of technology—something new comes along and suddenly the old way that was once revolutionary seems archaic and its risks unnecessary. Assuredly, the new technology I am exploring will perhaps quickly seem outdated and ineffective, but during its time it too saved lives. The old manner of detection is angiography, and specialized MRI is the new.  The heart, like the brain, is another area of the human body where invasive procedures are less than desirable, but angiography, the long-time method that was in the past more effective then noninvasive alternatives, used to diagnose coronary artery disease required just that. Physicians insert a catheter into a blood vessel in a patient’s thigh or arm (sigh of relief) and moved into the heart where it releases a contrasting agent that allows doctors to observe blood flow using X-ray imaging. Loosened black and build-up along the artery walls could actually lead to stroke or heart attack, and even more probable would be damage to the heart. Thankfully, computer advancements have now equipped a new-and-improved MRI, which was once unable to replicate the constant motion around the heart, to do the job. No longer will diagnosis of artery disease be a balancing act between gaining key information about a patient’s condition and doing “no harm”. More to come.

MRI of the heart

Sources:

http://www.technologyreview.com/read_article.aspx?id=17065&ch=biotech

STEALTH

This entry will be largely from my own experience. After the opportunity to view two craniotomies at Memorial with Dr. Robert Yount, my interest in medical technology grew incredibly. The procedure involved removing a portion of the skull to extract tumors from inside the brain, and as you can imagine, anytime you are working inside the brain there are consequences. I remember Dr. Yount telling me after removing a back portion of the skull covering the occipital lobe and the dura, the skin-like membrane that covers the brain, “so far I have done no damage to the patient, but I’m about to as I go into the brain.” Fortunately for these patients, Dr. Yount utilizes the latest computer navigation-assisted technologies that enable neurosurgeons to minimize invasiveness and therefore damage to the brain (or spine) so the worst they could expect would be some minor, peripheral, and hopefully temporary vision loss. It’s called the STEALTH system and it enables surgeons like Dr. Yount to apply three-dimensional CT and MRI scans to the spatial situation of the patient in the operating room. The technology even registers the probe used to mark a point of entry and gives surgeons real-time readings of their percentage error away from the direct route to the tumor and also allows them to perfect their “angle of attack”. No longer are surgeons merely referencing scans but interacting with them in a manner that greatly improves the speed and precision of the operation. Minutes after the portions of their skulls had been replaced and secured the patients awoke and began communicating.

STEALTH Display

Source:

http://www.neurospinewi.com/newsletters/stealthsystem.html

Nanotechnology:Cost and Ethics

I’ve explored ways in which nanotechnology will be used, and now I’ve stumbled on some articles discussing nanotechnology and politics.  I mean to look into some of the negative aspects of all this technology, but as far cost, I didn’t find it. Medical technology and technological research in the healthcare industry account for only 25% of costs (compared to factors such as the 48% linked with “reduced competition from providers”), and while I’m not here to debate for or against healthcare reform, this clears up an assumption that I had that growing costs were associated with recent breakthroughs in technology. Unnecessary testing however, is considered a large cost with $700 billion associate with it (by the Progressive Policy Insitute) and nanotechnology could change that. Nanoparticles have the potential to improve medical imaging such as MRI tests, and consumer diagnostic equipment could become an industry of its own, but in the long run save Americans money. “These technologies are best classified as nano-enabled microtechnologies and offer new capabilities such as in-home diagnostics and personalized testing that could eliminate unnecessary spending and simplify the process and application of many medical tests,” writes Jeff Morse of InterNano. Things are really looking up for nanotechnology and its implementation in medical equipment at this point, but as I expect with many of the frontiers I look into, there are ethical concerns.

Nanomedicine can be used for treatment of diseases with its drug-delivering nanodiamonds, but what about the usage of nanomaterials to improve ourselves? Maybe the future’s competitive athletes will use nanoparticles to soothe muscular inflammation (ibuprofen on steroids?) to gain an edge (Mark McGuire on steroids?) and it will only expand from there. Robert Freitas, a researcher at Molecular Manufacturing says it better than I can, ““on a long term perspective nanotechnology envisages not only the creation of autonomous nanomachines to be used inside the human body but the enhancement and even transformation of the human body and human identity particularly in case they were used to modify the human brain.” Clearly, the great enthusiasm of this technology will also be matched by heated opposition as it progresses.

Sources:

Nanotechnology Changing the Status Quo in the Healthcare Industry

http://www.internano.org/content/view/307/251/

Politics and Nanotechnology in the Health Care Industry

http://pubs.acs.org/doi/full/10.1021/nn9013609

Nanotechnology in Medicine – Nanomedicine

http://www.understandingnano.com/medicine.html

Ethical Aspects of Nanotechnology in Medicine

http://www.bioethicsinternational.org/blog/2008/01/10/ethical-aspects-of-nanotechnology-in-medicine/

Nanodiamonds

Exploring the different types of “medical technology” seems as good a place as any to start. My original intent was to deal with the machines and diagnostic tools in operating rooms around the world, but there are exciting things going on at a smaller level. I have read about the breakthroughs in genetics and stem cells, and I’ve decided to start off on the microscale, or actually nanoscale. I recall reading months ago about research at Northwestern University using nanodiamonds as a means of delivering drugs throughout the body, and sure enough, it’s all very relevant to my project. I could do an entire exit project just on these therapeutic nanodiamonds, but I will limit them to showcasing the impact of technology on medicine at a cellular level.

There seem to be  several advantages that nanodiamonds have over traditional drug-delivering agents. Their crystalline structure provides them with maximum surface area and therefore maximum carrying capacity, and according to genetic testing done on cells that have encountered the diamonds, they pose no measurable threats to cells after delivering drugs. Most importantly however, they release the drugs very slowly and not until the clusters of diamonds have reached their target, which limits the otherwise blanket killing of unhealthy and healthy cells alike by the often toxic treatment of cancerous cells.

Nanodiamonds will not be limited to delivering drugs however, as described in second article that details their effectiveness as “contrast agents” used for MRIs.  Again, the main advantage of these diamonds is their crystalline structure and non-toxicity. They play well with our other cells.

Sources:

http://www.mccormick.northwestern.edu/news/articles/311

http://www.sciencedaily.com/releases/2010/01/100114143327.htm

Some work I did last year.

Conor Dorgan

Ms. Graf/Mr. Sauer

American Studies

March 25, 2009

Penicillin and the Birth of Modern Medicine

Although Ian Fleming is commonly acknowledged as discovering penicillin, a mold that attacks many bacterial forms without harming other cells, it is not so often recognized that his accidental discovery may never have brought about the drug as we know it without Ernst Chain’s discovery in 1938 of a paper Fleming had written ( Bowler 452). Chain’s work developing the antibiotic with Howard Florey would launch penicillin, and medicine in general, into unimagined territory (Bowler 452). As satirized in a cartoon on cartoonstock.com ( The cartoon reads: penicillin is called the ‘wonder drug’ because any time the doctor wonders what you have got, that’s what you get), the drug has enjoyed widespread use and popularity, but these are only small aspects of its influence. As the harbinger of today’s antibiotics, penicillin has defined modern medical practice, birthed a multi-billion dollar pharmaceutical industry, and fundamentally changed the American lifestyle.

Today’s general practitioners have Penicillin to thank for their role in the medical community. Born in Greece in 460. A.D., Hippocrates, commonly attributed as being the father of medicine, was the founder and representative of a medicinal school of thought that valued an approach based on observation and logic, rather than the mythological superstitions that were popular at the time (Delvey). In short, Hippocrates was one of the world’s first physicians and his philosophy was not unlike the wellness and lifestyle trend of today. “[Hippocrates] believed in the natural healing process of rest, a good diet, fresh air and cleanliness” according to Josephine Delvey of San Jose State University, and this personable, wellness-based style of diagnosis continued until the 20^th century, when, with the popularization of Penicillin, the role of the physician fundamentally changed.  In Robert Bud’s Penicillin: Triumph and Tragedy, Bud illustrates how one drug legitimized an industry and shifted the role of the doctor to encompass, and be dominated by, pharmaceutical prescription. During WWII, penicillin helped to save “countless lives” (Steinert) and its wartime success and global use treating a variety of formerly lethal bacteria created “ [a brand that] seemed the very model of the means by which post-war aspirations of a break from the suffering of pre-war days could be achieved” (Bud 214) and the effect, according to Swedish professor Gunnar Biorck, was “more hospitals, more group practices, less individual medicine” (Bud). With new technology and funding (Bud), now there was an industry. Physicians were no longer the freelance, personable professionals of Hippocrates’ time onward, but were agents to satisfy the public’s craze for antibiotics and effectively all pharmaceuticals due to what Bud describes as penicillin’s assimilation into patients’ trust and “life worlds”. By the end of the century, this “cultural branding” would create a multi-billion dollar industry (Gatyas and Savage).

“The pharmaceuticals market is one of the most profitable sectors in the global economy” according to Adriana Petryna, Andrew Lakoff, and Arthur Kleinman in Global Pharmaceuticals.  The industry is expected to exceed $820 billion in sales in 2009 according to IMS Health (Gatyas and Savage) and despite economic slowdown is “reflecting sustained double-digit growth in key emerging countries.” Antibiotics are responsible for the growth of the entire industry, but in the case of developing countries, antibiotics maintain significant application as well. “ [The] need for antibiotics is driven by the high incidence of infectious disease” (Okeke, Lamikanra, and Edelman), to the extent that “antibiotic resistance” has become an issue. Health care spending in developed countries, however, remains strong. In the U.S., government spending under the broader healthcare industry exceeds $1 trillion (Chantrill). Whether they like it or not, officials are forced to comply with the force described by Robert Budd as the “pressure of modern expectations” placed on them by the public. At what point does spending based on the public’s affection for early antibiotics become superfluous health care consumerism? This pharmaceutical fervor married with consumerist tendencies was to change American lifestyle.

The rise of pharmaceuticals has created new American attitudes and a new lifestyle in the 21^st century. In his book High Level Wellness: An Alternative to Doctors, Drugs, and Disease, Donald Ardell, P.h.d., argues “Modern medicine is a wonderful thing but there are two problems: People expect too much of it, and too little of themselves.” Antibiotics have reduced the occurrence of former killers such as Pneumonia, but in the process of trivializing treatment, are Americans trivializing their own health? Have we lost the wellness values Hippocrates swore by in his foundation of modern medicine? “Increasingly, [Americans] treat [health care] like everything else” claims David Gratzer, in an editorial in the San Francisco Examiner, “They expect to get what they want, when they want it”. This redefinition of health as a product that can be bought is taking its toll on Americans’ habits.  Childhood obesity rose from 5% of the American population to 17% between 1980-2004 (Levi, Juliano, and Segal 3) and the number of Americans who suffer sleep deprivation “moderately to severely” is 40% (Statistics:). Both of these conditions have the potential to cause disease according to the Mayo Clinic. Treatments of disease have been idolized while prevention has been ignored. It may seem a stretch that penicillin is causing Americans disease, but by creating the pharmaceutical industry, penicillin created the means by which a consumerist society could devalue their own health to dangerously low levels.

Neither Fleming, who discovered penicillin, nor Merck, the company who first sold it commercially (Bowler 454) could have foreseen the influence the drug would have on America and the world. Penicillin would change the role of the physician from a personal, wellness mentor to a clinical diagnostic tool and prescriptive agent. Within half a century it was responsible for a multi-billion dollar industry driven by both public and government demand, as well as bringing about a negative consumerist image of health and wellness.

Works Cited

Bowler, Peter J., and Iwan Rhys Morus. Making Modern Science A Historical Survey. New York: University Of Chicago P, 2005.

Bud, Robert. Penicillin Triumph and Tragedy. New York: Oxford UP, USA, 2007.

Chantrill, Christopher. “US Health Care Spending 1792-2014 – Charts.” Federal Spending, State and Local Public Spending 1792-2014 – Charts. June 2008. 12 Mar. 2009 <http://www.usgovernmentspending.com/us_health_care_spending_10.html#usgs30210&gt;

Gatyas, Gary, and Clive Savage. “News Releases – IMS Health Forecasts 4.5 &acirc;€“ 5.5 Perc – IMS Health.” IMS Health-Intellgence. Applied. 29 Oct. 2008. IMS. 12 Mar. 2009 <http://www.imshealth.com/portal/site/imshealth/menuitem.a46c6d4df3db4b3d88f611019418c22a/?vgnextoid=9e553599b554d110VgnVCM100000ed152ca2RCRD&vgnextfmt=default&gt;.

Gratzer, David. “Consumerism: A Prescription for Change.” The Examiner [San Francisco] 2 Feb. 2007: 1-1.

“Heart disease: Causes – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 28 Jan. 2009. Mayo Clinic. 12 Mar. 2009 <http://www.mayoclinic.com/health/heart-disease/DS01120/DSECTION=causes&gt;.

Delvey, Josephine. “Hippocrates.” San Jos&eacute; State University – Powering Silicon Valley. 12 Mar. 2009 <http://www.sjsu.edu/depts/Museum/hippoc.html&gt;.

Levi, Jeffrey, Chrissie Juliano, and Laura Segal. Trust for America’s Health – Preventing Epidemics. Protecting People. Aug. 2006. 12 Mar. 2009 <http://healthyamericans.org/reports/obesity2006/Obesity2006Report.pdf&gt;.

Petryna, Adriana, Andrew Lakoff, and Arthur Kleinman. Global Pharmeceuticals Ethics, Markets, Practices. New York: Duke UP, 2006.

Okeke, Iruka N., Adebayo Lamikanra, and Robert Edelman. “Socioeconomic and Behavioral Factors Leading to Acquired Bacterial Resistance toAntibiotics in Developing Countries.” Centers for Disease Control and Prevention. Mar. 2009. 12 Mar. 2009 <http://www.cdc.gov/ncidod/EID/vol5no1/okeke.htm&gt;.

Penicillin Joke. Digital image. Cartoon Stock. 12 Mar. 2009 <http://www.cartoonstock.com/lowres/ear0578l.jpg&gt;.

“Statistics: Sleep Deprivation in America.” ISlumber.com — Tools, tips for better sleep, improving sleep habits, interactive sleep log. 2007. 12 Mar. 2009 <http://islumber.com/page.jhtml?id=islumber/articles/stats_sleepDeprivation.inc&gt;.

Steinert, David. “History of WWII Medicine.” World War II- Combat Medic. 05 Apr. 2002. 12 Mar. 2009 <http://home.att.net/~steinert/wwii.htm#The%20Use%20of%20Penicillin%20in%20World%20War%20II&gt;.

My Topic

I have finally decided on my topic. I will be researching biomedical technology and its impact on  future medicine. I recently had the opportunity to view two craniotomies and I was both impressed and surprised by the computer-assisted navigation technology used throughout the surgery. I have previously explored how antibiotics revolutionized the field, so the questions are will, and if so to what extent, 21st century medicine be defined by increasingly sophisticated technology?

What I should look into first is the difference between “biomedical technology” and “medical technology” if there is one.

Why do we care? In the brain surgery cases, minimizing invasiveness means minimizing brain damage, so I believe the two patients in particular care a great deal. Hopefully, I’ll only find  more technologies and more reasons for us to care.