A new military portable hospital packed with
technology might be the envy of many a substantial glass-and-concrete edifice.
Could it possibly be a pointer to the way all hospitals of the future should be
developed — as portable, modular units offering fast replacement and upgrades
and the ability to sell or donate unwanted or out-of-date modules to
under-served communities?

Speaking of “out of date”: The stethoscope defines the
line not just between legacy analog and modern digital med tech, and not just
between intimate and remote patient exams, but also between the older and
younger generations of physicians.

Medical device makers have begun advertising hip-replacement implants,
implantable incontinence devices, and knee-replacement devices directly to
consumers, to persuade them to go to the doctor and ask to be implanted with a
particular device.

Some patient advocates worry that consumers cannot be sufficiently educated
by a magazine or television ad for such complex devices and procedures, yet may
feel informed enough to pressure doctors into giving them what they want.
Implants often carry great risk during the implant procedure and may have
serious side- and long-term after-effects.

In theory at least, drug advertising is regulated by the Food and Drug
Administration, but that is the case only for the riskiest of medical devices
such as artificial hearts and pacemakers. One company’s television ads, notes
the New York Times‘ Melody Petersen, “include a brief statement that
‘surgery involves potential risks and recovery time,’ while [its competitor]’s
ads include no information on risks other than making it clear that a hip
replacement involves surgery and rehab.”

Such marketing could in theory spur device manufacturers to improve their
products, in order to remain competitive. The companies claim that many elderly
patients today are better informed than ever, and that many use the Internet to
research solutions to their health problems. They also say that many patients
suffer joint pain out of ignorance of the available remedies.

Reference: Petersen, Melody (2003). “Campaign for
Medical Device Bypasses Doctors.” New York Times, October 30.

Devices Market Picking Up

U.S. industry analysts predict double-digit growth in reconstructive implants
and heart devices. A Wall Street Journal article reports robust demand
for implantable cardiac defibrillators, and that three manufacturers sold
replacement hips and knees “almost as fast as they could make them, thanks to
swelling sales to baby boomers.”

A clue as to at least one of the causes of this acceleration can be found in
“Cutting Out the Middleman in Medicine” in the Practice section of this
issue.

Reference: Rosenberg, Daniel (2003). “Medical-Device
Sales Set For Solid Quarterly Growth.” Wall Street Journal, October
8.

Patients Take Charge

Informed and encouraged by the Internet, drug advertising, insurance plan
leaflets, and philanthropic/community initiatives, savvier patients are
beginning to wrest control of their healthcare from the hands of physicians.
Wall Street Journal reporter Amy Dockser provides an in-depth story
describing how the parents of a brain-injured infant researched the Internet to
find a new medical procedure of which the child’s highly qualified doctors had
never heard.

Evidently, the acceleration of medical innovations leaves even the best
physicians unable to keep up with developments in their own field; and the 20th
century doctor-patient relationship is disintegrating in the 21st.

Reference: Marcus, Amy Dockser (2003). “Saving Baby
Dalton: Doctors, Nurses — And Mom and Dad; Helped by Internet, Families Assert
Bigger Role in Care.” Wall Street Journal, October 22.

Portable Hospital

The U.S. military’s prototype “Forward Deployable Digital Medical Treatment
Facility” (or what you and I, in our civilian ignorance, might call a portable
hospital) is a complex of tents housing a lab, two-bed emergency room, intensive
care unit, patient ward, pharmacy, a sterilizing area, and a patient
administration area. It has a portable X-ray machine, water purification and
distribution systems, and a portable ultrasound unit. The facility also has a
state of the art digital wireless communications system allowing remote
monitoring of the patients, from a central location within the facility or
thousands of miles away.

Reference: Fleming-Michael, Karen (2003). “Unit
Puts Telemedicine Technology Through Its Paces.” American Forces Press
Service, September 24.

End of an Era, End of a Generation

Since 1926, when the last major enhancement to the stethoscope was introduced
(the double-sided chest piece to enable the physician to discern sounds of
different frequency), the only modifications have been to introduce electronic
amplification and digital recording of the sounds. One company is now testing a
stethoscope with apparently a built-in decision support system (DSS) that helps
identify the sounds for the physician.

Though still a staple of medical practice, some in the medical community are
noticing a resistance to its use from a younger generation of physicians who
have “grown up relying on high tech PETs and MRIs and all other scanning types
of things,” said one older physician, who worries about relying on technology at
the expense of the hands-on physical exam. Ultrasound, for example, which is
spreading fast as the price of the new handheld devices comes down, should be an
adjunct to, and not a replacement for, stethoscopic examination, he feels.

While one physician asserts that “the ultrasound device will never replace
the stethoscope as a physician’s primary tool,” another (who has used ultrasound
for some time) flatly disagrees. It can deliver 30 percent more findings,
including detecting many cancers, than a stethoscope, he says.

Reference: Franczyk, Annemarie (2003). “The
beat goes on: High-tech medical advances haven’t replaced the stethoscope.”
Business First of Buffalo, September 26.