And it is not the only revolutionary innovation about to hit the practice of
medicine: “This really is a discontinuous innovation here. It’s something that’s
going to change the life, productivity, the workflow, the whole sense of how
somebody in life sciences, cell-based life science research does business. There
aren’t many of those that I see come along,” said a venture capitalist. What is
it? — a desktop cytometer, and
it’s already out there.

Also out there — far out there, in space — is telemedicine, and some
extraordinary dental
technology, for dentists and patients who can afford it. Yet today’s
advances, such as painless tooth repair without anesthesia, are only half-way
stepping stones to the ultimate: a vaccine that eliminates tooth decay — and
with it, the dentist — altogether.

The British consumer will shortly be able to eliminate the doctor as well, at
least for controlling cholesterol. The British government is allowing low-dose
statins to be sold over the counter,
without a prescription. This is relevant to the growing shortage of primary care physicians.
Whether the shortage represents a crisis, as some claim, may depend on the trend
to patient self-care, which may be both partial cause and partial effect of the
shortage, and on how well patients can perform as their own GPs given lots of
technological assistance, from diagnostic and therapeutic information posted on
the Internet to medical devices available for home use to prescription drugs
sans prescription. As we have argued in the case of the alleged looming
crisis in gerontology, the case of primary medicine needs to be considered in
the context of the acceleration of innovations and its associated trends.

A wearable computer system called Vigilance enables surgeons and
anesthetists at Vanderbilt University Medical Center to remotely monitor and
supervise up to four operating rooms at a time, reports Bill Lewis in The
Tennessean. A tiny video screen is attached to a pair of surgeon’s goggles
and wired to a small computer worn on a belt. The computer in turn is wirelessly
connected to the center’s computer network, which constantly transmits video
images and information about each patient’s condition from ten operating rooms.
The doctor can monitor four of the OR at a time by glancing left into what seems
as big as a 17-inch monitor hanging in the air.

Vigilance is also being tested at Vanderbilt Children’s Hospital by
anesthesiologists to remotely monitor and supervise nurses administering
anesthesia to patients. The system is connected not only to video cameras but
also to the anesthesia machines, heart monitors, and other equipment in each
operating room, giving the anesthesiologist the same information s/he would get
onsite. The system sends out pop-up alerts if a patient in surgery needs, say,
more oxygen, and it suggests actions. The doctor also has something which, from
Bill Lewis’s description, sounds like the Vocera badge we have covered in
recent
issues, enabling near-instant communication with the nurses or indeed anyone
else.

Vigilance also keeps track of the schedule for each operating room and
uses color codes to alert staff members if a procedure is taking longer than
expected. It will soon be in use in all 37 adult operating rooms, and will then
be linked to the hospital’s electronic medical records, which can also be called
up on the small view screen.

The doctors have adapted to watching their view screens out of the corner of
their eyes without losing sight of what is going on around them.

The US military is apparently considering funding further development of
Vigilance as part of its Operating Room of the Future concept, which will
incorporate telemedicine and telerobotic surgery.

Reference: Lewis, Bill (2004). “Keeping
one eye on the future of medicine.” The Tennessean, May 27.

See also “Wearable Monitors” in this
section.

Wearable Monitors

The display technology used in Vanderbilt’s Vigilance system described
elsewhere in this section “is here and it has the right price point,” quotes
Penelope Patsuris in Forbes. The microdisplays used in digital cameras
are clipped onto surgeon’s glasses so they can glance at a patient’s vital signs
without having to lift their heads. The company that makes the clip-on monitors
is backed by one of the biggest eyeglass companies in the world, and together
they are working to embed the screens into eyeglass frames, so they are
completely unobtrusive, and to connect the monitors wirelessly to PDAs and cell
phones. The extra large virtual viewing area enabled by the microdisplays will
mean that much more functionality can be built into those devices, and the
entire Internet can be accessible to people wherever they are, whatever they are
doing.

This is revolutionary.

Reference: Patsuris, Penelope (2004). “The
Future Of Digital Imaging: Wearable Wireless Displays Are In Sight.” Forbes,
May 7.

See also “Eyeglass Video in Use in
Medicine” in this section.

Desktop Lab

The maker of the Personal Cell Analysis System (PCAS) believes it will
do for lab researchers and diagnosticians what the spreadsheet did for managers
— reduce their reliance on the mainframe technical gurus, reports David Levine
in the San Francisco Business Times. PCAS is an easy-to-use desktop
cytometer for cell analysis, taking that task away from “the high priests of
flow cytometry” and their large laboratories. The analogy with a PC spreadsheet
falters a little given the device’s US$40,000 price tag, which is still a fair
savings on the $100,000 to $200,000 cost of traditional cytometers.

It is “about a third of the size of a conventional unit and, because it uses
smaller samples, it reduces the amount of chemicals needed in cell analysis.
This can cut the cost of a test to about $1 from between $5 and $20.” The
company says PCAS systems have been purchased by all the leading pharmaceutical
and biotechnology companies, as well as the National Institutes of Health and
many leading universities and government labs. A University of California
researcher ported a PCAS on a trip around Indonesia, conducting HIV testing
using finger sticks rather than having to draw the larger blood samples a
standard cytometer would require. She described it as “extremely fast, extremely
easy to use and doesn’t take a lot of calibration.”

The catch? “It doesn’t do the very sophisticated types of markers.”
Nevertheless, the company has attracted several significant rounds of venture
funding, and one funder said:. “This really is a discontinuous innovation here.
It’s something that’s going to change the life, productivity, the workflow, the
whole sense of how somebody in life sciences, cell-based life science research
does business. There aren’t many of those that I see come along.”

Reference: Levine, Daniel S. (2004). “Bringing
cell analysis to a scientist’s desktop: Guava says market’s ripe for its
technology.” San Francisco Business Times, May 7.

Telemedicine Taking Hold

The Dutch government is funding health technology innovations to help control
spending as its baby boomers age. One of them is the three-year “CamCare” pilot
project designed to reduce costly home visits by professional caregivers. Free
during the trial, it is expected to cost under US$24 a month when fully
operational. It is easy to use — a nurse can be summoned with the push of a
single button, and the patient’s medical record is automatically brought up on
the nurse’s screen.

The technology — a television, a set-top box with a webcam, and an ISDN
phone line — is not new, writes Anthony Deutsch for the Associated Press. The
nurse sees the patient on a computer monitor, and the patient sees the nurse on
the TV.

NASA is running a more ambitious telemedicine trial on the international
space station. Digital ultrasound images of an astronaut are beamed to Earth
where doctors can look for signs of heart problems, collapsed lungs, muscle
loss, and abdominal conditions. Telemedicine is a mission-critical element for
the proposed Moon base and the long-distance, long-duration, and dangerous
manned missions to Mars now being planned.

Of course, as CNN’s Michael Coren notes, telemedicine can have a pretty
substantial impact on Earth as well. Dr. Scott Dulchavsky, chairman of surgery
at Henry Ford Hospital in Detroit, Michigan, and principal investigator for the
NASA initiative, said the experiments can give insights into how the equipment
is used in an emergency — “whether it’s a Mars mission or a hockey game.”

Reference: Deutsch, Anthony (2004). “Dutch Patients Start
Using Online Nursing.” Associated Press via eWeek, May 11.

Reference: Coren, Michael (2004). “Remote
medicine on frontier of space.” CNN, May 12.

Lessons from Dentistry

Digital X-rays are popular among dentists and their patients, but that’s just
the beginning for today’s high-tech dentist, who will also need:

• A Diagnodent laser (US$3,400), which has “revolutionized” cavity
  hunting, according to Wired‘s Kristen Philipkoski, “by spotting even the
  slightest decay. It’s small, portable and 90 percent accurate, whereas
  traditional X-rays are 67 percent accurate. It also eliminates the poking around
  dentists do with a probe to find spots that might have decay.” Some 18,000 of
  the 166,000 dentists in the United States have bought one, but small-town
  America puts up with the painful poking. 

   

• A Waterlase ($50,000) — “the holy grail of dentistry: painless,
  quiet drilling” of “anything but old-fashioned amalgam (silver) fillings, and in
  most cases doesn’t require the dreaded Novocaine shot.” But only 2,000 US
  dentists have bought one, and since “The market is not dictating that we need to
  lower our (price),” as a company executive told Philipkoski, the rest will
  presumably have to continue to do without. 

   

• A LaserSmile ($25,000) that can cut tissue (though not painlessly)
  and whiten teeth. 

   

• A DioLase ($11,000), which can do “everything but whitening,” writes
  Philipkoski, though it is not clear what “everything” means. 

   

• A Vita Easyshade or X-Rite (prices not mentioned) to digitally
  scan and measure the exact light wavelength of teeth, enabling exact color
  matches. 

   

• A Cerec ($100,000) cad-cam system that images a tooth in three
  dimensions then sends the specifications to an on-site mill that creates a
  porcelain tooth while the patient waits. 

“I think the way of a single dentist in a small town is going to be pass�,”
said one. “I really think we will be the dinosaurs, because we just can’t afford
it. There’s no way you can compete with (multi-dentist practices).”

But these are only halfway technologies. “The dental world of the future will
be one where patients grow their own new teeth, much like a 6-year-old.” She
bases this prediction in part on work at the Forsyth Institute using stem cells
to generate tooth crowns made of dentin and enamel from young pig “tooth buds,”
which should lead to bioengineered teeth “that don’t need replacement, just
repair.”

Painless tooth repair is available today in Europe, Canada, and Australia,
with KaVo’s HealOzone machine that generates ozone to kill cavity-causing
bacteria. “The device and follow-up treatment . . . also reverse decay in all
but the deepest cavities,” writes Philipkoski. It may be approved for use in the
US in 2006.*

But Forsyth researchers could make the HealOzone rapidly obsolescent
if planned clinical trials of a cavity vaccine — proven to work in animals —
succeed. A single treatment at age 12 to 24 months would provide a lifetime free
of cavities. The small town dentist then will have no worries, because there
will probably be no dentists, small town or otherwise.

* We checked out this product on KaVo’s German
website in mid-June. On re-checking shortly before publication, on June 29, we
found that KaVo has been sold to a US company and there is no longer any mention
of any ozone-related product on the new website.

Reference: Philipkoski, Kristen (2004). “High Tech Has
Dentists Smiling.” Wired News, May 18.

Reference: Philipkoski, Kristen (2004). “New Drill for
Tomorrow’s Dentists.” Wired News, May 19.

Push to Self-Diagnosis, Self-Prescription

Other countries, including the US, may soon follow Britain’s lead in allowing
low-dose, cholesterol-cutting statin drugs to be sold over the counter, without
prescription. In the US, less than half of the people who could benefit from
such drugs actually get them, and the theory is that if low-dose statins are
available OTC, more people will take them and cost-savings will accrue through
prevented heart problems.

The US Food and Drug Administration (FDA), usually extremely cautious about
giving OTC status, is hinting that it might follow suit, and its main concern
seems to be that consumers be able to use statins — which can have serious, if
rare, side effects — correctly without a doctor’s supervision. Low dosage may
ameliorate that danger to some extent, and Merck is due any day now to reveal
findings from a study measuring consumers’ understanding of how to use statins
in a simulated retail setting.

Correct self-diagnosis is another issue — high cholesterol doesn’t show
clear symptoms, and a blood test is needed. Our expectation is that if they are
not already available, home- or retail-pharmacy-based cholesterol test kits will
likely soon be available.

Reference: Tsao, Amy (2004). “Statins
in Aisle 7?” BusinessWeek, May 20.

Trend to Specialization

Recent surveys show that today’s medical students, anxious to maintain a life
outside medicine and to be able to pay off the heavy debts they incur in medical
school, are increasingly turning away from the relatively unpredictable and
often less well paid generalist fields of primary care, general surgery, and
internal medicine; turning instead towards the specialties. The president of the
American Medical Student Association says the trend has “serious ramifications,”
reports Joseph Wilcox in the Pittsburgh Post-Gazette.

Even of those who choose primary care, many are pursuing subspecialties such
as cardiology, gastroenterology, oncology, and rheumatology, further depleting
the pool of general practitioners. The president of the American Academy of
Family Physicians said: “We have a very sick health system. . . . We value the
wrong things.” He points out that “In Canada and Europe, a general practitioner
makes 70 to 80 percent of the salary of a specialist. In the United States,
primary care doctors make about half the salary of a specialist.”

Reference: Wilcox, Joseph D. (2004). “More med students are
shunning time-demanding specialties.” Pittsburgh Post-Gazette, May 11.