Technology and medicine- future directions?

I couldn't pass up an opportunity to comment on a recent article in the latest issues of the Economist.  Basically there is a 3-D bio printer machine on the horizon that can be programmed to create cell lines and eventually whole organs.  Researchers are starting simply with skin, muscle and blood vasculature but hope to progress to larger patches of cells that are grown on artificial scaffolds in the shape of particular organs.  Researchers have created ex vivo bladders this way but not using a machine approach. My feeling is that a bladder is one thing, but a functioning organ such as a kidney will be a great deal more complex. Human biology being what it is, I think it unlikely that a machine primed with recipes for 'baking body parts' will become a reality any time soon, if ever.  I do applaud the effort however.  There is certainly no progress in any field without imagination.

It's obvious that our current healthcare system is unsustainable and this piece from the New York Times sums it up nicely. In addition to speculating on the future collapse of the system he talks about his son's recent wrestling injury which I must admit distracted me from the meat of the message, having a young wrestler myself (see pic).  Regardless, if you are thinking healthcare reform is unnecessary, you should take a look at what he has to say.  We spend the most but are way down the list when it comes to outcomes such as life expectancy and infant mortality.  For those worried about tax increases to pay for universal access, would you rather pay a few hundred more each month for health insurance with higher deductibles and more procedures not covered, or a bit more tax for higher coverage for all.  The the country as a whole, the latter makes so much more sense.

I don't hear much about this yet but it's eye opening how much 'high-tech' doctors are earning these days.  Even taking into consideration their malpractice insurance, these salaries are likely to come under scrutiny as health reform progresses (yes, it is progressing, albeit very slowly).   When physicians earn up to half a million per year and patients are going bankrupt to afford the services, something is out of balance.  Even for those who are adequately insured (a rapidly decreasing segment of the US population), increases in insurance premiums and decreases in covered services will bring the actual costs of medicine and everything it encompasses further under the microscope.  It's hard to figure how this will re-balance, given the costs of med school and malpractice, but re-balance it must.

This posts brings up a related question: High tech means high cost; how much technology in medicine is too much? And who makes that determination?  Ultimately, it must be you and I, the consumer.  Are we prepared?

Scanning the mind--a quacker or not?

Another one from Wired.com that fits the sorcery or science mold (Brain Scans as Mid Readers? Don't Believe the Hype, Wired, May 19, 2008). The article deals with brain scanning using functional and structural tools to determine how 'healthy' the brain is. The writer believes it is sorcery, the doctor he reported on believes it is science. I think it is classic Edge science where both sorcery and science are involved. The scans show particular features of an individual's brains, but the reported argues that this is meaningless without the solid hypothesis generation and testing that is a hallmark of 'real' science. The comments to the article are also interesting in that you get hearty agreement from some that the guys is a quack, while others defend the good doctor with a much vigor. Science at the edge involves observation and tolerance of soft measures. Many are uncomfortable with this, and with good reason. But, it has to be done this way if new advances are to be had.
My take: the images give a doctor data that he can use along with regular clinical data to better form his opinion about what may be troubling the patient. It think the approach is probably more useful to understand brain irregularities when a patient has symptoms rather than just assessing overall brain health. The doctor's recommendation to take Gingko to improve activity in the brain is dubious and doesn't add to his credibility in my opinion. Edge science is by definition unproven. Benefits are often seen before they can be explained or clearly predicted. In fact, that is true of even pharmaceuticals if one takes the data on a person-to-person level. I'm reluctant to endorse these tools for marketing purposes but already we see them employed to this end. I don't know why i don't like it; it just feels a bit too predatory I guess.
I think we must remain open to the possibilities highlighted in Dr Amen's work for brain assessment as it accompanies more traditional psychological and psychiatric methods. The reporter is judging the work and his own 'diagnosis' by Amen based on reductionist values and he can't be blamed for that. Science has relied on these values since the Renaissance. We are now moving towards less reductionist approaches to science and medicine (we know too much to settle for pure reductionism in this day and age) and, provided we stay grounded in our objective of genuine enquiry, I think brain scanning in all its guises must be observed, debated, and eventually included (or not) as an important tool in the diagnosis and treatment of psychiatric brain dysfunction. It's role in marketing, however, requires some ethical debate. The article asks the right kinds of questions; the comments back show the polarized thinking that usually occurs at the Edges.
See: Wired Magazine 16.06 on 19th May 2008