Biomedical Engineering will Save the World - Research Paper Example

Biomedical Engineering will save the world The dramatic changes that have taken placein the diagnosis and prevention of diseases in the last 100 years are shown in the chart below that appeared in The New England Journal of Medicine in 2012. The discovery of antibiotics and vaccines have found cures for many of the major US diseases of 1900 such as Pneumonia, Tuberculosis and Gastrointestinal infections, removing them as significant causes of death in 2010. For every reported case of death, there are several thousands of people who suffer from the disease and the advances in medical science have helped prevent this suffering. (Chart from Jones, et al) In the last 60 years, the field of biomedical engineering which combines physiology and medicine with engineering has led to major advances in the means of diagnosis of disease and for therapy and rehabilitation. Dr. Linda Griffith and Dr. Alan Grodzinsky of the MIT, in their paper “Advances in Biomedical Engineering” write that the most visible contributions of biomedical engineering are in the instrumentation used for diagnosis, therapy and rehabilitation. The invention of computed tomography, magnetic resonance imaging and ultrasound imaging instruments in the 1970s provided means of early diagnosis of many major types of disease. These instruments also helped save thousands of lives by detection of internal injuries due to trauma such as accidents. Minimally invasive surgery became possible with the invention of miniature cameras, laser guides and specialized surgical tools. These techniques have reduced risks and costs for surgery procedures for kidney and gall bladder stones and blockages in blood vessels and intestinal tracts. Implantable pacemakers and vascular stents helped treatment of cardiovascular disease and cochlear implants helped many deaf people to hear. The development of arthroplasty has enabled replacement of joints such as knees, hips and elbows to alleviate chronic pain and improve the quality of life for people with arthritis. With increased understanding of cell and tissue culture, biomedical engineering is poised to deliver even more dramatic advances in the management of medical conditions and faster recovery and rehabilitation from major injuries (Griffith and Grodzinsky). Biomedical engineering has clearly contributed to saving lives and alleviating human suffering in the past 60 years. The criticism of biomedical engineering arises from the rising costs of medical care. In most fields, advances in technology result in lower costs. In the computer industry or the automobile industry, for example, the products made today are far more efficient and cost less than older products. The focus in these industries has been to make the products affordable to more people each year. The first CT scan machine was developed in 1974 and the cost of the machine in the early 1980s was about $ 450,000. In 2014, the costs have range between $ 60,000 and $ 300,000 depending on machine features but the scale of this reduction is not comparable to the computer or the automobile industry. The industry continues to focus on whole body scanners and has neglected the development of smaller machines for the scan of limbs, joints or for head injuries that could have lowered costs of these procedures. The high costs of these machines have prevented scanning techniques to be used by general practitioners. The US healthcare spending is 17.9% of GDP, the highest in the world but healthcare standards for US citizens are well below most advanced countries of the world. High cost biomedical devices become unaffordable to the poor and the middle class sections of the population. These high costs have caused medical insurance costs in the US to be amongst the highest in the world. The invention of new biomedical devices is often blamed for US healthcare costs spiraling out of control. New medical procedures are over used where simpler and lower cost procedures are adequate and effective. A 2012 report in the WebMD Health News says that as many as 2 out of 3 of the 400,000 angioplasty procedures performed each year in the US are unnecessary. Angioplasty was initially approved as a procedure immediately after a heart attack to open up blocked arteries. It is now performed routinely even for early stage heart disease that could be treated with medication. This is in spite of the American Heart Association and the American College of Cardiology recommendation that patients with stable angina where pain is experienced only with exertion or patients with narrowed arteries without pain symptoms should be treated with drugs (Boyles). A 2010 report in the Scientific American says that an analysis of over 65,000 injury related emergency room cases in US hospitals between 1998 and 2007 showed that the percentage of cases where doctors ordered CT or MRI scans increased from 6% IN 1998 to 15% in 2007 but the number of life-threatening injuries discovered in the scans remained the same, 1.7% in 1998 and 2.0% in 2007. Besides the costs incurred in the scan procedure, the patients were exposed to radiation dosage from the machines that increases their risk of cancer (Harmon). The term “defensive medicine” has been coined for this practice of ordering treatments, tests and procedures that may not substantially improve the quality of diagnosis or treatment. A 2009 study by Jackson Healthcare estimated the annual cost of defensive medicine as $ 650 billion to $ 850 billion which is a substantial portion of the $ 2.5 trillion healthcare spending in the US. One major reason for the practice of defensive medicine is the threat of medical malpractice lawsuits. These lawsuits put the physicians’ career, reputation and net worth at risk every day. In addition to the risk of lawsuits, the survey found that increased tests and procedures are ordered to “rule out” medical conditions in place of only the tests to diagnose the affliction. Physicians depend on test results (and often order repeat tests) rather than trust their clinical judgment and want to ensure against a missed diagnosis. Younger physicians, female physicians and those working under time pressure in hospital emergency rooms are found to be more likely to practice defensive medicine than others. Very often a test is ordered merely for the reason that the hospital has the test equipment (Jackson Healthcare Report). The solution to the excessive costs of defensive medicine has also been suggested in the same study. Eliminating personal financial liability for unintended physician errors, creation of independent medical review boards to examine damage claims and to award consistent and fair compensation to wrongfully injured patients eliminating the need for lawsuits would contribute to containment of the practice of defensive medicine (Jackson Healthcare Report). Prof. Kenneth E. Thorpe, Lydia L. Ogden and Katya Galactionova of the University of Atlanta however attribute the rise in healthcare costs to the increased awareness of health issues in people. This is a positive development for improved health and wellness in people. More people opt for periodic health screening and physicians start treatment of chronic conditions such as diabetes, arthritis, elevated blood pressure and kidney disease much earlier than was the practice 20 years ago. Such treatment is predominantly with prescription drugs at the patients’ home and not in hospitals (Thorpe, et al). The increase in life expectancy and the rise in percentage of older people in the population also lead to the need to handle chronic conditions for longer periods of time. These chronic conditions are aggravated by lifestyle issues such as obesity, smoking and job related stress. One major criticism in healthcare management is the physicians’ non-attention to recommending lifestyle changes in place of prescribing drugs for early stage medical conditions. (Chart from Thorpe et al) The invention of drugs such as statins to alleviate such chronic conditions is one beneficial outcome of early health screening that prevents higher costs of treatment if the disease were to advance. Similarly the medical advances in the last 20 years have made it possible to handle health issues such as low birth weight babies and heart attacks which were not handled adequately in earlier times (Thorpe, et al). Much of the debate on the high cost of healthcare in the US focuses on aggregate costs and does not go into the underlying details. A study by the MIT economist Jonathan Gruber quoted in the International Business Times of October 31, 2013 has broken up the US healthcare spending by the age of the patient and the medical condition treated and the finding is summarized in the chart shown below. (Chart from Young) There is the not-surprising finding that money spent on older patients is higher than the spending on younger people. What grabs attention is the finding that 5% of patients consume half of the total US healthcare spending. These 5% of patients have severe chronic diseases. The next 15% of patients use up another 31% of the healthcare spending and the bottom 50% use only 2.9%. (Young). This study casts an entirely new perspective on the high cost of healthcare in the US. In place of blaming the biomedical industry for high cost innovation and the physicians for practicing defensive medicine, the focus should be on analysis of the causes of the chronic medical conditions in the 5% patients that use up 50% of the healthcare budget. There should be a systems approach to identifying the underlying causes of these chronic medical conditions and to find holistic approaches to managing these. This approach is no different to the approach traditional medical research has taken to find cures for the high prevalence diseases such as pneumonia and tuberculosis in the previous century. The new directions of research in biomedical engineering promise solutions to manage such chronic ailments better than the present methods of medical care. Dr. Sergio Fantini of the Tufts University in a 2011 paper reports that Biomedical Engineering is now being integrated with cell and molecular biology into a new field that is being called Regenerative Medicine. Cell and tissue engineering already promises technologies for repair of cartilage, bone, liver, kidney and blood vessels. Artificial skin for treatment of burns is one of the first products from this new field. These technologies could find new ways of managing diabetes, hypertension and kidney disease, three of the major chronic medical conditions in the US population. The field of bio-engineering has the potential to use DNA level information to tailor medication and treatment to the specific patient and deliver the medication in the appropriate dosage to the afflicted organ through nanotechnology based carriers. New systems of implantable sensors are being developed that would help continuous monitoring of a patient’s response to new therapy including through real time capture of images from inside the patient’s body (Fantini, et al). The World Health Organization charter defines a “right to health” which it says is access to “timely, acceptable and affordable health care of appropriate quality” to everyone in the world. WHO also says that the state (governments) must generate conditions where everyone can be s healthy as possible (WHO Charter). The field of biomedical engineering is playing an important role in helping in the diagnosis, cure and management of human health and therefore needs governmental encouragement and support. The biomedical industry perhaps is overly focused on new devices and has not done adequate work on developing lower cost versions of its devices so that the benefits of new technology are also available to the less affluent sections of the world population especially in the low income regions of the world. There is however no doubt that biomedical engineering has a very important role to play in saving the world from avoidable pain and suffering through disease and disability. *************** References 1) Boyles, Salynn. “Stents overused in Stable Heart patients”, WebMD Health News, Feb 27, 2012. Web, May 1, 2014. . 2) Fantini, Sergio., Caoimhe Bennis and David Kaplan. “Biomedical Engineering continues to make the future”, IEEE Pulse, July-August 2011. Web, May 3, 2014. < http://lifesciences .ieee.org/images/pdf/bme-future.pdf >. 3) Harmon, Katherine. “A surge in CT and MRI scans has not boosted diagnosis rates”, Scientific American, October 5, 2010. Web, May 1, 2014. < http://www. scientificamerican. com/ article/ct-mri-diagnosis-rate/ 4) Griffith, Linda G. and Alan J. Grodzinsky. “Advances in Biomedical Engineering”, Journal of the American Medical Association, Vol. 285, no.5, Feb 7, 2001. Web, May 1, 2014. < http://www.jama.jamanetwork.com/data/Journals/JAMA/4070/JSC00415.pdf > 5) Jones, David S., Scott H. Podolsky and Jeremy A. Greene. “The Burden of Disease and the Changing Task of Medicine”, The New England Journal of Medicine, 366:2333-2338, June 21, 2012. Web, May 1, 2014. < http://www.nejm.org/doi/full/ 10.1056/ NEJMp 1113569 > 6) Jackson Healthcare Report. “Quantifying the cost of Defensive Medicine”, Jackson Healthcare. Web, May 2, 2014. < http://www.jacksonhealthcare.com/media-room/surveys/defensive-medicine-study-2010.aspx >. 7) Thorpe, Kenneth E., Lydia L. Ogden and Katya Galactionova. “Chronic Conditions account for rise in Medicare Spending from 1987 to 2006”, Health Affairs, April 2010, Vol. 29, No.4, 718-724. Web, May 2, 2014. < http://content.healthaffairs.org/content/29/4/718.full >. 8) WHO Charter. “The Right to Health”, Fact Sheet No. 323, November, 2013. Web, May 3, 2014. < http://www.who.int/mediacentre/factsheets/fs323/en/ >. 9) Young, Angelo. “MIT: Technology has not helped to lower US Healthcare Costs”, International Business Times, October 31, 2013. < http://www.ibtimes.com/mit-technology-has-not-helped-lower-us-health-care-costs-contrary-1449656 >. Read More