Brave New Medicine
Wondrous technology could bring back the house call
On the old Star Trek television shows, fast diagnosis was a cinch for the USS Enterprise's doctor. Leonard "Bones" McCoy waved a stage prop gizmo called a medical tricorder over a supine, ailing life form. "Blood pressure's all wrong," he might exclaim to Capt. James T. Kirk. "Jim, this man is a Klingon!"
Modern technology will make such scenarios--sans Klingons--common early in the next century. Medical futurists also expect biomaterials blending living cells with synthetic substances to form replacement kidneys or other organs and "virtual hospitals" where doctors can practice on cyberentities that look and feel like people but are generated electronically.
Unlike the results of previous rounds in the medical arms race--the costly CT scans, MRIs, artificial organs, and dialysis machines--most of the new tools are designed to save money. In the world of health maintenance organizations, low costs mean business survival. "There is a lot of cute technology out there. So what?" says Harry Selker of cardiovascular health services research at New England Medical Center in Boston. "Technology that is just cute, we never hear from again. It has to really be useful, and it has to be economical." His pet idea: an electrocardiogram machine that not only measures heart rhythm but suggests a treatment. Here are more medical technologies close to reality or already emerging that may be both useful and economical:
Telemedicine. Doctors are starting to consult with colleagues in another hospital, another city, or even another country via Internet or similar connections. So far, the consultations are mostly just conversation, but soon physicians will be sending via the Internet detailed digital X-rays, EKGs, and biopsy samples (reduced to computer data) to farflung experts.
This year, perhaps 100,000 patients benefited from telemedicine, but its use is doubling every year and could be in the many millions within a decade. Hundreds of doctors at a time, worldwide, will be able to witness the latest in surgical or other procedures, spreading the most modern methods at the speed of light and learning. "It's a quality enhancer and a cost reducer at the same time," says Nasser Menhall, CEO of WorldCare Ltd., of Cambridge, Mass., a telemedicine consortium anchored by Massachusetts General Hospital, the Cleveland Clinic Foundation, Duke University Medical Center, and Johns Hopkins Medicine.
Robot surgeons. Automated surgeons are here now, placing artificial hips with a precision humans cannot reliably match. Soon to come will be robots doing some surgery a person can't do at all, such as poking slender, flexible tubes deep into a brain, armed with clusters of cutters, suction pumps, cameras, and chemical sensors, avoiding tiny blood vessels and nerves on the way to detecting tumors or other diseased tissue. Already, biomedical engineers at NASA's Ames Research Center south of San Francisco learn by poking their prototype smart probes into tofu. The various grades of the bean curd mimic brain tissue. NASA wants to have robot surgeons where no specialist is available, like on a spaceship to Mars. The possibilities are enormous, and recently engineers began to modify their probes to search for, and destroy, breast cancer tumors.
Biosensors. Here is where the tricorder is moving from fiction to reality. At the University of Pennsylvania Medical Center, chief of anesthesia/critical care medicine C. William Hanson III is already testing an electronic "nose" that is able to sniff a person's breath and detect an infection such as pneumonia just from the odor.
Scientists at the University of California--San Diego are cooking up a super-sensor to almost instantly detect DNA defects, antibody activities, and other health indicators. It has the tongue-tying name "porous silicon-based optical interferometric biosensor," but biochemist Michael Sailor, who helped invent it, says he had the TV tricorder in mind all along. If exposed to chemical signs of disease in breath, blood, sweat, hair, or other tissues, specially modified, sponge-like silicon changes color almost instantly and with a sensitivity up to 100 times better than today's elaborate and costly lab tests. Techniques now used by the computer industry could make chips with millions of different kinds of biosensors, all on one thumbnail-size piece of silicon. "You would then read the thing out all at once and be able to determine not only that your patient is a Klingon but what diseases he has, what drugs he has in his bloodstream, and if he ate a tribble last night," Sailor says.
This story appears in the December 1, 1997 print edition of U.S. News & World Report.