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It may not have been Gerald Imber's primary intention, but his recent biography of William Halsted sheds light on how the U.S. developed the world's best-performing clinical care system, and even hints at a better way forward. It started with a group of medical pioneers committed to both research and clinical practice, with a deep respect for repeatable and verifiable scientific findings, and holding themselves and others to high standards. That plus an unfettered market proved a recipe for success.

William Halsted can justifiably be called the Father of Modern Surgery. He pioneered local anesthesia; raised aseptic surgery to a higher level; and invented procedures such as hernia and aneurysm repair. But his overall contribution extends far beyond these technical achievements. Halsted transformed surgery from a brutal act of desperation into a gentle, life-saving art. He and his colleagues at Johns Hopkins not only developed new methods of diagnosis and treatment, they set new standards for physician training and proficiency.

As the title suggests, there is another and quite disturbing side to Halsted. The man was a drug addict. But Halsted did not set out to get high; he became addicted as a result of experiments he performed on himself with local anesthetics. Little was known about treating drug addiction at the time. Though his addiction spanned 38 years of a lengthy career, it did not stop him from performing hundreds of operations and achieving a series of breakthroughs.

It's too bad that our current political leaders are too arrogant to consult history, but if they are truly interested in ensuring affordable health care for all they should study the careers of surgeons such as William Halsted and Harvey Cushing. Both men could and did command exorbitant fees from those who had the means. They could have sat around waiting for the occasional wealthy patient, but they understood that it was in their own interest to treat everyone, regardless of financial means. They charged nothing to the poor, moderate fees to the middle class, and high fees to the wealthy. That allowed them to keep their skills sharp and their coffers full.

Though Imber explores Halsted's personality and personal life, he also describes in detail a number of the medical advances achieved by Halsted and his colleagues. Included are Halsted's gallbladder surgery and Walter Dandy's pneumo-ventriculography for locating brain tumors. These were huge developments in their day. After reading this book, you'll also understand why Johns Hopkins is one of the world's best hospitals--if not the best.

The following is the Introduction to The History & Future of Medical Technology. The book will begin shipping May 14, 2010 and will retail for $34.90 (hardcover). A special pre-publication price of $19.90 is offered for orders received by May 17th.


Medical technology has come a long way over the last several decades. CT, MRI, and ultrasound machines produce stunning images of your vital organs. Implantable defibrillators intervene when your heart rhythm goes haywire. Teletherapy machines use invisible rays to destroy tumors. Another type of machine takes over for your heart and lungs so that a surgeon can make repairs. If you go deaf, a cochlear implant may restore your hearing. Need a new knee joint? No problem.

And best of all, the era of life saving and enhancing medical technology is just getting started.

I’ve been interested in the history of technology for a long time, having worked in the high-tech industry for 30 years. I wanted to know more about the evolution of modern medical technology, and I was surprised that I couldn’t find a comprehensive history. There are many books on the history of medicine, but few books that explain how today’s wonderful medical technologies were created. So I decided to research and write such a book.

There is so much great medical technology that I had to cast a wide net. The book encompasses microscopes, endoscopes, x-ray machines, CT scanners, ultrasound imaging, magnetic resonance imaging, pacemakers, defibrillators, nuclear medicine, the heart-lung machine, kidney dialysis, artificial hip joints, brain-computer interface chips, laser surgery, and much more.

But I also had to set some boundaries. This book focuses on systems, instruments, and devices—the mechanical and electrical stuff. Pharmaceuticals and genetic engineering are also great medical technologies, but they are a different story for another book. I applied a simple test: If it contains a microprocessor, can communicate via the Internet, or has moving parts, it is probably in this book. If you take it orally one hour before meals, it probably isn’t.

I also drew a line between modern and primitive medical technology. This book is for anyone who wants to know how we got to where we are today and how medical technology is likely to evolve in the next several years. The narrative chronicles discoveries and inventions with long-lasting impact; this is not a book about medieval bone saws and tooth extractors.

I drew one more boundary. This is not one of those esoteric histories for historians. My target audience is consumers, health care professionals, and investors who want to learn how we came to discover the causes of disease, develop powerful diagnostics, and invent effective therapies. My purpose is to inform and inspire by concentrating on the most important figures and events—not ask readers to trudge through minutiae.

The history of medical technology is a confluence of three distinct streams: the history of biological research, the history of clinical practice, and the history of the health care industry. I must warn readers that much of the research described in the following pages was performed on laboratory animals. They—along with the human patients who agreed to undergo experimental procedures—are the unsung heroes of modern medicine.

Many people feel that making profits and saving lives don’t mix. I concede that there are legitimate ethical concerns. However, there’s also wisdom in the saying “Don’t throw the baby out with the bath water.” Businesses have done a good job identifying patient and health care provider needs, adapting new technology to serve those requirements, and figuring out the best way to package and distribute the technology to ensure it gets in the hands of the right people in a form that they can use.

The first decision for anyone writing a history is deciding where to begin. A history of medical technology could begin with the ancient physicians. Or it could begin at some arbitrary starting point, such as the year 1900.

I chose to start with the invention of the microscope. Though introduced at the same time as the telescope, the microscope was practically ignored. The telescope could be used to sight approaching ships, spy on enemy armies, and explore the heavens. The microscope could only be used to examine objects already in hand. Plus, early microscopes produced terribly distorted images and no one had a clue that there was a living microcosm awaiting discovery. Antony Leeuwenhoek, a Dutch draper, was the first person to observe protozoa and bacteria.

Chapter Two shows how the microscope spurred the development of experimental medicine and the germ theory of disease. Today, those ideas seem obvious. Prior to 1850, physicians could do little to cure diseases; many created and maintained an aura of authority by spouting bizarre theories. A new generation of scientists—led by Claude Bernard in France and Hermann Helmholtz in Germany—put medicine on a more solid footing. Louis Pasteur, Robert Koch, and Joseph Lister took the ball and ran with it.

The germ theory of disease encountered fierce resistance. In part, it was because it was difficult to prove that microbes cause disease. But it was largely because physicians did not want to admit that they had unknowingly been spreading diseases. Eventually the body of evidence grew too large to ignore. Vaccines were developed, public sanitation was improved, and aseptic surgery became accepted.

For medicine to advance to the next level, physicians needed some way to see inside the body. Chapter Three chronicles the evolution of endoscopy, the discovery of x-rays, and the progression to computed tomography—the technology behind the CT scanner.

Other diagnostic tools paved the way to timely and effective interventions. Chapter Four describes how Willem Einthoven perfected the electrocardiogram—and how it spawned tools for mapping and even repairing the heart’s electrical system.

Today, getting an artificial pacemaker is a relatively minor procedure. Chapter Five explains how medicine slowly advanced beyond helplessly watching patients with dangerously slow heartbeats die. External pacemakers—intolerable to most patients—came first. Pacemakers requiring major surgery came next; the cure was almost as bad as the disease. The discovery that pacemaker leads could be threaded through the veins made it all worthwhile.

Magnetic resonance imaging (MRI) added a new dimension to diagnostic imaging. Chapter Six describes how a series of discoveries led to what one inventor called “wireless chemistry.” To get there, physicists first had to learn how to make atomic nuclei dance in unison.

Radioactivity is rightly feared. But when used with proper caution, radioactivity is a powerful diagnostic and therapeutic tool. Chapter Seven chronicles the beautiful experiments of Ernest Rutherford and the incredible perseverance of Marie Curie—and how their work led to PET scanners, the Gamma Knife, and proton accelerators.

Physicians also found ways to exploit sound waves. Chapter Eight describes the development of the stethoscope and blood pressure monitor—both of which depend on listening. Decades later, a device developed to detect icebergs and enemy submarines was modified to produce images of the beating heart and even measure the flow of blood through the heart’s chambers and valves. Ultrasound is another powerful diagnostic tool that has also found therapeutic uses.

Chapters Nine and Ten describe how physicians learned to repair, replace, and assist failing organs. To get there, doctors had to develop the habit of keeping accurate records and analyzing the data. First they discovered they could replace blood—but only if they followed certain rules. An unlikely trio—John D. Rockefeller, Charles Lindbergh, and Alexis Carrel—paved the way for John Gibbon’s heart-lung bypass machine.

That brings us to some of the cowboys of medicine: colorful figures such as Werner Forssmann, Andreas Gruentzig, and Christian Barnard. Forssmann experimented on his own heart. The flamboyant Gruentzig found a simpler and safer method (compared to coronary artery bypass graft surgery) to clear clogged arteries. The equally flamboyant Barnard performed the first successful heart transplant. Less well known, Willem Kolff invented kidney dialysis and pioneered the artificial heart.

The success of the cochlear implant gives us reason to be optimistic that we will one day restore vision to the blind. A versatile biological material, small intestine submucosa (SIS), has demonstrated an almost magical ability to replace and even regenerate natural tissues.

Ophthalmology has its own story, told in Chapter Eleven. A series of discoveries—some of them accidental—led to laser-based vision correction surgery, implantable lenses, and new ways to treat sight-threatening disorders such as detached retinas, glaucoma, and age-related macular degeneration.

Dentists are also not to be ignored. As explained in Chapter Twelve, it was a dentist who invented safe and effective anesthesia—benefiting the entire medical profession. Dentists also pioneered body part replacement.

Computers and communications have become ubiquitous in health care. As Chapter Thirteen shows, we are getting our first glimpse of what devices and networks can do. Doctors are accessing diagnostic scans via smartphones. Patients and their families are finding specialists via the Internet. Wireless devices keep patients in touch with their health care providers and advisors. Personal health records enable patients to take a more active role in their own health care.

A note about terminology: I use plain language as much as possible, referring to the official medical terminology only when necessary. Modern medicine is brimming with jargon, and it can be intimidating. However, there is no way to completely avoid technological jargon, so I’ve included a glossary of terms used in the book.

The sources of this work include not only books and journal articles, but interviews with pioneering physicians, lectures, videos, and tours of research labs.

Medical technology can work wonders. That’s not to say, however, that modern medicine is perfect. Success breeds complacency—or at least over-reliance on the same set of procedures and tools. But even when you add all of the minuses to the plusses, we as patients still come out way ahead.

This post is the thirteenth in a series based on my soon-to-be published book, The History & Future of Medical Technology. Each week I’ll present highlights from one of thirteen chapters.



Bodies in Cyberspace

From pacemakers to CT scanners, computers have become ubiquitous in health care. Now networks are taking medicine to the next level. A doctor pulls up a digitized scan on a laptop within seconds. A radiologist in Australia working the day shift reads x-rays in Kansas where it’s 3:00 AM. Hospitals instantly locate IV pumps, wheelchairs, and vital sign monitors scattered around the facility. Surgeons use video cameras, robotic instruments, and speech recognition systems to enhance their operating skills.

No modern hospital is complete without in-building mobile communications. Most install either a distributed antenna system or a wireless local area network. Today’s hospital IT manager can employ tools such as Armstrong World Industries’ ceiling tiles with integrated antennas; Vocera’s Star Trek-like Communications Badges; Air Magnet’s performance and security monitors; and Centrak’s people and equipment tracking system.

The most dramatic changes are coming not in how health care providers communicate amongst themselves, but how they interact with patients. Patients perform an expanding portfolio of diagnostic tests and therapies in the comfort of their own homes. Medical devices are monitored, reconfigured, and updated over phone lines. Medical emergencies are reported and responded to anytime, anywhere. Routine communications between patients, pharmacies, and doctors are automated using mobile phones and the Internet. Qualcomm VP Don Jones calls it “putting every body on the 'Net.”

The Internet gives patients unprecedented access to information about medical conditions and treatments. Patients share their concerns and ideas with each other in online discussion forums. The Internet also enables a new type of voyeurism: Surgeons live-streaming updates from the operating room via Twitter. Though some people consider hyper-access frightening, and not all online information is reliable, it can’t help but empower patients and their families over the long run.

Telemedicine goes beyond remote interpretation of scans. Robotic tools are increasingly used in the OR for greater precision and steadiness. But if a surgeon sitting across a room can operate on a patient using robotics, the same can be done a continent away. And that’s just what is starting to happen. On Sept. 7, 2001, Dr. Jacques Marescaux operating in New York removed the gall bladder of a woman in Strasbourg, France using a remote-control, robot-assisted laparoscopic device. That proved it could be done, but no one has quite figured out the best way to exploit it.

Health care applications for mobile phones are getting ready to take off. CardioNet lets cardiologists monitor patients’ cardiac rhythm and performance. The Pill Phone reminds users when it’s time to take their medicine and even handles refill requests. GreatCall's Jitterbug mobile phone service gives senior citizens 24-hour access to registered nurses.

Expect biological sensors to be integrated with mobile phones in the next few years. For example, Orla Protein Technologies and Japan Radio Company announced they are developing a mobile phone chip that can read swabs and blood samples and transmit the results to doctors.

Microsoft and Google are promoting Internet-based personal health records (PHRs). Microsoft’s HealthVault ecosystem includes major health care providers; patient advocacy groups; and device vendors. Google Health has its own portfolio of online health services. Though PHRs put patients in control of their own medical records, they raise a host of privacy and security concerns.

Some physicians fear that the Internet provides patients information that is wrong, only partly true, or not applicable to their specific circumstances. Those are legitimate concerns, but they apply to all sources of information and not just the Internet. Patients just need a little healthy skepticism.

One clear benefit for patients and their families is the ease with which they can track down physicians and facilities with experience treating rare conditions. In fact, the Internet has taken the quest for optimal health care global. Patients are increasingly traveling overseas for specific medical expertise or to save money—a practice known as “medical tourism.”

Some health care reform advocates believe we rely too much on expensive technology. They have it exactly backwards. As more people monitor themselves we will learn to detect specific health problems during their earliest, most treatable stages. Medical technology isn’t the problem—it’s the solution.


Next time: Better Living Through Biomedical Engineering

Note: If you would like to be notified when The History & Future of Medical Technology is published, please go to Telescope Books and enter your email address in the newsletter sign-up field on the left menu bar. This email list is only used to announce book offers from Telescope Books; your email address will not be shared with third parties.

This post is the twelfth in a series based on my soon-to-be published book, The History & Future of Medical Technology. Each week I’ll present highlights from one of thirteen chapters.


Technology with Real Teeth

We think nothing of it when our teeth do their job—and we can think of little else when they subject us to agony. Perhaps that’s why humorists depict the history of dentistry as a chronicle of pain. If that is true, then it turned out to be just the incentive needed. Dentists pioneered anesthesia, one of the pillars of modern surgery. And dentists scored again by producing some of the first materials and techniques for repairing and replacing body parts—body parts assaulted daily by a phalanx of mechanical and chemical stresses.

Dentistry continues to lead the charge in key areas. Dentists are migrating to digital x-ray technology. Dentists have started to employ computer aided design/computer aided manufacturing (CAD/CAM) to aid restoration. By focusing on the body’s portal for nourishment, dentists are also doing their share to prevent disease.

The French surgeon Pierre Fauchard is considered the father of modern dentistry. Working in Paris, he published a systematic study of the subject in 1728 (The Surgeon Dentist, A Treatise on Teeth). Until that time, the few skilled dentists kept their knowledge secret. Fauchard described a number of dental instruments and recommended the use of human urine to treat early-stage tooth decay—an idea that originated in ancient times. (The ammonia often found in urine is truly beneficial.) Fauchard debunked the “worm theory” of tooth decay, identified sugar derivates such as tartaric acid as the true cause, and prescribed the use of lead fillings.

In 1790, John Greenwood—famous for producing President George Washington’s dentures—used an old spinning wheel to build what may have been the first foot operated drill. Mercifully, he didn’t use it to drill patients’ teeth; he used it to fashion dental prostheses. However, it wasn’t long before dentists began using hand drills running about 15 revolutions per minute (RPM) on patients.

In 1864, British dentist George Fellows Harrington invented a clockwork dental drill—a drill that was wound up like a clock and ran for two minutes. However, that invention was preempted by James Beall Morrison’s 2,000 RPM pedal powered drill in 1871. It reduced drilling time by about 50% but had an unintended downside: In the 19th century, dentistry was completely unregulated, and once the pedal powered drill became affordable, the field was flooded with uneducated, unskilled, and unethical practitioners.

The S.S. White Company introduced the first battery-powered electric drill in 1883. To modern readers, this might suggest the company was seeking to create wireless drills. In truth, they employed batteries because there was no power distribution grid at the time.

High speed (60,000 RPM) turbine drills were developed after World War II by John Walsh, a dentist with the Royal Australian Air Force, and Dr. Robert J. Nelsen, research associate with the American Dental Association at the National Bureau of Standards (NBS) in Washington, D.C. Then Dr. John V. Borden used compressed air to power his 250,000 RPM Airotor. Air turbine units are still used for 95% of dental drilling—though high-speed, microprocessor-controlled electric hand pieces threaten to replace them.

New technologies have been developed for early detection of cavities and even oral cancer. KaVo Dental’s Diagnodent uses a 655 nanometer wavelength laser to detect small cavities. LED Dental’s VELscope employs a blue light to detect fluorescence associated with potentially malignant tissue.

Dentists played a leading role in the development of anesthesia. In 1844, Horace Wells in Connecticut discovered nitrous oxide’s anesthetic properties and used it to perform tooth extractions. He conducted the first public demonstration of anesthesia in 1845, but the demonstration was a failure because the patient cried out. In 1846, Wells’s student William Thomas Green Morton conducted the first successful public demonstration of anesthesia using ether. Many people have pointed out that Morton did not invent ether. However, that argument misses the point. It was Morton who recognized the importance of administering the right amount of anesthetic at the right rate using the right equipment. He invented a way to make anesthesia reliable and safe. (Ironically, today most dental procedures use local anesthetic.)

Roentgen’s discovery of x-rays in 1895 was a boon to dentistry. Dental x-rays reveal problems such as cavities, hidden teeth, and bone loss. Fortunately, most dentists didn’t embrace x-ray technology until after 1930; by that time more was known about the health risks associated with x-rays and exposure times had been greatly reduced. (Even so, many dentists and their assistants developed cancers on their fingers from the habit of holding films in place in their patient’s mouths.)

Traditional film-based dental radiography is being replaced by digital x-ray technology. X-ray film must be shielded from light before use, developed in a darkroom using harsh chemicals, and then physically stored for future reference. Digital x-ray technology is safer, saves time, and ultimately saves money. Digital x-rays can be viewed immediately. It’s easy for dentists to share digital x-ray images with specialists; instead of sending the original film or a copy in an envelope, the images can be sent via email. Another advantage of digital x-ray technology is that it requires less than half as much radiation exposure. There are even special CT scanners for planning dental implants.

Dentistry is rapidly changing thanks to new technology. Or perhaps it would be more accurate to say that consumers’ expectations from dentistry are rapidly changing thanks to new technology. As one dentist told me, dentists who do not use the latest technology, or at least offer referrals to dentists using the latest technology, risk being accused of malpractice.


Next time: Bodies in Cyberspace

Note: If you would like to be notified when The History & Future of Medical Technology is published, please go to Telescope Books and enter your email address in the newsletter sign-up field on the left menu bar. This email list is only used to announce book offers from Telescope Books; your email address will not be shared with third parties.

This post is the eleventh in a series based on my soon-to-be published book, The History & Future of Medical Technology. Each week I’ll present highlights from one of thirteen chapters.


The Vision Thing

A phalanx of high-tech products provide the ophthalmologist with one of the most advanced toolkits of any medical practitioner. Lasers, corneal mapping systems, and foldable silicone lenses enable ophthalmologists to repair the eye with non-invasive and minimally invasive techniques—often under computer control.

Ophthalmology has benefited more than any other medical specialty from the laser. The same light waves that enable the sense of sight can also be used to treat diseases of the eyes and correct vision. It’s as if the ear could be repaired or improved with carefully measured sounds.

Today, we can repair or even replace parts of the eye. Once we learn how to deliver images directly to the brain, as we almost surely will, then it will be possible to replace the eye entirely.

The history of vision correction surgery is a remarkable saga. It began in the now-defunct Soviet Union. Svyatoslav Fyodorov overcame his father’s denunciation and imprisonment, an accident in which he lost a leg, and massive Soviet bureaucracy to develop a revolutionary technique called radial keratotomy (RK). When Fyodorov’s daring method landed in the U.S., it evolved into today’s popular LASIK vision correction surgery.

In 1973, Fyodorov encountered a patient whose vision (at least in one eye) was corrected by a punch. Fyodorov examined the boy and found a small curvilinear incision outside the visual axis. He confirmed that the boy’s myopia was reduced by three diopters. Fyodorov exclaimed “If a fist can do this, so can I. After all, I am an eye surgeon.”

Once Fyodorov perfected his technique (involving up to 16 straight-line incisions arranged about the center of the cornea like spokes of a wheel), he found he could treat individuals with visual impairment in assembly-line fashion, employing multiple technicians, each assigned to perform a specific step. He established clinics all across Russia. By 1990, the clinics were treating more than 200,000 patients per year.

Fyodorov’s luck ran out when he died in a helicopter crash in 2000. Fortunately, by then his technique had spread beyond Russia. In 1976, Dr. Leo D. Bores of Detroit, Michigan visited Moscow to learn about Fyodorov’s work. Bores returned to Moscow a year later to confirm that RK patients enjoyed good long term results. He invited Fyodorov to lecture at the Kresge Eye Institute in Detroit in 1978. However, ophthalmologists in the U.S. were hesitant to accept RK; many felt cutting healthy corneas was too risky.

Vision correction surgery received a big boost when it was shown that lasers can be used to modify the cornea. Laser eye surgery proved to be faster, more precise, and pain free. I wrote earlier about how Charles H. Townes invented the laser.

Briefly, the operation of the laser is based on an amazing phenomenon called population inversion. An atom with an electron in the excited state emits a photon when the electron drops to the ground state. Einstein realized that an atom with an electron in the excited state can also be stimulated to emit a photon when merely grazed by another photon—turning one photon into two photons. Meanwhile, atoms in the ground state become excited when they absorb photons. If absorption of photons by atoms in the ground state and stimulated emission by atoms in the excited state take place simultaneously, there will soon be more atoms in the excited state than not. If there are more atoms in the excited state, more photons will be emitted than absorbed, and the light used to initiate the process is amplified.

A type of laser well suited to surgery was developed in 1970: the excimer laser. An IBM researcher, Rangaswamy Srinivasan, discovered in 1981 that excimer lasers can be used to finely etch living tissue without damaging surrounding tissue. Each laser pulse removes just 39 millionths of an inch of tissue. Srinivasan teamed up with Steven Trokel, an ophthalmologist at Columbia University, to show that use of the excimer laser was safe and effective.

In the early 1990s, two researchers working independently—Ioannis Pallikaris and Lucio Buratto—used microkeratomes to create and lift corneal flaps, ablate the exposed corneal beds, and replace the flaps. Pallikaris dubbed the technique laser assisted in-situ keratomileusis, or LASIK. Clinical trials of LASIK in the U.S. began in 1996 and the procedure was FDA approved in 1999. In one of the first studies, 70% of approximately 500,000 Americans who underwent LASIK surgery emerged with 20/20 vision.

LASIK is surgery and all forms of surgery entail risk. Many patients fail to obtain 100% correction; while a second procedure is possible it is discouraged. Proponents point out that the risk of serious problems is less than 1%. Critics say that’s still unacceptable.

Ophthalmologists use advanced technology for a number of other purposes including detailed mapping of the cornea; replacing the eye’s crystalline lens when it becomes clouded with an implantable intraocular lens (IOL); and treating detached retinas, secondary cataracts, age-related macular degeneration (AMD), and glaucoma.

The history of ophthalmology reminds us that technology can often achieve more than at first seemed likely. After all, the eye is a very delicate organ. Who would have guessed that vision can be improved by cutting the cornea? Or that the eye’s crystalline lens can be removed and replaced with a man made lens?


Next time: Technology with Real Teeth

Note: If you would like to be notified when The History & Future of Medical Technology is published, please go to Telescope Books and enter your email address in the newsletter sign-up field on the left menu bar. This email list is only used to announce book offers from Telescope Books; your email address will not be shared with third parties.

Everyone says the iPad will be a game-changer—and they are probably right. While I fervently believe that great technology can improve and enrich our lives, I must confess I have mixed feelings about the iPad.

Many people thought radio and television would bring high culture to the living rooms of average homes. They didn’t anticipate Bart Simpson, Jerry Springer, and professional wrestling. Likewise, the iPad could spur book consumption. But will eBooks exercise our minds—or merely dazzle our senses?

I fear that the iPad marks the dawn of an era dominated by interactive, multimedia books. The emphasis will be on the visual presentation rather than the ideas expressed in the text. A good analogy is the difference between a great novel and its movie version.

When I see the movie (multimedia) version of a classic novel (text), I may or may not be entertained, but I almost always end up preferring the book. When I read the book, I get to imagine many details about the characters and settings. I can savor the author’s use of language. And most important, I am the one who interprets any messages that the writer may have been trying to convey.

When I watch a movie, I don’t get to use my imagination nearly as much. I often feel I am presented with caricatures of people and time periods that were gradually revealed over the course of hundreds of pages in the book. To wit, I find myself stuck with someone else’s interpretation of the book.

Most modern educators seem to feel that interactive multimedia provides a superior learning experience. I’m not so sure. When I read non-fiction I must integrate the information with what I already know. And it is up to me to analyze the information and determine how it should be used. When I encounter an interactive multimedia presentation, I often feel that decisions about what’s important and why it’s important were made for me.

There are other reasons to be concerned. During the 1990s, Newt Gingrich proposed giving laptop computers to the poor. My fear is that he was simply ahead of his time. It’s not hard to imagine that when global eBook reader sales reach several hundred million units per year, politicians will propose giving eBook readers to every public school student in the U.S. This is a bad idea for at least two reasons. First, it’s not the proper role of government to be buying products for citizens. Second, eBooks issued by public schools could easily be used for indoctrination purposes--and probably would be.

My understanding is that if you want to play a published audio book on Amazon’s Kindle or Apple’s iPad, you must purchase the audio book separately. However, it seems inevitable that good quality text-to-speech capability will become common on these readers. If most people would rather have books read to them, that’s their choice. (Having taken Evelyn Wood Reading Dynamics, I’m convinced we can take in information more rapidly with our eyes.)

But if most people prefer Aldus Huxley’s Brave New World, where does that leave the rest of us?

One thing we can all agree on: Health care is becoming more impersonal and bureaucratic. The good news is that there are a growing number of options for taking control of your own health—whether maintaining it or managing a known medical condition. I use a small collection of devices and Web sites for both purposes.

I recently began wearing an Omron Pocket Pedometer (model HJ-720ITC). This is a simple and inexpensive device with some nice features. The unit distinguishes between the ordinary steps you take during the day and the "aerobic" steps you take when you go for a brisk walk. The unit also includes a USB port and PC software so you can upload your daily activity, not only in terms of ordinary vs. aerobic steps, but an hourly breakdown of steps taken.

The biggest benefit of a device like this is that it motivates you to do more walking. Now if only someone would come up with an easy way (preferably automated) to track calorie intake. The combination of a pedometer, bathroom weight scale, and calorie intake monitor—all with USB ports—would let you know the precise adjustments in food intake or steps needed to ensure that you burn as many or more calories per day as you take in. (I'm thinking of a kitchen scale that measures the calories—rather than weight—per plate, bowl or glass.)

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