Ira Brodsky.com

I am somewhat dismayed that less than 50% of Americans recognize that big government endangers individual rights. The good news is that 15% are undecided. These are the results of the Rasmussen Poll announced today.

You only need to study history or visit a cross section of the world's countries to know that wherever there is a lack of freedom of speech, freedom of religion, or freedom of assembly there is sure to be big, despotic government.

Sadly, young people today are rarely taught that the Founders of our country were the first to approach the design of government from a scientific perspective. The Founders examined forms of government past and present with the purpose of architecting a government that recognized the people's unalienable right to "life, liberty, and the pursuit of happiness." It was the brilliantly conceived system of checks and balances that made it work and, for the most part, endure.

It's also sad that 37% of adults believe that big government is a protector of individual rights. Though it's not surprising: even police states have supporters. We've seen this recently in Iran, where a brutally oppressive theocratic government still manages to stage mass rallies in its support and has no trouble finding people willing to beat and kill peaceful protesters. I doubt that 37% of Americans would support a police state, but I'm fairly sure they would be willing to trade some of their individual freedoms for the illusion of government-guaranteed financial security.

The real question is: how determined are the 48% to fix things?

Yesterday President Obama said we need to reduce our dependence on fossil fuels and produce more "clean energy." That may be so, but what are the chances that the federal government can cause a major shift to renewable energy by the end of the President’s second term—assuming he is reelected?

Consider these facts. The federal government has been pushing energy conservation and a shift to renewable energy since the OPEC oil embargo in 1973. There has been some progress, but it doesn’t amount to much. According to Wikipedia, renewable sources account for just 3.4% of electricity generated worldwide.

It gets worse. The vast majority of today’s renewable energy comes from hydroelectric plants—a technology that wreaks havoc with the environment—and biomass—a scientific euphemism for wood-burning stoves. Solar, wind, and geothermal energy barely register a blip on the global energy radar screen.

Having done some work in the solar energy field in the early 1990s, I am baffled by those who think we can switch to solar energy by decree. Today, solar energy is simply too inefficient, unreliable and expensive to meet our energy needs. People have been working on solutions to these problems for decades with only meager results. And contrary to reports in some science magazines, there’s little evidence that we are on the verge of a breakthrough. Today’s research could bear fruit in five years or fifty years. Or something unexpected might intervene, causing us to change course entirely.

I did some consulting work for a solar energy company called Midway Labs. The company’s founder, the late Paul Collard, wisely focused on developing a solution for small villages in Africa and Asia. Collard’s unique solution employed light concentrating optics and solar cells designed to withstand high temperatures. The system could generate enough electricity to meet a small village’s basic requirements, but it required a mechanical system for tracking the sun as it traveled across the sky. It also required a large bank of storage batteries to take over at night and on cloudy days. The cold, hard fact is that a gasoline-fueled generator is more efficient, more reliable, and less expensive.

What’s almost completely missing from the public debate about renewable energy is informed discussion about the manufacturing, distribution and maintenance challenges. We can build wind farms all across the U.S., but what’s the cost to build and maintain enough of them? How much energy will be lost transporting electricity from rural areas to population centers? What's the environmental impact of large-scale deployment? Similarly tough questions apply to solar electricity and rechargeable batteries.

As one skeptic observed, renewable energy sources must be subsidized to create demand, while the fossil fuel industry is profitable despite being heavily taxed.

Like the fiber-to-the-home technology in telecom, expect several impressive showcase deployments. But the mass market evolves according to its own timetable and logic.


UPDATE June 17, 2010: Today's IEEE Spectrum Tech Alert was dominated by bad news about renewable energy and CO2 emissions reduction. Both stories (California's Geothermal Plans in Trouble and Why Carbon Capture Won't Work) concern projects that depend on access to scarce water supplies.

All politicians believe they know what to do about the high cost of health care. There's just one problem: most of them are not qualified to solve the problem.

During the 1990s, we had the failed Health Security Act. The key elements of this plan were to increase government regulation and decrease the number of doctors--particularly specialists.

Now we have the Patient Protection and Affordable Care Act. The crux of this plan is to increase both government regulation and the number of doctors. However, there's strong evidence that the Obama Administration believes we should shift the emphasis of health care from aggressive, high-tech treatment to lifestyle management and hospice.

I admit that these plans have the potential to reduce costs. But I fear it will be by returning medicine (as experienced by the average consumer) to the 19th century.

The following is a transcript of Benjamin Netanyahu's statement regarding the attempt to create an unrestricted supply line to the Hamas terrorists:

Once again, Israel faces hypocrisy and a biased rush to judgment. I'm afraid this isn't the first time.

Last year, Israel acted to stop Hamas from firing thousands of rockets into Israel's towns and cities. Hamas was firing on our civilians while hiding behind civilians. And Israel went to unprecedented lengths to avoid Palestinian civilian casualties. Yet it was Israel, and not Hamas, that was accused by the UN of war crimes.

Now regrettably, the same thing appears to be happening now.

But here are the facts. Hamas is smuggling thousands of Iranian rockets, missiles and other weaponry - smuggling it into Gaza in order to fire on Israel's cities. These missiles can reach Ashdod and Beer Sheva - these are major Israeli cities. And I regret to say that some of them can reach now Tel Aviv, and very soon, the outskirts of Jerusalem. From the information we have, the planned shipments include weapons that can reach farther, even farther and deeper into Israel.

Under international law, and under common sense and common decency, Israel has every right to interdict this weaponry and to inspect the ships that might be transporting them.

This is not a theoretical challenge or a theoretical threat. We have already interdicted vessels bound for Hizbullah, and for Hamas from Iran, containing hundreds of tons of weapons. In one ship, the Francop, we found hundreds of tons of war materiel and weapons destined for Hizbullah. In another celebrated case, the Karine A, dozens of tons of weapons were destined for Hamas by Iran via a shipment to Gaza. Israel simply cannot permit the free flow of weapons and war materials to Hamas from the sea.

I will go further than that. Israel cannot permit Iran to establish a Mediterranean port a few dozen kilometers from Tel Aviv and from Jerusalem. And I would go beyond that too. I say to the responsible leaders of all the nations: The international community cannot afford an Iranian port in the Mediterranean. Fifteen years ago I cautioned about an Iranian development that has come to pass - people now recognize that danger. Today I warn of this impending willingness to enable Iran to establish a naval port right next to Israel, right next to Europe. The same countries that are criticizing us today should know that they will be targeted tomorrow.

For this and for many other reasons, we have a right to inspect cargo heading into Gaza.

And here's our policy. It's very simple: Humanitarian and other goods can go in and weapons and war materiel cannot. And we do let civilian goods into Gaza. There is no humanitarian crisis in Gaza. Each week, an average of ten thousand tons of goods enter Gaza. There's no shortage of food. There's no shortage of medicine. There's no shortage of other goods.

On this occasion too, we made several offers - offers to deliver the goods on board the flotilla to Gaza after a security inspection. Egypt made similar offers. And these offers were rejected time and again.

So our naval personnel had no choice but to board these vessels. Now, on five of the vessels, our seamen were not met by any serious violence and as a result, there were no serious injuries aboard those ships. But on the largest ship, something very different happened.

Our naval personnel, just as they landed on the ship - you can see this in the videos - the first soldier - they were met with a vicious mob. They were stabbed, they were clubbed, they were fired upon. I talked to some of these soldiers. One was shot in the stomach, one was shot in the knee. They were going to be killed and they had to act in self-defense.

It is very clear to us that the attackers had prepared their violent action in advance. They were members of an extremist group that has supported international terrorist organizations and today support the terrorist organization called Hamas. They brought with them in advance knives, steel rods, other weapons. They chanted battle cries against the Jews. You can hear this on the tapes that have been released.

This was not a love boat. This was a hate boat. These weren't pacifists. These weren't peace activists. These were violent supporters of terrorism.

I think that the evidence that the lives of the Israeli seamen were in danger is crystal clear. If you're a fair-minded observer and you look at those videos, you know this simple truth. But I regret to say that for many in the international community, no evidence is needed. Israel is guilty until proven guilty.

Once again, Israel is told that it has a right to defend itself but is condemned every time it exercises that right. Now you know that a right that you cannot exercise is meaningless. And you know that the way we exercise it - under these conditions of duress, under the rocketing of our cities, under the impending killing of our soldiers - you know that we exercise it in a way that is commensurate with any international standard. I have spoken to leading leaders of the world, and I say the same thing today to the international community: What would you do? How would you stop thousands of rockets that are destined to attack your cities, your civilians, your children? How would your soldiers behave under similar circumstances? I think in your hearts, you all know the truth.

Israel regrets the loss of life. But we will never apologize for defending ourselves. Israel has every right to prevent deadly weapons from entering into hostile territory. And Israeli soldiers have every right to defend their lives and their country.

This may sound like an impossible plea, or an impossible request, or an impossible demand, but I make it anyway: Israel should not be held to a double standard. The Jewish state has a right to defend itself just like any other state.

Thank you.

Collectivists have been with us since the beginning of recorded history, and will probably be with us for as long as the human race exists. But the popularity of collectivism ebbs and flows.

My theory is that the more prosperous a civilization becomes, the more its idle rich (and just plain idle) are able to indulge in Utopian dreams of a more egalitarian (and necessarily regimented) society. It’s only after the dead bodies are counted that most people recoil from collectivism.

Sadly, we seem to be experiencing another rising tide of collectivism. We are confronted at every turn by exhortations to be good team players, to serve others, and to “give back to the community.” We are asked, as individuals, to make sacrifices to save the planet, reduce the cost of health care, and support an ever-expanding roster of government programs. If you act in your own self-interest, you are bad. If you serve the faceless crowd, you are good.

But questions continue to nag me. If it is better to give than to receive, shouldn’t we do more to ensure that only those truly in need receive? With so much giving going on, it’s hard to imagine there isn’t a great deal of illicit receiving. Personally, I wonder about politicians whose wealth cannot be explained by their comfortable (but hardly extravagant) salaries.

One of the most important indicators of the success of a false ideology is how people frame the issues. You know you are in trouble when the ideology’s language and assumptions are built into almost every discussion. False ideologies are often draped in “fairness” and “the common good,” while anyone who disagrees is labeled “greedy” or “an extremist.”

It never ceases to amaze me how collectivists invent new theories, lexica, and excuses whenever they need them. During the 1930s, it was the workers versus the bosses. During the 1960s, it was the students versus The Establishment. Now it is members of the community versus anyone who believes in limited government.

You know it’s time to worry when collectivists start rewriting (or worse, inventing) history to prop up their ideas. In fact, I was prompted to write this post by Matt Ridley’s essay in this weekend’s Wall Street Journal: Humans: Why They Triumphed.

Ridley claims the reason humans have been so successful (compared to other species) is “collective intelligence.” That phrase is no doubt music to the ears of collectivists. To individualists, however, it is (like “the wisdom of crowds”) an oxymoron. Worse, it leads Ridley to conclude that “innovation is a collective enterprise.”

Ridley conflates the accumulation and exchange of knowledge with collective action. Here is my illustration of how this gets it all wrong. Danish scientist Hans Christian Oersted noticed in 1820 that a compass needle was deflected when an electric current in a nearby wire was switched on or off. British experimenter Michael Faraday followed up that finding and made a series of discoveries of his own about electromagnetism. While it’s fair to say that Faraday built on Oersted’s work, it would be quite a stretch to say they were engaged in collaborative research.

When you boil it all down, Ridley claims that printing, communicating, trading, and even specialization all show that innovation is a group activity. He’s right when he asserts that most of today’s products—whether a computer or a simple pencil—are too complex to be made by an individual. (Sure, manufacturing is generally a group activity.) But he appears blind to the fact that most products result from innovations made by individuals—often in the face of collective resistance.

In 2007, Gary Kasparov published How Life Imitates Chess, a book drawing parallels between success on the chessboard and success in the boardroom. I’ve gotten glimpses of how he operates in both realms.

In 1999, Kasparov played an online chess match titled “Kasparov versus the World.” The game provided a great opportunity to observe a creative individual battling against the wisdom of the crowd (in this case, with a panel of experts on their side). As you might expect, the world played a very safe and sound game. Kasparov employed just enough subtlety and surprise to score a victory. He understood who he was up against and fine-tuned his strategy for a very smart but ultimately predictable opponent.

The contest reminded me of the difference between a standards committee and an inventor. A standards committee is good for dotting the i’s and crossing the t’s. But if you want to do something that has never been done before, you need imagination and daring.

I had my next encounter with Kasparov ten years later. In 2009, my son entered the U.S. Chess Federation SuperNationals chess tournament in Nashville, Tennessee. Kasparov was the keynote speaker at the opening ceremony. But first, we had to listen (for what seemed an eternity) to USCF dignitaries thanking the many people who put the event together. Finally, Gary Kasparov was introduced, and his words immediately resonated with the predominantly young audience. He talked about how, during his youth, he hated opening ceremonies because of the boring speeches—he couldn’t wait to start competing. The audience roared with delight.

There is much wisdom in How Life Imitates Chess. My favorite line is “Better decision-making can’t be taught, but it can be self-taught.” Modern educators either don’t believe it or won’t admit it, but most learning is an individual activity.

Many of us welcomed the World Wide Web as a liberating technology. The Web promised to perfect the capitalist system: from now on, all markets would be global and all transactions would occur at the speed of light. Consumers would have instant access to information on any subject. No government would be able to stem the free flow of facts and opinions. With anonymous but verifiable digital cash, even oppressive taxes could be circumvented.

It turned out we were just a tad too optimistic.

It’s not acknowledged as often as it should be, but a falsehood travels as fast as the truth on the Internet. Breaking news stories often contain inaccuracies that spread quickly across the Web—even after the original report has been corrected. There is much good information on Wikipedia, but there is also some bad information. You should not always believe what you read—whether it’s in a book or on the Web.

My wakeup call came about ten years ago when online activists began promoting “direct democracy.” The activists claimed that the United States was established as a representative democracy primarily because at that time there was no simple and timely way to poll a geographically scattered population on the issues as they came up. Thanks to the Internet, it was now possible to directly poll the people, so we could do away with elected representatives. I knew that wasn’t the real reason we are a representative republic and that “direct democracy” was simply mob rule in new clothing.

On balance, it still seemed that the Internet was a liberating technology. A falsehood could spread quickly, but the truth would never be far behind. Though some people were calling for government regulation of the Internet, most users understood the Internet succeeded because it was self-regulated. Besides, no single entity could really control the Internet. There is no central point of control; on the Internet, most of the power resides at the edges. Getting on the Internet is easy and inexpensive for content publishers. And digital technology makes it easy to operate anonymously—beyond the reach of censors.

Still, one point continued to nag me. During the 20th century, several writers warned that if we weren’t careful technology would be used to pacify, manipulate, and even oppress us. Their books, films, and television programs depicted several different dystopian futures. The warnings were particularly hard to ignore because some of what they predicted was already happening.

Patrick McGoohan’s television series The Prisoner, Aldus Huxley’s book Brave New World, and George Orwell’s novel 1984 are three important examples.

In The Prisoner, McGoohan plays a secret agent who resigns only to be abducted and brought to a place called The Village. Both wardens and prisoners are addressed only by their assigned numbers. A variety of high-tech psychological techniques are used in a relentless effort to get Number Six (McGoohan) to disclose why he resigned. The Prisoner foreshadows the Web in that individuals are known by numbers (analogous to IP addresses) and elaborate schemes are used in order to extract private information (analogous to phishing attacks).

Huxley’s Brave New World depicts a futuristic, class-based society in which people are created in test tubes and trained from infancy to serve defined roles. Technology is used to keep everyone happy—and somewhat numb to reality. Huxley also believed that in the future people would be controlled through subliminal suggestion. In retrospect, the most worrisome thing about Brave New World is how willingly people give up their individual sovereignty for hedonistic pleasures. Though some Internet users still worry about privacy, many more seem comfortable trading their privacy for perks such as free email (example: Gmail).

Orwell’s novel 1984 graphically depicts how brutal leaders might use technology to brainwash, control, and spy on citizens. Big Brother’s primary tool for controlling the upper and middle classes is the “telescreen”—a combination television and surveillance camera. That was a pretty good guess—given that Orwell wrote his book in the late 1940s. Even today, most users probably don’t realize how much information they reveal about themselves when they use search engines, social networks, and cloud computing. A video camera can see your body; a Web access device is a window into your soul.

Do we really have something to worry about? A handful of online companies—most notably Google but also companies such as Facebook—have the ability to gather data on hundreds of millions of users day in and day out. Most of us can hardly begin to imagine what that information reveals about the behavior of individuals, groups, and humanity as a whole. Meanwhile, the U.S. is moving rapidly towards Crony Capitalism, a system in which leading politicians and powerful government agencies forge special relationships with a few large corporations. And there are many examples of how the Web is being used to mislead us—from altering digital photographs to manipulating search results.

Yes, it’s time to start worrying.

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

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