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Excerpt from Kessler's 'The End of Medicine'
With my head spinning from this "High Anxiety" flashback, I stroll into the conference, half expecting to be given a barium enema by a cross between Nurse Diesel from Mel Brooks' flick and Nurse Ratched from One Flew Over The Cuckoo's Nest. I really gotta switch to decaf on days like this.
The 7th International Multi-Detector Row Computed Tomography Symposium sounded innocuous enough. I assumed it would be a bunch of technical papers on the future of scanning, where I would read the paper in the darkened hall until lunchtime and then head off for some hot Hunan and home.
Instead, the place was like a carnival for cardiologists. Talk about feeling like a fish out of water. Outside the hall was an expo of sorts, with big signs flashing Toshiba and Philips. Instead of TVs or microwave ovens, there were PCs with 3D models of some poor schmuck's diseased coronary arteries being folded, stapled and rotated.
The back wall of Toshiba's booth caught my eye and I just stared at it. Rule number one at any tradeshow booth is never look interested or you are doomed to a rapid-fire ten-minute lecture on the ins and outs of the product and forced to give up your card as a qualified lead, to be hounded by phone, fax, email and snail mail for the next year.
"Those are our detectors." Damn, I was snagged.
"They look like the display on my laptop," I noted.
"Well sure, they are not that much different from a flat-panel display."
"Same economics making them?" I asked. Flat panels are notoriously expensive to manufacture, because of their size, unlike chips, where hundreds can fit on an eight-inch diameter wafer.
"Oh no, as we go from 4- to 16- to 64-slice, the detectors can be manufactured discreetly and butted up against each other. We don't have yield issues."
"How much is one of these 64-slice scanners?" I asked.
"Are you ready to buy one today, or this month?" booth-guy asked me.
"No, no, although I wouldn't mind one in my garage. I'm a tech guy."
"Oh, OK. Well, these are basically one- or two-million dollar machines."
"Wow." I wasn't sure if that is a lot or a little, but often a well-placed 'wow' gets you all sorts of inside scoop.
"I know, pretty cheap. We think we have a variety of advantages over the competition and you will see in the face-off that ..."
"Why so much? I've been in enough factories, and those flat panels are a couple of hundred bucks each and the motor to rotate can't be more than ..."
"Well, the X-Ray source is not inexpensive."
"What? Hundreds of thousands of dollars?" I trolled.
"Probably not. We do have high selling expenses. When you only sell a hundred of anything, there is lead generation and a sales pipeline and funnel."
He started whispering. "They could be a lot cheaper." He must be having a tough month.
"Don't let me stop you, by the way," I said, looking around, trying to imply he should hard sell some of these cardiologists and radiologists who were buzzing around the display.
"Doctors aren't buyers, not for these machines. We sell to a few clinics. The rest is into hospitals - they are the only ones that can afford them for now."
"But you said cheaper — I mean, these can be in the hundreds of thousands of dollars instead of millions." It was a statement dressed up as a question.
"Someday," he whispered, again.
That's all I needed to know.
Several times, I heard references to the big face-off that afternoon, like it was the reason everyone was there. "Don't miss the face-off," "This ought to show well at the face-off," "This year is going to be so much better than last year's face-off." OK, I get it.
I sat down in the auditorium and the talks and dim lights put me right to sleep.
The head whips woke me up, as my neck turned into Jello and my chin dug into my chest. I wasn't sure if I was awake, my heart was beating fast - I was on the top floor looking over the rail next to Mel Brooks ... Nope, I'm OK, I'm awake, although embarrassed as quite a few radiologists turn to see what the commotion was in my seat.
"Ladies and gentlemen, welcome back, take your seats, fasten your seatbelts, this is going to be exciting. I am pleased to announce that for our 3rd Annual Workstation Face-off, we have five different vendor groups competing — well, facing off. We have five different data sets: brain, runoff, lung, colon and heart."
The room exploded in applause, like this was some sort of important revelation.
"On the stage, we have workstations from GE Healthcare. Dr. Gruden, please take a bow. Also Vital Images, Philips Medical Systems, Siemens Medical Solutions and TeraRecon. May the best workstation win. Let's get started."
The room was buzzing. On stage were two giant screens. On the left was a view from the monitor of the workstation and on the right was a live feed from the operator's keyboard and mouse so the audience could see how many clicks and keystrokes and other contortions are needed to get through the data set.
"OK, let's start with the brain. GE, you have six minutes for both the Angiogram and the Perfusion. Go."
A giant clock on stage started counting down from 6 minutes. The doctor operating the GE workstation was furiously clicking and slapping his mouse around and on screen; we all could share his view zooming through someone's brain.
"OK, we can see the internal carotid artery on the right-hand side, so now let's quickly move over to this area on the left, ah, not hard to find, there it is, we see the ICA stenosis, let's measure it, 63% blockage." A smattering of applause. "We can zoom in and clearly delineate the calcified vs. the soft plaque." More applause.
"OK, let's quantify the infarct core ..."
I was transfixed. This guy was zooming through someone's brain like it was a Sunday drive. More like a Sunday afternoon video game. I kept looking for a brain in a jar of formaldehyde labeled "Dysfunctio Cerebri — Abnormal Brain" and Dr. Frankenstein's assistant Fritz limping back to the laboratory.
"Let's mark this tissue at risk for infarction and measure some things while we are over in the left cerebral - OK - MTT is 86.7, TTP let's call it 52.5 ..."
He zoomed around the brain like it was just a bunch of bits on the screen, which of course it was. Duh.
"OK. Time. 5 minutes 32 seconds. Very nice. Thank you," the moderator said. The place went crazy. This was repeated on each of the workstations by different doctors to often-thunderous applause. I had a mild headache from all the excitement.
I watched these workstations find aneurysms in the arteries from the waist down, the run off. The trick is to remove the bones from the view and be left with just the arteries. Jeez, everyone knows that. Even I could find the mild aneurismal dilation of right renal arterial trifurcation! But my feet started to hurt and I looked around and lots of folks were rubbing their calves.
In the lung, the fly-throughs were looking for lobe nodules, which weren't so obvious. It was a maze of tubes in there — who can even find their way, let alone in under 4 minutes? But sure enough, there was the posterior and the one adjacent to the heart. Each of the five operators then went back and compared them to a study from three years earlier, after finding them in the previous study, of course. Pretty cool. Does my doctor have this? I coughed, more of an unconscious reflex than anything else.
"OK, a perennial favorite, let's move on to the bowels. This year's virtual colonoscopy will require identifying and measuring five different polyps as well as comparing supine and prone data sets to differentiate stool from polyps."
There was a gasp from the crowd, probably from all the men over 50 who have not-so-fond memories of their real colonoscopies.
"The folks from TeraRecon will go first." "Thank you. For this data set, we have decided to show off our handheld interface device. It is a two-handed device, requiring minimal keyboard usage."
On the right-hand screen, the view zoomed into the doctor's hands wrapped around what looked like a Nintendo or Sony Playstation controller. He was banging it and twisting it around, not much different than my kids playing Halo 2. Except that on the left-hand screen, instead of you as Master Chief blowing away the Covenant to stop them from destroying Earth, you are Master Doctor searching for cancerous polyps extracting revenge and trying to destroy your patient. Or something like that. And you only have six minutes and a crowd of a thousand to cheer you one.
"OK," the doctor running the TeraRecon station said, "let's go into C.A.D. mode to navigate through the colon."
On screen, the screen started flying through the wrinkled walls of the colon, twisting and turning, to the left, sliding over, turning up, then right, around a corner, then down again until it saw something abnormal and stopped in front of a hanging polyp. Ah, that's what Steve Sandy was telling me about.
Massive applause.
TeraRecon found all the polyps and so did everyone else. It wasn't hard, those polyps hung like fruits from a tree, pretty obvious against the background of the empty colon. Each of the operators had to go to the alternate data set to show that a few potential polyp looking globes were nothing more than a pile of, well, stool.
My cough had mysteriously turned into a pain in my lower gut.
"Now, what you have all been waiting for, the grand finale, someone left their heart in San Francisco."
On screen was a giant rendering of a heart and most of the coronary arteries. It might as well have been pumping and spraying blood all over the audience like the movie Carrie, there was such a frenzy.
Each of the workstations zoomed in, probed for diameters of sinotubular junctions and aneurismal sinuses. Ho hum. But in no time, each found blockages, stenosis that either had already caused a heart attack or was about to any day.
I just stared at the screen. My eyes were wider than Marty Feldman as Igor in Young Frankenstein. It's not some dream of the future, there it is in front of my face. I felt some pains on the left side of my chest, but my stomach ache went away.
This is it. The resolution was high enough, and there was plenty of speed to zoom around and find all the gunk in less than five minutes. These guys could peak inside and tell me if I was going to have a heart attack, before I do, before I drop on the floor grabbing my chest and my wife screams to the 911 operator to get someone there as fast as they can, before all my relatives get the call saying Andy has had a heart attack, before I get overloaded with blood thinners and can't remember what day it is.
This changes everything. Blood pressure readings, cholesterol checks for low-density lipoproteins, echocardiograms, all that stuff is primitive stuff, like silent movies — OK, another Mel Brooks reference. It just has to be cheap enough and it will be as routine as the doctor banging your knee or squeezing the crowned jewels.
Let's see: $2 million machine, 5 minutes per patient, of course, that means
144 a day, 720 per week, 36,000 per year, hmmm, that's $55 per scan.
Add a little for the attendees and five minutes of the radiologists
time and voila, maybe this is a mass market thing after all.
Avoid any surgeon run by Windows, it might BSoD while working on your heart!
/. is not to be used by individuals with high blood pressure or a history of heart attacks
Like, quietly? Or discretely?
my computer doctor isn't plagued by 503 errors in the middle of surgery!
Monstar L
Spoke with one of my esteemed colleagues re this. There are still certain things that the CT virtual scan is not good at detecting - Not all polyps are pedunculated (like a tree) - some are broad and flat (sessile), some vascular lesions can not be appreciated with the CT, etc.
So what to do if you find a polyp? - get an actual colonoscopy of course, so that they can snip it off.
While most people don't look foward to having this done, it's still probably the best way to have your colon checked out. Everyone over 50 NEEDS to have this done. Missed colon cancer can lead to a colostomy - yeeecch! - or worse. So put up with the distastefulness of it and get it done, or convince your parents to get theirs.
..........FULL STOP.
As an undergrad in the 80s, I worked with some computers in a university chemistry lab. In this lab, one of the research professors was developing "shape fitting" methods to design drug molecules. Need to attack a certain receptor? Design a drug that fits. Need to protect a certain receptor? Design a drug that plugs the hole until the intended natural molecule is present. It was all very next-century super-futuristic stuff.
Now that computers should be able to handle that task easily, I rarely hear anything about it anymore. And honestly, there's a lot more than geometry and a few chemical bonds that need to be better understood. We all thought buckyballs would be completely inert and pass through the system... until we actually found that living bodies can get choked up with them. It's like explaining how bees fly-- there's a lot to the science which is still just guesswork and lab experiments.
Lastly, it may be great if a new treatment helps 94% of patients... unless you fall in the 6% it doesn't help. Everything is statistical until it's personal. There are a lot of areas of the response tree which are not known, or even if a certain branch of pathy is known, there are risks in all modes of treatment.
Somehow, I don't think human fuzzy-thinking seat-of-the-pants gut-instinct doctors will be replaced with deterministic analytical machinery anytime soon.
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I was too busy drowning in the 1 million bizzare, random references to figure out what the excerpt was actually talking about. Also, somebody's got a serious hard-on for Mel Brooks.
I thought it was Igor. Pronounced "eye-gore".
I stroll into the conference, half expecting to be given a barium enema by a cross between Nurse Diesel from Mel Brooks' flick and Nurse Ratched from One Flew Over The Cuckoo's Nest.
Wishful thinking?
Is this part of the coming Singularity?
Finally, went to a third doctor who gave me a different Lyme test which came back borderline (but still technically negative). She put me on antibiotics for a few months, and thanks to that treatment, I'm much better (not as well as before, but about 95%) now. It takes a good diagnostician to listen to the patient's symptoms, ask questions about his/her history, and *not* blindly look at test results.
I'm not saying that this equipment isn't important, just that there's still a place for talented physicians - those things are an adjunct, not a panacea.
-b.
Reading bits of TFA cause me to recall a scene in "ST4:The Voyage Home" where Chekov takes a bad fall and lands in a San Francisco hospital, near death, because the late-1980s medical technology can't help him.
Dr. McCoy finds him, puts some kind of device on his forehead and he's back to normal in less than a minute. He also finds time to cure an innocent bystander of their kidney disease.("Dialysis?! It's like the goddamn Spanish Inquisition!!!")
Star Trek's fictional technology, such as the communicator, tricorder, phaser, even Transparent Aluminum... have all come to exist as reality much quicker than imagined. While I did not imagine a crossover into medicine, perhaps that too will undergo a similarly fast transformation.
One can certainly hope.
The problem with socialism is that they always run out of other people's money. - Margaret Thatcher
As long as robots don't touch psychology I'm perfectly happy with this. Though this reminds me of a debate I was in several years ago about robots and medicine..
"I thought what I'd do was I'd pretend I was one of those deaf-mutes" ~ Laughing Man - GITS:SAC
Mind you, I happen to have had an echocardiogram just last week, my first, and it's a freakin' miracle to see all the little valves doing their stuff, and a technician watching my heart in real time for many minutes and making literally dozens of quantitative measurements without poking sharp things into me or injecting dubious "dyes" into me or (I trust!) toasting me with radiation.
But I have to wonder. If high-tech medicine is actually effective--not just awe-inspiring, exciting, and, well, entertaining--why is it that with so much of the stuff, the United States ranks about #40 in infant mortality (worse than New Zealand, Portugal, Slovenia)? Why is our life expectancy only 78 years when forty-seven other countries, including Aruba, Spain, and Iceland, do better?
Is it possible that we need less of these robotic surgeons and computer imaging centers and a few more humble, prosaic things... like visiting nurses, or immunization programs (How is it possible that people in the United States are still getting mumps)?
"How to Do Nothing," kids activities, back in print!
"Read 12683 More Bytes.."
Yes, because that's a descriptive way to tell a person how long a piece of text is.
James Tiberius Kirk: "Spock, the women on your planet are logical. No other planet in the galaxy can make that claim."
One of the main theses of this book is the comptuer technology will do to doctors what ATMs did to tellers. I call BS. My wife is studying to be a doctor (MD), and its more than memorising disease X and treatment Y. It involves alot of bedside manner and gut instinct. Think about what a teller does... a tellers does not need 4 years of teller school and 3+ years of teller residency to do his or her job. A teller fscks up a transaction, no one's going to die. An doctor fscks a diagnosis, well the patient may be up the proverbal polluted creek without a means of propulsion (i.e. death).
I've done research into using AI methods to diagnosis patients with a disease based on MALDI-TOF of proteins from patients with and without lung tumors. The group I worked in had a difficult job spliting groups. When we presented at a conference, everyother presenter could not find and answer (this was a sponsored 'contest' to see if it could be done). It was a b*tch to seperate patients by biological markers. AI will probably be able to do it one day, but not now.
(paper: Proteomics. 2003 Sep;3(9):1704-9. Multiple approaches to data-mining of proteomic data based on statistical and pattern classification methods. Tatay JW, Feng X, Sobczak N, Jiang H, Chen CF, Kirova R, Struble C, Wang NJ, Tonellato PJ.)
Just my 4 bits...
Accentuate the positive, don't waste your mod points on the negative.
You get to a point with investigations where more isn't necessarily better. There is always a chance that a scan will show a false positive. You see what looks like a suspicious nodule in an asymptomatic patient. Now you have to do more investigations, and some investigations carry a risk. Finally they decide to biopsy the nodule to see what it is and it turns out to be benign. The end result can be a patient exposed to unnecessary radiation, surgeries and/or worries. That's why it's nice to have doctors who decide who and when to scan. 'Magic Scans' aren't the panacea they are cracked up to be.
That being said, it is incredible what technologies are doing for medicine. Some of the stuff in medical textbooks is obsolete, particularly clinical findings, because you almost never see that disease advanced to the degree that the book describes as we get better and better at finding things early.
So like the other poster said, sign up to get your screening colonoscopy today! (provided that your 50)
"I thought what I'd do was I'd pretend I was one of those deaf-mutes" ~ Laughing Man - GITS:SAC
You know, if you're going to quote something like that, you should probably refer to the original source material, Catcher in the Rye.
Far more interesting than most of the stuff Kessler discusses here (stunted writing and four(!) Mel Brooks references), is what is going on beneath the surface. He is clearly having some serious medical issues of his own. He starts tripping balls when he's looking at the hotel carpet, has phantom psychosomatic pains, and starts coughing and jabbering for no apparent reason in the middle of the show. What is his purpose here anyway - to tell us that technology is making medicine better? Thanks. Pop-science or no, this is more a sad look at a confused and deranged former techie trying to find his way in a world that seems to be closing in around him than it is about how technology is 'rebooting' my doctor. Oprah will probably love it though, and I suppose that's all that matters.
I have been running a radiology IT company for the last 4 years and have been involved with radiology in one way or another half my life (all of my life if you count my father as being a radiologist). I frequent medical technology trade shows and have seen quite a bit of this 3D post processing.. Very intriguing stuff and the resolution on these machines is very beautiful, I often wish my home PC could render the same resolution as these machines. Doom 6 would be the next best thing to sex..
However, I don't think any machine will be capable of replacing a medical professional in the next 20 years and I really feel there is only one major reason holding vendors back: liability. The human body is simply too complex for a computer to check for issues, understand complications, diagnose and recommend further action.
Currently the systems can highlight and pinpoint potential problem areas, but these systems still rely on a medical professional to review and approve the findings. From what I here the systems are pretty good at finding "problem" areas but offer a lot of false-positives that the doctor has to check out.. thus negating any upper hand advantage they gave in work flow optimization.
Let's mark this tissue at risk for infarction
I don't think farc.com is very interested in brain tissue.
try { do() || do_not(); } catch (JediException err) { yoda(err); }
My brother currently has about 2-3 months to live because he didn't and for the last five years has battled cancer. Five bouts of chemo. Not something to wish on anyone. Please get that checkup.
That is where the best use of a "knowledge base" to imbed the best minds' knowledge in a computer can be used to help out eliminating tedium and lengthy page by page hand tallied results by a doctor.
That lets the doctor get to range of possible problems & solutions more quickly.
Unfortunately, we are barely now graduating the first doctors who have now lived their whole school experience with computers and are comfortable with them, and then there is the constant upgrades and training and cost. Lots of doctors won't keep up. Going to take awhile longer than anticipated, by my guess.
In my experience algorithms are rarely monopolized by any single field very long and fairly quickly find themselves distributed across all sciences and engineering. For example the algorithm of tomographic inversion was picked up by seismologists, astrophysicists, meteorologists, material scientists, etc. for similar situtations in their fields. Likewise radiology engineers monitor devlopments in image processing and 3D graphics to construct even move vivid and useful body images.
The best thing would be to automate the scans of MRI's to find issues. Then you could go in for a health check and they could just MRI all of you and let a computer look for stuff that's wrong with you and let you know. Sure, it wouldn't find everything but my guess is if done well it could find issues before symptoms appear.
set softtabstop=4 shiftwidth=4 expandtab nocp worlddomination
Having watched SAC, I find your obsession with the "original" hilarious.
I have seen the future, and it is inconvenient.
It's pretty clear that better Lyme Disease tests would have been easier and more effective. Bring on the technology!
As an undergrad in the 80s, I worked with some computers in a university chemistry lab. In this lab, one of the research professors was developing "shape fitting" methods to design drug molecules. Need to attack a certain receptor? Design a drug that fits. Need to protect a certain receptor? Design a drug that plugs the hole until the intended natural molecule is present. It was all very next-century super-futuristic stuff.
Now that computers should be able to handle that task easily, I rarely hear anything about it anymore...
You have to find the receptor. You have to design a drug to fit in the receptor. You have to figure out (mostly guess) whether or not the drug will actually bind at the receptor. You have to figure out (at least guess) as to whether or not the drug will kill people in addition to stopping acne. You have to figure out how to make the drug. Then you have to actually go through all the trials.
If you mass test random potential compounds against random proteins, you get to cut out some of those steps.
There are companies that do the designer route, but it seems like most go for the shotgun "spray a bunch of compounds at a bunch of proteins and see what sticks".
Really, we don't even know how these proteins are gonna fold, so we're a ways away from automating designer drugs.
*I am not a biologist, chemist, physicist, etc. I'm a programmer.*
He started whispering. "They could be a lot cheaper." He must be having a tough month.
Sheesh, why are we asking the sales guy what it costs to develop something that he doesn't have the first idea about how it works or what it takes to develop?
Having worked in the medical industry, I can tell you that the documentation and testing are what costs a lot of money, not just the raw cost of the parts. Any change to the system (either hardware or software) requires a lot of documentation, paper trails and analyses. It's NOT like your typical software shop where you throw stuff out into the world, collect bug reports, and fix them. There are lots of hidden costs.
Not to say that medical companies don't make a lot of money (they do), but it's just silly to argue that these devices should be sold at the same 5% markup as Joe's PC Shack down the street.
Sometimes it's best to just let stupid people be stupid.
Absolutely, and I'm all for creating better blood tests, since the current generation of tests checks for a certain kind of antibody rather than the spirochaetes themselves. Problem is: not everyone produces enough of the antibody to be detectable :(
My point was quite different: that doctors must be first and foremost taught to *think* and also listen to patients' symptoms and use that data as part of their method of making a diagnosis. My point was that doctors shouldn't make the mistake of thinking that technology is infallable. Even if the Lyme Disease test is perfected (I hope so), there'll be a new test 42 years from now for Martian Contagious Pseudo-Leproid Syndrome that is thought to be nearly 100% accurate, but turns out not to be 15 years after it is invented.
-b.
yeah it takes a real pro to prescribe antibiotics for a mystery illness.
Both.
I am defenseless. Use your button. Mod me down with all of your hatred.
Iceland - there's no stress because there's nothing to do excape ride some really cool horses, drink, and outrun the occasional lava flow.
Spain - go to Bilbao. Just melt into the green hills. It's like Wales, except they don't talk funny.
Aruba - no 'toot' of the angry horn.
You'd live longer too.
"Win treats sysadmins better than users. Mac treats users better than sysadmins. Linux treats everyone like sysadmins."
Half the posters seem to have read into the title and tag line that doctors would be replaced by computers. Is that part of the book that isn't presented here?
First of all, more tools are generally better. It appears that, as with practically all disciplines, doctors will need to become more savvy regarding computers. But really it seems pretty minor - you will still need a doctor, someone who understands the basic operation of the human systems and diseases to use these new tools. I see doctors being around for quite some time. My hope is that the increased volume of products will tend to bring down the unit costs, and that (questionable) legal settlements don't more than offset the savings.
The thing is that, no matter what tools are available, it will still require a human - a smart human - to link the symptoms with the problem, and the problem with the cure. It is still the doctor's responsibility to look at the entire patient, not just the gee whiz stuff, to make a diagnosis and specify treatment. Engineers deal with this all the time - Finite Element Modelling has revolutionized mechanical and structural design. Still, the best designers out there know how to do it without the programs. They understand how and why things work; the FEM gives them a more detailed view and can make things more accurate, more efficient. Doctors are the same way - these tools let them refine their practice, do more with less invasive procedures.
Hey - choose your three least favorite medical exams. They're probably annual to tri-annual, right? And you put them off when you can anyway. Now, what if they sent you through a CT scan once a year and sat down with you in the office, and there were no invasive procedures necessary unless you actually had a problem? Making that appointment is a lot easier. I say overall health is the winner in this case (providing we can afford it).
Is it just my observation, or are there way too many stupid people in the world?
However, I googled him recently out of curiosity to see what had happened to him and his ideas, 20+ years on. I have to say that the results were remarkably disappointing. It seems that Larry Weed was too far ahead of his time and may still be. Check out his company at http://www.pkc.com./ One rather dramatic quote of his: if physicians ran airports they wouldn't have radar, just lots of intensive care units around the periphery.
For each 100MDs today, there will probably be only one MD in the future. Which will be better for the surviving MDs, they will be paid MUCH BETTER.
The same with the bank tellers, there are still some, but fewer than in the past.
The same will apply to any profession.
(a) antibiotics don't treat Lyme immediately. It can take weeks to months to completely remove the bacteria from your body. Thus, the usual course of 10-days of antibiotics at a normal dosage would have done little or nothing (also, when you start antibiotics, Lyme often gets worse, not better).
(b) the Lyme symptoms are close to many autoimmune disorders, and thus can be mistaken for such. Thus, some doctors have prescribed steroids - corticosteroids lower immune responce, which is the exact opposite effect than the one desired.
-b.
Exactly. That's the whole reason why I quote it from there and not the orginal. Because the quote itself represents the concept explained in the last ep. So so many copies. :)
"I thought what I'd do was I'd pretend I was one of those deaf-mutes" ~ Laughing Man - GITS:SAC
Actually, with a good enough detection system, a computer could detect your borderline case.
.01% of them orange and the rest was green, could you tell? It would be far more accurate to have a method of detecting each molecule and being able to accurately add it up to 45.4223 million green paint molecules and 40 thousand orange paint molecules.
Currently, tests for most virii simply test for molecules your immune system creates to fight them. They do bucket chemistry types of test rather than detecting individual molecules. Imagine trying to test there are any orange paint molecules in a bucket of paint. It would be pretty damn hard unless there was a lot of it. If there were
With a good enough detection system, there is no such thing as borderline. It would detect the foreign substance, virus, or bacteria molecules and allow for immediate treatment the very day you noticed a symptom.
Unfortunately, we're nowhere near that level of detection.
Just imagine feeling any symptom at all, or even doing a weekly test just for kicks. Run the detection system and it finds 120 forms of flu your body is successfully battling, 3 forms of cold, and an unusual lyme disease.
Treating these things immediately would prevent any damage, as well as eliminating a source of contagion for the flu and cold virii.
Can you imagine everyone having a home detection system that does a scan when you enter your door?
It's like explaining how bees fly-- there's a lot to the science which is still just guesswork and lab experiments.
The problem with explaining how bumblebees fly was that the wrong model was applied. They tried to analyze a bumblebee as if it were a fixed-wing glider (or a helicopter - which is mainly a fixed wing aircraft flying in cricles) and discovered that it would drop like a rock.
Which it will if it stops flapping.
Took a while to figure out that they create a vortex with one part of the flap, then use it to create lift with another. But they've pretty much got it down solid at this point - and are building tiny flapping flying machines using the same principle that perform about as analysis predicts.
Of course the same is no doubt happening all over medicine. So your analogy is right on (even if the example is a bit dated).
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Speaking as a practicing physician (pediatric hospitalist, to be precise), there are at least three things that are going to keep me from worrying too much about being "rebooted" by a really good CT scanner.
First, there's the unpleasant reality than in medicine the diagnosis is usually not the most important question. I've had about three true diagnostic conundrums in the past two years, and in two of those the question wasn't what was wrong (we were virtually sure it was cancer) but where it was. Yes, in those two cases, a very high-tech scan (a PET/CT) helped make the diagnosis, but for every one of the other hundreds of patients I've seen recently, the key issue was management, where all the 3-d algorithms in the world are brutally inferior to one reasonably well-educated intern.
This is even more important because diagnosis isn't enough, ever. You can't just find the polyps, you have to deal with them. You can't just find the coronary stenosis, you have to repair it. And in both cases, the skill of the physician (and the knowledge to accurately measure benefit and risk) are my real stock in trade. Hand me the diagnosis, and I'm not threatened, I'm thrilled. And since you need a good radiologist to really read the CT well, my radiology colleagues are pretty OK with the new tech as well.
Second, the excerpt is coming from a radiology trade show. I'm glad that the tech is cool, and I love the pictures, but radiology is only a small part of medicine, and most of the non-trauma diagnoses we see aren't really that dependent on a good CT. As other posters have noted, echocardiography and endoscopy do pretty well at all of this, and the CT is at best a screening adjunct that might increase the numbers of people who have the definitive studies. Eventually the imaging will be good enough to really replace colonoscopy (just as it became the standard of care in diagnosis of appendicitis), and I really do hope that it happens before I get to 50. But it's a tiny part of medical care, blown into high relief because it's at a show where nothing else is important. It's like going to an embedded-systems trade show and not noticing that graphics exist, because nobody is embedding 3D in their network storage appliances.
And third, and possibly just because I'm being cynical, I've been replaced by various kinds of high technology since before I even became a doctor. I've been outmoded by fuzzy logic systems, by automated diagnostic software, by genomics, by proteomics, by targeted drug design, and by about fifteen different funding agency mandates. I've been told I'm obsolete so long that the first ones that told me are already dead. Sure, I expect to die myself some day - as far as I know, even in this age of high tech, everybody pretty much does die - but I'm not going to spend much time worrying that technology will make physicians obsolete before then. The game changes, and I practice medicine very differently from the way it was done in my grandfather's day (and thank God that this is so), but as long as I'm willing to employ my intellect and manual skills on behalf of sick kids, there'll be a way to do it.
How old is your brother, if you don't mind me asking?
My father was diagnosed with colon cancer at 45 years old. Luckily just early enough.
I was tested at 40 (sigmoidoscope and barium enema - ugh) and at 45 with Colonoscopy. The colonoscopy was no big deal. Not eating for a day and drinking some 'go fast' was the only hard part.
Over 50, or over 40 with a family history. Do yourself a favor, dudes AND dudettes.
Think of it this way, all the medicine in the world won't help if we go extinct will it?
I'm all for stem cell research and medicine, I'm all for working to increase the lifespan, but it's just not going to happen. The life expectancy is decreasing and will continue to decrease. The young growing up today most likely will not live to see 60 unless something changes, in fact many will not live to see 40. If we only have a decade or two left, what difference does it make if we have good hospitals? Work on cryogenics and suspended animation if you want to work on something, and maybe work on genetics.
I do not think there will be a such thing as a human in 40 years, I could be wrong, in fact please prove me wrong, but the way the world is currently headed, humans won't exist, and if they do they won't be recognizeable as humans by todays standards.
I'm all for trans-humanism, I see that as the best option our species has to survive. Basically, we will either invent a better human, or there will be no humans, and a better human can be anything. We have computers now, we have the technology to make life better, it's a choice we seem to not want.
Many people want to talk about their problems - hard to do that and get reassurance from a machine.
Bedside manner counts for a lot! Some people needs gentle reassurance, some need stern reinforcing, some need to be yelled at. This all helps a person to be motivated to become better, and push themselves in therapy, etc.
I'm a surgeon - and a lot of what I and my colleagues do is from a "gut" instinct. Something just doesn't add up - the patient "looks" sick, even though all the tests look O.K., etc.
I've been reading about how computer programs will make the diagnostician/clinician obsolete for 15 years now, haven't seen anything useful as of yet. Maybe in the far, far future, when we have friggin' magic robots, there will be fewer MDs, but not a lot fewer.
..........FULL STOP.
We are past the point where medicine can help. The situation looks something like this;
1. We go extinct.
2. We design newer and better versions of humans using medicine, science and technology.
3. We spend our time enjoying the limited time we have left and stop worrying about healthcare, medicine and science.
So these are 3 potential outlooks, there might be more, but in general there is not much time left. Fusing technology and medicine is fine, and transhumanism is fine, but what exactly does surgery have to do with it? In the end, even if we have the worlds greatest hospitals, it will not make a bit of difference because we cannot even decide if we want to live or die, or have long or short lifespans, or if we want to be transhumanist or extinct. The point is, nothing can change if people simply consider it business as usual, if this is just a ploy to make money by the technology and medical industries, in the end there will be a lot of very sophisticated yet useless equipment, that may extend the lifespans of a few individuals, but which won't really influence the lifespan of the species itself. So the whole debate is about the lifespan of the species not simply the lifespan of the individual, how does this technology change anything?
I'm guessing it doesnt, but it would make a very wise investment, and it will be very profitable, much like cosmetics and genetically engineered food. In our current stage, the next debate will be designer babies, and nootropics. Yes it is possible to invent a pill to boost an individuals intelligence. Yes it is possible to ONLY have intelligent babies, and this would decrease the need and cost of the education system.
Go to Better Humans . COM, Plenty of info there.
Well, it depends, it's definately coming, but it's undecided if it will destroy us or not. The Singularity sounds good on paper, but seriously, how will the singularity help the species itself anymore than say, nuclear energy did, or any of the other discoveries?
Say what you will. Medicine is as immune to progress as ever. We're beginning to have issues just fighting off bacterial infections thanks to overprescription of antibiotics.
The demos weren't from live patients, but from prepared data sets. From looking on the web, it looks like the scanning itself takes 15 to 60 minutes with a fair amount of that time in setup. Then you might wait to make sure that the scans are good. That, I imagine, just gives you the rough data, there isn't any indication on how long it takes to format it into something these computers can zoom around in.
And then do you really think a doctor (and hospital as the employer) who would be facing a malpractice suit if he screws up would really strap on a glove, zoom through in four minutes and go "WOOT!"? My guess is "test results in about two days" will be the default, regardless of the technology used.
-- I browse at +5 with stripped sigs
Now that computers should be able to handle that task easily, I rarely hear anything about it anymore.
Nooo, I'd say you don't hear so much about it anymore because (1) the idea is no longer new, and (2) it isn't working out as well as we'd first hoped, and perhaps (3) you're not in the field. We've a loooong way to go before rational drug design in silico becomes truly routine. At the moment it's a big help to the trained chemist, but that's it.
A couple of problems remain:
(1) Often enough, the molecular structure of drug targets are a mystery. Most often, it's a mystery clinically, in the sense that no one knows the target molecule or even the target biochemical pathway. How do you fight the development of atherosclerotic plaques in the coronary arteries? Given that we have incomplete knowledge of how it happens, it's very hard to identify a target for drug therapy. Here genomics and proteomics, e.g. the correlation of the expression of certain proteins with certain clinical conditions will undoubtably help.
Even in cases where a target is known, it may well be a mystery physically. It's very difficult to crystallize proteins to determine their 3D structure. I think good labs can do maybe 3 or 4 a year. More vexing is the fact that probably a lot of useful targets are on cell membranes, and membrane-bound proteins are usually impossible to crystallize at all.
(2) The solvent has a profound influence on the interaction between macromolecules and possible ligands, so computer simulation of these systems has to take good account of the solvent. But the solvent (water) is small and moves on a femtosecond time-scale, while the interactions of interest are maybe 5 to 10 orders of magnitude slower. That means your computer spends essentially all of its time simulating (useless) solvent behaviour, and very little simulating interesting protein/ligand behaviour. The problem grows exponentially with the size of the system of interest, so it can't be solved even by Moore's Law. Better theoretical models of solvent are needed.
(3) The interactions that govern the dynamics of these systems are strongly many-body, but the calculation of true many-body dynamics is prohibitively expensive. Inevitably simplifying approximations are made, but that tends to reduce the utility of the methods, because the approximations must be validated in a system not too dissimilar from your target system. That means you have to have some independent means of knowing the behaviour of a system not too far from your target system to validate your computer model. That makes them less generalizable and useful than one would hope.
That said, it's an area of vigorous research and much progress. There have been some noteable successes. But the idea in the 80s that by now we'd be routinely designing drugs by computer simulation is sort of like the idea in the 60s that by 2000 we'd have moon colonies and be routinely sending manned spacecraft to Mars. The future is arriving more slowly than we'd hoped. As it always does, except maybe around April 15.
Medical diagnosis software has outperformed doctors for about 20 years now. The only major reason holding vendors back is (gasp) doctors . As long as doctors are in charge of medicine, medicine will never become inexpensive or excellent.
This work needs a live, warm, human editor, who knows it's
*discretely* not discreetly
*peeked* not peaked
Very well said! Both here and in the original post.
An additional factor (besides the highly inelastic demand people have for life) that gives us such rapidly rising health care costs is shared with many other service industries: the cost of the services is not rising so much as the cost of manufactured goods and food is falling. That is, it's not so much that going to the doctor is getting way more expensive than buying a loaf of bread, or a new car, but that the real cost of a loaf of bread or a new car has fallen very steeply in the last century or so. We spend a much larger fraction of our income on health care largely because we are able to spend a much smaller fraction of our income on basic needs like food, clothes, transportation et cetera than our grandparents did. We can afford to buy more healthcare -- so we do.
An interesting anecdote bears on this: I recall some years ago reading a newspaper article on a farmer in Urbana, Illinois, who had just retired after 50 years farming corn. He remarked that it so happened the nominal (not accounting for inflation) price of a bushel of corn was the same on the day he retired as it was when he started farming 50 years earlier. Mechanization, improvements in seed genetics, crop management, and weather prediction had all so hugely improved the productivity (per man-hour) of farming that the real price of corn had plummeted. Similar things have happened in most manufacturing and agricultural sectors. Technology makes the productivity of each employee soar. I think the modern steel industry, for example, has a productivity of nearly 1000 tons of steel per employee, and that probably counts secretaries and floor sweepers...
Medicine is different. Technology just can't increase the productivity per employee very much. You still need a human physician to make initial diagnoses, however much technologically-gained information he might have at hand, and he still needs some modest fraction of an hour per patient to do it. Technology can't let him diagnose hundreds or even thousands of patients per hour, because it can't multiply the speed of his trained thought processes. In fact, technology may make things worse, because it causes a need for larger teams of trained experts to use it. If you fell and knocked yourself unconscious 50 years ago, the doc would check your pupil diameter with a pocket flashlight, evaluate your speech, et cetera, to decide whether you'd cracked your skull. Now he's going to send you for a head CT, maybe an MRI, and while that's more definitive, it also means you need to pay for the time of half a dozen more trained experts to build, maintain and operate the fancy machinery you're using.
*Phone ringing somewere in London someone picks up the phone*
Hello?
This is the overseas operator. I have a collect call for a Mr Jackass.
Who's it from?
A Mr Jerf
Sorry, Mr Jackass passed away several months ago from the mumps.
The most amazing thing is that it is assumed that Slashdot readers have health insurance or general medical coverage.
A large percentage of those living in the United States don't.
When you're young, it doesn't matter because young people don't get sick often. They only need health care as a result from doing stupid things and getting injured. (Or, if they are female, they need medical care access to avoid unwanted pregnancies. But how many Slashdaughters are female?).
If you get sick in the USA and don't have any very expensive health insurance, you get fucked. Tossed out like a used tissue. Simple fact of life there.
That would be way cool, if it scanned your entire body as a whole, not just blood, urine, or what have you. Some viruses and bacteria like to hang out at particular sites in the body (CSF, joint fluid, muscles, skin, liver, whatever) and testing other parts is going to give you little or no result. Also, unless the system is sentient or nearly so, it's only going to detect known baddies, or at least baddies that look similar to known problems.
-b.