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Excerpt from Kessler's 'The End of Medicine' 116

Posted by timothy
from the naked-trackballs-easier-to-control dept.
The same technology and silicon and 3D algorithms we play around with every day are about to invade medicine. The following is an excerpt from Andy Kessler's new book, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor.

CT Anxiety

I always feel a certain anxiety when I walk into the Hyatt Regency at the bottom of California Avenue in San Francisco. The cutsie Trolley car outside, the Embarcadero tile pattern on the sidewalk — they are all part of the package. But as I've done every time I've been there, I head straight into the lobby, tilt my head back and scan the Escher-like floors, starting at the top and then down and outwards to the bottom until I start feeling dizzy. I thank Mel Brooks for this.

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.


Andy Kessler is a former Bell Labs chip designer, turned Wall Street analyst and hedge fund manager turned author. Sounds like he can't keep a job. See this book's page at Amazon.
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Excerpt from Kessler's 'The End of Medicine'

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  • What if (Score:2, Funny)

    Avoid any surgeon run by Windows, it might BSoD while working on your heart!
  • by antifoidulus (807088) on Monday July 17, 2006 @02:13PM (#15732335) Homepage Journal
    my computer doctor isn't plagued by 503 errors in the middle of surgery!
  • by spineboy (22918) on Monday July 17, 2006 @02:13PM (#15732342) Journal
    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.
  • nothing new here (Score:4, Informative)

    by Speare (84249) on Monday July 17, 2006 @02:19PM (#15732405) Homepage Journal

    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.

    • I am not sure I understand your point. Technology advances, treatment improves, novel risky things become routine, and people live longer. And you don't see advancement?

      Personally, I sure hope technology can do something about the high price of medicine in the US. It is really becoming burdensome, and shifting demographics make it even moreso. And I know other countries have it even worse. Between a weaked economy and a diminishing worker base in Japan, I'll bet those Anime about receiving medical an

      • Personally, I sure hope technology can do something about the high price of medicine in the US. It is really becoming burdensome, and shifting demographics make it even moreso.

        The only way to lower the cost of medicine in the US is through political decisions and different health care policies. The exact same procedures AND the exact same medications AND the exact same equipment can be found in many countries (including european countries) at a fraction of the cost.

        Maybe it has to do with the fact tha

    • It's like explaining how bees fly--


      Bees don't fly. They just convince the air to keep them aloft. It's true! Do the maths!
    • Designing drugs (Score:3, Informative)

      by kwerle (39371)
      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
      • If you mass test random potential compounds against random proteins, you get to cut out some of those steps.

        Actually doing the "designer" thing lets you cut out a ton of the testing, since you're only testing compounds that have a geometry that would allow them to fit the receptor.

        There is/was a pretty huge investment in the software and hardware that could do the umpty-kabillions (that's a technical term, sorry) of combinations of molecules and receptors, but the savings is in the back end with reduced

      • 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 t
    • by Ungrounded Lightning (62228) on Monday July 17, 2006 @04:20PM (#15733376) Journal
      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).
    • 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 s
    • Having spent a little time in the cardiovascular research and therapeutics world, I have to agree. The human fuzzy-thinking seat-of-the-pants gut-instinct doctors will... or at least SHOULD be kept around to teach the ones who think they can diagnois everything by lab, x-ray, CT and MRI, while shunning the idea of doing a decent history and physical. Sorry, guys, there are things I can discern with a decent stethoscope and a bit of clinical acumen that the labs, CTs and ultrasounds will remain equivocal o
  • 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?

    • 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?

  • by b0s0z0ku (752509) on Monday July 17, 2006 @02:25PM (#15732446)
    Winter 2004-5. I was feeling like I had the flu all the time, sleepy all the time, dizzy, feverish, achy, back pain, had a remnant of a strange rash in two places on my body. Also a history of tick bites and living in NJ and PA basically my whole life. This went on for a few months (really more like a year beforehand, to a lesser extent). Went to two different doctors. They gave me a bunch of blood tests each time, and said that I had nothing wrong with me. Even the Lyme disease test came back negative.

    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.

    • by Anonymous Coward
      It's pretty clear that better Lyme Disease tests would have been easier and more effective. Bring on the technology!
      • It's pretty clear that better Lyme Disease tests would have been easier and more effective. Bring on the technology!

        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 da

    • by Anonymous Coward
      yeah it takes a real pro to prescribe antibiotics for a mystery illness.
      • by b0s0z0ku (752509) on Monday July 17, 2006 @03:47PM (#15733115)
        yeah it takes a real pro to prescribe antibiotics for a mystery illness.

        (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.


  • 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, t
    • you're a little over enthusiastic there :)

      calling cellphones 'communicators' is hardly the same thing even if i've heard of 'wearable' cellphones.

      and a gun that shoots out two wires and lets you 'stun' people is hardly a 'phaser.' as for the rest i don't even know what you're talking about, but unless someone corrects me i'm going to assume you had too much crack to smoke while slashdot was down :)

      • I was talking about the communicators in The Original Series, not from The Next Generation. They looked very much like today's flip phones.

        Nor was I talking about stun guns. We do have honest to goodness laser weapons now, which at this point only cause blindness, but there are also weapons under development that will do further damage.

        http://en.wikipedia.org/wiki/Personnel_Halting_and _Stimulation_Response_rifle [wikipedia.org]

        There is also a laser-equipped 747 that can shoot high-powered beams at a given target.

        http://ww [defensetech.org]
        • Well, yeah, and the Heim Hyperdrive (promising theory as of now) and the phaser actually.

          My theory is that this is happenning because ST infected our minds with the memes that all of this stuff is possible, thus we look for it and sooner or later it happens.

          The 21st century is more advanced than the 23rd -- my communicator can take pictures AND play games, plus I can set a cool ringtone. And I think my usb drive is actually smaller than an isolinear chip. whatever. Wake me when the ps6 is a holodeck.

    • 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

      I know I can't believe how quickly we are advancing. For example, I bought a tricorder last week, it records CD, DVD and HD-DVD.
  • 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..
  • by dpbsmith (263124) on Monday July 17, 2006 @02:34PM (#15732531) Homepage
    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) [cia.gov]? Why is our life expectancy only 78 years [cia.gov] 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 [sun-herald.com])?

    • Simple, For the first one, The people who need the most help with chidbirthing and pre-natal can't get it. They don't have health insurance or money. In the US that sentences you to almost no health care, except emergency room visits.

      For the second one "HFCS" (High Fructose Corn Syrup) and Portion sizes

      The use of HFCS in American foods have gone up by several hundered percent over the last 30 years and portion sizes in most restaurants have also gone up, largely due to the influence of the Super sized port
    • I think that is due more to

      1) our failing insurance system coupled with rising costs
      2) the typical American lifestyle

      The medical technology is there. Getting access to it affordably and ahead of the millions of other people who need it after a lifetime of TV and McDonalds is another matter.
    • apples and oranges.

      The US counts all premie babies, were most countries don't count those weighing less than 3 (I think)pounds. High risk births are called high rsik for a reason.
    • Life expectancy has a lot to do with your life style. The simplest answer is a lot of americans are FAT and do not excercise. The diet also sucks - too much fat, wrong fat (trans fat and Omega-6 vs. Omega-3 ratio 20:1 or worse instead of healthy 3:1), wrong carbs (fructose - thank you cord subsidies), and lots of fried crap.

      Poeple that live past their 70'th year will usually live past their 80s. The low life expectancy is due to people that die in their 40s-60s mostly due to the above and its complications.
      • 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 cryo
    • by Jerf (17166) on Monday July 17, 2006 @03:27PM (#15732936) Journal
      Our infant mortality is high because our pre-natal survivability is quite good. Many babies are "born" today who would have been still-births in other countries. When a doctor fails to keep them alive, we count that as an infant death; in other countries they either die before birth or are not counted as an infant death for statistical purposes. Under those circumstances, as medical technology advances this measure of infant mortality can rise. See also [overpopulation.com]. In general, infant mortality statistics are not comparable between countries or across definition changes within the same country.

      Life expectancy I have no easy answer for, although our diet has some serious problems, and I believe our "scientific" nutritionists have gotten stuck on some bad memes and no science, and have merely made the problem worse.

      And as for dying of the mumps, there are several old diseases that are making a comeback. Some jackass started spreading the unsubstantiated rumor that vaccines cause autism (even if they did, the effect would have to be undetectable if it went unnoticed this long and lots of things have little undetectable effects), and as a result a large number of people have been "saving" their children from vaccination. As this passes a critical percentage, the disease begins to resurge. Measles are also doing this, from what I understand. Unfortunately, correcting this problem is quite difficult as it plays into the paranoia meme; anybody with the authority to tell people this isn't true are themselves part of the conspiracy. But it has more to do with freedom to not vaccinate than the health system per se. (A freedom that may well be taken away at some point if the diseases continue; public health tends to override a lot of other rights.)

      The US does have an obesity problem which I believe is caused more by diet and the lack of true science than anything else, and that hurts some of the statistics. Other than that, if you want the best treatment, you by-and-large come to the US. (There are some exceptions, mostly in treatments that have not passed FDA approval. One can argue about the FDA's thresholds, but it's hard to find an objective standard there.)

      It's fashionable to bash the US, and fashionable to bash "Western Medicine", and bashing US Medicine gets you two for the price of one. But that's all it is: fashionable, built on anecdotes. Not terribly well grounded in data.
      • Other than that, if you want the best treatment, you by-and-large come to the US.

        Assuming you have the money to do so. 'course, that also applies to US citizens, so at least it's all fair...

        It's fashionable to bash the US, and fashionable to bash "Western Medicine", and bashing US Medicine gets you two for the price of one. But that's all it is: fashionable, built on anecdotes. Not terribly well grounded in data.

        And for some, it's fashionable to ignore problems right in front of them, despite any data to t
        • I consider financial problems to be separate from quality problems.

          Moreover, I'm not convinced the financial problems are "solvable" in any real sense. The root problem of the financial problems the health systems have isn't lack of compassion, it's not bad social policies, it's not greed, it's much simpler than that: The demand for health care services is infinite.

          (Remember that infinity doesn't always mean "a really big number"; it is the thing that is larger than all other numbers. What this means is tha
          • 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
      • Our infant mortality is high because our pre-natal survivability is quite good. Many babies are "born" today who would have been still-births in other countries. When a doctor fails to keep them alive, we count that as an infant death; in other countries they either die before birth or are not counted as an infant death for statistical purposes. Under those circumstances, as medical technology advances this measure of infant mortality can rise. See also. In general, infant mortality statistics are not compa

    • 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.
    • 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?

      These are social problems, not technical ones.

      For example, why are there hungry, homeless people in XYXYE when there are p
    • It's because we allocate the money we spend so poorly and inefficiently. The majority ends up in the pockets of the insurance companies and the drug companies and the hospital companies, especially those who have friends in government to mandate their use. Example I just read about today: after this
      Medicare D fiasco http://www.sptimes.com/2005/webspecials05/medicar e [sptimes.com], the VA software fiasco (with a single software vendor), after so many numerous examples, the government has handed to 3-M on a gold-edged
    • Probably because Americans get two weeks of vacation out of 52, and work eight hours a day, five days a week, for every other day, plus unpaid overtime, traffic jams, commuting, pollution, and so on. Most of the time when people actually DO take their vacation, they use it to catch up on all the things they didn't have time to do during the other 50 weeks of the year.

      Compare that to Spain. Do people in Spain work as hard as Americans? Perhaps. Do they work the same hours? Could be. They do, however, get mor
    • I would dare say that yeah the tech is working a great deal. It's the Diet and the Life style (when was the last time you ran for one mile a day just for the hell of it) that has us in bad shape. If anything our lifespan should be in the 40s but medicine and tech is proping it back up to the 70s. That my friend IS awe inspiring.
    • "Why is our life expectancy only 78 years when forty-seven other countries, including Aruba, Spain, and Iceland, do better?"

      Welcome to the U.S., home of some of the best and most advanced health-care technology on the planet...for those who can afford it, which unfortunately isn't many. The U.S. health-care system is many things but affordable is not one of them.

    • I agree. I think that healing is fundamentally a low-tech artform. There's no accounting for, but also no underestimating the power of genuine human caring and empathy.

      Technology can certainly help, but at it's essence, the healing arts is talking with people, and understanding them and their problems. It's human to human, not human to computer to human.

      As far as the mumps and vaccination, here's an excerpt of data:

      Of the 133 patients with investigated vaccine history, 87 (65%) had documentation of recei

      • >I suppose the exception would be a cure for cancer, and a cure for AIDS.

        Nope, those aren't the best exceptions to cite. Your immune system is an extremely potent cancer fighter, especially for younger patients and chemically induced cancers (pollution, cigarette smoking, etc.) And I would hazard a guess that toxins/pollution account for nearly all cases of cancer, the remainder is age-related and a slim margin are genetic.

        AIDS...lol. Same exact thing. You should look into it.

        Both of these represent f
        • Hmmm, you're probably right. Cancer and AIDS are ultimately products of our modern world as much as they are "natural" diseases, and having better environmental conditions (which includes, and indeed, necessitates, better, smarter & wiser humans) is the ultimate solution, although I still think that we will see med-tech "cures" for them, in the not too distant future.

          But, yes, with these too, the real cure is eliminating the root cause: Human ignorance. Fortunately, or unfortunately, this only happens
  • "Read 12683 More Bytes.."

    Yes, because that's a descriptive way to tell a person how long a piece of text is.
  • by zubernerd (518077) * on Monday July 17, 2006 @02:36PM (#15732556)
    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...
    • Well... at some point the computer should be able to handle most situations where we can say with near 100% certainty that if x happens, we apply y. Example: Broken femur happens, we apply splint/cast, and so on.

      We will however, will still need doctors for times when the patient has multiple symptoms that point to n number of problems and solutions, but the real problem needs to be flushed out before anything can be done.

      Doctors will never be eliminated.
    • Using tools will allow the doctors to spend more time with data to apply to problem solving, and less time attempting to extract that data using less advanced techniques. These will not replace the doctors they will help them realize their potential.
      • Using tools will allow the doctors to spend more time with data to apply to problem solving, and less time attempting to extract that data using less advanced techniques. These will not replace the doctors they will help them realize their potential.

        Mod up. Exactly, you hit the head and the nail. These tools will allow for greater doctor/patient interaction because the doctor can offset time spend diagnosising with more face-to-face time with the patient.
    • A teller fscks up a transaction, no one's going to die.


      Well, that depends on how eager Vinnie the Nail is to get back that ten large he loaned me...
    • Woah, a cite on Slashdot. I never thought I'd see the day!
    • Doctors screw up a lot more than the bank, in my experience. You sound like someone who has never had a serious illness or watched somoene with one.

      Expert AI is essentially the definition of what a MD does. Except a computer can bring it to the masses, much cheaper. With the demographics shifting, we're either going to be a nation of doctors, or people are going to be dying in the street. I'm all for mass-marketed medicine if it can help.

      An expert AI would also be upgradable without extensive re-training.
      • Doctors screw up a lot more than the bank, in my experience.

        I've seen MDs screw up, it happens quite a bit. Medicine is not an exact science, we aren't at the Star Trek level of medicine yet. As for your bank, they must suck to screw up that many times, I'd find a new bank if possible.

        You sound like someone who has never had a serious illness or watched somoene with one.

        My father has prostate cancer. It responds to hormonal therapy for now, but it will come back, and the number of treatments he
  • 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 doct
  • 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 o
  • Radiology (Score:3, Informative)

    by eko33 (982179) on Monday July 17, 2006 @02:44PM (#15732615)

    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.

    • What is you pay a small fee to walk through one of these scanners, for peace of mind. You could have them in the mall, perfectly healthy people could walk through - not for a guarantee that they are actually perfectly healthy, but to reassure them that they don't have 5 or 6 things that the computer can know for sure. If you have something wrong, it refers you to the local clinic for some more test. There would be very little liability in this sort of system.

      Medical professionals do a lot of great work, bu
    • Doom 6 would be the next best thing to sex..


      Except for the fact that you can't enjoy either one because it's too dark to see what you're doing...
  • Let's mark this tissue at risk for infarction

    I don't think farc.com is very interested in brain tissue.

  • 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
  • by peter303 (12292) on Monday July 17, 2006 @02:59PM (#15732729)
    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.
    • Even cooler would be a biological "diff" of your previous scan to determine abnormalities.
    • That's precisely what I'm researching for my Ph. D. The technology is actually fairly far along, though there are a number of reasons why this won't replace radiologists anytime soon - many of them nontechnical.
  • 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 a

  • 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 aroun
    • Right on, brother. No one is saying doctors will be replaced, simply: 1.) the price of diagnostic tests will decrease 2.) creating a focus on preventative medicine 3.) driving down the number of advanced stage treatment cases The commoditization of medical diagnostics benefits patients and does not reduce the need for skilled doctors. It's just technology picking the low-hanging fruit in the medical field. If I have a $200 way to check for cancer, heart disease, etc. I will get checked, regularly. If
  • One of the most interesting lectures I attended as a graduate student (at Ohio U.) was by a visiting MD from Harvard. Larry Weed was his name. His basic thesis was that the medical profession couldn't keep adding new "ologies" (immunology, embryology, etc.) to the curriculum indefinitely and that at some point it would be necessary to a) teach people how manage information better and b) provide them with computer based tools which could allow them to work with probabilities and the underlying literature. Fo
    • His program "PKC" would basically eliminate the tv show "House"
      This show seems to be designed to make the diagnostic process something that could obviously be done (better, as Weed states) by a computer program.
      (the link is NG. Better to just google his name)
  • by TheMohel (143568) on Monday July 17, 2006 @04:33PM (#15733463) Homepage

    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.

    • That is exactly what I was thinking yesterday - my mother was recently diagnosed with a metastatic brain tumor, and while we can see the thing very well, all that wonderful imaging technology does is tell the doctor where it is. It does nothing to prevent it, and the treatment is still very crude - knives and protons.

      Where is the application of these technologies to preventing the disease in the first place - genetic therapy, immune therapy, and so on?

      We still fumble around with trying to predict the tertia
    • Excellent comment. BUT, TheMohel, I hope you are not actually a mohel. Ritual genital mutilation based on ancient superstitions is not what I want from someone who practices the medical sciences.
  • 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 s
  • This work needs a live, warm, human editor, who knows it's
    *discretely* not discreetly
    *peeked* not peaked
  • 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 h

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