A squad of lipstick-sized prototypes robots developed at the University of Nebraska are being deployed to test minimally invasive surgery techniques. Specialized devices for illumination, biopsy, clamping and cauterizing are planned, some of which could be mobile in the stomach or the abdominal cavity. Soldiers on the battlefield, astronauts in space and trauma victims on the roadside could benefit. See the developers’ web site for a remarkable video (in Real Network format) of a motorized robot roaming a patient’s abdomen.
Today’s Sunday New York Times featured a very good article by Abigail Zuger on concierge medicine: "For a Retainer, Lavish Care by ‘Boutique Doctors.’"
Living in New York, I’ve always gone to great doctors: they have Park Avenue offices, major teaching hospital affiliations, bibliographies of books and journal articles they’re written, and the time and willingness to answer my questions and explain things in detail. They don’t take insurance. I pay C.O.D. and then submit the bills to my insurance company for reimbursement.
Usually I only get part of the money back. Insurance companies have their own set rates for office visits, tests and procedures, but my docs don’t care. They charge what they charge, and I pay what they ask. The spread is the difference between a great doctor visit and the kind of de-humanizing, form-filling, hurry-up-and-wait, ask-no-questions assembly line that overworked practitioners inflict upon their managed care patients. It’s worth the money to me, and it’s a better lifestyle for the physicians.
Since 1996, hundreds of doctors have formalized this kind of care by establishing controversial "concierge" or retainer medical practices. They take only patients who pay an annual fee — anywhere from $1,500 to $10,000 — for privileges like same-day appointments, housecalls and 24 hour phone access, They may still bill insurance companies for covered expenses, but they’ll go with a patient to see a specialist and follow-up with the kind of attention HMO doctors can’t afford. The result is better care for patients and a better lifestyle for doctors.
Over 73 million Americans use the Internet to answer health questions, harrying their doctors with self-diagnoses and putting stress on the physician-patient relationship. Medical web sites, disease discussion forums and health blogs give the "Worried Well" an endless supply of symptoms and therapies to ponder.
But sometimes, the Internet can save some pain, some suffering — and some billing. An article in the Google Blog reports on a premature baby admitted to an ER with very low hemoglobin levels. ER doctors told the parents that an immediate emergency blood transfusion was necessary, but Dad whipped out his Palm computer and Googled the Web. He found an on-line article in American Family Physician that a hemoglobin drop in premies was "not uncommon." After a respectable period of further study, the docs agreed that the kid was fine. Dad wrote:
Google literally saved our newborn son from having to endure an extremely dangerous, and totally unnecessary, blood transfusion.
Maybe Googling should be added to the list of standard medical practices.
"…the country is not preoccupied with moral questions about the beginning of life."
In an article in Slate this week on South Korea’s science-friendly culture — The Seoul of Clones: Solving a biotech mystery: Why South Korea leads the world in stem cell research — David Plotz describes some critical factors that contribute to the country’s news-making stem cell successes:
Plotz compares the relative size and investment of U.S. and Korean stem cell initiatives and their results, and he highlights the influence of Korea’s stem cell leader, Hwang Woo-suk. Dr. Hwang adds another reason for Korean exceptionalism: their lifelong use of metal chopsticks helps Koreans with the micromanipulation of embryos and eggs.
If you could take a pill to run faster or jump higher, would you? How about a drug to keep you sharp when you’re up all night? Or a treatment to make you feel happier or deal with a bad memory? Of course, we have all that now, but steroids. blood doping, amphetamines, cocaine, whiskey and anti-depressants are illegal, expensive or tightly controlled, mostly because of nasty side effects like fatal addiction.
University of Pennsylvania neuroscientist Anjan Chatterjee (at right) wrote a paper last year for Neurology titled Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. [PDF]
Chatterjee describes how medicines created to cure neurological disease might someday be applied to neurological enhancements. "Are better brains better?" he asks, and discusses the possibilities for medically improving things like movement, memory, attention and mood. "Would you give your child a medication with minimal side effects half an hour before piano lessons if it meant that they learned to play more expertly? … Would you take a medicine that selectively dampened memories that are deeply disturbing? Slightly disturbing?"
And if we could, does that mean we should? (Doesn’t it really mean we will?) The Chatterjee paper contains an excellent discussion of inevitability, ethics, justice and the role of the physician as cognitive science, but it seems to me that "elective neurology" might be a more accurate term.