How Medicine Might Change

Last week’s Economist had a few articles on how costs will be controlled in medicine. I’d summarize the higher-profile 3-page briefings can be summarized in one word: specialization.

Physician assistants in America can do about 85% of the work of a general practitioner, according to James Cawley of George Washington University.

Great, but this has nothing to do with technology and all to do with simple economics and… politics:

But any change will first require swaying the doctors. The American Medical Association, the main doctors’ lobby, greeted the IOM’s report with a veiled snarl. “Nurses are critical to the health-care team, but there is no substitute for education and training,” the group said in a statement.

The doctors’ power rests on their professional prestige rather than managerial acumen, for which they are neither selected nor trained. But it is a power that they wish to keep. The Confederation of Medical Associations in Asia and Oceania, a regional group of doctors’ lobbies, wants “task-shifting” limited to emergencies.

The pace of productivity increase in medicine needs to keep up with the pace of technological innovation, which in medicine, unlike in most other industries, increases costs. The power of new toys to create their own demand is something Facebook wishes it could share with medical device makers.

I’m far more excited about the second article, from the Technology Quarterly, on ‘open-sourced’ medical technology. What’s that?

Two medical physicists, Rock Mackie and Surendra Prajapati, are designing a machine to combine radiotherapy with high resolution computed tomography (CT) and positron-emission tomography (PET) scanning. Their aim is to supply, at zero cost, everything necessary to build the device from scratch, including hardware specifications, source code, assembly instructions, suggested parts—and even recommendations on where to buy them and how much to pay.

You can see some specs here, which looks like a work in progress. Could DIY instructions combined with something like additive manufacturing be cost-killing future of medicine?

Here’s another awesome idea from the same article:

More intriguing still is the Medical Device Co-ordination Framework being developed by John Hatcliff at Kansas State University. Its aim is to build an open-source hardware platform including elements common to many medical devices, such as displays, buttons, processors and network interfaces, and the software to run them. By connecting different sensors or actuators, this generic core could then be made into dozens of different medical devices, with the relevant functions programmed as downloadable “apps”.

The problem? The FDA is not set up to monitor this kind of thing and (probably) fumbles the approval process.

“In the 1990s we developed an excellent radiation-therapy treatment-planning system and tried to give it away to other clinics,” says Dr Mackie. “But when we were told by the FDA that we should get our software approved, the hospital wasn’t willing to fund it.” He formed a spin-off firm specifically to get FDA approval. It took four years and cost millions of dollars.

The FDA’s power is in the ascendent. In a way, this is good because it will help protect us. But remember that stories like this have happened:

An especially absurd example of device delay occurred to the Sensor Pad. The Sensor Pad is so simple it hardly justifies the term device: it is two sheets of sealed plastic that sandwich a silicon lubricant. With the Sensor Pad, a woman can more easily detect unusual breast lumps in a self-examination. Although the product is simple, it is quite useful and can save lives through early detection of breast cancer. The Sensor Pad was invented in 1986 by Earl Wright of Inventive Products and was submitted to the FDA for approval. The FDA, however, could find no other substantially equivalent product on the market and thus automatically classified the Sensor Pad as a high-risk, Class III device. Before being allowed to sell the Sensor Pad, Inventive Products had to submit a premarket approval application to the FDA.

There’s a bottomless pit of demand for event the most modest improvements on existing devices and tests. And then there are the big scary problems that we barely understand for which there is also unlimited demand for innovation.

Combine this with an unparalleled expertise bias in medicine (as evidenced by the FDA when at its worst) and you get some truly toxic economics. There is very little wikipedia/crowd-source/open source innovation in medicine right now.

Doesn’t that have to change eventually?

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