November 9, 2005
New Technology and Distributed Healthcare
As I like to define it, healthcare is a technology based, information dependent, personal service. Like most folks, I love the technology part. It holds promise for solving some knotty problems we now face. But the forces of society make simple things difficult sometimes.
It seems every time somebody develops something that would be useful in the hands of the people who have the greatest interest in it (i.e., customer, patient), the Cartel (read entrenched interests) rise up to stop it or at least slow it down.
Today the debate is over home HIV testing. The test has been used for over two years in physicians' offices and clinics and is known to have acceptably high sensitivity and specificity; so it would be good to put into the hands of whoever wants to know the results.
The anti-over-the-counter forces in this case have a stretch on their hands. About the only reason they can come up with for not wanting this piece of rationality is that there isn't any counseling immediately available with the test results.
So we've come to that in our society. We are not able to handle a piece of good or bad news without professional counseling immediately available? Hooey!! I say. We aren't that weak. Oh, and also, the FDA is concerned because this is the first home test for an infectious disease agent. So what?
On TechnologyReview.com (the MIT publication) Web site, I was interested in the report entitled “Drugstore Cancer Tests” from October 31. This would make HIV home testing look like making mud pies by comparison. And would rock entrenched laboratory interests. But it could help patients and the physicians advising them in their care immensely.
Kevin Bullis reports: “Biomedical researchers have been discovering more and more proteins that reveal the presence of a cancer before its symptoms appear -- and while its treatment success rate is still high. Yet turning these findings into quick, accurate, and inexpensive diagnostic tests has proven difficult. Recent advances in nanotech devices, however, point to new ways for developing inexpensive and effective cancer-screening devices.”
“One of the most promising of these new detectors is being built by Charles Lieber, a chemist at Harvard University . In an article this month in Nature Biotechnology, he announced a highly-sensitive detector that can simultaneously find multiple cancer markers.”
“According to Lieber, the device, which uses nanowires to detect telltale cancer proteins, could lead to inexpensive and highly-accurate tests -- people could even buy them in a local drugstore and perform the testing themselves. "We can take a very small amount of blood and with a very simple filtration step get an answer within five minutes," Lieber says, adding that the device has 'a sensitivity a thousand times better' than in a lab.”
“To detect specific cancer markers, Lieber attached a monoclonal antibody specific for a certain type of protein to nanowires each about as narrow as a virus. Some earlier experiments showed that changes in the conductivity of nanowires occurs when proteins bind to an antibody. The more proteins that bind, the more the conductivity changes, revealing the concentration of the protein.
“In talks with Lieber, oncologists have also suggested another application. Because the device gives results in real time, it could be used to monitor the effectiveness of cancer treatments.”
“How soon a cancer-detecting nano-device will be available depends, to a large extent, on developing the technology for mass production, according to Lieber, rather than with overcoming basic science obstacles. "If it's sufficiently cheap, then people can get these tests on a periodic basis and see if they're developing cancer. It could be ultimately like a CVS [pharmacy] test or a pregnancy test."
It is not too hard to see how this technology might initially be rolled out to clinics and oncologists in its earliest forms. It will be interesting to follow the progress of such testing into the public space and to see how fierce the resistance is to putting this type of information into the hands of consumers.
In healthcare, generally speaking, a win for consumers and patients is a loss for some entrenched business. Isn't it interesting how maintenance of the status quo slows down medical innovation?
This type of self-directed care also points up another area where The Center for the Future of Health is working. It is not enough to just get some factual information. Individuals need new ways to assess the importance of new information to them personally and to then decide what to do about it. The work The Center is doing around decisioning and making decisions in states of high uncertainty should lead to ways to easily and cheaply assist individuals with complex decision making of this type.
Robert B. Teague is a pulmonologist and business consultant who is based in Houston, Texas. E-mail him.
Read other blogs in this series.
