Medical and Biological Technologies

1
Medical and Biological Technologies

• Volti Chapter 7

2
Medical and Biological Technologies

• Despite problems, most agree technology has
  improved medicine and longevity for human beings
• Technology has also reduced agony associated with
  illness
• Dialysis for kidneys
• Artificial Hearts and transplants
• Technology not solely responsible for improvement
  in health
• Nutrition, sanitation, personal hygiene has made
  significant impact
• As long as we live, experience illness and die
  there will be a demand for medical
  (technological) intervention

3
Expenditures for medical attention are not
weighed against other expenditures

• We may forgo a car for a down payment on a new
  house
• But we will not forgo heart surgery for some
  other good or service
• BUT, nonetheless, technology has created new
  health problems

4
Costs

• Despite rising cost of medical technology, the
  individual is largely unaffected
• 1950 ? private insurance paid less than half of
  medical expense
• 1990 ? Medicare/Medicaid pays over 90
• Given spiraling costs, medical technology may not
  always be a solution
• Medical technology inappropriate when
• Unnecessary ? Patient has condition too advanced
  to respond to treatment
• Unsafe ? Complications outweigh possible benefits
  
• Unkind ? After treatment, quality of life no
  better or worse than before
• Unwise ? Resources could be better used on other
  patients

5
The Dilemmas of New Technologies

• We tend to minimize or ignore costs when someone
  we love may improve by the use of medical
  technology

6
Kidney Dialysis

• Kidney Failure (end-state renal disease)
  significantly improved by medical
• technology
• U.S. ? fourth largest killer
• Development of Dialysis Machine Willem Kolff --
  Dutch doctor (1940s), salvaged bathtub and parts
  to create dialysis machine
• Machine cleanses blood
• Artificial kidney became possible because of
  machine
• Demand for dialysis greatly outnumbered machines
  available ? some patients had to be rejected
• Seattle Artificial Kidney Center (leading
  institution in field) decided who would get
  kidney treatment
• Making this "life or death" decision based on
  certain criteria aroused much consternation
• Children and adults over 45 excluded
• People chosen on the basis of gender, marital
  status dependants, emotional stability
• Treatment very expensive ? 1970 2X/week 3,000 -
  5,000
• Start up expenses ? 9,000- 13,000
• 1987 ? U.S. government spends 24 billion/year
• As population ages, demand for dialysis will
  increase
• Current ? 1/3 of dialysis patients gt 65 yrs.
• Britain ? no one over 55 receives dialysis
• U.S. ? much more liberal distribution of
  treatment
• Which system is better???

7
Replacing Broken Hearts

• Bypass Surgery segment of vein is removed from
  leg or chest and is spliced into one or more of
  the five coronary arteries that transport blood
  to the heart
• Treatment has become routine, but expense not
  equal to population treatment serves
• Bypass ? 1 of national medical expenditure but
  serves only .04 of population
• Often bypass is not helpful because heart is
  already too weak from disease
• Heart transplant is a possibility but not a
  viable solution
• 75,000 need heart transplant ? 2,000 donors
  available
• Artificial hearts (Jarvik-7 1970s U. of Utah)
  not effective ? caused seizures and host of
  problems
• Means hardly justified by end result
• Artificial hearts can be "bridge" for those
  awaiting human heart ? but no permanent solution
• Transplant very costly ? 160,000/transplant

8
How should funds for costly medical procedures be
allocated?

• Artificial heart program or anti-tobacco
  education program/
• Sustain life of premature infants or invest
  in prenatal education programs?

9
Halfway Technologies

• Medical technologies often palliative ? treats
  kidney disease but not the causes of disease.
• Technology has extended life and made it more
  comfortable but has not addressed causes and
  conditions

10
Diagnostic Technologies

• Stethoscope, X-ray machine, ophthalmoscope,
  laryngoscope have taken mystery and "guess work"
  out of medical diagnosis.
• No longer do we rely on 4 humors.
• These new technologies have often created their
  own need.
• Fetal heart monitors have no evident benefit ?
  but number of Cesarean section deliveries
  increased.
• Doctors often over-prescribe technology for fear
  of mal-practice lawsuits.
• Tests can make patient worse than when they
  initially were ? especially true for the elderly
• Sociologically, diagnostic tests and technologies
  helped to create an "objective disease"
• Physician ? no longer is it necessary to talk
  with the patient and obtain their account of
  their illness.
• Technology has objectified and legitimated the
  medical profession.
• Technology doesnt account for the psychological
  component to illness.

11
The Genetic Fix

• Medicine is badly in need of technology that is
  more than palliative.
• Fundamental Scientific insight behind new medical
  Technologies ? The Gene.
• Gene manipulation became possibility in this
  century as new information emerged.
• Watson and Crick ? The Double Helix.
• Gene manipulation seen as possible way of curing
  disease.
• Genetic Manipulation has LOADS of problems
  associated with it
• Altering genes can affect succeeding generations
  ? with no end in sight
• Errors can be made
• Strong moral implications
• BTW A recent poll of the top CEOs reported that
  (of all people) Bill Gates was the only one who
  unreservedly opposed gene engineering. He was
  asked, "If you could clone yourself, would you?"
  No! Interesting, huh?

12
The Commercialization of DNA Technology

• Bio-technologies based on genetic discoveries
  have emerged as commercially significant
  enterprises.
• 15 bio-technology based drugs on market today.
• 1980 ? U.S. Supreme Court ruling (Diamond v.
  Chakrabarty) human made organisms entitled to
  full patent protection.
• Although profit is a motive, bio-technology not
  solely driven by free enterprise.
• 1987 ? U.S. Government spent 2.7 billion on
  bio-tech research, private industry spent 1.5-2
  billion

13
Controlling Bio-Technology

• Few technologies have aroused as much debate as
  genetic engineering has.
• Eugenics ? the attempt to perfect humanity
  through the reinforcing of "desirable" traits and
  the suppression of "undesirable" ones (Nazi
  Germany, USA, too!).
• Genetics does not contain all the answers for
  solving disorders.
• A gene that malfunctions under one environment
  may be fine in other circumstances.
• We cannot always identify the "problem" gene.
• Not all disease are genetically caused
  (Alcoholism??).
• The "genetic fix" is seductive ? maybe it can
  explain deviant behavior as well as disease of
  the body.

14
But

• "Fastening upon genetic endowments to the
  exclusion of everything else exemplifies the
  naïve belief that science has all the answers and
  that technology offers the best solutions for
  what troubles us as individuals and as members of
  society."