Transcript Medical and Biological Technologies

Medical and Biological
Technologies
Volti Chapter 7
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
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
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
The Dilemmas of New Technologies
 We
tend to minimize or ignore
costs when someone we love
may improve by the use of
medical technology
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 (1940’s),
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 > 65 yrs.
Britain  no one over 55 receives dialysis
U.S.  much more liberal distribution of treatment
Which system is better???
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 – 1970’s 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
How should funds for costly
medical procedures be allocated?
heart program – or – antitobacco education program/
 Sustain life of premature infants –
or – invest in prenatal education
programs?
 Artificial
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

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 doesn’t account for the psychological component to illness.
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 CEO’s 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?
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
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.
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."