Printing people February 21, 2012
Posted by Cameron Shelley in : STV203 , comments closedTechnology Review has a piece about researchers who are using 3D printers to print muscle tissue. So far, the purpose of the research is modest, to create tissue that can be used for drug testing. Of course, longer-term goals are more ambitious:
So far, Organovo has made only small pieces of tissue, but its ultimate goal is to use its 3-D printer to make complete organs for transplants. Because the organs would be printed from a patient’s own cells, there would be less danger of rejection.
This research joins other efforts in the area of using 3D printing technology to create living tissues. Dr. Anthony Atala, for example, is pursuing a similar program with the goal of printing up organs for transplant. You can see his recent TED talk below.
All this research sounds great! However, I wonder how far this work will take us. Will it eventually allow researchers to print off entire people, for example? If it could, then what would we do with it?
A doctor’s touch September 30, 2011
Posted by Cameron Shelley in : STV202 , comments closedIn a recent TED video, Abraham Verghese discusses how computerization of medicine has distanced doctors from their patients. Whereas physical examination of patients was a standard part of medical practice, examinations now often focus on ordering tests, such as CAT scans, that can be examined on a computer. Conceding the informativeness of such tests, Verghese laments the damage they do to the doctor-patient relationship as he sees it. Doctors focus more on treating the “iPatient”, that is, the problem presented through a computerized representation of the patient, instead of the physical patient. The patient loses the sense of being cared for as a person and the doctor loses the opportunity to offer such care.
(Mcjudy/Wikimedia Commons)
Many people, I suspect, can sympathize with Dr. Verghese’s perspective. It is true that medical care, particularly for patients with complex or serious conditions, can seem like a serious of encounters with various, computerized diagnostic machines; not a particularly warm experience. It is true that we have traded off some of the personal qualities of patient care in exchange for increased effectiveness of treatment, and the opportunity to offer treatment on a large scale to more people. Indeed, this issue has been discussed before in this blog. As I noted earlier, it is not necessary for computerized medical technology to distance doctors from patients. For example, perhaps a computerized medical record system could require doctors to enter information obtained from a physical exam.
Part of the problem is that the design of medical equipment reflects the organization of industrial innovation, and the priorities of the public health system. On the first point, doctors like Verghese are often not involved in the development of diagnostic technology. Instead, engineers and programmers are given the job. A doctor might be engaged after a prototype has been created, after the design of the equipment has largely been set. It is not a mistake for engineers and programmers to do this sort of work. However, leaving until last consideration of how the equipment will affect doctor-patient interactions will likely lead to a less than wholly satisfactory result.
On the second point, medical technology is designed to provide health care at a low cost to as many people as possible. So, again, the effect that it might have on individual relations between doctor and patient do not naturally enter into the picture until it is too late. Also, the people who acquire such equipment for hospitals, for example, may be administrators without much experience in giving clinical care. As a result, they are not in a position to judge medical equipment based on how it mediates doctor-patient interactions.
In short, although Dr. Verghese makes a moving case for bringing back emphasis on physical examinations, I think that it does little good to plead the case to doctors. I would guess that many doctors would enjoy having the opportunity to interact appropriately with patients. However, that is not a priority for health administrators nor equipment designers. Those priorities need to change if the problem that Dr. Verghese highlights for us is to be addressed.
New infertility treatment on the horizon August 9, 2011
Posted by Cameron Shelley in : STV203 , comments closedJapanese researchers have succeeded in generating viable sperm cells from mouse stem cells. They know the sperm derived from these stem cells are viable because they were used successfully to fertilize a mouse egg. Furthermore, the fertilized eggs were implanted in a mother mouse and carried to term. The offspring then had little mice of their own, showing that the procedure did not seem to have any unhealthy effects on the recipients.
(AxelBoldt/Wikimedia Commons)
One application of this research would be a male infertility treatment:
Dr Allan Pacey, a leading researcher into male fertility at the University of Sheffield, said: ‘This is quite a step forward in developing a process by which sperm could be made for infertile men, perhaps by taking as a starting point a cell from their skin or from something like bone marrow.
Of course, this treatment might also be used to produce viable sperm cells from a female donor. Thus, any woman wishing to be a father could also be treated for her ‘infertility’ with this procedure.
So, here is another way in which the fruits of biotechnology seem unnatural, that is, by upsetting the model of family generation and inheritance that is built in to the English language. This research presents an instance of how technological development can challenge time-honored linguistic assumptions. Think of how the invention of time travel (has had) affected grammatical tense in the Hitchhiker’s Guide to the Galaxy:
The major problem is simply one of grammar, and the main work to consult in this matter is Dr. Dan Streetmentioner’s Time Traveler’s Handbook of 1001 Tense Formations. It will tell you, for instance, how to describe something that was about to happen to you in the past before you avoided it by time-jumping forward two days in order to avoid it. The event will be described differently according to whether you are talking about it from the standpoint of your own natural time, from a time in the further future, or a time in the further past and is further complicated by the possibility of conducting conversations while you are actually traveling from one time to another with the intention of becoming your own mother or father.
Most readers get as far as the Future Semiconditionally Modified Subinverted Plagal Past Subjunctive Intentional before giving up; and in fact in later aditions of the book all pages beyond this point have been left blank to save on printing costs.
Recall also this previous post on whether human-derived gelatin is vegetarian.
When thinking about whether or not the products of genetic engineering are “unnatural”, it might help to remember that what counts as natural or otherwise, particularly when it comes to what human beings do, is a function of what technology may be taken for granted, which is always a moving target.
In-car infarctions July 28, 2011
Posted by Cameron Shelley in : STV202 , comments closedA FastCompany article reports that Toyota plans to equip steering wheels in their cars with ECGs in order to detect when the driver is having a heart attack. The idea seems to be to read the drivers’ heart rates through their hands gripping the wheel. Why?
If a vehicle can detect that a driver is having a heart attack, alert him to pull over, and then automatically call 911, many lives could be saved.
Well, who would question the saving of lives on the road?
(chrisdigo/Flickr)
Some obvious issues with this plan relate to the sorts of errors such a system would make.
- False positives: The system could mistake some other event for a heart attack. Can the system distinguish the rhythm of a heart attack from, say, the rhythm caused by swerving to avoid a collision? Suppose that the driver was maneuvering suddenly to avoid a deer when the car says, “Hey! You’re having a heart attack! Pull over immediately.” Or, we might find out just how many people really watch porn while driving.
- False negatives: The system could mistake a real heart attack for something else. In that event, the system does not help to prevent consequences of a heart attack.
Then there is the problem of effectiveness of the response. Would alerting someone that they are having a heart attack help to save them from creating an accident? At low speeds, the driver may be able to pull over. However, news reports of drivers having heart attacks seem often to speak of the driver losing control of the car, as in the case of Macho Man Randy Savage:
TMZ spoke with Randy’s brother, Lanny Poffo, who tells us the wrestling legend suffered a heart attack while he was behind the wheel around 9:25 AM … and lost control of his vehicle.
…
Florida Highway Patrol tells TMZ … Savage was driving his 2009 Jeep Wrangler when he veered across a concrete median … through oncoming traffic … and “collided head-on with a tree.”
Would a flashing light or verbal alert prevent such outcomes or would the driver be too incapacitated? In that event, perhaps the car should flash the four-way lights and bring itself to a gradual stop. (Of course, that would not please porn viewers.)
Here’s an interesting thought: Suppose that the system can distinguish reasonably well between heart attacks and other sources of heart-rate anomalies such as sexual arousal. Should the car then issue you a warning in the latter case? Alert the police that you are a potential menace to others on the road? Or, perhaps, simply issue you a ticket? Once such data is available, the community may have a legitimate interest in its use to preserve public safety.
Another benefit touted for the system would be a simple increase in medical data:
A daily reading of your heart could result in patterns that might not be seen at your less-than-annual physical.
That may not be a bad idea, although it encounters the same issues as above regarding false positives and false negatives. Since we have not routinely collected massive amounts of health data on individuals (who are not currently hospitalized), your doctor, and Toyota, may not be sure how to interpret it. Which patterns merit concern and which are merely within normal variation?
Also, what would Toyota do with the avalanche of health data it receives about all these drivers? Would the company have the right to sell it to third parties? (Did you know that car rental agencies can share your credit card data with companies that operate speed cameras?) I can imagine that drug companies would be very interested. Perhaps they could identify new, suspicious heart-rate patterns in drivers that could be treated with patented drugs. And, as always, insurance companies might be interested also.
The good that might emerge from data-collection systems can be substantial. To realize these benefits, we have to be mindful of the potential challenges as well.
Electronic health records and the environment May 4, 2011
Posted by Cameron Shelley in : Uncategorized , comments closedA NYT blog entry discusses the results of a study done by Kaiser Permanente about the environmental impact of electronic health records.
(Image courtesy of Wikimedia Commons.)
The study draws some interesting conclusions. First of all, you would think that a major reduction in environmental impact would come from the elimination of paper. If anything, the study suggests the reverse:
In fact, the researchers found that if electronic records simply replace paper records — without changing how things are done — the national impact would be to increase carbon dioxide emissions by 653,000 tons. (Or putting more than 100,000 more cars on the road.)
So, simply digitizing the existing system is not an environmental winner. However, an environmentally friendly result can be obtained by using the technology to change how people access the medical system:
The gas reduction comes from doctors using the electronic records and e-mail to answer inquiries from patients about simple problems, like mild side-effects from a drug or muscle strains, and thus avoid visits to a clinic.
“What stands out is the opportunity to reduce automobile trips,” said Kathy Gerwig, Kaiser’s environmental stewardship officer.
So, the environmental benefit would come not from digitizing health records per se, but from distributing their use over the Web.
This note puts me in mind of work by Edward Tenner. In his book, Our own devices, Tenner discusses how technology and technique interact. Technology, I take it, you understand. Technique comprises the ways and methods people use to employ technology. The arrival of athletic shoes, for example, changed the way that people run when wearing them, as compared to other sorts of shoes or going barefoot.
If the study cited above is correct, the environmental benefits that could flow from electronic health records will proceed not from the technology but from the techniques that people use to deploy it. Precisely what techniques those will be remains to be seen. One obvious possibility is the use of social media by doctors. Some doctors advocate the use of social media whereas others regard it as a bad idea.
Also, I cannot help wondering if the study took into account the environmental impact of the use of the Web that medical work would induce. After all, even a simple Google search has a (disputed) environmental impact too.
Technology and anxiety March 10, 2011
Posted by Cameron Shelley in : STV202, STV302 , comments closedLast month, I discussed how medical information technology is not a panacea, meaning that the mere application of high tech in medicine does necessarily lead to improved medical results. In the article in question, a medical doctor discussed the tradeoffs involved in computerizing existing medical practices. I chimed in that designers of the technology tend to overlook some of the disadvantages of computerization because of their optimistic attitude towards the technology itself. This phenomenon of optimism leading to exaggerated views of the advantages of computerization I put down to motivated design.
It was interesting, then, to see this article on the potential overuse of diagnostic technology in pediatric medicine. Dr. Sean Palfrey of the Boston University School of Medicine argues that pediatricians sometimes rely too much on diagnostic high tech and not enough on simple physical examinations and their own training. Dr. Palfrey notes that increasing reliance on diagnostic technology raises challenging questions:
The evaluation of a child with fever and cough is a good example. There are many possible causes, and we have a huge battery of available tests that might give us potentially relevant information. But why should we no longer trust our physical exam, our knowledge of the possible causes and their usual courses, and our clinical judgment? How much will we gain by seeing an x-ray, now, and how likely is it that the result will necessitate a change in our management? How dangerous would it be if we chose to perform certain tests later or not at all? Might our residents not learn more by thinking, waiting, and watching?
I can think of a number of reasons whey pediatricians might be risk-averse in their diagnostic practices:
- Doctors, parents, and people in society in general have a special concern for the health and well-being of children. When a child appears in difficulty, their doctors naturally want to take special measures to help.
- As a doctor, the pediatrician’s job is to restore their patient to health. The effects of their treatment decisions on others, or on society in general, is not their responsibility. So, they arrange for whatever tests they feel might be useful to decide on an appropriate diagnosis and treatment.
- Insurance requirements and professional standards may demand the use of a diagnostic technology even where it may not be warranted in the view of a doctor in a given case.
- Then there is a simple aversion to failure. My impression, at some remove, is that doctors are strongly success-oriented and thus particularly averse to the possibility of making a mistake. They see diagnostic technology as a means to avoid failure and so they make use of it.
All these reasons are coloured, to some extent, by anxiety. That is, doubt about the outcome is present, and the pediatrician must consider the (possibly negative) view that others will take of their conduct. The result is that they experience anxiety, for which diagnostic technology provides some relief.
(Image courtesy of US Navy Journalist Seaman Joseph Caballero via Wikimedia Commons.)
So, the uptake of medical technology is driven by a push-pull mechanism. One form of push is provided by the optimism of the designers of medical technology. A form of pull is provided by the anxiety that doctors experience in diagnosing the ailments of their patients. If the result is too much reliance on diagnostic technology, then we might consider alternative routes for satisfying the mechanism that produces it. Dr. Palfrey suggests more professional discipline from doctors and more education for patients. I would not deny the importance of such measures. Yet, it seems to me that designers and doctors should think about some way of increasing their confidence, appropriately, in existing and established diagnostic technologies, such as the old-fashioned flashlight and tongue depressor.
An implant to end obesity March 7, 2011
Posted by Cameron Shelley in : STV202, STV302 , comments closedFrom FastCompany comes new of an implant that will help to curtail obesity, called the “abiliti“. The device is described as a pacemaker for stomachs:
… the surgically-implanted pacemaker detects when a patient downs food or drink, and zaps the stomach with a series of electrical impulses to generate a feeling of fullness…
The device tries to calibrate feelings of satiety in order to allow the patient to maintain a health intake. Also, the device collects data that can be downloaded into a computer for monitoring by the patient, family, doctors, etc.
(Image by Thomas Nast courtesy of Mkoyle via Wikimedia Commons.)
The idea certainly seems plausible. Heribert Watzke talked about the brain in your stomach in a recent TED talk. “About the size of a cat’s brain.” So, modifying the function of this gastro-brain should affect people’s feelings of fullness or hunger with consequences for their physique.
Such a device could be a boon to those who cannot resolve their weight problems through less drastic measures. Of course, there are also challenges that need to be considered, such as:
- As with heart pacemakers, the abiliti might be sensitive to electromagnetic interference from cellphones, store security alarms, airport scanners, etc. Provisions to prevent or avoid such interference must be considered.
- Since the device is remotely accessible, its vulnerability to hackers must be considered. Hackers could violate the privacy of a patient by accessing their data without permission. Also, of course, hackers might be able to change the programming of the abiliti, resulting in harm to the patient.
- If the device becomes widely and cheaply available, then it may alter people’s perception of who qualifies as obese or just overweight. People who are sensitive to their body image, even if it is medically healthy, may feel under pressure to receive an abiliti to become more trim. It might even become popular with sufferers of anorexia who could use it to injure themselves.
- If the abiliti proves effective, then there will also have to be debate on whether it should be included in public health programs. In Canada, each province maintains a list of treatments that are covered by public insurance. At what point should abiliti be included in this plan?
- The abiliti will create a stream of health data about each patient. What should be done with this data? Undoubtedly, it will be put to work in illness prevention. However, a deluge of data from novel types of sensors may lead to a deluge of false positives, that is, blips that may seem threatening but prove to be benign. Doctors and patients should consider how they will respond to the kinds of alerts that the abiliti might generate.
As usual, none of these issues mean that the abiliti is a bad idea. Indeed, it may be a great idea, considering the challenges we face regarding obesity in our society. It is just that the abiliti raises challenging questions that we should begin answering before introducing the device for general consumption.
Medical information technology is not a panacea February 10, 2011
Posted by Cameron Shelley in : STV202, STV302 , comments closedIn reading this TIME article about a doctor’s experience with medical information technology, I was struck by his conclusion that, although the technology can be a great boon, it is not a panacea. That expression provides a nice medical analogy to the claim, discussed before in this blog, that technology is just a tool. As noted previously, this expression has several, contradictory meanings but, here, it means that we have an obligation to be critical about computerizing an existing system.
(Image courtesy of Jejecam via Wikimedia Commons.)
In this article, Dr. Meisel makes it clear that health information technology has a lot to offer. He recounts when an elderly women was brought to ER obviously in a bad way but without medical records or family members. Thus, he had to treat the patient with almost no knowledge of her previous medical history. Had her medical records been available for retrieval on a distributed database, her care could have proceeded more immediately and accurately than it did.
However, although health information systems help to open some channels of communication, they tend to close others. Dr. Meisel mentions two:
- Patient status used to be represented in hospital wards on a giant whiteboard (which you may well have seen). Health IT systems replace this board with small computer monitor. Unfortunately, secluded monitors do not invite impromptu conferences among doctors and nurses in the way that the big whiteboards did. Such conferences could produce insights that helped with patient care. Has the computerized system unintentionally reduced this benefit?
- Previously, when Dr. Meisel ordered an X-ray, he would have to go to the Radiology department to get it. There, he would encounter the radiologist. They would often discuss the X-ray, and the conversation might reveal something that neither had noticed on their own. Now, X-rays are delivered electronically with the radiologist’s comments. Such a system tends to discourage casual discussion. What important information is going unnoticed as a result?
Computerization of health information systems can and does produce great benefits but important aspects of the previous, informal information system can get lost because they go unnoticed by the analysts designing the system, or because the analysts do not acknowledge their importance.
Why do designers make these mistakes? There are many contributing factors but I will comment briefly on one only: The designers are trained an paid to make the existing system more efficient by reducing it in various ways. For example, networking different medical record databases reduces the time and effort needed to dig up relevant information about a patient. Not a bad thing! However, the computerized system also reduces the number of channels through which information flows. This reduction makes things speedier but also reduces feedback loops, think casual meetings, built into the informal system. Since they are achieving desirable reductions in time and effort, designers may not think critically about whether all the reductions are a good thing. This phenomenon is an instance of what I have called motivated design. When designers aim to do good, they sometimes do not think through or properly evaluate the consequences of their work. If Dr. Meisel is right, this phenomenon may be adversely affecting patient care.
What can be done? Perhaps the designers of computerized systems need to develop a greater appreciation for the drama of human interactions in informal information systems. That is, what characters are involved in the informal system? What roles do they play? What happens when they interact? Is it important? If so, should it be reduced at all? Or, can it be accommodated in a computerized system?
Five articles on computer technology in society January 13, 2011
Posted by Cameron Shelley in : STV202, STV302 , comments closedWell, there are lots of stories that deserve our attention, so I will just supply pointers to a select few:
- From the Risks digest comes the story of a failed FedEx package delivery. The delivery failed because FedEx staff were unable or unwilling to override the package’s incorrect status on their computer system. My question: In the end, is this a story of human triumph or human bondage?
- A doctor writes about how an electronic health record system can change how doctors think about patients. In this case, the system in question limits doctors to a 1000 word description of a patient’s condition. This limit can be a Procrustean Bed that is ill-suited to patients with complicated medical conditions. I am particularly concerned by the attitude of the technician to whom the doctor turns for help:
In desperation, I call the help desk and voice my concerns. “Well, we can’t have the doctors rambling on forever,” the tech replies.
- In the wake of the flash crash of May 2010, concern over the automation of stock trading in the form of high-speed trading has grown. It appears that, at some point in the not-too-distant future, no human being will understand how the stock market really works. Is that a good thing?
- This Wednesday, January 12, 2011, a stolen snow plow was driven recklessly through the city of Toronto. A Toronto Police officer was struck and killed by the plow. In addition, the owner of the plow was tracking it via a GPS device, attempting to recover it. Apparently, such incidents are on the increase, as more and more things become geo-locatable. Police urge that people not do this, and leave tracking and apprehension to them. After all, owners of stolen property getting involved in apprehension can make a charged situation more dangerous. However, it may be difficult to stop people from doing what their gear enables them to do and following their instincts in the heat of the moment.
- Google is creating a conversation mode for its Google Translation software. It promises to allow real-time translation between languages. Such a service might make it much easier and more inviting for people from different parts of the globe to interact with each other. What a gain for mutual understanding! Of course, it could also dis-incentivize people from actually learning foreign languages. So, will the mutual understanding perhaps provided by this gear remain somewhat superficial?
Anyway, clearly, it has been an interesting week for information technology and society.
