IMPACT  OF  TECHNOLOGICAL  RESEARCH  ON THE  PRACTICE  OF  MEDICINE

We live in an age unknown to previous generations of Mankind, when healthcare has benefited  by the extraordinary advances in technology. Though this progress has been sustained since the seminal works and thoughts of men of science in the 17th,18th and 19th Centuries, it is only in the mid-20th Century that we have seen such a phenomenal expansion in different areas of medicine: laboratory tools for diagnosis; advanced imaging procedures through computed axial tomography and magnetic resonance; ultrasound investigation of the skull, of arteries and veins, of the abdomen, of soft tissues and of the heart; mini-invasive surgery through cylinders called laparoscopes; and the amazing progress of the pharmaceutical industry, producing drugs and remedies which cure or control once fatal diseases. 
 
A tale worth telling is that of the development of antibiotics. In his Laboratory, in the early thirties, Alexander Fleming had left a small dish with nutrients for germs to grow on: after a time, spores of fungus floated onto this small dish. As the fungus grew, the bacteria growing round them were wiped out, as the fungus colonies produced a substance which was antibacterial. He observed that the fungus was of a species called Penicillium notatum, so he called the product penicillin.  After its commercial development a few years later, other fungi were studied by this method, and a whole new  list of antibiotics appeared. 
 
The dreaded killer across the centuries, tuberculosis, was brought under control; pneumonias began to be cured; typhoid fever became a rare disease; syphilis could be cured in its early stages, and so on. As the years passed, we began to witness the emergence of antibiotic resistant strains, which posed a new threat and challenge to develop newer antibiotics and procedures to combat these bacteria. This came about through several reasons: overuse and prolonged use of some antibiotics; taking antibiotics when unnecessary, and upsetting the normal balance of bacteria in the intestines; quitting treatment in some illnesses which require prolonged, combined treatment to erradicate the germs; prolonged stay in Hospital for serious conditions which require multiple antibiotics: these practices are the most common offenders.
 
The development of more sophisticated anesthetic agents, coupled with better life support systems and improved monitors of what is going on in the body when under general anesthesia, have permitted complicated and prolonged surgeries. This, coupled with the research into plastics and metallurgy, have brought into general use heart valve replacements, prosthesis to replace diseased hips and knees, and, among others, implantable hearing aids for some deaf youngsters. Another area, unthinkable some years ago, and now practically taken for granted, is the use of flexible tubes –called catheters- to be threaded into arteries, and so gain access to partially or completely blocked vessels, eliminating the obstruction and then placing a stent to hold the artery open. This is now common in the coronary arteries of the heart, in the carotid arteries of the neck, in the abdomen, in the legs and even in the cerebral arteries. 
 
Transplant surgery is here to stay: the organs most frequently replaced are hearts, kidneys, bone marrow, livers and lungs. Corneas have been used for years, and pancreas and the intestines are gradually coming to the fore.
 Perhaps the most spectacular development in these last  years has been the introduction of robotic surgery, commonly named the Van Gogh surgeon. The robot has articulated limbs and grasping fingers, which can rotate in any direction, working through lapaoscopes: the actual surgeon sits in a small desk nearby, guiding, through television monitoring, the precise movements of the robot. Though very expensive, the better results in some particular surgeries, with less bleeding and complications, and faster recoveries, are making health care institutions consider this heavy investment.
 
Another area worthy of mention is the use of the Internet in Medicine. There are many Libraries on the Web, which either free or for a small fee, can allow physicians and surgeons to read daily the latest publications in any given specialty. Furthermore, the subscription to any given medical magazine permits doctors to peruse them right after the date of publication. This cuts down the time of looking up magazines, chasing librarians for a particular article, and so allowing better informed judgment when deciding the fate of patients. The other side of the coin, is that there is now no excuse for ignorance, unless one is so far away or deprived that one cannot gain access to the Internet.
 
Last, but not least, is the tremendous improvement in the delivery and surveillance of patient care. Hospitals are obliged to comply to strict norms of procedure and equipment. They organize the modalities of attention and the vigilance of in-hospital infection; they develop guidelines for the diagnosis of prevalent medical conditions and illnesses;  they set up systems to search out for errors, based on advanced practices in different illnesses; they open their doors to outside agencies (usually non-governmental) to be evaluated as to their environment and to their way they deliver health care; they develop indices of complications, morbidity and mortality, to compare on line with other first rate Institutions and to share with their accrediting agents.  All this has come together to deliver the highest quality in health care.
 
This should put into perspective the enormous costs incurred to deliver and access health care in the 21st Century. The gradual prolongation of life, with more elderly people in good health but with several medical conditions requiring ever more costly medications, not matched by a more rapid growth of young people, is putting a tremendous burden on Social Security systems, as on governments around the world, to finance all this marvellous and costly structure, which by now everybody considers right to be covered by it.

Dr. John D.C. Emery
Internal Medicine and Institutional Relations
Hospital Británico
Buenos Aires.