Medical Culture, Medical Technology, and the Medical System

1
Medical Culture, Medical Technology, and the
Medical System

• The interaction between new technology and
  health-care
• How are the new technologies pushing for change?

2
Medical Eras

• Medicine has developed through different eras
  mechanical medicine, chemical medicine,
  electronic medicine
• The technology of one era is added to another
• Each era is a combination of technology and
  medical culture

3
Mechanical Medicine

• Cut and sew
• Up to WW II
• Anatomy, Surgery, Transfusions
• Bacteria and antisepsis
• Nobel prizes about specific diseases 1901 von
  Behring Diphtheria, 1902 Ross Malaria, 1905 Koch
  tuberculosis

4
Chemical Medicine

• Take a pill
• Fix the problem chemically
• Diabetes from lethal disease to treatable
  chronic state
• Post WW II
• Antibiotics, Psychopharmacology
• Transplants
• Nobel prizes for treatment methods
• 1945 Fleming, Chain Florey, 1948 Müller DDT,
  1956 Cournand et al heart catheter, 1979 Cormack
  Hounsfield CAT scan, 1990 Murray Thomas
  transplants 

5
Electronic Medicine

• The machine that goes ping
• 70s and onward
• Life support systems for intensive care
• CAT/PET/MRI, ultrasound etc.
• Endoscopy, key hole surgery and micro technology
• Centralised systems of technology

6
The Threshold of Informational and
Biotechnological Medicine

• Today most Nobel prizes on cellular level
• Biotechnological medicine based on control on
  smallest level of organism
• Human health is fundamentally biological, and
  biology is fundamentally molecular 
• Genes are information

7
Information Medicine

• Knowledge is power
• The medical process as an information process
• Information management, decision support,
  augmented reality
• Remote medicine and electronic homes
• Medicine becomes delocalised, distributed and
  instant
• Rise of the Internet patient

8
Sensors and Telemedicine

• Smaller, cheaper, more capable chips
• Both more non-invasive and more implanted
• Active smart sensors in wireless communication
• Bacterial sensors, automated medication
• Changed role of hospitals, primary care and home
  care
• Changes where diagnosis and treatment occur
• Information overload, integrity issues, expensive
  solutions, education needs, diffusion to the
  public.

9
The New Pharmacology

• To speak the language of cells
• Pharmacogenomics personalised medicine
• Biochemistry of ageing, cancer, neurochemistry
• Vaccines for treatment rather than prophylaxis
• Everything from cancer and diabetes to cocaine
• Generics threatened, challenges to current
  business models in pharma
• Border treatment, preventionand enhancement blurs

10
Genetic Medicine

• Everything is cells and genes
• Fit medication to person
• Gene chips for fast diagnosis
• Spread of gene tests
• Cheap, fast genetic tests for many conditions
• In the hands of the public
• Medicine becomes truly individual
• Can health care supply the demand?

11
Regenerative Medicine

• Enhance the healing process
• Regenerative medicine
• Direct biochemical control
• Tissue engineering
• Stem cells
• Artificial implants
• Regulations and financing may slow clinical
  applications

12
Disruptive Technologies

• Telemedicine and advanced sensors
• Care moves in the direction of home
• The neurocognitive revolution
• Transformation of the mental health sector
• Gene testing
• Information monopolies break, diagnosis expands
  faster than treatment
• Decision support
• Integrating IT into the patient-doctor relation

13
The Individualization of Medicine

• Well informed, demanding patients
• Monopolies of diagnosis and treatment break down
• Individualized medicine

14

• We need certain organisations to make best use of
  a technology, but the technology does not create
  the organisation.
• Progress is not a buffet
• Technology does not arrive when ordered
• Technology forms closely knit systems
  cumulative and accelerating
• Bad news for central planning

15
Conclusions

• Some of the new technologies pose profound
  challenges for current health care organisations
  and funding
• In order to apply them new institutions are
  needed
• Patients are getting impatient and mobile
• Need for transdisciplinary education and
  communication
• Need for adapting to continuous change