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Dr. Andre A. Kulisz
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Assorted Thoughts on Science, Medicine and Economics* There are elements of civilizations that coexisted in a symbiotic relationship: science, technology and economics. All three of them were tightly intertwined. It is difficult to say which one of them was the leading, or the trailing one. All of them substantially depended on each other. Neither one could exist, nor perish on its own. Their mutual dependence was their strength. It allowed them to grow as societies grew and develop as needs developed. From the beginnings, the curiosity and the intellect of man wrestled out the secrets of nature compiling the human experience. Starting from a fire, a wheel and a knife, through stone cutting, ship building, mechanical chronometer, steam and electricity, the expansions of common knowledge covered more and more disciplines that were farther and farther apart. This intellectual property of the human race was not in a vacuum. It was closely assisted by material benefits that it helped to create. And in turn, these benefits propelled the knowledge to become science and then science, to become technology. And, again, the technology multiplied the wealth, which in turn multiplied the science... Medicine, that was the one of very first disciplines of knowledge, followed. Medicine is as old as civilization. In cultures that are thousands of years old, it compiled a tremendous base of knowledge that is used today with great results. Although mysterious, difficult to understand and often ridiculed and dismissed by western practitioners, it helps and heals and brings health back. Unlike the medicine of old civilizations, the western medicine is about 70 to 100 year old. It never accumulated the precious annals of medical knowledge so specific to old cultures. Almost from the beginning it became dependent on instruments. The knowledge of scientists, engineers and technicians became indispensable to the practice of western medicine. Without them, it would not progress. Pasteur, Roentgen, Curie, to mention a few, started the momentum that propelled the field of medicine to new levels. It became obvious to large corporations that the demand for medical technologies will grow if medicine wants to claim new successes and discoveries. And obviously, they were right. The business of medicine arrived. Although the payment was always a component of medical practice, it was a domain of a clinician, a pharmacist, and occasionally a prostheticist. Now the corporation joined. Equipped with sophisticated laboratories, staffed by splendidly prepared scientists, engineers and technicians, started a mass production of everything that any physician may ever need. From advanced surgical laser instrumentation, to computer-based diagnostics, to prepackaged, premeasured medications. The corporation set the pace of medical progress. For the first time in the history of medicine, the physician has been reduced to an interpreter of instrument readings, or an instrument operator. The overwhelming competition among medical companies floods the marked with newer and newer generations of medical products. In such an environment, the progress of medicine is being paced by a scientist, or an engineer. This new form of medical practice became ultimately dependent on medical technology. Since technology is dependent on economics, extrapolating this relationship, we could conclude that the field of medicine and its progress is also dependent on economics. To prove the validity of this assumption it is enough to look into the present state of the national health care budgets and how they relate to ever increasing populations and, longer than ever before, life expectancies. It is interesting to observe the evolution of medical instrumentation industry in the environment of the economics and technology, and the influence they have on each other. Such a mutual influence is noted in many industries, but it is particularly well pronounced at the juncture where economics, technology and medicine meet. The medical instrumentation industry is ruled, more than any other, by economic conditions of the complex health care environment. The economic health care environment, on the other hand, is experiencing constant assaults from the industry inventing and producing technologies that, although often expensive, provide much better, and more successful treatment than the medicine was able to offer to the patients even 10 years ago. As it is with all the economic resources, the amount of available health care is finite, and the need for it grows continuously. In a way, modern health care is a victim of its own success. Better and more successful treatment extends the life of patients, who, in turn, need more medical services as they grow older. Additionally, a new requirement has been added to the treatment outcome: improved quality of life. We are no longer satisfied that medical technology keeps us alive; we demand that the life we live, after the treatment is completed, is of the same quality as that of healthy people. Many believe that health care is the right we have, and it's an obligation of some, often unidentified entity to provide it. Understanding that health care is an economy with a supply and demand like any other, is either forgotten, or omitted, as not appropriate (or politically-correct, perhaps) to mention. After all, what is the price of one's health, or life? In this tumultuous environment of often contradictory demands from doctors, patients, medical institutions, medical manufacturers, insurance companies, national health care plans, politicians, governments, regulatory agencies, and others, the new form of health care emerges: outcome-oriented, cost-efficient. In this new environment the amount of available health care is limited. For the first time in the history of medicine, the procedures and treatments are evaluated as to their efficacy and cost. The use of general practice is expanded and consultations from specialists reduced. Patients, after even substantial surgeries, are being sent home within days, or sometimes even hours. Physicians are no longer free practitioners of their art: they are employees or associates of various medical plans and health maintenance organizations. They are subjecting their judgments to the policies of insurance companies. The medicine of today was unthinkable yesterday. As general practitioners increase the broadness of their medical practice, the need for specialists is getting reduced to serious cases. General practitioners are getting actively involved in almost any specialty of medicine. Such an environment puts a special demand on medical manufacturers: create medications and medical devices that will be simple and safe, even if misused by a nonspecialist physician. They must be less, or substantially less expensive than the previous equivalents, and if they won't benefit the patient, their removal, or withdrawal will leave the patient not any worse off than the patient was before the treatment. As it happens in the market-driven economy, such medications, devices and medical instrumentation are appearing more and more often on the scene. For example, in the relatively new field of the nonsurgical treatment of female stress urinary incontinence (SUI) and urinary retention, a number of new solutions has been developed recently to add to the practitioners' "toolbox". The Autocath 100, a new nonsurgical, intraurethral bladder control device for incontinent and retentive women is one of these developments offering a new generation treatment. It is the most recent of the devices and methods whose concept I have developed. Successful development of medical devices cannot depend only on technical skills of the development teams, as it is presently believed. In fact, better and less expensive devices, and associated treatment methods, are developed by small, highly educated and committed groups usually associated with start up medical ventures.. These groups represent broad interdisciplinary expertise in basic science (mathematics, physics), technology, economics, medicine, regulatory requirements, finances and other disciplines. Small teams develop their medical products faster, at much lower cost (10% to 20% of the "normal" estimated development costs) with a treatment success ratio of 70% to 90% of targeted patient populations. It is particularly important at the time of the stretched national healthcare budgets, and ever longer life expectancy, giving national health care much needed relief combining low treatment costs with high success ratios. (*) A. A. Kulisz; Development of Medical Instrumentation, Technology Versus Economics...; Page 1- 6; Knightsbridge University Library, U.K.; Dr. Kulisz was a co-founder of HK Medical Technologies, Inc., Chief Researcher and Executive Vice President
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