Review: The Edge of Medicine: The Technology That Will Change Our Lives

The Edge of Medicine: The Technology That Will Change Our Lives

By William Hanson

Palgrave Macmillan, 2008;

256 pp.; $24.95;

ISBN 978-0-230-60575-6

One night, William Hanson was sitting at a computer workstation monitoring more than a hundred patients scattered around Philadelphia. He was the ”doc in the box” in a new telemedicine service designed to provide closer supervision of critically ill patients in lightly staffed hospitals late at night.

Peering into his monitor, Hanson noticed that something was very wrong with a particular patient in a surgical intensive-care unit. Too much blood was coming from her drainage tubes. Hanson alerted the on-call physician, who found serious internal bleeding that required immediate surgery.

”We are in the midst of an evolutionary explosion in medical technology,” writes Hanson in The Edge of Medicine: The Technology That Will Change Our Lives. He is well qualified on both fronts: a professor of anesthesiology at the University of Pennsylvania—the same university where I teach but in a different school and department—and also an affiliated faculty member of the computer science department at Princeton University. He knows of what he speaks.

Network-based medicine gives doctors more tools for working ”under the hood.” For instance, Hanson describes robotic operations conducted by a surgeon working remotely—the topic of an October 2006 IEEE Spectrum article, ”Doc at a Distance”—and networked anesthesia control stations, which allow anesthesiologists to direct care in several operating rooms at once.

Hanson interweaves stories about patients and their medical histories with details on current and forthcoming technologies that may improve their treatment, such as that of ”Beth Dougherty,” the middle-aged woman who had internal bleeding the evening after her heart-valve operation.

Despite Hanson’s being an unabashed technology maven, his book is impressively well written and aimed at a popular audience, with colorful examples and a jargon-free style. He describes coming wonders of all sorts, such as medical robots engaging in ”virtual patient rounds,” brain implants so powerful that people without disabilities will want them to increase their abilities even further, and long-term hibernation for space travel. Some technologies are very distant: Nanorobots will someday circulate within a patient’s bloodstream, scooping up cancer cells. Others are close at hand, such as using individual genetic information from patients to improve therapy for cancer, or head-up displays that superimpose a patient’s anatomical data on a surgeon’s field of vision during an operation.

But who will pay for all this stuff? Admittedly, the relationship between advances in medical technology and the inexorable rise in total U.S. health-care costs and those of other developed countries is complex. But some economists argue that technology accounts for about half of the increase in health-care costs in the United States, which are already at unsustainable levels. [See the Kaiser Family Foundation 2007 study "How Changes in Medical Technology Affect Health Care Costs" and the findings of the 2000 Technical Review Panel on the Medicare Trustees Reports.]

Consider proton beam therapy, one of Hanson’s enthusiasms. It is an innovative but hugely expensive treatment for prostate cancer—and little is known about its cost effectiveness relative to much cheaper forms of radiation therapy [see, for example, a 2008 study published in the journal Radiotherapy and Oncology, ”Cost-Effectiveness of Particle Therapy: Current Evidence and Future Needs”]. In fact, as a recent article in The New York Times pointed out, ]it’s not even clear that radiation therapy is any more effective for most prostate cancer patients than the vastly cheaper strategy of watchful waiting. The medicine we wind up with will reflect an uneasy compromise between cost cutters, technologists like Hanson, and the lawyers. Readers need to consider Hanson’s glowing vision with some skepticism.

With all its eagerness for future developments in medicine, Hanson’s book, written by a high-end doctor in a high-end medical center, tells only part of the story.