Tuesday, September 29, 2009

Quantification

To condense my previous blog into a comprehensible list, here are 10 ways for bioengineers to cut healthcare costs:
1. Creative manipulation of existing technologies (like using cell phones for medical imaging [1])

2. Building new technologies with cost in mind, rather than addressing it as an afterthought

3. Going smaller:
nanotechnology could enable us to do more with less material. Although the development of such technology would be expensive, in the long run it could cut costs

4. Improve basic scientific knowledge.
Dr. Bogen noted that many people today question Vannevar Bush's insistence on fundamental knowledge as opposed to practical applications. Think, however, about the advantages of complete knowledge. If we could precisely model the behavior of molecules on a virtual level with advanced knowledge of biochemistry, we could bypass costly clinical trials since we would already know the exact outcome of the treatment.
5. Getting personal:
As I blogged about earlier, clinical trials provide knowledge about the population, not about a specific individual. Once we move beyond the clinical trial - based nature of medical research, we could personalize treatments for individuals' specific genotypes and phenotypes to achieve better results with the same effort.

6. Make technology more user-friendly.
As I noted in my last blog, the new cell-phone imaging technology produced at Berkely would allow anyone with some basic cell phone technology to do medical imaging, but not to interpret the results [1]. We need to be able to use technology not just to determine information but also to present information in comprehensible ways. This ties in with the importance of communication in engineering and in medicine.

7. Consider the impact on society.
Although it may be in the interests of one individual or company to conduct research in an expensive manner and then charge exorbitant fees for the resulting technology, society cannot bear the strain of many such individuals taking care of their own interests at the costs of everyone else. According to information from the American University Washington College of Law, "
There are many examples of the successes of our super-charged pharmaceutical marketing system at shifting massive amounts of prescriptions toward newer, more expensive drugs that do not benefit patients" [2]. We have to realize that if we don't think from a societal perspective, we will all suffer.

8. Don't go after lofty but impractical goals.
Like I said before, we all want to solve the big problems like cancer, AIDS, and heart disease. There are, however, many approaches to all of these problems. We shouldn't dive into an avenue of research if it looks like there are more cost-effective options.

9. Common Sense.
This is actually less common than the name implies. Good old-fashioned efficiency could go a long way.
10. Making systems of technologies interact with each other more efficiently.
We see this every day in the real world when hardware and software made by different companies or even the same company don't interact in the way they were intended. In the medical world, combinations of drugs taken together can often be dangerous but can sometimes work properly. On another level, researchers using technologies not available to the general public may have problems transferring data from one format to another or interpreting and manipulating the data. This goes along with making research in general more user-friendly.

Works Referenced

[1] Yang, Sarah. UC Berkely Researchers Bring Fluorescent Imaging to Mobile Phones for Low-cost Screeining in the Field. UC Berkely News. 21 July 2009. Available: http://www.berkeley.edu/news/media/releases/2009/07/21_cellscope.shtml.

[2] Flynn, Sean. Litigation Challenging Regulation of Data Mining. American University Washington College of Law: Program on Information Justice and Intellectual Property. 31 March 2008. Available: http://www.wcl.american.edu/pijip/go/blog-post/litigation-challenging-regulation-of-data-mining.

Friday, September 25, 2009

Balance is Everything

Engineering as a discipline is out of balance in the modern world, and that is the cause of our most serious problems. Engineers can certainly reduce healthcare costs by developing new, cost-saving technologies; in fact, we are probably the only ones who can do so. The key, however, is not just MORE engineering, but better engineering. This is especially the case with biomedical engineering.

I already cited one new engineering development with the potential to save costs in my first blog entry. I was asked to identify a news article about biomedical engineering and mention it in my blog. I chose an article about a cheap medical imaging technology that can save costs in developing countries. To quote myself, "I was particularly interested in the research article I found on the UC Berkeley site, however, because it seems particularly relevant at the moment. While politicians in Washington argue over why health care costs are so high and how to solve the problem, researchers have once again shown that sufficiently advanced technology can make anything affordable." I did not cite myself here because I certainly will not press charges against myself for stealing my own ideas.

Let's take another look at this article. This summer, using fluorescent imaging technology, researches at UC Berkeley developed a cell phone microscope that can be used for medical imaging in developing countries [1]. The only problem with this article is, if you read closer, the technology can be used for the imaging part of the process but the images may then have to be sent to experts for analysis [1]. Basically, this technology is not seriously reducing costs, it is just shifting the heavy work to the experts to enable people in developing countries or other places with limited medical care to feel the benefits of technologies they would otherwise not have access to.

Nevertheless, this is one example of a step in the right direction for engineering. Unfortunately, the field of biomedical engineering is currently dominated not by such practical, cost-cutting measures, but by a drive for better quality technologies. The tremendous effort being put forth in an attempt to conquer all remaining health problems is admirable but highly impractical. We can barely afford the quality of health care we have now. Before increasing the quality of that care and simultaneously contributing to the rising costs of health care, we should find ways to make the care we already have less expensive and find ways to incorporate new technologies into our healthcare system without an unbearable cost to the economy. Of course, many people would argue that the kind of health care spending occuring in the United States is necessary in order to fund our great medical research. In truth, however, researchers can profit financially by making healthcare more affordable. Pharmaceutical companies with the cheapest products would ideally attract more customers, generating more revenue, and thus having more cash available to fund their expensive research. This general principle should extend not just to pharmaceutical companies but to all forms of biomedical and health-related research.

My opinions above, of course, would merely be worthless speculation unless they were put in perspective. This January, a Scientific American blog analyzed Barack Obama's claim that techonology was the solution to health care costs [2]. The blog cited a 2003 study by Stanford professor Lawrence Baker which argued that more technology could cause healthcare costs to rise [2]. When questioned, Baker agreed that, "'there are huge technology opportunities out there,'" and clarified that "'The most health care isn't always the best health care. Decisions about value is [sic] probably key'" [2]. This was paraphrased in the blog as "finding and using the technology that makes the most sense" [2].

Researchers around the world are pouring money into several different approaches to the battles against AIDS, cancer, obesity, malnutrition and other major health problems. All of this research is beneficial and necessary if we are to improve our health care. It is important, however, that we introduce cost cutting measures into all forms of research and spend significant time and money researching the art of cost cutting itself.

There are many exciting technological possibilities that could help in this process. One possibility is introducing cheap methods like the cell phone imaging technology not just into developing countries but into the most advanced research laboratories, so we can do great research without spending great amounts of money. Another possibility is that the concept of individualized medicine could help us cut costs. I read in the greatest engineering challenges that clinical trials are the gold standard of the current method of health research, but would not be applicable to individualized treatments. If we can develop a system of research that relies not on statistics and costly clinical trials but on empirical knowledge of exactly how genes and proteins function, perhaps we could develop drugs and treatments knowing exactly what they would do without a costly process of trial and error. I don't know if this is just wishful thinking, but I plan to find out.

Works Referenced

[1] Yang, Sarah. UC Berkely Researchers Bring Fluorescent Imaging to Mobile Phones for Low-cost Screeining in the Field. UC Berkely News. 21 July 2009. Available: http://www.berkeley.edu/news/media/releases/2009/07/21_cellscope.shtml.

[2] Harmon, Katherine. Is Obama Right That Technology Can Lower Health Care Costs? Scientific American: 60-Second Science. 20 January 2009. Available: http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=is-obama-right-that-technology-can-2009-01-20.

Wednesday, September 23, 2009

Correlations and Contradictions

Here's how my view of the 20th century's greatest achievements matched up with that of the experts.

Both of our lists contained:

Airplanes
Computers
Internet

The following categories (on left below) on the list at http://www.greatachievements.org/ were analogous in one way or another with some of my entries (on right below):

Automobile ~ Cars, Tanks
Lasers and Fiber Optics ~ Lasers
Nuclear Technologies ~ Nuclear Fission
Spacecraft ~ Hubble Telescope, Moon Landing, Intnl. Space Station, GPS, weather satellites
High Performance Materials, Petroleum and Petrochemical Technologies ~ Plastics
Health Technologies ~ Antibiotics, Angioplasty, Human Genome Project
Household Appliances ~ Video Cameras, Cell Phones, Liquid Crystal Displays
Telephone ~ Cell phones
Imaging ~ Hubble Telescope

As you can see, my entries tended to be somewhat redundant because I picked several specific achievements from the same general categories. The website had more general categories and was thus able to fit in several classes of achievements that I had not even considered:

Electrification
Electronics
Radio and Television
Air Conditioning and Refrigeration
Water Supply and Distribution
Highways

Some of these categories are so obvious that you might be amused by my omission of them. Consider, however, my reasoning for each of the omissions:

Radio and Television
Being able to find news and even TV shows on the internet, I seldom have use for television and have never listened to the radio except occasionally while in a car.

Electrification
Ben Franklin did his famous lightning and kite experiment in 1752 [2]. Thomas Edison invented the light bulb in the late 1800s [2]. Knowledge of electricity and electric appliances have been around since before the 20th century, but the widespread availability of electricity for common use certainly grew dramatically in the 20th century [2]. I was not alive when this happened; during my lifetime, electricity has been taken for granted throughout most of the United States. I did not even consider electrification when writing my list.


Electronics
As for electronics, I took the concept itself for granted since it certainly didn't seem revolutionary during my lifetime, and instead listed some of the household appliances that were enabled by electronics, like video cameras, liquid crystal displays, and cell phones.

Highways
We all learned in history class that President Dwight D. Eisenhower, by signing the Federal-Aid Highway Act, pioneered the systematic building of a national highway system beginning in 1956 [3]. When I was born, this system was well in place and I took it for granted. I seldom stopped to think that the food I eat every day often comes from miles away and that millions of people commute to work daily on well maintained highways. The existence of highways to enable transportation is vital to our economy and our daily lives, and the building of the highway system in the United States was certainly a tremendous feat of civil engineering. I should not have neglected this achievement, but I did not think of it because its effects on my life, although serious, are all indirect and easily go unnoticed.

Air Conditioning and Refrigeration
I have no excuse here. This one was just plain obvious.

Water Supply and Distribution
This is perhaps the most important item on the ENTIRE LIST. The availability of fresh water resources could well be one of the greatest challenges of the 21st century, alongside such staples as including eliminating poverty and reducing health care costs. Here, however, I have a very good excuse: fresh water is something that many people take for granted. This may change, however; in the past decade, there have been sever water shortages and filtration problems in places like Atlanta, Georgia [3]. The distribution of clean, fresh water is the most important challenge that any society faces. Humans cannot survive for more than a few days without water; it is easier to starve. The 20th century saw great achievements in water purification and distribution. Today we have a variety of sources for acquiring fresh water, including harvested rain water, river water and desalination of sea water, as well as a variety of techniques for filtering water, from chlorination to reverse osmosis. The demand for water is, however, growing as the human population grows and as each human uses more and more water with our growing consumer economy. In the years to come, we will have to figure out the problem of water supply and distribution anew.

As a freshman engineering student at Penn, I truly appreciate the great achievements of the 20th century, and I hope to participate in the progress of the 21st century.

Works Referenced

[1] Constable G, Somerville B. Greatest Engineering Achievements of the 20th Century. National Academy of Engineering. 2009. Available http://www.greatachievements.org/.

[2] Energy Timelines: Electricity. Department of Energy: Energy Information Administration: Energy Kids. 2007. Available: http://tonto.eia.doe.gov/kids/energy.cfm?page=tl_electricity.

[3] History of the Interstate Highway System. U.S. Department of Transportation: Federal Highway Administration. 2009. Available: http://www.fhwa.dot.gov/interstate/history.htm.

[4] Lavelle M, Kurlantzick J. The Coming Water Crisis. U.S. News and World Report. 4 August 2002. Available: http://www.usnews.com/usnews/biztech/articles/020812/archive_022254.htm.

The Pupil

I was able to correctly predict some of the experts' choices for the greatest 20 achievements of the 20th century. Some of my choices were not exactly the same as theirs but were somewhat analogous. A few of the experts' choices took me completely by surprise and made me look at the modern world in a new way. Aspects of my life that I take for granted and did not even consider to be great achievements were actually areas of significant progress during the 20th century. I learned a lot just from glancing over their list. Come back next time, and I'll give a more detailed explanation.

The Prophet

I was born in 1990, so I was not alive for 90% of the 20th century. Nevertheless, I have lived throughout that century vicariously with the help of movies, popular culture, and history classes. Now, my knowledge of the 1900s is being put to the test. Right here on this blog I will reveal what, in my opinion, were the 20 greatest achievements of the 20th century. Then, we will check with the experts on http://www.greatachievements.org/. I know it's tempting, but don't peek just yet. I was able to resist.

1. Nuclear fission
2. Computers
3. The Internet
4. Cars
5. Airplanes
6. The Human Genome Project
7. Intercontinental Ballistic Missiles
8. The Hubble Telescope
9. Antibiotics
10. Lasers
11. Cell phones
12. Angioplasty
13. Tanks
14. Plastic
15. Moon Landing
16. International Space Station
17. Satellite-based weather forecasts
18. Global Positioning System devices
19. The video camera (YouTube, anyone?)
20. Liquid Crystal Displays (enables digital watches, LCD HDTVs, etc.)

Now let's see how close I was! Follow me to http://www.greatachievements.org/ and let's see what the experts think.

Saturday, September 19, 2009

The World of the Engineer

On Thursday, I had my first taste of being an engineer. I used facts to discuss the topic of swine flu with other aspiring bioengineers. The discussion helped me make informed decisions about whether or not to get a swine flu shot and how I think swine flu vaccines should be used if supplies are scarce. After the discussion, I used my blog about swine flu to document the process of discussing the problem and making my decision. I looked up most of the facts that other students had cited to check the accuracy of their data. I did my best to cite all sources for the information in my blog in IEEE format, but I had to make approximations for internet sources like the CDC website.

Somewhere along the way, while learning to communicate my ideas to others, cite my sources, and make informed decisions, I become an engineer. I now know what it feels like to carry the responsibility of this great profession. Engineering is about applied scientific ideas and building technology for society, but at a deeper level, it is about making informed decisions with reliable facts. So far, I have learned a little about what information to trust and how to make it clear that I am reliable and informed. I certainly experienced a tremendous transformation this week.

The act of becoming an engineer, however, is also in some ways a more gradual process. I am sure there was information I could have found about swine flu that I did not find, and I am sure that my first attempt at proper citation style was not perfect. I am eager to improve my skills and become a better engineer over the course of this year and during my entire stay at Penn. I have one foot in the world of the engineer, and I'm ready to step inside.

Friday, September 18, 2009

The Swine Flu Dilemma

Before our recitation*, I had a general background knowledge of swine flu, epidemiology, public health concerns, and the news about the swine flu vaccines. I had also looked up a few specific facts about the swine flu. At the beginning of the discussion, I outlined my initial views on the facts. I had read in the Daily Pennsylvanian that several Penn students were already sick with symptoms of flu. Combining this with the basic knowledge that diseases can spread rapidly in a community like Penn where many people are in contact with many others, I reasoned that I was at reasonably high risk for spreading the swine flu if I contracted it. Therefore, I argued that it would wise for me to receive a swine flu vaccination.

In regards to Dr. Bogen's second question of what to do from a public health perspective with only limited stores of vaccines, I made two comments. I had read in a New York Times article that new clinical trials provided evidence that, contrary to earlier predictions, only one swine flu shot and not two were needed to vaccinate someone, thus making the problem of limited vaccines less severe than it was earlier [1]. I recounted this fact and then went on to suggest that if supplies were still limited, those at highest risk should be vaccinated first.

Once the discussion got underway, however, I was forced to at least reconsider all of my opinions in response to new data that others brought to the discussion. First, someone cited the CDC website, stating that anyone below the age of 24 would fall into one of the categories of high risk [2]. Following this argument, I am a college student at high risk and should indeed receive a vaccine.

Several others, however, were skeptical of the vaccine. One student argued that the safety of the vaccine was in doubt because it contained a mercury additive[3]. Yet another student recounted a massive 1976 flu vaccination campaign that was "blamed for causing a rare paralyzing disorder known as Guillain-Barré Syndrome" [3]. I was able to find both of these pieces of information after the discussion in a Washington Post article written in August. The original article, however, stated that versions of the vaccine without mercury were being developed for pregnant women and parents of young children, and that the CDC was closely monitoring any possible side effects for the swine flu vaccines. For these reasons, although the new data made me reconsider my decisions, I still think it would be beneficial for me to receive the vaccine.

During the recitation I contributed to the conversation, listened attentively to others, and gained experience in interpreting data. Towards the end of the recitation we began to integrate all the data into a full-scale public health analysis of the situation, and I gained on of my first experiences of thinking like an engineer, which I will outline in more detail in my next blog. Walking away from the discussion, I feel that I should indeed consider getting a swine flu vaccine. If there are limited supplies of the vaccine, I think that those at high risk and those who are likely to spread the vaccine should both get priority.

*Unfortunately, I went to the wrong recitation on Thursday (Muse 328 instead of 319 Towne), but I still gained a lot from the discussion.

Works Referenced
[1] D.G. McNeil. "One Vaccine Shot Seen as Protective for Swine Flu." New York Times. 10 September 2009. Available: http://www.nytimes.com/2009/09/11/health/11vaccine.html.
[2] United States Center for Disease Control and Prevention. 17 September 2009. Questions & Answers: 2009 H1N1 Influenza Vaccine. Available: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
[3] R. Stein. "Swine Flu Campaign Waits on Vaccine." Washington Post. 23 August 2009. Available: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/22/AR2009082202337.html?hpid=topnews.

Saturday, September 12, 2009

Assignment 1

1) I chose to study bioengineering because I love both math and biology and this was the best subject I could find that used both. I am a pre-med student, but I chose bioengineering rather than any other major because I am interested in the subject. I wouldn't want to spend four years as an undergraduate student studying a topic that did not interest me. What's great about bioengineering is that not only does it involve both biology and math, but it is a highly diverse field with many paths to choose and many practical applications. The progress ocurring today in medical technology fascinates me.

2) I think a bioengineer is someone who uses engineering skills along with a knowledge of biology to solve problems in the medical field. Of course, bioengineers accomplish many other tasks as well. Bioengineering majors can become surgeons, lawyers, or even business owners, but the first image that comes to my mind when I think of a bioengineer is that of the researcher or technician.

3) If I had a chance to go back in time, I would help develop the process of angioplasty. The idea of using balloons and stents to expand clogged arteries is very creative. Medical technology keeps improving so that doctors can do more and more for their patients with fewer risks. Angioplasty is an excellent example of this; although the idea was ridiculed at first, it has become an important surgical procedure that makes treatment of heart disease much simpler and less dangerous than in the past. Since I cannot actually go back in time, the best I can do is to get involved in modern technological developments.

4) I want to learn about how and why things work. This begins with a basic knowledge of the sciences, encompassing chemistry, physics, and biology, all of which I took in high school and all of which I will study again in more detail in college. At a deeper level, I want to be knowledgeable about the kinds of medical technology in use today and how and why that technology works. I also want to learn a lot about the developing ideas of today so that I will be able to build the technology of tomorrow.

5) I want to acquire skills in communication, organization, planning, and technical ability. The most important skill taht anyone can have is that of communication, and this is true even for engineers, who often forget about communication while focusing on more technical skills. I know, however, that I will need to be able to explain my knowledge, give presentations, speak clearly to others, and write well in order to use my bioengineering degree with any success in any field. After communication skills, my next priority is to improve my organization skills and develop new methods of planning. I was not always organized in high school, but I knwo that I will only acquire more responsibilities in the future, and I want to be prepared for anything. Finally, I certainly want to improve my technical ability to work with laboratory equipment and engineering tools, whether they are physical objects or other tools like software. All of these skills will be useful after I graduate.

6) Researchers at the University of California at Berkeley, under the leadership of Bioengineering Assistant Professor Dan Fletcher, have developed a cell phone microscope that takes color images of malaria parasites and tuberculosis bacteria, provided that the TB bacteria have been prepared with fluorescent markers (http://bioeng.berkeley.edu/cellscope/pioneers/mobile/fluorescent/imaging.php). The significance of their achievement is that the normally expensive and complicated process of flourescent microscopy can be carried out with a normal cell phone camera and a few relatively inexpensive accessories. The researchers believe that the new technology can be used in remote areas of the developing world by health care workers who lack more expensive equipment.
Advanced medical research is also happening right here at the University of Pennsylvania, where, among other accomplishments, researchers recently proved that one type of cell can be changed into another by adding the right kinds of RNA to the cell. I was particularly interested in the research article I found on the UC Berkeley site, however, because it seems particularly relevant at the moment. While politicians in Washington argue over why health care costs are so high and how to solve the problem, researchers have once again shown that sufficiently advanced technology can make anything affordable.

7) Although this may not be directly related to medical technolgoy at the level of the doctor's office and operating room, I have always been curious about molecular biology. The research I mentioned above at the University of Pennsylvania involving RNA is an example. In my high school biology class, I had a lot of fun learning about biology at the cellular level and how genetics translates into the properties and behaveior of living cells.