Science in Your ER

My father's cousin may not have been the first scientifically minded person in the family, but he is the first that created scientific  businesses (from what I know). My father worked with him for many years, and I have co-authored papers with him. To this day he still owns a polymer testing lab that my father and grandmother worked at as his first employees. His scientific curiosity is somewhat of an inspiration in my family, as was my grandmother who may very well have passed it down to him. My grandmother used to spend hours with me going through scientific and medical books, and even without a degree she was extremely well versed in anatomy and biochemistry, and later in polymer physics. Those books to her were somehow extremely important to her identity and to her hope for mankind. She was kind and sad, but not when immersed in either her nephew or son's and later grandsons' businesses, and in medicine and science. (My cousin Mark is a professor of science and technological history, my father an engineer and entrepreneur, and I professor and technology entrepreneur. I have no other cousins and no siblings.)

Her nephew Bob who I mention above is equally as curious as she, and has throughout his life gone through a number of near death illnesses, which I can relate to. He did say something to me after I was sick and hospitalized and shortly after he was as well that has stuck with me. He said that he loved hospitals. This was a shocking statement to me as they seemed at the time depressing places. I asked him about this and he said that being hospitalized is an incredible way to see the future of technology. He could observe EEGs, CT Scans and MRI's. He could see the IV dosage techniques. He could also speak with doctors about diagnostics, which must be something that he can relate to. I of course am writing about a living relative, so I apologize if I am getting any of these details wrong, but the lesson has stuck with me. Every time I get a test I want to see what the doctor is doing. I want to discuss the possibilities. I want to know how the tech works. This is no small influence on the fact that I have a company that will soon be making medical diagnostic equipment for bedsides in clinics and hospitals. For those things that patients can't see because they are happening in a pathology lab, this is a chance to bring it to the bedside.

So I am encouraged by tech and I am also encouraged by research. I have seen the labs of Robert Langer, and Stephen Badylak who work in Regenerative Medicine. I have seen my Columbia Colleagues like Tomas Guillarte working on Neuroscience. I have had a front row seat without being in the hospital bed like Bob was when he was enjoying hospitals so much. I am afraid though that the romanticism of healthcare does not extend to the bedside where general Medical Treatments are concerned. That is a vast overstatement as I have had some of the best doctors in the world who have saved my life. They do have something in common with each other though. Those doctors generally have a background and an interest in research, not just a long tedious generalized education and anecdotal experience with patients.

Just today I went to get a check up for a very minor pain I was having. I went to an emergency room because I know emergency rooms have portable sonograms.  I had a theory on what could be wrong. Now I know that a theory of mine is not worth much. I have no biology or medical background, and the doctor in the ER who has real stressful emergency patients to deal with doesn't need to hear about my ideas concerning this. Still her response to my inquiry was a bit disconcerting. She couldn't relate to my reasoning at all. It was foreign for her to think causally in this way in which we do as scientists. She was thinking about treating a problem, but not what the problem really was. She even suggested pain meds for a situation that wasn't even about ongoing pain. Eventually I convinced her of the sonogram, and sure enough it showed nothing, though that isn't for sure. She made a point of telling me that she never uses them, so wasn't certain that she was the best person to be screening me. She suggested that I was in no danger, but if I wanted I should see a surgeon.

Now this doctor was not wrong, and I was not right. It is still unclear. The problem though for me was that she either doesn't have time, or the inclination for the intellectual curiosity that would lead her down different paths. This I would guess is not her fault, but rather a fault of the system. I see two possible issues. The first is that medical doctors can't possibly keep up with research and remain generalists. This is likely. Our medical school training is geared towards 19th century knowledge at best. There is no way that my doctor today could have known how to best diagnose my problems. She would need to keep up with the latest research in hundreds of disciplines while working this stressful job. The other option is that it is our fault as a society that we still rely on doctors more than on scientists, technologists and quantitative technology. This last point is for certain self serving as I mentioned my job and my company earlier. The fact is that I have a love and a clear self interest in medical technology. Still I admit that with all of our advances technologically it is hard to say whether reforming medical school or having completely automated diagnostics systems would be easier. Everyday the Nanotronics Imaging staff struggles with something that would seem to the outside simple, but which all companies like ours dealing in imaging face. That is the ability for the technological system to be better than the human eye. At first when trying to design a diagnostic tool for industry or medicine the pathologist (or engineer) is always better. There is an inflection point however when that completely changes, and the human eye is no longer as reliable as the algorithm. This applies to many technologies. They start out crude, and need the assistance of doctors. The problem remains the first issue of the generalist physician. Eventually the doctor will not know if the tool is right or wrong.

So we are faced with a big choice as a society. That is rather to train doctors differently. That would be to get rid of a system that has been in place for centuries and train doctors the way we now train scientists. In other words train them to always think statistically, causally and to use the scientific method. The other choice is to start replacing human diagnosis as our tools get better. I would of course like to see both happen, as most people would. The question remains how to get to that point.

Neither Bob nor my Grandmother were Doctors, yet they both embraced (and in Bob's case still embraces) technology, but only as a way to augment a scientist. We are faced with two problems. People like Bob and my Grandmother who have not gone to medical school should have an opportunity to contribute within the system. At the same time we need to utilize the technologies for medical diagnosis and treatment so that we can allow ourselves and our doctors to be intellectually curious and technologically sophisticated.