Introduction

Last week I began a discussion on the impact of technology on health care. I will continue on that topic this week.

Wearable devices

Wearable heart monitors have been around at least since the 1980s. However, due to technological advances, these devices have become much more common — Apple watches, for example.

Although insulin pumps were invented in the 1970s, their use became much more common in the early 2000s. When the first continuous glucose monitor was approved by the FDA in 1999, the stage was set for these devices to “talk to each other,” and potentially mimic a key function of the pancreas — adjusting insulin dosage, depending on the glucose level (that’s why such a device is often called an “artificial pancreas”). In 2016, the FDA approved the first of these “closed loop systems” for patient use. Other devices with similar functionality have also been approved.

Last week: Imaging technology created decades ago has greatly improved

Artificial intelligence (AI)

No discussion about the impact of technology on medical care would be complete without mentioning artificial intelligence. AI has been around in a simple form since the early 1950s, when computers learned simpler games like checkers, and then later more complex games like chess. But much more sophisticated AI has been developed in the last 25 years — for example, IBM’s Watson, which beat humans on the game show “Jeopardy!”

AI’s ability to look at very large data sets, and “learn” them by looking for patterns and associations and creating algorithms, makes it an obvious candidate for uses in the medical field. But AI’s limitations (for example, identifying causations), must also be considered.

By looking through large volumes of data sets, AI can be useful in identifying disease risk factors and clinical trends, help guide discovery of new treatments and medications, help improve medical care efficiency (patient scheduling, documentation, giving clinicians alerts to possible drug-drug interactions and/or allergies to medications, etc.), and help improve communication between clinicians.

There are also areas where AI is beginning to support more direct clinical care, including by “reading” certain images to “highlight” things for a clinician to focus on, or by identifying possible worrisome data/trends.

The future promises an increased role for AI, such as in helping diagnose patients, managing patients (including suggesting possible treatment plans or even identifying patients who may benefit from certain tests) and even in helping with direct patient interventions (such as robotic-assisted surgeries).

Although I don’t think AI will replace humans in providing medical care, more areas where AI can play a larger role will continue to be identified. So at the present time I see it as augmenting the care clinicians can provide. Yes, in some circumstances this may mean a smaller number of clinicians may be needed to provide required care.

Brain implants

As our understanding of brain function increases, interaction between the brain and technology would also be expected to improve. And indeed it has. Especially when we consider that communication signals between neurons of the brain, and between the brain and other body systems, are done utilizing electrical and chemical impulses.

Given the above, it’s not surprising that even as early as 1987, technology was developed to send electrical signals to the brain to help treat certain conditions, such as intractable seizure disorders, Parkinson’s disease, essential tremor, and other diseases. It’s reasonable to think of this as similar to a pacemaker for someone’s heart, but in this case the electrical signals are used to stimulate areas of the brain. Over the last 25 years, so-called “deep brain stimulation,” or DBS, has become much more sophisticated, and more widely used.

Creating a device that can have a two-way communication with the brain, sensing a specific signal from an area of the brain and then in turn sending a signal somewhere else, is a natural extension of the above concepts. Although this is in the early stages, this technology has the potential to help many patients (think about helping paralyzed patients walk, stroke patients improve functionality, etc.). There is already real-life progress on this front, with a patient having a Neuralink device implanted and then being able to control a computer via controlling its mouse interface.

Bottom line

The last two week’s discussions have just barely scratched the surface of how technology has changed medicine in the last 25 years, and how it promises to do even more in the years to come. We are certainly living in an exciting time.

Jeff Hersh, Ph.D., M.D., can be reached at [email protected].

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