Chapter 3: Biomedical Technologies
A Robust Economic Force
GPS is now a dual-use technology with civilian uses
that rival its continuing military role. President Clinton announced in
1996 that the U.S. government would continue providing GPS signals to
the world free of direct user fees, as a public good. GPS has since developed
into a multi-billion-dollar international industry, creating thousands
of new jobs while saving lives and bringing many other benefits. The number
of companies identifying themselves as providers of some sort of GPS-related
goods or services has grown from 109 firms in 1992 to 301 firms in 1997.
Even though relatively few of these firms compete to provide the core
GPS technology, a large number of firms provide GPS-enhanced products
and value-added services. The technology has clearly carved out a crucial
role for itself in the global information infrastructure. The precise
GPS timing signals that help synchronize global information networks of
fiber optics, coaxial cable, copper wire, radio, and communication satellites
have become essential to daily commerce.
Like many of the other technologies covered in this report, global positioning
in both its history and
its current uses draws on the breakthroughs in the Information
Technology field; we highlight it here mainly because of its amazing economic
promise. The global GPS market, currently estimated at more than
$2 billion per year, is projected to expand to $30 billion annually before
2030. GPS receivers and transmitters may soon be smaller than credit cards
and cheap enough for use in almost any vehicle, cell phone, or
pocket, for that matter. With every square yard on Earth measured and
labeled with an address, and with computerized databases available that
give latitude and longitude as well as addresses, its conceivable
that no one will ever need to ask directions again.
The United States has seen amazing changes in biomedical technologies
over the past 100 years. We have come from the family doctors signature
black bag in the first half of the century to the powerful scanning equipment
of the modern medical center; from surgical saws to the lasers, endoscopes,
and angioplasty of todays operating rooms; from tens of thousands
dying in influenza epidemics to hundreds of thousands of seniors receiving
their annual flu shots; and from an average life expectancy of about 49
years to our present expectancy of 75 years.
Medicine saves lives and relieves suffering. It embodies for many of
us the greatest achievements of science and technology. The rapid progress
in medicine has come from life sciences such as biology and genetics
but also from physics, math, and many other fields of science and
Hello... Is the Doctor In?
Dr. Jerri Nielsen was a part of the National Science Foundation-funded
research mission in Antarctica.
Millions of Americans received their first introduction to telemedicine
in the summer of 1999 by following the news story of Dr. Jerri Nielsen,
47. Dr. Nielsen, who was serving at the U.S. Amundsen-Scott South
Pole research station, discovered a lump in her breast during a
routine self-examination. She conducted telephone consultations
with doctors via satellite. On their advice, medical supplies were
air-dropped, with which Dr. Nielsen treated herself for several
months until warmer weather permitted her to be airlifted out safely.
Less dramatic telemedicine occurs daily. Some doctors regularly
e-mail medical images such as CAT scans to colleagues for review.
In remote rural areas, telemedicine can mean the difference between
life and death. For example, a specialist at a North Carolina University
Hospital was able to diagnose a patients hairline spinal fracture
at a distance, using telemedicine video imaging. The patient avoided
paralysis because treatment was done on-site without physically
transporting the patient to the specialist, who was located a great
As the practice of telemedicine spreads, doctors may be speaking
literally when they say, Call me in the morning and let me
know if you feel better.
Contributions from Physical Sciences
For example, over the past 25 years physicists have developed revolutionary
imaging technologies that have allowed us to see deeper and deeper into
the materials and processes of life itself. Doctors are now using non-invasive
means of looking into the human body to diagnose a wide variety of diseases
including cancer, multiple sclerosis, Alzheimers disease,
stroke, heart failure, and vascular disease. CAT (Computer-Assisted Tomography)
scans combine X-rays with computer technology to create cross-sectional
images of the patients body, which are then assembled into a three-dimensional
picture that displays organs, bones, and tissues in great detail. Magnetic
Resonance Imaging (MRI) scanners use magnets and radio waves instead of
X-rays to generate images that provide an even better view of soft tissues,
such as the brain or spinal cord. Ultrasound images, produced by very-high-frequency
sound waves, can help doctors visualize a developing fetus, detect tumors
and organ abnormalities, and identify women at risk of developing osteoporosis.
Imaging technologies have also greatly helped in early detection of breast
cancer, which claims the lives of nearly 42,000 American women each year.
The deeper and smaller we see, the more we understand how life processes
work on their most fundamental level.
Mathematics and computer science have greatly contributed to biomedicine
through information technology. Much of todays imaging technology
relies on microprocessors and software. Computers are also making it
easier for researchers to collect, analyze, and share data in research
and in telemedicine, and to model biological systems to project likely
outcomes more accurately. It would be impossible for scientists to sequence
the entire human genome without the information processing power of supercomputers.
And information technologies have provided essential tools to collect
and analyze data for epidemiological research that helps us understand
distribution of disease and to develop clinical and public health interventions.
Improving the health of all Americans requires a broad spectrum
of basic research across all the scientific disciplines, often drawing
upon tools developed in the physical sciences. Here a laser is used
to treat eye disease, before (left) and after (right).
Another development from the physical sciences, the laser, has made the
scalpel unnecessary in many kinds
of surgery. Laser surgery reduces pain and trauma for the patient, speeds
healing thereby shortening costly hospital stays and improves
the accuracy of certain surgical procedures. Most notably, eye surgery
has been revolutionized by this new technology. Precision lasers have
been used to halt, and in some cases reverse, diabetic retinopathy, a
dangerous complication of diabetes and the leading cause of new cases
of blindness in adults. Lasers can also be used to repair small tears
in the retina, preventing retinal detachment, and also to provide follow-up
treatment to patients after cataract surgery. Most recently, ophthalmologists
have begun to use lasers to correct nearsightedness, in a procedure called
LASIK (laser in situ keratomileusis). Not only is laser eye surgery effective,
but it is fast and relatively painless.
A Powerful New Prevention Tool
The vaccine against Hemophilus influenza type b (Hib) meningitis
provides the means to completely eliminate this disease from the
United States within the next few years. This turnaround is largely
a result of basic scientific research in molecular biology. For
years this disease struck 15,000 to 20,000 U.S. children each year
almost as many as polio at its peak. It killed 10 percent
and left one-third deaf and another one-third mentally retarded,
making it this countrys leading cause of acquired mental retardation.
Fortunately, two NIH scientists made a discovery about how to make
infants bodies fight the disease, a discovery that led to
the development of a safe and effective vaccine. The vaccine, routinely
administered to babies only two months old, is saving more than
$350 million per year in avoided infections, and the incidence of
Hib has declined by 95 percent since 1988. With greater use of the
vaccine across the country, we have the hope of completely eliminating
Contributions from Life Sciences
Of course, the biomedical revolution also sprang from fundamental advances
in our knowledge of the life sciences, particularly knowledge of genetics.
Between 1665, when Robert Hooke first observed cells, and the middle of
this century, researchers learned that heredity is controlled by genes,
that genes are located on chromosomes, and that genes are made from deoxyribonucleic
acid (DNA). In 1953, Watson and Crick discovered that the structure of
DNA, which is common to all life on Earth, is a double helix. That breakthrough
swiftly cascaded into new techniques that allow researchers and clinicians
to control biological processes in very precise ways.
Today industrial-scale production of insulin for diabetics is possible
because scientists learned how to cut and paste the human insulin into
bacteria that can produce large quantities of the substance inexpensively.
Gene transfer techniques are also used to produce antibodies that can
attack cancerous tumors directly or deliver lethal doses of drugs to tumors
without damaging surrounding tissue. Many of todays vaccines
which save $6 to $16 in medical costs for every dollar spent on production
come from genetic engineering.
Knowledge of genetics will be further extended by the Human Genome Project,
an ambitious international effort to determine the complete human DNA
sequence, funded by the National Institutes of Health, the Department
of Energy, and the United Kingdoms Wellcome Trust. A map of the
human genome published in October 1998 contains over 30,000 genes, almost
twice as many genes as the map published in 1996. The work of the Human
Genome Project has led to development of tests that doctors are already
using for screening and diagnosing disease.
The HGP includes an important new research component that focuses on
the ethical, legal, and social implications (ELSI) of genetic research.
This program will help ensure that developments in genome science and
technology take account of values such as privacy and affordable health
care. The ELSI program also will serve as a model for other technological
initiatives that raise concerns about established cultural norms even
as they offer tremendous advantages.
Healthy Hearts--Right From the Start
Over the past two decades, medical science has managed to reduce
deaths from stroke by 59 percent and deaths from heart attack by
53 percent. One major reason for this success has been the development
of drugs that combat hypertension. A concentrated research effort
that combined the efforts of the Federal government, pharmaceutical
companies, voluntary health agencies, and private foundations contributed
to this feat. Although these decreases in deaths are encouraging,
we still dont know enough about how hypertension works. Preventing
this condition is still an elusive goal.
In addition to modern drug therapy for heart disease patients,
medical scientists consistently advise careful eating habits, since
diet can contribute to the risk of cardiovascular disease. The long-established
eating habits of adults can be extremely resistant to change. But
it may be possible to teach younger Americans to eat more nutritious
foods. A study supported by the National Heart, Lung, and Blood
Institute at the National Institutes of Health suggests that an
intensive school and family-based intervention program can have
More than 5,000 grade-school students from nearly 100 ethnically
and racially diverse elementary schools
in California, Louisiana, Minnesota, and Texas participated in the
original CATCH (Child and Adolescent Trial for Cardiovascular Health)
Study between 1991 and 1994. The children learned to read labels;
to select Go, Slow, and Whoa!
foods; and to prepare healthy snacks. They ate heart-healthy school
lunches, participated in more moderate to vigorous activities in
PE classes, and engaged their families in entertaining activities
and games promoting healthy eating and exercise behaviors.
In a follow-up study, researchers found that the students who received
the health promotion intervention in grades three through five maintained
a diet significantly lower in total fat and saturated fat and continued
pursue more vigorous physical activity levels than did students
in the control groups. These results suggest that schools can be
an important place to help young people establish habits that may
help prevent the early onset of
cardiovascular disease the leading cause of death among Americans.