Need a kidney transplant? No problem. I’ll just print one out. It is now possible to run living cells through a 3-D printer and engineer a transplantable kidney. With more than 60,000 people on the national transplant list, this technological breakthrough could be a lifesaver. It also could be a game-changer because there would no longer be a need to look for a donor match.
Also on the cutting edge, MC10 Inc. in Cambridge, Mass., has just developed a process that embeds tiny pieces of technology into bendable, stretchable material. Their first product, BioStamp, is a wearable device that looks something like a temporary tattoo. It has sensors that collect and transmit biological data such as body temperature, heart rate, brain activity and exposure to ultraviolet light. Collected information can be readily uploaded to a nearby smartphone. Leave it on for two weeks!
Kiplinger recently highlighted several other biomedical breakthroughs that are likely to affect the medical industry: radio frequency applications to the kidney that can lower blood pressure; dissolving metal stents for the heart that leave behind a healed blood vessel; an external, artificial pancreas that reads blood sugar levels and delivers insulin; an artificial retina for the eye; and vaccines to treat cancer.
Undoubtedly, some of these new technologies will result in new cost benefits, but most will add to the price of health care even as they improve quality of life. The unstoppable force of advances in biomedical technology faces the immovable mountain of health care reform. As access to care unfolds for millions of underserved citizens, despite best efforts at creating efficiencies, American health care must resort to rationing. This is only exacerbated during an economic downturn.
In 2009, while in the midst of the Great Recession, the Hawaii Department of Health cut its budget for mental health services by $25 million. At Manakai o Malama, a number of patients with serious mental illness who had been barely able to keep a roof over their head with the support of mental health caseworkers were simply lost to follow-up after the cuts. Without their caseworkers, many of our patients became homeless once again. In a recent meeting, the physicians working at Straub Emergency Department reported a marked uptick in recurring visits to their facility beginning at that time.
It turns out that the economic decision to cut back on mental health services, which resulted in our patients being seen in the ED instead of the clinic, cost more than it saved. There was an increase in emergency room visits, hospital admissions and charges statewide, according to Hawaii Health Information Corp.
Total ER visits jumped 20 percent last year, and hospital admissions rose 14.3 percent in the same period. Emergency room charges and inpatient admissions related to mental illness totaled $98.3 million — 30 percent more than the $76.1 million spent in 2009.
If biomedical technology could only come up with a scientific breakthrough that prevented substance abuse, mental illness and homelessness, all concerned would benefit greatly. Unfortunately, social ills are not so amenable to technical solutions. The human touch remains an indispensable part of health care, and many of the mentally ill simply cannot do without their case managers.
At the same time, advances in biomedical technology are also sensitive to funding. According to one former investment banker who moved to Hawaii to start a medical business, "if you start taking dollars away, people aren’t going to want to do the research, and you are going to start getting inferior technology. Future entrepreneurs won’t focus in the health care space."
For the moment, health care reform seems to be causing more problems than it is solving. In the end, the pain of change will result in increased access to care, but to pay for it will require a determined effort to balance high tech and high touch.
———
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
