Category: Medical

Intrauterine Device (IUD)

Intrauterine Devices (IUD’s) are long-lasting passive birth control for women. Once inserted they work anywhere from ten years to life. IUD’s are the most common birth-control method in the world.

Background

IUD’s were first developed in 1909 by Richard Richter of Waldenburg, Germany. Ernst Gräfenberg also supported the devices. He is the doctor the “G-Spot” is named after. However, neither device caught on.

In the early 1960s, Jack Lippes created plastic IUDs that became the standard-bearer for years. Lazar Margulies improved the IUD, making it possible to insert without dilating the cervix.

There are two types of IUD’s, hormonal and non-hormonal. Hormonal slowly release hormones that slow down or stop menstruation and must be replaced every decade. Conversely, non-hormonal use copper that creates a hostile environment for sperm. By comparison, non-hormonal IUD’s theoretically last indefinitely.

Unlike sterilization, which might be reversible, removing an IUD restores fertility to its prior state virtually immediately. Specifically, there are no lingering side effects beyond the initial comfort of insertion and, in the case of non-hormonal IUD’s, a short period of mild cramping.

Dalkon Shield

One early IUD, the Dalkon Shield, damaged both women and the reputation of IUD’s for decades. Invented in 1968 by Dr. Hugh Davis, the plastic Dalkon Shield was intended for women who never had children. Eventually, it became wildly popular and, by 1970, over 600,000 were implanted. However, reports soon surfaced about severe pelvic infections. The manufacturer reiterated the device was safe. By June 1974, Notwithstanding their claims, six women had died of complications. The manufacturer finally discontinued the product.

Newer IUD’s function differently than the Dalkin Shield and, over decades, have proven to be as safe or safer than other birth control methods.

Markedly, IUD’s are especially popular in China. From 1980 to 2014, 324 million Chinese women started using IUD’s as part of the now-abandoned one-baby policy. However, Concerned about a lack of babies, the Chinese government is now funding IUD removal, illustrating the benefits of IUD over the more permanent tubal ligation.

Genetic Testing

Genetic testing identifies genetic patterns, including irregularities. In 2019, genetic testing is typically used to search for abnormalities and susceptibilities. However, new treatments under development target the specific traits of patients or disease. These treatments attack and cure at the genetic level. In addition, genetic testing is entertaining. People find unknown relatives or trace family origin.

Background

In April 1953, James Watson and Francis Crick worked with Rosalind Franklin to discover that DNA is a double-helix. They explained how DNA self-replicates and encodes hereditary information. Eventually, Watson & Crick won the Nobel Prize for their work (Franklin died, rendering her ineligible). However, while they accurately described the form of DNA they did not explain the chromosomes that render our biological blueprint.

In 1956, Joe Him Tjio and Albert Levan released the first substantive work on chromosomes, the core of genetic testing. Particularly, they found human DNA contained 46, not 48 as previously believed. Almost more importantly, they identified how to read information from chromosomes.

Not long after, the earliest genetic testing began. Eventually, reports emerged concurrently identifying the genetic abnormality responsible for Down syndrome. Next came reports tying Turner and Klinefelter syndromes to genetic anomalies.

Markedly, progress identifying genetic differences proceeded slowly until the 1980s. Eventually, new technologies lowered the cost and increased the value of the information. By the 1990s, these techniques increased in speed and decreased in cost.

Human Genome Mapping

In 1990, scientists started a project to map the entire human genome, the Human Genome Project. It finished in April 2003, and cost about $2.7 billion USD. By late 2018, one company ran a sale to sequence an entire human genome for $200. The full price was $999 though the company, Veritas, predicts the retail price for a full DNA sequence will be $99 by 2024 at the latest.

Countless DNA sequencing companies exist that read and report partial DNA results. For example, 23 and Me offers a “Health + Ancestry Service.” For $199, customers receive over 125 gene-related health reports plus a fun family history report. The family history report, “Get a breakdown of your global ancestry by percentages, connect with DNA relatives and more,” costs $99 alone.

Sonography

Sonography is the process of using sound waves as an imaging device, typically for medical purposes.

Background

Indeed, the principles of sonography come from the natural world. For example, bats and whales are mammals that use sound waves for navigation. In 1794, after performing medical studies on bats, Lazzaro Spallanzani gained a basic understanding of ultrasound physics.

In 1880, French brothers Jacques and Pierre Curie discovered piezoelectricity. Simplifying, piezoelectricity is an electric current generated by deforming certain crystals. For example, flint-less cigarette lighters and inkjet printers both utilize the piezo effect. Getting to the point, piezoelectricity enables ultrasound transducers that emit and receive soundwaves.

On April 14, 1912, the RMS Titanic famously struck an iceberg and sank, killing about 1,500 people. Accordingly, government agencies around the world called for some method to better detect icebergs. Eventually, In 1914, Paul Langevin built on the work of Reginald Fessenden (of AM radio) to invent the first ultrasound transducer aimed at icebergs. His machine detected icebergs up to about two miles away but had no directional capability. To clarify, it could detect there was an iceberg somewhere close but not in which direction.

Ultrasound as Weaponry

The use of submarines in World War I increased the need for directional ultrasound in water. Eventually, Langevin and Constantin Chilowsky created a high-frequency ultrasound machine with directional capabilities. On April 23, 1916, their “hydrophone” was used to sink a German U-boat.

Medical Imaging

Eventually, in 1942, Austrian Neurologist Karl Dussik used sonography to detect brain tumors. Dussik used a method where sound waves were beamed towards the head of a patient partially submerged in water and the resulting echo recorded on heat-sensitive paper. Specifically, this became the first ultrasound image. Eventually, George Lewig used ultrasounds to detect gallstones and kidney stones.

Progress continued with physicians and engineers using ultrasound to measure various fluid-based organs. Most notable are studies in cardiology and obstetrics. By the 1970s, Doppler and color Doppler ultrasound imaging became commonplace. In the 1980s, Kazunori Baba of Japan developed 3D ultrasound.

By the 1990s, with the help of computers, real-time 3D ultrasound enabled surgeons to see inside a body during biopsies. Today, ultrasound machines are common, especially in obstetrics. Unlike radiation-based imaging devices, the ultrasound machines are entirely harmless.

Heart-Lung Machine / Cardiopulmonary Bypass

Heart-Lung machines temporarily do the work of the heart and lungs allowing surgeons to operate on the heart or lungs. Despite the sci-fi nature, it was a husband-wife garage invention.

Background

In 1931, surgeon John Gibbon lost a patient he felt sure would have lived if he could temporarily keep blood circulating and oxygenated. He worked with his lab assistant, Mary Hopkinson, to develop a heart-lung machine. More than the machine progressed, and John and Mary eventually married.

The Gibbon’s experimented on cats. By 1935, they were able to keep a cat alive for 20 minutes while their machine replaced heart and lung function. However, the machine damaged blood cells and virtually no cat lived longer than 23 days after surgery.

Gibbons’ machine relied largely on a blood oxygenator. This was a series of rollers, developed in 1885 by von Frey and Gruber, that thinned out blood and exposed it with oxygen. The rollers mimicked the surface area of the lungs. Additionally, it was a challenge to find a pump as strong as human hearts. Patients’ blood must be saturated with heparin to prevent coagulation, which would gunk up the machine.

By 1945, Gibbon included other researchers and expanded their research to dogs. They found that by adding filters to remove blood clots and applying suction to prevent air from entering the bloodstream survival rates dramatically increased.

On May 6, 1953, Gibbon and his team decided their machine was ready for use on people. Gibbon operated on Cecelia Bavolek, bypassing her heart and lungs with his machine for 45 minutes. She lived and fully recovered from the operation. Unfortunately, Gibbon’s next four patients died and he abandoned heart surgery.

Walton Lillebei

Walton Lillebei picked up where Gibbons’ left off. He tried a radically different approach, connecting one person to another whose heart and lungs would do the work for two. Typically, a child would be connected to one of their parents. Lillebei also invented the bubble oxygenator, replacing the rollers used in Gibbons’ machine. Finally, the heart-lung machine was reliable.

Despite the success, there was one major problem: the heart kept beating during the use of the machine. This caused a literal bloody mess, making it difficult for surgeons to see. Returning to animal research, they found it was possible to stop a heart while a patient was connected to the machine and restart it later. However, the lack of blood in the heart caused tissue damage. Surgeons operated with beating hearts until the 1980s when researchers at St. Thomas Hospital found that cooling the heart below 28°C (82°F) and treating it with a combination of drugs kept the heart healthy and intact. Today, this technique is used for extended operations where a heart must be stopped and also to transport hearts for transplanting.

Chemotherapy

Chemotherapy refers to a group of drugs that fight cancer. Surgery and radiation were the two common anti-cancer therapies before the discovery of effective chemotherapy. Immunotherapy was also studied but showed little promise.

Background

In the 1800s, scientists thought drugs might be able to fight cancer. However, none of them worked well. In the 1910s, scientists discovered how to transplant tumors between mice, enabling them to attempt curing the tumors. Despite attempts with various drugs and hormones, nothing made a substantive difference.

An Accident

The initial breakthrough in chemotherapy was accidental. Both the Allies and Axis engaged in chemical warfare in WWI. They banned it by WWII. However, in recognition either side could break the ban, both continued developing chemical weapons in secret.

On December 2, 1943, Nazi bombers launched a surprise attack on ships near Bari, Italy. One of those ships, the John Harvey, was a floating chemical weapons bunker. Mustard gas combined with seawater and the combination covered sailors from many ships who jumped into the water. The gas was not immediately fatal because seawater diluted the concentration.

Within a day, sailors began suffering illness from mustard gas poisoning. By the end of December 83 of the 628 hospitalized died and an unknown number of civilians were also affected.

Diluted Poison

Milton Winternitz of Yale noted many of those injured by the gas showed marked depletion of bone marrow and lymph nodes. Winternitz speculated the diluted poison might have therapeutic benefits, especially in cancer patients. Early tests with diluted nitrogen mustard proved especially effective for non-Hodgkin’s lymphoma. Due to the illegal genesis of the finding, results were not reported until after the war, in 1946.

Early enthusiasm turned after discovering remissions were brief. However, later scientists found folic acid analogs similar to mustard gas produced better results.

Besides the poisons, experimental work with WWII antibiotics also stumbled upon some substances that fight tumors.

Chemotherapy research continued with Mary Lasker (Albert Lasker’s wife) leading the charge via the American Cancer Society, that Albert named. The group pioneered the public/private partnerships with the US government to research and produce drugs private companies owned. At the time, this seemed the best way to speed along development. However, it was controversial then and remains controversial today.

Today, there are countless chemotherapy drugs to fight cancer. In 2016, about 1.7 million people developed cancer and just over one-third of those died. Worldwide estimates are about 18 million cancer patients every year and many die from the disease.

Health Insurance

Background

Germany has the oldest health insurance system, the Sickness Insurance Law of 1883. Employers paid one-third and employees two-thirds. The insurance covered both medical treatment and sick leave. In 1911, the UK created basic health insurance. Russia followed in 1912, nationalizing all healthcare after the Russian Revolution of 1917.

Most countries rolled out some form of Universal Healthcare Coverage after WWI. Some countries for care directly, including the UK and Canada. There are no co-pays.

France created a hybrid system. The government program pays for basic care. However, individuals are obligated to purchase supplemental policies from private non-profits insurance companies. Most French doctors and clinics are private whereas most hospitals are government-owned. Many service providers require out-of-pocket payment which is reimbursed, via a single-payer system, to the patient’s bank account.

Switzerland is entirely private but people must purchase healthcare policies.

Regulation of Medical Costs

All countries, besides the United States, regulate rates for care and medicine. For example, in France’s semi-privatized system, the government sets a reimbursement rate for ordinary physician visits. Doctors may charge more and patients pay out-of-pocket or have a supplemental policy which pays all or part of the different.

Health Insurance in the United States

The United States took a different approach than the rest of the world, leaving most people covered by entirely private loosely regulated insurance plans. There are government programs for the elderly and poor people. Government workers, including soldiers, enjoy health coverage. Government retirement plans usually include high-quality health coverage. However, the vast majority of Americans carry private insurance or are uninsured.

US law prevents the US government from negotiating lower drug prices, legalizing price gauging. Drugs in the USA routinely cost many times what the same drug, from the same manufacturer, produced in the same factory, costs in Europe.

Finally, US health insurers are exempt from antitrust law. That is, they may openly and legally collude with one another to drive up prices and profits.

These provisions create an extremely expensive healthcare system in the US. Besides the obvious problems, American healthcare providers spend an enormous amount on overhead trying to negotiate with the myriad of healthcare providers. Additionally, healthcare providers spend enormous sums trying to minimize prices. None of this leads to better care.

In 2016, the United States spent 17.2% of GDP on healthcare, compared to 8.9% of the 36 OECD countries. However, American healthcare outcomes are mediocre at best.

Laparoscopy

For centuries surgeons have been purposefully cutting holes in people trying to heal them.

Background

Before anesthesia, antibiotics, and Lister’s germ theories surgery often meant a slow and painful death from infection. Putting things into perspective, more people died in the US Civil War from infection than from direct strike of a weapon. Purposefully cutting into people was extraordinarily dangerous.

Worse, surgeons tended to use blood-stained clothing. Bloodstains, in the 19th century and before, demonstrated surgical experience. In an era where surgery very likely led to death, with immeasurable suffering along the way due to the lack of painkillers, patients did anything to improve their chances.

Georg Kelling

In 1901, a half-century after the discovery of anesthesia and Lister’s germ-theory but before antibiotics, German doctor Georg Kelling theorized the possibility of using specialized tools to perform surgeries through tiny incisions. By minimizing the surface area open, Dr. Kelling thought, the risk of infection would also be minimized, and patient survival rates increased.

Kelling experimented on dogs, performing surgeries through small openings. Due to his lack of modern instrumentation, especially micro-cameras, and fiber-optic cables, the experiments were dangerous and crude. Still, Kelling the basic idea was recorded for posterity. As technology improved, physicians returned to operating on small holes.

Despite that antibiotics, discovered decades after Kelling’s work, thwarted infection large surgical holes still presented problems. Laparoscopy, the process of making a small incision then using specialized fiber-optic cables for lighting and vision, eventually took off. Today, Laparoscopy is common. Post-operative pain is reduced and patients are often released the same day as surgery. The primary problem with Laparoscopy is many surgeries do not work in a small incision. For example, it is impossible to perform a Cesarean Section and remove a fetus through a small hole. Despite these challenges, Laparoscopy has vastly decreased the time, cost, and pain related to countless surgeries.

Psychoanalysis

Psychoanalysis is a process of working with highly trained professionals. Through discussions, doctors uncover and heal often forgotten events or disturbances.

Freud was a neurologist who noticed that patients under hypnosis talked about disturbing events, oftentimes from their childhood. He theorized that speaking about these events would allow a person to confront, heal, and work through issues affecting their personality. Personality quirks were referred to as “hysteria.”

He quickly found that, with the right type of guidance, patience need not be hypnotized. However, he noted the difficulty of discussing painful events and many patients did not even remember the events until confronted. Freud found many of these painful memories to be sexual in nature, especially for female patients.

In 1896, Freud first wrote about his theory. There is a link between the psychological and psychological anchored chiefly in the unconscious, he opined. The process to uncover these links, the hidden landmines, he referred to as “psychoanalysis.”

His work progressed until he eventually identified three components of personality, an id, ego, and superego. The id are instinctive impulses. Ego involves self-esteem or self-importance. Superego refers to the part of the mind that is self-critical, that reflects social standards learned from others. In Freud’s world, most problems stemmed from superego issues, often inherited from parents or teachers.

Only trained physicians were qualified to perform psychoanalysis in Freud’s time. This eventually evolved into its own field, where a new field — doctors of psychology, or psychologists — were qualified to perform psychoanalysis.

Freud went on to influence virtually every known psychologist. Some of his early theories have been discounted but the field of psychology, no matter which branch, all eventually tie back to Freud and his work.

Clusters of Regularly Interspaced Short Palindromic Repeats (CRISPR)

CRISPR is like a word processor for DNA. It allows easy and inexpensive gene editing. Edited genes are passed to future generations, making mutations permanent.

Doudna and Charpentier

Doudna and Charpentier worked on and invented the technology as a team. First, they worked on plants and, later, on animals.

History becomes murkier with the involvement of Feng Zhang. Depending on the origin story he either modified Doudna and Charpentier’s work or invented a new version that works on humans. In an initial ruling, the US patent office ruled that his work was original and awarded him a patent for the use of CRISPR in humans as opposed to plants and animals. Like similar histories in innowiki, there will no doubt be appeals and lawsuits for many years.

Charpentier and Doudna are professors at the University of California at Berkeley. Zhang is a professor at MIT.

Zhang is a founding member of The Broad Institute of Harvard and MIT. As of 2018, they have the sole right to use CRISPR in humans. They have announced academic researchers may use the technology freely, but commercial uses must be licensed.

There were many precursor innovations to CRISPR but most articles suggest it was Charpentier’s 2011 discovery, that the technology could guide gene selection, which is the core value of the technology.

Designer Babies

In late 2018 Chinese researcher He Jiankui announced the use of CRISPR to genetically alter the DNA of twin girls. He allegedly fabricated ethics approval and claims he edited the genes to make the girls immune to HIV. In any event, the Chinese government declared the work illegal.

Based partly on He’s claim, scientists now say CRISPR is not as accurate as they initially believed. They say it works “more like an ax than a scalpel” for genetic manipulation. In any event, some form of CRISPR is likely to eventually have an enormous impact.

Human Genome Project

The Human Genome Project mapped the human genome, the DNA map of human life. It enables future genetic technologies that can cure disease, preemptively find problematic genes, or even allow genetic manipulation (designer babies).

Francis Watson was the initial lead. He is the Nobel Prize winning co-discoverer of DNA sequencing. As the project gained in size and scope, Collins took over.

Sulston led the UK part of the project that sequenced about 1/3rd of the genome. Venter worked for the Celera unit of Applera Corp., which was creating their own map.

There was collaboration and co-innovation.

Watson and Sulston have been awarded Nobel Prizes while scientists buzz that it’s only a matter of time until Collins is awarded the Nobel Prize. Many argue Venter also deserves a Nobel Prize. However, the prize committee has a history of shorting people working for private companies, no matter their merit. [See Raymond Damadian.]

The Human Genome Project, first published 2001 then published in a nicer form in 2003, took about a decade and cost about $1 billion USD. By 2020, industry sequencing leader Illumina predicts a full-body sequence will take about an hour and cost $100, and that time and cost will continue to decline.