Bioengineering: A Problem or A Solution

Bioengineers spend tons of money researching, developing, and innovating health care technologies. Sure the end result may be a better drug, device, or tissue, but at what cost is it really at? It's obvious that bioengineers contribute to the raising costs of health care through the development of new technologies. They are part of the problem. Although, along with new technologies comes with reducing the cost of the older ones. So basically what I'm saying is bioengineers make new treatments more expensive, but more traditional treatments more affordable.

This may seem different. For bioengineers to be a part of the solution for reducing health care costs, they have to work backwards and forwards at the same time. In other words, bioengineers have to continue to work on new technologies (better drugs, imaging, etc), while also making existing things like a x-ray machines better and cheaper. This is a hard balance for anyone to do. Engineers want to go forwards, not backwards. The end goal here is to reduce health care costs, because the fanciest newest 3-D brain scan is practically useless if no insurance company will approve a test using that.


http://www.ny3d.org/3D_brain_Scan.jpg

the government has a plan?

Everyone in the US has heard something about health care reform. People heard about it in the months leading up to the presidential election in November 2008, and people have been hearing about it all summer as attempts at reform get twisted into things that barely resemble the initial plan. Last fall I wrote quite a long paper and participated in a debate about Obama's proposed health care plan. I will only focus on the technology aspect of it here. Essentially the common theme among business, education, and government is the recognition of the need for digital health records. The site tells of the nation's progress and lists all of these vague goals in the realm of health care. I am bias on this issue and believe that all American citizens should be given health insurance, but I can still criticize the government's plan.

Eventually there could possibly be a cap on health care spending. There could be a rationing of which technologies are used to treat which patients. How can the government create a policy listing which patients are the priority and which are secondary? Creating clear cut boundaries is difficult in medicine. There are always exceptions to the rule. Not giving a healthy person with a history of cancer routine scans could make it too late before doctors find the tumor. Not giving an athlete an MRI could make them play with an injury and destory their entire knee. Ethical decisions are difficult to make and broad policies can leave people behind.


http://abhisays.com/wp-content/uploads/2009/09/obama_healthcare.jpg

http://www.healthreform.gov/

claims, claims, claims (business and education)

As health care technology advances, the older health care technologies become cheaper. Let's take for example an x-ray versus an MRI. The x-ray at the time it was first introduced was a big deal. You could see bone structure. Now MRIs enable easy viewing of bones, muscles, ligaments, etc. X-rays now are cheap (maybe a few hundred dollars- cheap relative to the medical imaging world). MRIs cost thousands of dollars. But because of the advancement x-rays are cheaper and better imaging is out there if needed.

I found a few websites making different claims on how to reduce health care costs. One site talks about how digital data entry and insurance claims entry machines will reduce health care cost. The thing is that the site is a PR log and the article was most likely written by a company representative of E*Healthline.com, which is making such a technology. The article has random statistics that make the information system seem like such a necessity. You have to remember the bias of the source. I kind of believe that digital records will reduce costs, but I did beleive that before I read the article.

Another site mentions how health information technology, individual ability of a patient to research home care, digital health databases, and prescribing medication digitally from the doctor directly to the pharmacy. The site is a ".com" so some sponsors most likely influenced this article. There is no concrete evidence presented in the article either, but I still think that digital databases for records will reduce cost. I am skeptical about the other claims, although they are logical, because they have no facts in the article.

A different website mentions a digital health records database as well as a way to evaluate new technologies in terms of their net gain. The health records database seems like a good thing. The article did not really provide numbers on the benefits of a digital system, but it seems to be a general conclusion that it will reduce costs. The implication of grading technologies in terms of net gain can be difficult. How can you say doing this procedure has risks (like death), but it has benefits (like cutting someone's recuperation time by six months)? I agree that evaluation could lower costs, but how many technologies would never be improved if the world thought that way. It's a tricky game. The site is educational and from the University of San Francisco. It just evaluates a paper that a professor wrote in 2007, so it's tech-saviness is off, while the ideas remain the same. It kind of plugs the university a little more than the topic of reducing costs.


http://origin.arstechnica.com/articles/culture/electronic-health-records.media/Immune_auto.png

http://www.prlog.org/10198630-ehealthline-reduces-health-care-administrative-cost-while-increasing-efficiency.html

http://www.howtodothings.com/health-fitness/how-information-technology-can-reduce-the-cost-of-health-care

http://news.ucsf.edu/releases/better-review-of-new-technology-is-needed-to-reduce-health-costs/

Newer, Better, Cheaper? (10 ways)

Technology can theoretically reduce health care costs. There are a few different specific technologies that can reduce health care costs.

1. Digital health record databases (more efficient than paper records)
   
2. Automated "check-ups" where the results are sent to your doctor (fewer doctor visits)
   
3. Improved preventative medicine programs (tips and schedules of what to do and what not to do to prevent sickness and chronic conditions)
   
4. Digital ER waiting room evaluation to see if perhaps sending a patient to a clinic is a better option (save money from unnecessary ER visits)
   
5. Giving patients with chronic conditions monitoring systems that could send updates to their physicians (fewer doctor visits)
   
6. Improved virtual reality training for medical students (cheaper than actual training)
   
7. Improved discharge procedures for patients in hospitals (give them individualized programs that can be uploaded onto smart phones)
8. Devices that can decrease healing time (decrease doctor visits, less cost)
9. Cheaper diagnostic testing for diseases (quicker results, faster treatment is given leads to less treatment needed)
10. Genome analysis of a newborn to know ways to avoid diseases they may be prone to

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what's the deal with the obsession with antibacterials

Random topic, I know. I am reading Genome: The Autobiography of a Species in 23 Chapters by Matt Ridley for my writing seminar, and in one chapter it says that as most scientists know that "our immune sysems are set up in such a way that they 'expect' to be educated by soil mycobacteria early in childhood; when they are not, the result is an unbalanced system prone to allergy" (Ridley, 1999). So the debate is I guess for parents of young children whether to let the immune system develop properly and run the risk of catching some virus at the playground or reduce the risk of catching that virus and possibly making your kids have allergies. I am not anti-purell or something like that, but I do not know what side to pick. Is society as a whole becoming too afraid of germs and is this leading to more sensitive immune systems (allergies, asthma, etc.)? Or are we picking the lesser of two evils? This ethical debate worries me.


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Individual Vs. Community

Health is on an individual level. A person can be healthy (not sick, not obese, not injured), while living in an unhealthy community. Public health is more of an overall entity. It deals more on the overall scale from the community, to the region, to the country, to the world. A public health concern deals with things like smoking. Governments come up with public health policies to attempt to make people healthier overall. Individuals can have poor health in a community with overall good health and vice versa.

Obviously, doing things that impact public health can have an impact on more people that doing things that are in the interest in an individual's health. Providing clean drinking water to the more than one billion people who lack access to that is a public health initiative. An individual going to the doctor to get medicine for a respiratory infection is a personal health issue.


http://www.health.state.nm.us/PHD/Dist3/Graphics/PublicHealthFamily.jpg

what's happened and what will happen

The "Greatest Engineering Achievements of the Twentieth Century" and the "Grand Challenges for Engineering" are so broad that they basically say everything that was ever done was a great feat and everything that will be done will be a challenge. People can definitely try to classify most all accomplishments under one of the twenty categories presented in the list of achievements. As can any challenge be twisted to fit into the categories of the "grand challenges."

Electronics and the Internet are the two biggest achievements that my generation cares about. People around my age basically used a computer since grade-school and the internet since around the same time. Now most people use laptops, ipods, digital cameras, and most recently smart phones. The electronic industry is key in helping define my generation. The internet has created an entire community as well as improved instant communication with anyone anywhere. Networking sites ease communication among far away friends and family members.

Contrasting with what already happened (and is continuing to change as I type this entry), is what will happen and why my generation cares. Securing cyberspace and making solar energy economical are what young people probably care about the most out of all of the challenges. Cyberspace is expanding all the time. More information is available, and with that more viruses are created. If eventually (and I hope this happens within the next few decades) all health care files become digital a much more security will be needed to make it safe. I guess that issue kind of overlaps with advancing health informatics, but if you tell the average eighteen year old what health informatics is odds are they won't care. Solar energy is also an important issue. As we all know or just constantly deny in some cases, the world oil supply is diminishing. Conventional oil used for heating and transportation will become drastically too expensive in the next decades. Natural gas is also a limited resource. People are becoming increasingly concerned with "going green," and they are realizing that fossil fuels are not renewable resources. Making solar energy more economical will be necessary in the future. These days young people have a greater sense of the natural environment than they did years ago.



http://www.sedonawildflowerinn.com/images/going%20green.jpg

under the radar

Engineers seem to go about unnoticed in society. Of course, engineers are in a way the backbone of society (may be slightly bias here). The goal is to get more young people involved in engineering. Having middle school and high school classes that let students solve problems and build things could make engineering more "appealing" in the eyes of young kids. Ad campaigns could show how what engineers help create affects people's lives.

Engineering also has so many different specialties that it's hard to send one unified message about what engineers really do. Basically because engineers build bridges down to cells. It can be hard to convey to the younger generation the importance of engineering, when in school those kids are not really exposed to it.

In recitation it was also brought up that engineers face different legal issues. They have to sign documents basically signing off all rights to the company they work for. One individual engineering team cannot really take credit. The company takes the credit, which could be why these great innovations are under-publicized in the media as compared to doctors performing less invasive surgeries. No one ever hears about the tool that made that surgeon able to perform that procedure.


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Transforming into an Engineer

Engineers think in a way in which they try to weigh all possible options before coming to a final conclusion. From the discussion I realized that engineers think about the big picture more often. I don't only think about the question of should I get a swine flu shot, but the question of who should get it before me. What groups should receive the vaccine in order to best control the spread of the swine flu, minimize cases, and of course minimize fatalities caused by swine flu? Engineers use logic to make sense in a difficult situation, such as the current swine flu situation. Initially I thought that college students have a descent immune system and are not a crucial group to immunize, but I later realized the public health aspect of that group. College students could rapidly spread the disease because they live in such close quarters. I was not thinking on a geographic level, rather I was thinking about more of an individual group level. I thought to protect young children, who have weaker immune systems, would be the best group. Then I thought and currently think that health care workers are the best group to immunize.

In the decision-making process, engineers use facts, studies, and statistics to help justify their decision. I think the process of investigating before coming to a conclusion is quite logical. The investigation not only requires the evidence but more importantly the analysis to see what exactly is the best course of action. I used a variety of databases and articles to get background and specific information to prepare for the discussion. Seeing as much information as possible helps in making a better and more educated decision.



http://www.publichealthforums.com/images/h1n1vaccine.jpg

Manage Swine Flu and Manage Things at Penn

Several items could help manage the swine flu. The first of which is basic hygiene. Campaigns are already in action to make people constantly sanitize and wash their hands. Washing hands is incredibly effective in preventing the spread of viruses, like the swine flu.

A more complex technology to help manage the flu would be keeping a live-updating electronic database of where sick individuals were. This database could be global and doctors would be forced to enter new information every time a new case was diagnosed. The data could be view by world region, country, country region, state or province, county, town, and so on. Residents could take caution when in infected areas. From a public health stand point the flu could be better contained.

More specifically at UPENN the system could track by which dorm the sick residents are in and how many cases are in each college house or apartment building. This way students could be particular careful when in those areas, and also the people who live in highly infected areas could all get vaccinated to prevent the further spread of the disease. This logistical programming may be more effective at controlling the spread of the swine flu than certain medications.

The system, on both the large and small scale level, could send alerts to residents as to the current situation on not only cases of swine flu, but also where to get vaccines and such.


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Who should get swine flu shots if there were only 500,000 of them?

It is hard to pick who can get vaccinated and who can't. It is as much as an ethical issue as it is a scientific and logistical issue. The CDC recommends that the five groups of people who get vaccinated are, "pregnant women, people who live or care for children younger than 6 months of age, health care and emergency medical services personnel, persons between the ages of 6 months through 24 years of age, and people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems, " ("CDC," 2009). Those groups make up many hundred times more than 500,000. I think that health care and emergency medical services personnel should be the first group of priority because they can then administer the proper drugs to those who have already caught swine flu. Of course only those who come in direct contact with the sick on a daily basis should be able to get the vaccine and then only those who spend the most time with patients and so on until there is only a group of 500,000 left. If there were more vaccines available ideally all the target groups would be vaccinated as well as those in an area where swine flu is spreading rapidly.

(2009, July). CDC newsroom press release July 29, 2009. Retrieved from http://www.cdc.gov/media/pressrel/2009/r090729b.htm

Should I Get a Swine Flu Shot?

I should get a swine flu shot when one becomes available. It is a lot easier to get a shot and maybe get minor symptoms, than it is to have the full-blown flu. I am willing to go out of my way to get a shot to avoid over a week of possible agony. Also the FDA approved four H1N1 vaccines this past Tuesday (Skinner, 2009). I am not really that concerned with the possibility of a bad side effect after all of that FDA testing. The side-effects in the preliminary clinical trials have be close to those of the regular seasonal flu vaccine anyway, such as muscle aches, sensitivity at the injection site, and fever according to the New England Journal of Medicine (Clark, 2009). I get the regular flu vaccine, why shouldn't I get the H1N1 vaccine when it is available in a month (Skinner, 2009). I do not care that I am not part of the most likely group to die from swine flu, but the symptoms of the swine flu are enough for me to go to a doctor's office and get the shot. From a public health perspective, college students should definitely get the shot. Once one person is sick chances are within a week or two most of the campus will be sick moving from the floor the sick person live on to the building to the classes and so on.

Clark et al. (2009). Trial of influenza A (H1N1) 2009 monovalent MF59-adjuvanted Vaccine-- preliminary report. New England Journal of Medicine. Retrieved from PubMed database.

Skinner, T. (2009). FDA approves 4 swine flu vaccines. Medline Plus. Retrieved from http://nlm.nih.gov/medlineplus/print/news/fullstory_89386.html



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Other Things

I have mentioned a few bioengineering-related fields that interest me.

1. Biomechanics
2. Tissue Engineering
3. Pharmacy
4. Medical Imaging

Now all these fields have new innovations and developments all the time. Biomechanics will be more for me if I decide I like creating items like implants or physical devices to aid in healing. Tissue engineering can be more for me if I want to work on a smaller level and create tissue that can be used to repair non-functional human tissue. Pharmacy to me means medicines, vaccines, and the like. Medical imaging helps in the diagnosis, treatment, and even prevention of health problems.

Currently, all I really know is that I do not want to be a doctor. As far as bioengineering, I may want to go into consulting, research, or plenty of other things. Maybe I will have a clearer idea of what I want to do in bioengineering by the end of this class.

News Article on Helping Heal Bone and Cartilage

This article from the New York Times on August 15, 2009 explains how instead of taking cartilage from another part of the knee to use to repair torn cartilage one company is producing items that can promote the re-growth of cartilage and bone.

Mimicking Human Cartilage to Repair a Knee

Donna Coveney/M.I.T. News Office

Lorna Gibson, right, is one of the inventors of a small plug that can support new tissue growth in the knee. In an image of a knee, center, the plug is at lower left.

http://www.nytimes.com/2009/08/16/business/16novelties.html?_r=1&scp=1&sq=bioengineering&st=cse

I think it is quite amazing that we are in a time where with the aid of the device smaller then a quarter cartilage can essentially regrow and regenerate. The "osteochondral scaffolds" (Eisenberg, 2009) can help both bone and cartilage to regenerate and heal. Less than six months after the scaffold is inserted it dissolves and has done its task of helping heal the patient. Of course different doctors have different opinions on the use of this device. The thing I think is most impressive is that pateient rehabiliation will be dramatically shortened by this device because it provides less stress than removing cartilage from another area.

Learn How to Solve Problems

I would like to learn how to solve problems. That may seem vague so I'll clarify. I think that bioengineers solve problems, just like mathematicians do. The difference is that problems can be solved using different methods. I want to learn to be able to see a problem, think of a way to solve it, and then put that plan into action.

For example let's say hypothetically that I see that the number of people driving automobiles without certain types of headrests tend to, when they get in an accident, have whiplash. I would recognize the problem as the lack of proper support in the headrest and try to design such a headrest for this automobile that could be tested to minimize potential spinal injury. Then I could take this design to a company and eventually get this put into those cars.

http://www.mdconsult.com/das/patient/body/159522948-3/0/10041/30408.html

I want to have the skill of solving problems by creating designs and plans to be the solutions. That skill can be used in any field, and I think it is the most valuable skill for a person to have.

Learn About...

I want to learn about how to design biomedical devices and possibly medications. In order for me to get to that point I have to learn other fundamentals to be able to truly understand what I will learn about in later bioengineering courses.

Learning about biomechanics would be pretty interesting as would tissue engineering. I think I want to learn about those fields in order to see how I can apply knowledge to the construction of a device or artificial tissue. Biomechanics could enable me to create devices that could not only help heal, but help prevent injuries altogether.

There's always more to learn about and maybe I would be interested in pharmacy too. Medications treat disease and infection every day. I mean I have only had the fundamental sciences (biology, chemistry, and physics) in high school, and this is my first real class in bioengineering as I am sure it is for most other people in the class. I am open to what I will learn about. I will find my interests after being exposed to a wide variety of fields within bioengineering.



http://www.datlof.com/8Axamal/docs/Marketing/jhu/JE/index.htm

MRI

If I had the ability to go back in time and work on some biomedical technology it would be magnetic resonance imaging. Imaging may not have the appeal of say an artificial heart for some people, but I think that imaging can impact more people in a positive way than an artificial heart could. Images from an MRI machine can be used to detect all kinds of injuries and diseases. The imaging can allow physicians to view more vivid images of the brain, heart, and muscular system. This imaging can also detect cancer, most commonly brain cancer.

The reason why I chose to work on the MRI machine as opposed to other types of medical imaging devices is that it provides no harm to the patient. The X-ray, predating the MRI by about a century, exposes patients to more raditation as do CT scans. Also X-rays can only show images of the bone structure of a patient. In a personal sense my first MRI was when I tore my ACL and without that machine a proper diagnosis could not have been made.





http://www.magnet.fsu.edu/education/tutorials/magnetacademy/mri/images/mri-scanner.jpg

What do bioengineers do?

I think bioengineers design and create products such as medicating stents, spine instrumentation, and artificial tissue that can improve the quality of people's lives. Bioengineers can build items that make medical treatment more effective. Also they have the ability to not just build, but also form a variety of pharmaceutical products. Bioengineers can help patients survive daily through innovations in science and technology.

But there are other things bioengineers do that do not directly involve tissue, stem cells, instrumentation, and medication. The other things may be more important even than what bioengineers have become known to be. A bioengineer's most valuable asset is his brain. This tool has been conditioned to view problems in a different way. The quantitative skills a bioengineer has enables problem solving to be applied to many different fields. A bioengineer does not have to work in a lab all day. Of course one can devote time to work on a specific problem pertaining to human health, such as spinal injury prevention in cars. Tissue engineering, biomechanics, pharmaceuticals are all areas that bioengineers can study and work in, but in either of those fields bioengineers always solve problems and think critically.

Why did I pick bioengineering?

A looming question all high school seniors face is what they would like to major in. I, as are most of the other people in this BE 100 class, chose to major in bioengineering. The question of why bioengineering seems pretty similar to many college application essays I have written. I'll try to sum up my life experiences and interests in order to do this post justice.

In eighth grade I tore my ACL at a soccer tournament, and it was not until months after that day did I realize what bioengineers do. I went through almost a year of rehab until I was back on the field playing how I used to. Bioengineers helped create the imaging machines that were used to diagnose the problem, the tools used in the surgery, and the devices used in recovery and protection.

http://www.aclsolutions.com/theacl_1.php

I volunteered at a local hospital in my high school years and have seen the devices bioengineers create being used to improve people's quality of life. I want to change the world in a positive way.

I really enjoy math and science as well. I like how bioengineering is a rapidly developing field with plenty of opportunities for future students to change the world. Also I believe that an engineering degree can lead to many career paths, a good thing for an eighteen year old who is not one-hundred percent sure about what she wants to do with the rest of her life. Engineering? Business? Law? All I really know is that I want to do what I enjoy.