Is biomedical engineering the future of medicine
In my article I will deal with the definition of the term medical technology and then show the breadth of the field of work. Using three examples, I will then deal with current research topics and then go into structures and their deficits and try to derive the need for action in the political arena from them.
Figure 1: Medical technology
Figure 2: Biomedical engineering
In my opinion, and I agree with that of my specialist colleagues, the term medical technology has been chosen too narrowly. Biomedical engineering should be used in its place, an artificial word that arose from the translation of the original term biomedical engineering. It is therefore an engineering activity, the results of which are used in biomedicine. The word biomedicine is sometimes used today as an independent term and still shows fuzzy contours. While the efforts in human and veterinary medicine are aimed at eliminating or at least alleviating pathological conditions in humans and animals, the connection to the bios indicates that fundamental life processes that may influence medical action in the future are also an object are of consideration. Technology, based on the scientific disciplines of physics and chemistry, provides methods, processes, materials, instruments, devices and machines and uses them with the aim of expanding the limits of human ability by utilizing the laws of nature.
Three phases can be identified. The first deals with the conversion of energy or the generation of energy from primary energy sources. In biomedical engineering, this knowledge is used z. B. when using pumps in artificial organs, with artificial ventilation and for wheelchairs. Without the second phase, the development of measuring tools or sensors, which are also of great independent importance, the first phase would not have the success that was achieved. The measurements of the most diverse parameters are to be mentioned here, which characterize and influence the function of the living cell, tissue, organ or organism. This includes the recording of the chemical components and the physical state variables in the living organism and their pictorial representation. The third phase of development is technical information processing. Without this, a meaningful interpretation of the measurement data obtained with the help of sensors, which are generated in large numbers, would hardly be possible. Modern imaging processes require the use of information processing machines.
Figure 4: Thesis on technology in medicine
From a technical point of view, the development of biomedical technology is supported by the classic disciplines of mechanical engineering, including materials science and electrical engineering, measurement technology and the more modern disciplines, process, control and information technology.
The decisive advances in medicine have been achieved over the past 20 years through the use of technology. This is evident from the examples of imaging and processing, clinical-chemical analysis technology, endoprosthetics, as well as organ or function replacement and function support. According to Hütten (1991), in a survey of medical experts in the early 1980s, the most important medical advances within the last 20 years were indicated by the following developments:
- Computed tomography, digital subtraction angiography, ultrasound;
- Heart-lung machine, artificial kidney, artificial joints;
- Heart, kidney, liver transplant.
I would like to make the following additions:
- Pacemaker, fiber optic and video endoscope;
- Extracorporeal shock wave lithotripsy, intravascular vasodilation.
Overall, it can be said that the medical technology equipment of German hospitals can withstand an international comparison and that the German medical technology industry exports over half of the production volume. Another-
On the other hand, however, medical technology research in Germany is not one of the priorities of public funding.
As in other areas of technology, two directions of development can also be identified in biomedical technology (cf. IEEE 1993): miniaturization and system integration. The first include both minimally invasive treatment methods and so-called "nano-technology". Minimally invasive examination and treatment methods are not new. With a speculum or endoscope equipped with an instrument channel, interventions in body cavities through natural openings have been carried out for over 100 years The range of applications has expanded considerably in recent years. A first step in this direction was vascular dilatation with balloon catheters. The operation is no longer carried out through natural body cavities, but through small incisures. The stock of methods is expanded by laser and high-frequency probes and diagnostics The intravascular ultrasound catheter examination. Operations in the abdominal cavity and on joints are increasingly carried out under endoscopic control. However, comparable methods are also used for interventions on the brain. The prerequisite for success was the provision of the appropriate technology k. This development is in full swing and will continue for the next few years.
Figure 5: Research subject
Nano-technology extends to both the medical approach and the use of microsystem technology in medicine. Basic medical research is increasingly concerned with understanding the disease at the cellular level, including biochemistry. Here, too, technology has to provide methods that support research and possibly allow new treatment methods in the future. In Anglo-American literature, this technology is summarized under the term cellular engineering. This area also includes the basic knowledge of the interaction between foreign bodies and cells, and in this special case
Figure 6: Information processing
a material which is to be used as an implant to remain in the body permanently or which, while retaining its properties, is then broken down by the body for a certain time and absorbed by the body without damaging it. This also includes research that deals with the targeted colonization with cells of exogenous material. On the one hand, this serves to improve the body's tolerance or to produce biohybrid organs. This means z. B. the production of an artificial pancreas in which islet cells are located on a plastic membrane and can perform their natural function after implantation in the body. Other impulses are expected from microsystem technology. The sensor technology should be mentioned here in the first place. Improved biochemical diagnostics should lead to diseases at an early stage and with great accuracy, i. H. Recognize cost-saving. A combination of such a sensor with enzymes or cells leads to the biosensor, which is of great importance. Miniaturized drive technology and feedback, d. H. Measurement technology, are required for the improvement of microsurgical technology. Great development potential is seen in all of these areas.
System integration has its roots in the intensive monitoring of the seriously ill, which began around 40 years ago. Several body functions were measured simultaneously and could be displayed on an oscilloscope or recording device at the same time. The number of measurable variables increased in the following years, which led to the data being summarized and presented with the help of computers about 20 years ago. A parameter extraction with subsequent data compression was not yet successful at that time. The intensive monitoring, initially only carried out at the bedside, was soon carried out for the duration of the operation as well as during the induction and discharge of anesthesia. The combination of relevant biological parameters and those of anesthesia machines, ventilators and infusors to form an overall system and to control the machines is currently only partially implemented and is still the subject of research.
The control of micro-invasive interventions using position indicators and other measuring methods and their combination with the three-dimensional reconstruction of body sections or organs from imaging methods is a further area of application. Also
Great progress is expected here in the future through the collaboration of doctors and engineers.
Another area, not as spectacular as the previous ones, but still of great importance, is home care. This concept is of great importance because it is not as costly as that in the hospital and because the patient can stay longer in the home environment in a familiar atmosphere. It is important that the engineers accept this task and develop the appropriate technology for it. This is not a question of whether a high or a low technology is to be used for this, but rather whether it is a technology that is adapted to the needs of the individual patient. Let us introduce a little deeper into current research using three examples:
Biomaterials (cf. Thule 1994) are those that substitute a body function. Materials that are used as protective covers e.g. B. for electronic implants are introduced into the body and also remain there permanently. Such materials must meet requirements with regard to their mechanical strength, their resistance to corrosion, degradation, leaching, abrasion and wear, as well as their processability and sterilizability. Biocompatibility is at least equivalent to this requirement. It is of particular importance for permanent and long-term implants. These are used, among other things. as artificial joints, vertebrae, intervertebral discs, vessels, tendons and ligaments. You are in contact with the body fluid, i. H. Electrolytes, proteins, organic acids, blood cells or other cells and tissues. In addition to thrombus formation, there are other defense reactions, e.g. B. neutrophilic granulocytes migrate to the implantation site and initiate entire cascades of action that have not yet been clarified in detail. There is a charge transport between proteins and the surface of the implant, the conformation of proteins in the electrical field of the implant, the deposition of substances on the surface of the implant, etc. By modifying the body's own proteins, which are then recognized as foreign proteins, the antigen - Antibody response can be triggered. Constructive aspects play a role, e.g. B. the load distribution between implant and bone or the formation of dead water zones on heart valves, which leads to adhesion of platelets. Furthermore, the roughness of the surface is important, which should be small compared to the molecular diameter in order to prevent the adsorption of proteins .
The condition of withstanding the mechanical stress in the body is relatively easy to meet. Metals and plastics with and without reinforcement are used. The difficult task is to prevent or specifically cause surface reactions of the implant with the environment. It is difficult to meet both requirements at the same time with the same material. The surface is therefore often modified by a coating, which, however, also occurs, but in an uncontrolled manner, as soon as the implant is introduced into the body environment. The properties of the artificially applied surface are intended to underpin the communication between the material surface on the one hand and the extracellular fluid, the cells and tissues on the other.
Figure 7: Biomaterials
tie. The understanding of this process is still relatively incomplete, so one has to rely on a large number of experiments, which only lead to empirical results. Predictability of biocompatibility properties is desirable. This is influenced by the roughness of the surface, its electronic structure and that in the electrolyte, the surface energy and the exchange of electrons between the solid and the biological environment as well as the electric fields that affect the structure of the proteins, combined with a change in their reaction behavior. In addition, these surface properties must be mechanically stable, specifically in the submicroscopic range, so that their properties do not change in the event of relative movements between the body and the implant. Basic research in interdisciplinary research groups, with a long-term perspective, is necessary in order to finally arrive at materials which, through technical design, can permanently fulfill their function in the organism.
Biohybrid organs (cf. Planck 1993) are understood to be the permanent connection of the body's own or foreign or animal cells with a foreign carrier material. In contrast to the properties of biomaterials discussed above, colonization is the goal of research here, whereby the cells should at least partially retain their cell functions in order to prevent the body reactions described above. The carrier materials used are polymers. Biohybrid organs in the narrower sense are to be understood as those in which the cells continue to exercise the function of the organ to be replaced. They are carriers of the metabolic functions, such as B. the liver and pancreas. For temporary use, such a
biohybrid organ used extracorporeally and connected to the body by tubes. This is only the first step in the development. With long-term implants, higher standards have to be set.
Figure 8: Biohybrid organ replacement
It has been shown that the surfaces must not be smooth for cell colonization; regular or irregular structures promote the adhesion of the cells. The coating with proteins has a beneficial effect. The exogenous carrier, a membrane, must be permeable so that the cells are supplied with oxygen and nutrients and they can release their metabolic products to the body. The use of the body's own cells is advantageous since there is no immune defense, but availability is not given at will. One of the tasks to be solved is therefore the in vitro reproduction of the body's own cells, which must not undergo any change in the process. To supply the implanted biohybrid organ, the body has to develop a new system of blood capillaries that surrounds the organ. Large surfaces, i.e. H. small diffusion paths are necessary. No deposits must be allowed to form on the surface and the organ must not be encapsulated by connective tissue, as otherwise the free transport of nutrients into the organ and of metabolic products out of the organ would be hindered.
The development of a biohybrid pancreas is of particular interest because, on the one hand, the number of diabetics requiring insulin is increasing and, on the other hand, it has not yet been possible to produce a regulated metering device for insulin that is stable over the long term, essentially because no suitable sensor is available. For the biohybrid organ, the islets of Langerhans are placed in a membrane covering. The requirement for a large surface is met in that the shell is designed as a capillary and has a diameter that corresponds to that of the islet cells. A number of questions need to be resolved: how can the formation of capillaries around the implant be encouraged; which are the biological stimulants, which are their formation
promote and what the material properties that currently prevent them; how can the life of the islet cells be increased, which currently have to be replaced after a certain period of time? If the capillary supply of the implant does not succeed, it must be checked whether the organ can be introduced directly into the bloodstream of an artery. This will add the problem of blood tolerance.
This example also makes it clear that many fundamental questions remain unanswered, that long-term research is necessary and that the willingness to take risks is necessary until the question can finally be answered as to whether organ transplantation will become less important as a result of biohybrid organs.
Figure 9: Thesis on biomedical research
The task of system integration should be illustrated using an example. In preparation for a surgical procedure, x-ray images, computed tomographic images or magnetic resonance images are generally produced. In particularly critical areas, series of slices are made so that a reconstruction of the entire volume of interest is possible.
The operation is prepared on the basis of such three-dimensional images; i.e., the access route to the target area, a tumor e.g. B., set.In so-called stereotactic operations that are carried out on the brain, a rigid frame is firmly connected to the skull bone, even before the sectional images are made. This makes it possible to establish a fixed assignment of image data and reality, i. H. between image points and the corresponding spatial coordinates in the operating area. By connecting the surgical instrument to the frame, the target area can then be reached on the previously determined route. A decisive step forward was achieved by integrating a surgical microscope into the overall system. For this it is necessary that the image data are available in a computer during the operation. By aiming at fixed points on the frame, a fixed spatial relationship is established between the field of view of the surgical
Figure 10: System integration
microscope and the image data. On the one hand, image data can be displayed in the field of view of the microscope and, on the other hand, the operating field can be displayed on the computer screen. Deviations from the planned surgical route are displayed, the planned surgical route can be changed. A straight access route can be deviated from in order to bypass particularly critical areas. By combining three-dimensional image data from sectional images with the optical image of the surgical microscope, the safety of the operation is increased, the duration of the operation is likely to be shortened and the risk of the operation is reduced. An expansion of the system is conceivable. B. by voice control, by superimposing sectional images, produced with different imaging processes and with computer-stored anatomical atlases as well as by an "intelligent" instrumentation equipped with sensors. This leads to systems including microsystem technology. Such systems make it possible to plan operations To check simulation, for which appropriate models would have to be developed, and finally to carry out the operation with a computer under the control of the surgeon.
Research and development in the field of biomedical technology is carried out in university institutes, in special publicly funded institutions or departments of such, in university clinics and specialized hospitals as well as in industry. This research is mainly carried out by academics with an engineering degree or one in physics and chemistry, less often medicine. There are institutes for biomedical technology at the universities of Aachen, Berlin, Dresden, Erlangen / Nuremberg, Gießen, Hanover, Homburg-Saar, Ilmenau, Karlsruhe, Lübeck, Rostock, Stuttgart, Ulm and Würzburg. The need for a close
Figure 11: Thesis on telemedicine
The gap between medicine and engineering only occurs in exceptional cases in the university itself. In the former technical universities there is seldom a medical faculty and vice versa. As a result, the individual medical departments built up research capacities by employing engineers. However, since they are separate from their mother science, they have difficulty accessing the entire arsenal of technology and methods available there. They also have poor prospects for further development and, in general, fixed-term contracts. On the other hand, it has a disadvantageous effect for the institutes at universities without a medical faculty that the constant daily contact with the problems of clinical medicine does not exist in the necessary breadth, but only exists selectively, problem-oriented. Another disadvantage for such institutes is that they almost exclusively have an extremely limited staffing capacity, higher-level positions are almost completely absent, so that experience is constantly draining off, since the next generation of scientists cannot be kept at the institute. The acquisition of external funds is necessary. An expansion of the research capacity from industrial contracts is also difficult, since basic research is rarely supported and a clinical partner is required for the implementation of applied research, who cannot be found in the institutes for biomedical engineering. The deficit in biomedical technology was recognized in Germany in the early 1970s and led to a priority program by the Volkswagenwerk Foundation and a special funding program by the federal government. Gradually, biomedical technology has been pushed back from this funding program, which is now entitled "Health Research 2000", although the total budget has risen considerably compared to the beginning. An urgent reorientation must be announced here if Germany wants to maintain its position in the world market In contrast, biomedical technology is well represented in the European Union's funding program, but only in the form of so-called "concerted actions". These serve to coordinate research within Europe, with research being financed from national funds. However, if only a few national resources are available, as in Germany, then this will decrease
Chance to participate. Only a few German applicants have been successful compared to those from smaller European countries. This program will probably be expanded to include so-called "Cost Shared Actions" in 1995. The situation in Germany will hardly have changed by then, so that here too it is to be feared that German participation will be disproportionately low.
In addition to research, the medical technology departments in the hospitals should be mentioned. You have the task of keeping the technical equipment installed there in operation, adapting it to special tasks and helping with the replacement. Such departments are not an integral part of our health system, in contrast to the former GDR, many other European countries, the USA and Canada. They often only have a limited say in the procurement of new equipment and are poorly staffed. In my opinion, there is still great potential for rationalization here. A different situation can only be observed in the area of health care institutions that work with ionizing radiation. Due to the legal regulation, the use of specialist staff is mandatory here. It is a domain of so-called medical physics, which in my opinion is to be understood as a branch of biomedical engineering.
Academic training in biomedical engineering is only available at a few universities. This is carried out as part of the classic engineering courses in electrical engineering, mechanical engineering and process engineering. This makes sense because the demands on an engineer who brings his knowledge into medicine are no less than those for other areas of engineering. In the form of a specialization subject, he can acquire additional knowledge that will help him to overcome or narrow the gap between exact natural sciences and technology on the one hand and biology and medicine on the other. It is easier to acquire further specialist knowledge from a discipline that is foreign to him when certain basics have already been laid. In addition, a number of universities of applied sciences that train engineers offer an independent course of study or, as at universities, additional knowledge is imparted within the classic courses of study.
Effective medicine is inconceivable without modern technology. Research in the field of biomedical technology creates the basis for providing this technology. The major advances in diagnosis, therapy and rehabilitation of the last 20 years have been achieved through biomedical technology. Diagnostic statements have become more precise and can be collected more quickly. As a result, therapeutic measures can be taken earlier and are then often more gentle on the patient, to which better technology in therapy also contributes. It was only technical developments that made therapy possible for certain diseases. The result is a higher life expectancy and lower morbidity.
The investment costs (cf. Stehr 1994) for medical technology are very low compared to the total costs of the health system and also to those for pharmaceuticals. Nevertheless, the therapeutic successes can only be achieved through the use of technology and the
Figure 12: Thesis. the cost of medical technology
to achieve with incurred personnel costs. This is the price society has to pay for improved medical care. As an economic factor, the medical industry, with its large export share, is not particularly significant if you compare it with mechanical engineering and automotive engineering or communication, energy and chemical engineering. However, it is a matter of "high technology" with a high export share (cf. Graßmann 1994), which for this reason alone should receive appropriate public funding.
The research structures are in need of improvement, with particular attention being paid to the interdisciplinary orientation and the clinical connection of research groups. Manufacturers should also be involved at an early stage. The instruments to promote such long-term collaborative research are largely lacking.
Graßmann, P. (1994): Elektromedizinische Technik in Deutschland, in: Medizinelektronik, Vol. 8, H. 2, 1994
Hütten, H. (1991): Biomedical Engineering 1991, Berlin - Heidelberg: Springer
IEEE Engineering (1993), in: Medicine and Biology - Magazine, Vol. 12, No. 2, 1993
Planck, H. (1993), in: P. Artzt et al. (Ed.): The future of the textile industry, Ehningen: expert
Stehr, H. (1994): On the costs and benefits of medical technology, in: electromedica 62, pp. 23-26, 1994
Thul, R. (1994): Scientific aspects of materials in medicine, in: Naturwissenschaften 1994 (in press)
- When dealing with the subject, the following understanding of the terms specified with the topic is assumed:
- "Modern" medical technology includes technologies that cause high investment costs and / or are associated with high personnel costs. In addition to “big ticket technologies”, this also applies to “small ticket technologies”, the individual application of which causes low costs, but which, taken together, lead to a high level of effort and must therefore also be taken into account.
Under the "Changing" societya situation is understood that is characterized by an aging population, the decline of traditional values, increasing problems in the financing of public tasks and an increasing complexity of reality,
- Modern medical technologies have one for society economic benefits, by contributing to economic value creation. That goes from the related research and development to production and sales. You can also have positive external effects in areas outside of medicine, especially through basic research and the development of new technical solutions.
- The modern medical technologies have for collective health (on which, among other things, the economic strength and self-assertion of a country depend) - a comparatively small one Use, by not aiming to maintain or improve the health of the social body, such as vaccinations, but to achieve cures in the individual patient in the event of an illness that has already occurred or to avoid premature death. But this indirectly implies asocial benefit, in that medical technology opens up individual treatment options and thus increases the feeling of security in life in the welfare state.
- Modern medical technology causes economic costs, which are inextricably linked to the solidarity-based financing of medical care and the claim of the welfare state to distribute health goods and services according to an existing need and not according to individual purchasing power. If the services of modern medical technology were to be distributed on the market, the effort involved would not have to be problematized.
- The effort especially for large-scale medical device medicine, which is particularly closely linked to the attribute "modern", is generally overestimated, probably because of the individual costs
Device (e.g. the purchase and operation of a magnetic resonance tomograph) are so extraordinarily high. In relation to the health system as a whole, the share of expenditure on large equipment is relatively small at less than 3.0%.
Smaller technologies (e.g. sonography) attract comparatively little attention because of the relatively low acquisition and operating costs, although their large number can cause high costs: in 1992, for example, 4.13% of the total remuneration was accounted for in the outpatient area = 1.16 billion DM on sonographic services.
- The effort of modern medical technology is increasing the or the individual patients related to their use indeed benefit (ie when considering marginal costs: how high are the costs of diagnosis or therapy for a patient that is only possible with modern, but not with older technology or clinical methods), then smaller technologies do not always cut cheaper than great off. The cost-effectiveness of care is not necessarily improved if complex procedures are always used as a last resort: step-by-step diagnostics often require the use of the entire spectrum of options before certainty about a finding is established, especially a false positive finding obtained during screening is clarified.
- The one under the subject Change of society primarily concerns the socio-economic framework under which medical care is provided. They are important for various reasons: A gap opens up between claims on the one hand (demographic development and medical progress) and affordability on the other (decrease in the number of contributors and declining economic power). The growing need to use funds in an alternative manner (e.g. maintenance of the long-term unemployed, fighting crime, future investments in education and research) also increases the opportunity costs of medical care.
- The modern medical technologies cause social cost by questioning traditional values:
- The relationship to death has been heavily influenced by intensive care medicine: in place of sensually perceptible signs of individual death, abstract death criteria, which can only be understood by specialists and which can be determined using certain techniques, have been used. The changes associated with this, which extend into deep basic human experiences, have not yet been realized in the population, as the sometimes surprising reactions to the fall of the Erlangen pregnant women in 1992 have shown.
- The dead body has undergone a change in meaning as a result of transplant medicine: it has changed from an "individual", which is still unmistakable for the relatives and who has only changed into a different form of being through death, to a disposable thing: With the appropriate consent, parts can removed and - again in violation of individuality - one
are implanted in another person or give rise to criminal offenses of a new kind without consent,
- Other costs and benefits are with the Effects of modern medical technology on medicine connected: You have an influence on medical theory - i.e. the conception of the nature and development of diseases - and the further development of this theory:
- Most modern medical technologies (e.g. all imaging methods are in accordance with the valid pathological-physiological understanding of disease and stabilize this understanding of the nature of the disease and the treatment approaches based on it. In this way, they promote progress within the framework of the valid paradigm of medicine.
- Modern medical technologies can make efforts to develop a broader understanding of illness - keyword psychosomatics and disorders of wellbeing - more difficult: The valid paradigm, i.e. the somatic conception of illness, corresponds to the socially accepted conception of illness as a primarily physical event or a state that can be experienced by the senses. With modern medical technology, deviations from the norm can be recorded which have no disease value, but which may be seen as the cause of the complaints. A proper explanation and treatment can then be omitted: This hinders the development of a new understanding of the disease.
- Taking into account the arguments presented, the following summary assessment of the contribution of modern medical technologies in a changing society results.
- There is one that can basically be expressed in terms of measure and number economic benefit in the development, manufacture and sale of modern medical technology for society.
- There is one that cannot be substantiated with measure and number social benefit of modern medical technology for society, which essentially determines the performance of the medical supply system, which is decisive for the individual.
- It is very difficult to determine with measure and number economic cost modern medical technology for society by the fact that the collective raising of the funds required for medical care consumes considerable resources for individual patients, which are not used for other treatment methods (with possibly greater effects on the health of the social body) or for non-medical treatments Tasks are available.
- There are basically no measures and numbers to be determined social cost for society, which are related to the serious influence on social values, especially through extreme medicine procedures. Among other things, they question the boundary between life and death and the unconditionality of the individual.
- Modern medical technology has an extraordinarily great "importance" for the individual patient, which has an indirect positive effect on social life: in a secularized era, health has become a goal in itself to a large extent. Correspondingly, the healing of illnesses and the avoidance of one come about The advances in the pursuit of these goals, including the ability to obtain certainty about the state of health, have been largely driven by modern medical technology.
- Modern medical technology carries through the associated direct Costs and those partly triggered by their successes indirect Costs contribute to the shortage of funds for medical care. The finite nature of the resources for this purpose has been brought to public awareness by budgeting within the framework of the Health Structure Act (GSG) of 1992. If the shortage of funds is increased by further advances in medical technology, the gap between what is medically feasible and what can be financed in the interests of society as a whole will widen further. In the long term, this will increase the political pressure on a forward-looking technology assessment and requirements planning, especially for large equipment. Nevertheless, rationing will be necessary in the future because it is not possible through this or through rationalization elsewhere to save so many funds that the additional demand resulting from the continued effectiveness of the expenditure-determining determinants can be met.
- Under the changed circumstances due to the shortage of funds and further advances, the treatments that are fundamentally possible in medicine will no longer be fully available to all insured persons in the medium term. If politics does not find the strength to undertake a more far-reaching reform, it becomes one through implicit rationing in the official system primary care develop and outside of this a market for health services and goods emerges on which they can be used according to the individual purchasing power.
- Medical technology can help all people according to its purpose, regardless of national, racial or religious differences. It is only widely used in a highly developed healthcare system. Important prerequisites for this are the financial possibilities and the infrastructure of a country as well as the level of training of doctors and medical staff.
- Medical technology has done a lot to improve the quality of life in the event of illness and to increase the average life expectancy of the population, not only in industrialized countries. Detecting, monitoring, treating or alleviating disease are important tasks.
- Medical technology multiplies the doctor's ability to obtain necessary information about the patient's body: this includes
- (1) Morphology and, if applicable, tissue properties and their changes through rapid imaging procedures,
- (2) Metabolic processes with the help of biochemical enrichment and conversion processes, e.g. B. with positron emission tomography (PET), magnetic resonance spectroscopy (MRS) and
- (3) Electrical processes taking place in the body directly with the help of EKG, EEG, biomagnetism.
- The diagnostic question determines the choice of the technical method. More complex situations require the use of several different and complementary methods and new decisions about their order of precedence. Unwanted side effects may also play a role here. Technical methods are e.g. B. X-ray and computed tomography with ionizing radiation (risks), ultrasound and magnetic resonance tomography without side effects and nuclear medicine, depending on the indication. Mix of methods, e.g. B. in the investigation of vascular diseases: ultrasound, angiography with X-rays, computed tomography or magnetic resonance tomography.
- The high detection sensitivity of medical diagnostic methods favors early detection. This improves the chances of therapy and the success of the targeted search for new therapy methods.
- The reliable overall diagnostic information enables effective therapy planning and allows therapy to be used in a more targeted manner. This includes surgical planning
with the aim of minimally invasive interventions, interventional procedures such as widening (dilation) or the closure of blood vessels, shock wave or radiation therapy as well as the choice of medication.
- The patient is burdened less and less by medical technology
- physical (less pain from a treatment modality);
- psychological (due to non-diagnosis or misdiagnosis, concerns about radiation);
- temporal (only coming and waiting once; shorter treatment times);
- financially (convalescence, incapacity for work, dependency on care).
- The patient remains socially integrated, e.g. B. with the help of hearing aids, pacemakers and defibrillators, as well as general means of communication. A shorter hospital stay / convalescence phase also work in this direction.
- Medical technology not only promotes medical progress, but also offers the health system considerable potential for cost reduction and rationalization and the economy the potential to conserve resources.
- Medical technology is ethically indispensable because it is helpful to people especially in the phase of physical weakness and dependence on third parties.
- Medical technology cannot be isolated from the overall health care system. It is an integral part of medical diagnostics and therapy.
The fact that it is dealt with independently of the other elements of care is mainly due to three special features:
- The essential standards of our health care are defined through technology.
- As a more or less capital-intensive investment good and means of production for the doctor, it has a not inconsiderable influence on the development of costs.
- Technical services appear to be more clearly distinguishable as a unit of costs than communicative and nursing services, which can only be economically grasped over time units.
The isolated consideration makes medical technology independent and medical action an accessory. One result of this independence is the equation of technical progress and cost increases. The standards of health care are not defined by technology, but by the high socio-cultural acceptance of technical services. As a result, medical technology can only be discussed in context.
Diagnostic technology is used to identify the disease to be treated and to be taken seriously and thereby differentiate it from the subjective disorder. Since this separation is constitutive for health care, diagnostic technology is indispensable - also from a cost point of view. The same applies to therapeutic technologies. Not only the moral pressure of the live-saving-imperative seems unavoidable, the decisive successes in maintaining or improving the quality of life also represent a standard that society cannot and does not want to do without.
The quality of the technical infrastructure defines supply options. But the quality of care implies a number of other parameters:
- Qualification of the doctor for the appropriate use of the technology,
- Clarity about the effectiveness of the use in each individual case,
- Clarity about the appropriate use of the devices from a cost / benefit perspective.
Only the evaluation of the health care results in the overall context says something about the quality of health care.
This development is particularly noticeable on two levels:
- Therapeutic technologies, the application of which places demands on the practical qualification of the doctor and which are widely used due to the low investment costs, force, conversely, to centralize for reasons of quality assurance. On the one hand, only a certain number of applications guarantees the required qualification; on the other hand, it must be avoided that the necessary number of services is achieved through unnecessary interventions.
- Non-medical technologies in the form of organizational and communication systems attract medical decision-making powers and delegate them to bureaucratically organized consultations.
The range of indications for an innovative technology can only be gradually clarified through its application. Inevitably, supply becomes a field of experimentation. The faster and more numerous a new technology is, the less it can be guaranteed that the experience gained will be known to all users. In addition, certain application problems can only be clarified through a large number of cases or through follow-up observations over a longer period of time.
A major problem in the development of costs is the medicalization of the population. This statement applies to pharmaceuticals in general, but applies equally to technology. Just like the recipe, the use of technology has become a sign of the doctor's preoccupation with the patient's suffering over the past 30 years. As a result, patients have a kind of expectation as a sociocultural standard.
attitude developed. Even though the treatment of a medium-sized neurosis by ultrasound or gastroscopy is not necessarily ineffective, this development is dangerous because, in view of the cost development, it leads to performance restrictions and so-called "deductibles", which call into question a basic principle of our health system, the equal access of all citizens regardless of income put.
Budgets and quantity specifications or - as in the case of large equipment - quotas are comparatively easy to control, but lead to undesirable performance distortions in terms of health policy. Medical care is based on science. However, it is scientifically exact only in its theories and models. This makes the development of standards difficult. Which diagnostics are appropriate and which therapy is effective can only be decided on a case-by-case basis. Nevertheless, there are empirical values that normally do not need to be deviated from. The implementation of application standards would not only reduce costs, but above all improve the quality of care by helping to avoid unnecessary diagnostics and therapy.
© Friedrich Ebert Foundation | technical support | net edition fes-library | February 2001
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