The Nightmare of Healthcare

Why is health care so expensive? Before today, I was clueless. I don’t mean that I didn’t know the basics: prices are climbing, debates are ensuing, people are unhappy—but I never knew the details or extent of the problem.

The United States spends twice as much as other wealthy nations on healthcare. At first, I thought this money seemed like a worthy investment, but then I learned that Americans may not be getting their money’s worth. The United States lags behind other nations (who spend less) in measures such as infant mortality and life expectancy (1). In 2000, the World Health Organization ranked United States health care as highest in cost, 37th in overall performance, and 72nd in overall level of health. There were 191 nations in the study (2). Furthermore, at least 15% of Americans are uninsured, and a considerable additional portion is “underinsured.” The Institute of Medicine of the National Academy of Sciences describes the somewhat embarrassing problem: “The United States is the only wealthy, industrialized nation that does not ensure that all citizens have coverage” (3). All in all, the total number of Americans who die each year because of lack of medical care exceeds 100,000.

How can America simultaneously reduce costs and improve the quality of healthcare? After perusing the Internet for about 30 seconds, I realized that this question does not have a simple answer. Americans seem to blame everyone and everything for the problem. Some claims are reasonable while others are outrageous, and basically nobody agrees upon a solution. Sometimes I don’t even know who to believe! The problem is multi-faceted: I guess this is a good opportunity for me to “think like an engineer.”

I soon learned that one contributor to the health care crisis is delay in seeking medical care. Uninsured Americans are more likely to postpone a visit to the doctor; but in the long run, such a delay can cause more medical problems, which tend to be more expensive to treat than ongoing issues (4). If simple office visits were more affordable and easier to schedule, such long-term conditions could be partly avoided. Perhaps patients could even meet with a nurse, rather than a doctor—could such a system save money?

Problems with care coordination also account for extra costs. About one in five doctors reported having patients retake tests because the results have been misplaced (5). Diagnostic tests tend to be very pricey; creating a more efficient system for filing results seems like a worthwhile investment. Another clerical problem results from different types of record keeping. I worked in my dad’s office over the summer—he is a physician—and saw firsthand how mixing paper and electronic records creates confusion and extra work. Implementing Electronics Medical Records (EMR) can save time and money and eliminate confusion, making patient care more seamless (6).

Sometimes disease prevention can be very cost effective. For every $1 spent in water fluoridation, $38 is saved in dental restorative treatments costs. Implementing an Arthritis Self-Help Course among 10,000 people lowers health costs by $2.5 million, while also reducing pain by 18%. Clinical smoking interventions cost about $2587 for each year of life saved—the most cost effective of all clinical health services. Similarly, a mammogram every couple years for women aged 50-69 costs about $9000 a year per life saved. All these measures reduce medical costs in the long run (7).

But I think the most interesting way to reduce healthcare costs is personalized medicine. Personalized medicine can determine someone’s predisposition to a certain disease. The cost of individualized treatments and diagnostic tests may be more expensive, but in the end, the tests may help people avoid more costly treatments (8).

So which of these measures will best help reduce health care costs? To be honest, I have no idea. I am afraid that some of the sources I used are biased. For example, one overwhelmingly conservative source places an entire argument around how the uninsured are “jacking up” emergency room prices, which ruins our health care system. Maybe there is some truth in his claim, but the argument seemed too one-sided to me. Another article I read blames healthcare prices on obesity. “One of the reasons that healthcare is so expensive is that we are fat,” the article begins (9). The website continues to discuss how obesity is “killing us.” Again, the article struck me as trying to pinpoint one specific cause of a multi-faceted problem. Everybody needs something to blame—a scapegoat— to explain away the healthcare crisis. But there is no one cause, nor is there one solution, to the problem.

Sources
1. Marian F MacDorman, Ph.D., and T.J. Mathews, M.S.. "Recent Trends in Infant Mortality in the United States" (pdf). National Center for Health Statistics, Centers for Disease Control.
2. World Health Organization assess the world's health system. Press Release WHO/44 21 June 2000.
3. Insuring America's Health: Principles and Recommendations, Institute of Medicine of the National Academies of Science, 2004-01-14. Retrieved 2007-10-22.
4. Hadley, Jack, "Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition", JAMA, March 14, 2007; 297: 1073 - 1084.
5. California HealthCare Foundation, [4] "Uncoordinated Care: A Survey of Physician and Patient Experience"], Harris Interactive. 2007. Retrieved March 20, 2008.
6. http://knowledge.emory.edu/article.cfm?articleid=1263
7. http://nextbigfuture.com/2009/06/best-ways-to-lower-healthcare-costs-by.html
8. Lesko L (2007) "Personalized medicine: elusive dream or imminent reality?" Clin Pharmacol Ther 81 (6) pp. 807-16.
9. http://www.whereistheoutrage.net/wordpress/2009/09/19/why-is-healthcare-so-expensive/comment-page-1/

I'm Not an Engineer...Am I?

I am an engineer. I am an engineer. Wait, what? Engineers sit behind secluded desks and avoid contact with the rest of the world. I run from one maze-like building to another—always learning and greeting, questioning and interacting—I’m not an engineer.

Or maybe, I just don’t know what an engineer really is. I thought, after all, that all my professors would be mumbling men with no social skills, and instead, I find them engaging and amiable. They can make good jokes—and not just ones about science.

So two weeks into the world of engineering, and I really do not know what to think. Most of my expectations—such as the ones where I envision an isolated person behind a desk—have been shredded apart by reality. Engineers are the same as everyone else, I have concluded; they just think in a different way. Exactly what this “different” method of thinking is, I do not fully understand yet, but I know that engineers must be methodical and thorough. Sources need to reliable and well-cited; unlike high school, I cannot just cut and paste a link to a random website and call it my bibliography.

I will probably have a different view in another week, and be at a different point in the engineer “transformation” process. Being an engineer is an ever-evolving route, especially for a freshman in college.

Swine Flu Strife

I have always been a bit wary of the swine flu vaccine. Is the shot trustworthy? After all, testing just began in August—have its long term effects been properly tested? Such questions leave me in a state of doubt; I swap from one side to the other. Should I be cautious and protect myself from the swine flu, or should I remain suspicious of the relatively new vaccination? Overall, however, when I need to make a final decision (for this question is very real), I think I will refuse the swine flu vaccine. I do not have any underlying medical conditions, nor do I get sick very often. Receiving the vaccine seems like an unnecessary risk to me. (If the disease were to flood Penn’s campus, however, I would most likely reconsider this decision.)

Another reason I would decline the vaccine revolves around need: many others need the vaccination much more than I do. Pregnant women, young children, and health care workers with direct patient contact should all receive the first doses when faced with a limited supply (2). One mathematical model, created by Medlock and Alison Galvani of Yale University, determines the best distribution by age for vaccinations. According to this model, children ages 5-19 and adults ages 30-39 should be inoculated first, the idea being that the disease travels from the schoolroom to the parents to the community. By vaccinating those most likely to spread the sickness, this model attempts to halt transmission and minimize the number of reported cases (1). I am a bit mistrustful of this method, however. The theoretical model was created almost 50 years ago, so it does not apply directly to the swine flu. Does this fact render the model obsolete or inappropriate? I would think so; but then again, I am not really qualified to make that sort of decision.

Many measures have already been taken in the battle against the swine flu. Everywhere I look, a hand sanitizer machine protrudes from the wall, reminding us of the need to stay clean and healthy (as if we could forget). I have always thought some sort of “spray” sanitizer would also be helpful. Many people do not take advantage of the manual hand sanitizers, but a spray would be easy and more universal. If such a feat proves impossible, perhaps Penn (or anywhere) could make hand sanitizing necessary before entering certain places. I went on a cruise last summer, and every time my family entered the dining room, we had to wait in a line to receive antibacterial soap—it was required. Such simple measures may serve us much more than we can imagine.

Sources:
1. http://www.time.com/time/health/article/0,8599,1917707,00.html
2. http://www.msnbc.msn.com/id/32206655/ns/health-swine_flu/

An Alternate to Liver Transplants

I could not believe how many news items appeared when I typed “Biomedical Engineering” into my Google News toolbar. Thousands upon thousands of articles filled the screen, all about breaking news, research grants, fresh technology—I was overwhelmed.

Thankfully, one title in particular caught my eye: “Engineering team to design and study liver mimics.” Upon reading the article, I learned that a research team at Virginia Tech College of Engineering is using a $1 million grant to research engineered tissues that mimic the liver. I did not know anything about this sort of research, but luckily, the article was informative and detailed. The goal of the project is to create 3D cellular structures that mimic the liver, and the main challenge revolves around regeneration. “Liver cells can regenerate inside the body, but lose this ability once removed,” explains Padma Rajagopalan, a professor of chemical engineering. “Therefore, researchers need to find a way to sustain cells in vitro. A critical aspect is capturing the precise spacing between different cell types in the liver.”

The article also addressed a sometimes ignored question: why is this research important? The liver is a crucial organ, performing functions such as metabolism and detoxification. When the liver deteriorates, serious health problems or death can follow. The solution—liver transplants—remains expensive, and may not be an option for patients at high risk for surgery. Even more, a lack of suitable donors plagues the country, leaving many people with no options. Engineering tissues to mimic the liver provides an alternative.

Lessons and Hopes

Learning about each and every part of Bioengineering is an impossible task. I find it a bit depressing that there will always be something that I do not know. But I need a basis to begin—goals and objectives for myself. I know I want to learn as much as possible, especially about prosthetic limbs. How do they function with the rest of the body? What are they created from? What does the future of prosthetics look like? I do not know the answer to any of these questions, I must admit, but I hope to change that very soon.

In addition to learning, I would like to improve certain skills I have struggled with in the past. Public speaking in particular comes to mind. In high school, I labored over my writing and crafted papers I was proud of—but when it came time to present, confidence evaded me. I no longer want the burden of stage fright holding me back. Clear, concise communication is an integral part of engineering, I have learned, and I want to master that skill and proceed without any barriers of my own making.

The Stethoscope Days

As a child, I loved to steal my father’s stethoscope. I would half-strangle family members as I played doctor, listening to the sounds of a heartbeat. Eventually my dad bequeathed his old stethoscope to me. It was now official—I was a doctor.

But like most seven-year-olds, I never spared a thought to the way the instrument was created, or how or why it worked. Not until recently (today, to be specific) did I revisit those old memories of the stethoscope days. And being much older now, I not only wanted, but needed, an explanation.

I was surprised to find that the stethoscope was invented by a lucky accident. René Laennec, a French physician living in the early 1800s, was examining a woman with a heart affliction. He was reluctant to put his ear to her chest, partly due to her stoutness and partly to the present standards of modesty. Instead he rolled up a sheaf of paper, pressed it to the woman’s chest, and placed his ear to the opposite end. “I was pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear,” he wrote in the classic treatise De l'Auscultation Médiate (1). Little did Laennec know that he just created the first stethoscope.

The stethoscope was among the first technological aids in the medical field. The invention revolutionized physical examinations, and to this day, remains the main instrument used for non-invasive investigations (2). One thought and one man led to this discovery—that is what I love about bioengineering. If I could pick one part of biomedical history to return to, it would be the moment Laennec rolled up that piece of paper. Simple, but revolutionary—and isn’t that the way all inventions begin?

1. Mikkelson, David. "Stethoscope." snopes.com. Urban Legends Reference Pages, 12 May 2009. Web. 13 Sept. 2009. .
2. Wijesinghe, Manique. "Stethoscopes." Student BMJ Archive. BMJ Publishing Group, 14 July 2006. Web. 13 Sept. 2009. .

"Real" Bioengineering

I do not know each and every way a Bioengineer can use his major—my knowledge of the field is spotty and incomplete. I do know that the field is vast and ever-expanding, and probably encompasses work that is completely foreign to me.

However, I am familiar with a few facets of Bioengineering: mainly, prosthetics and research. My handy calculus teacher—the former Bioengineer—talked to me about the designing and “engineering” part of the major. He used to design medical equipment before converting to the education field. My knowledge of the “medical” part (I don’t even know the right language to use yet!) of bioengineering ends here: I don’t know how any of this designing works, but I would like to learn much more about it.

I do not know much more about the research aspect of Bioengineering. Panels and tours at Penn taught me what I know about the field: that some Bioengineers continue on to Graduate School, and use their degree to pursue a career in research. This option appeals to me the most (as of now), and I hope to become involved in research; I want to test and taste the different parts of Bioengineering before deciding on one!

Bioengineers may also find careers in consulting and investing—or so I’ve heard. I know virtually nothing about this option (or any of the others, I am coming to realize…) I guess that is why I am at Penn.

Choosing Bioengineering

In high school, I struggled with a very simple question: what do you like? Nor could I answer the question’s counterpart: what do you want to do with your life? This issue did not emerge from a lack of interest in schoolwork, or an ever-changing set of hobbies, but instead from one little word: options. I loved writing. I read books on any and every topic. I took as many science courses as I could. I tried—and failed—to become fluent in Spanish. I secretly looked forward to my Calculus homework. Deciding which field to explore in college seemed an enormous and depressing task.

Looking back now, I have no idea how or when I decided to look into engineering. I talked to my Calculus teacher many times—he was a Bioengineer back in the day—and soon found myself leaning towards the major. I loved the idea of entering the medical field (without becoming a doctor—needles scare me), and research had always interested me as a kid. I am even happier now with my choice, after attending the first Bioengineering lecture and learning that communication is the most important skill of an engineer. One of my main fears about engineering was that it would involve only math and science; the fact that writing and communicating are so closely intertwined made me even more excited about the field. I feel lucky I found a major that suits not only one, but many, of my interests.