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The emergence of preventive medicine in the health care marketplace requires a change in the way in which patients encounter the healthcare market (Point of Care - POC) physician process and in how the payers … the insurance companies, government, Medicare, Medicaid,Military, etc… recompense necessary and many unncessary procedures and expenses. If we don't change the ways in which we do healthcare today, there is little hope of structural and process reformation … or financial sanity.
April 11th, 2010
Nanotech and Preventive Medicine Part 1
Nanotech and Preventive Medicine
Alan B. Shalleck
The emergence of preventive medicine in the health care marketplace requires a change in the way in which patients encounter the healthcare market (Point of Care - POC) physician process and in how the payers … the insurance companies, government, Medicare, Medicaid,Military, etc… recompense necessary and many unncessary procedures and expenses. If we don't change the ways in which we do healthcare today, there is little hope of structural and process reformation … or financial sanity. If the country doesn't radically revise the bloated healthcare system in the next decade, even more than in the recent Healthcare legislation, the predicted benefits will not occur. Static and cognitive inertia characterizes the healthcare world and change is not something that comes easily. The naysayers usually win in healthcare… But the nanoworld is beginning to show evidence that change is on the way … at least the first step… by developing the tools needed for a new Point of Care (POC) physician practice leading into the larger change.
It's very clear that we have to stop guessing at what is wrong with a patient who presents and finish developing comprehensive and specific diagnostic tools, processes and procedures that can be employed efficiently and quickly in the POC physicians office. Unlike today's visit, a future initial POC visit should generate detailed, accurate, precise and personal diagnosis within minutes of arrival. Once that "personalized" diagnostic information is a routine procedure, and all subsequent therapy or recommendations become directed, efficient and optimized, we will find ourselves in a controllable healthcare environment where ‘wellness" at reasonable price is the new mantra and the focus can be on "healthcare/wellness" as opposed to "therapy" … across the entire patient spectrum. Please understand that change starts in your primary physician's office.
I've been watching a trend for the last few years and I'm pleased to report that, after 10 years of flailing in nanoscience, I'm beginning to see real world, real size, nanobio, nanomedicinal, nanotechnologically based healthcare applications arising out of the "nanocloud", or at least major parts becoming commercially viable so that within the next 3 -5 years the next major impact of nanotechnology will be in the nanobased medical diagnostic procedures and markets.
Four years ago, in the predecessor to this column, I outlined a vision of 5-10 nanoarray slides - nucleaic, proteomic, imunologic, hematologic, etc. specific slides with thousands of nano dimensioned test cells, each containing unique single strands of DNA, or nanosized highly specific sensors of some sort, each marked in an ‘automatically readable' way. Each cell would first attract or detect the absence or presence of condition specific molecules - DNA complement fractions, antigens, antibodies, proteins, protein fractions, etc. , contain the ability to bind to the specific target and identify what is bound or discovered in blood, lymph or other bodily fluids spred through out the slide by nanofluidic processes. These "processed' slides would then be incubated or put in reactors of some sort. After an appropriate time (say 15 minutes) the slides would be placed in an automatic compehensive computer based reader that would provide the POC physician with a precise fact based picture of the health condition of the patient today and a predicted picture for the near future, with recommended treatments. This very personal complete picture ( like Dr. McCoy's handheld diagnostic device in Star Trek) would provide personal and preventive care information at the primary care level, changing the ways in which today's medicine is practiced.
Physical elements of this projected change in medical practice are extant already. Distributing fluids by nanofluidics has been recently shown by IBM on slide sized nanoarrays… your body fluid drop now can get distributed to the cells. That signifies that the input process for the slides will soon be commercially practical. (What needs to be defined and developed is how the fluid sample will be prepared for micro fluidic distribution…. a less difficult problem to solve.)
Second, the literature and lab reports has become full of announcements of successful use of micro and nanoarrays in research and in specific limited clinical evaluations. … some with tens of thousands of cells containing DNA fragments labeled by nanodots or dyes or flourescing substances for easy machine based readout… and more. Companies like Affymatrix, Combimatrix, and others have made significant progress in the practical use of nanoarrays in the past few years. Mechanically the nanobio industry is approaching nanodiagnostic array success very rapidly.
Two major challenges remain… The primary one has to do with determining the medical meaning of what is detected. Very few DNA parts or fractions ( or combinations thereof) can be specifically connected to medical conditions or aberrations. We don't know what stuff means… and that requires a major push by researchers world wide. I believe support for that effort… requiring billions of dollars … should be included in the next health care legislation bill being prepared by the government. No more pressing need exists than finding out what detected medical information means. A few companies are attempting to delineate the meaning of small sections of the genome but no where sufficient numbers of projects to make a difference. If the country wants to move rapidly to personalized medicine in the near future, researching the meaning of what can be medically detected is top priority…
The second major challenge in a move to personalized medicine is not in the nanotechnology sphere. It is simply how medical efforts today are paid for. We pay for procedures done, not for results or by per capita. We don't pay for information ( which is the output of medical diagnostic procedures) In sum, today's payer system schedules a procedure for reimbursement and when the physician or hospital or clinic bills the system, the system recognizes the sheduled procedure and remits the scheduled funds. Most diagnostic procedures aren't included, nor are there provisions for Nanoarray or micro array total analytic diagnosis. That will hold back any market penetration of the new process. No medical professional will engage in a procedure for which he or she won't get paid. Consequently, until today's payment methods are modified to include the true value of the information from nanoarrays, no significant change will occur in how medicine is practiced in the US. Today's healthcare system is structured by the payment system, not the other way around. There are entities with vested interests in the status quo. Changing the system will be no small battle.
In summation of this part one of nanotech and preventive medicine, If you want nanotechnology to increase your and your family's ‘wellness' in the near future, write to your congressman… the technology is beginning to win … help align the politcal and financial systems to allow these wonderful potential benefits to become reality.
Alan B. Shalleck
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