Appropriate Biomedical Diagnostic Technologies

While the 20th century was replete with examples of the success of medicine in treating and even eradicating types of infectious disease, the emergence of AIDS and SARS, threats of bioterrorism, and the persistence of chronic illnesses like malaria and tuberculosis, hint that the 20th century medical paradigm may not see us through the 21st century. There is a growing need for rapid diagnosis of disease and for the combination of diagnosis with therapy--“theranostics”—and there is a growing understanding that the well being of those in under-resourced portions of the globe is intimately tied to the well being of everyone else. These are problems with implications for the short-term political position of the US, and the survival of the international community as we know it.

The explosion of information technologies has put most of the pieces in place for integration of healthcare across the globe, if only there were ways to collect the medical information in the first place that were sufficiently inexpensive and simple to use. The creation of the types of diagnostic devices and protocols appropriate to the 21st century requires the creation of new technologies. However, that creation process must be carried out by a cadre of scientist-engineers trained to understand the socioeconomic, medical, scientific and engineering problems involved in diagnosing and treating the disease; this is a combination of skills for which there is not now any training program.

THE WORLDWIDE NEED

Today we are confronted with a growing disparity in availability of healthcare services between the developed and developing world. As the transfer of people and information between these two worlds increases in frequency and ease, we are entering a period in which health issues in one part of the world immediately become the problems of the entire world. Moreover, there are political implications to this problem of disparity of healthcare delivery; the problems are both economical and political. One could argue that there are both political and moral imperatives driving an improvement in the current disparity.

The "bottom line" problem is, however, one of economics. The poorer peoples and countries cannot currently afford the types of technologies available in the developed world. This restricts the type of medical care that they can receive to strategies that do not include the use of sophisticated diagnostics.

THE UNIQUE PROBLEMS ASSOCIATED WITH CREATING APPROPRIATE BIOMEDICAL DIAGNOSTICS

If one is to raise the level of healthcare in under-resourced environments, there are several problems to be solved. Clearly that cost of diagnosis and treatment must be low--a small fraction of that in the developed world. To do this without reducing the quality of diagnosis requires the creation of technologies that are inherently inexpensive. They must also generally not require the infrastructure available in the developed world; one has to do not only without a plethora of highly trained support personnel, but even the absence of such facilities considered essential as refrigeration. Moreover, it will not be appropriate simply to create inexpensive versions of the most common diagnostic instruments used in the developed world. Since the aim is to improve healthcare, it will be important to coordinate the new diagnostics closely with the most appropriate therapies.

Furthermore, it is not sufficient simply to lower the cost of medical care, because the socio-economic environment is critical. A socially inappropriate technology, no matter how affordable, will not be adopted easily, if at all. If any entity, be it commercial or not, is to successfully develop and disseminate new technology to address diagnosis in a particular environment, it is vital to first carefully define the problem to be solved. This problem has traditionally been beyond the resources of conventional Bioengineering Departments.

THE OPPORTUNITY

We believe the time is right to create an entity that is focused on the issues (medical, technical, and socioeconomic) surrounding the development of new biomedical diagnostic technology appropriate to use in under-resourced communities. For many reasons, the University of Washington is an ideal location for such an entity.

Growing awareness of importance of Diagnostics, particularly in Theranostics
The augmentation of the human senses through the use of what we today call diagnostic instrumentation has been vital to the diagnosis of disease and the monitoring of its progress since the invention of the stethoscope in the early nineteenth century. As our knowledge of human health as grown, so has our ability to discriminate between normal and abnormal health conditions. Consequently, our needs for diagnostics have become increasing sophisticated. Today there are hundreds of tests of blood chemistry alone used in the most sophisticated clinical laboratories that are used in diagnosis, critical care, monitoring of chronic conditions, and in the monitoring of the progress of therapies.

This last category--the monitoring of the process of therapy, or theranostics--is a rapidly growing area, and one that could be vital in the advancement of health in under-resourced areas. For example, in the treatment of AIDS, the proper mixture of drugs is dependent of knowing the state of progression of the disease; the wrong match is both wasteful of expensive medication and harmful to the patient. In cases such as the AIDS epidemic there are no resources to be wasted, so if a very inexpensive diagnostic modality could be brought to bear, better use could be made of what medications are to be available, and the medical regimens could be optimized based on that diagnostic availability.

Centrality of BioE in new diagnostic technologies

The development of biomedical diagnostic technologies is one of the enterprises that fits perfectly within the discipline of Bioengineering. There is no other single discipline that integrates the biomedical, biochemical, chemical electronic, physical and informational knowledge. Bioengineering students are trained in all of these areas, in a very rigorous curriculum that broader than any other in academe today.