Time - Man of the Year/Time_Man_of_the_Year_Compact_Publishing_3YX-Disc-1_Compact_Publishing_1993.iso/moy/051892/0518350.000

Text File | 1992-09-10 | 6KB | 121 lines

                                                                                MEDICINE, Page 68

Healing by Wire


With videophones and satellite linkups, an examination by the
world's top specialists can be a phone call away

By ANDREW PURVIS


    A neuroradiologist in Iowa studies the swirling contours
of his patient's cat scan and immediately books the man for
surgery. An Atlanta cardiologist, glancing at an untouched
bottle of heart pills, looks his patient in the eye and urges
him to take his medicine. A psychiatrist notes the pallor on the
face of an earthquake survivor in Armenia and counsels her on
post-traumatic-stress disorder.

    Typical encounters between doctor and patient? Perhaps.
But in each case the doctor and the patient are not seated knee
to knee in an examining room: they are hundreds -- in one case
thousands -- of miles apart. The physicians are practicing
telemedicine, an emerging hybrid of telecommunications and
patient care in which people in medically underserved areas use
ordinary telephone lines to consult with highly trained
specialists whom they could not otherwise afford to see.

    In the past two years, two-way video telemedicine projects
have been launched in Texas, Georgia and West Virginia, while
less sophisticated methods relying on still photography have
cropped up in Iowa, North Carolina and Nevada, among other
states. U.S. doctors via satellite have diagnosed conditions in
patients in Armenia, the Philippines and Belize. "It's a way of
cloning the specialist and sending him out to locations around
the world," says Dr. Jay Sanders, a telemedicine pioneer now
teaching at the University of Miami.

    Since the first videophone was unveiled at the New York
World's Fair in 1964, doctors have dreamed of healing by wire.
But the reality of transmitting a detailed picture over a
1-mm-thick (.04 in.) copper cable proved elusive. Then in the
1980s engineers working with a technique called digital signal
compression managed to boost the data-carrying capacity of
ordinary phone lines 30-fold.

    Specialists in radiology, cardiology and neonatology,
whose high-priced services are in great demand in rural areas,
have been quick to take advantage of the new technology. These
doctors do much of their diagnosing with tests such as
echocardiograms, CAT scans and fetal monitoring, which can be
displayed electronically and sent over the wires with ease.

    For towns like Indianola, Miss. (pop. 12,000), the
technology arrived just in time. One evening last month, the
physician on duty at the South Sunflower County Hospital
admitted a five-year-old girl who had miraculously survived a
brutal car wreck. Apart from cuts and bruises, she seemed O.K.,
although tests showed that she had lost some blood. A year ago,
a doctor might simply have kept her under observation. But the
hospital had recently hired Teleradiology Associates, a group
of radiologists based in Durham, N.C. Just to be safe, the
doctor sent them a CAT scan of the child.

    Viewing the image on a TV screen in his dimly lighted
office three states away, Dr. David Forsberg noticed that
something was wrong. "You could see a rupture in the integrity
of the spleen." He immediately recommended surgery; her bleeding
organ was removed and her life saved. "In the middle of the
night, it's reassuring to know that you're bringing your
patients the best care available," says Dr. Tony Kusek, a
country doctor -- and teleradiology enthusiast -- in Albion,
Neb.

    Outfitted with new data-compression technology, telephone
lines can also carry primitive video. Networks that allow doctor
and patient to sit down face to face, so to speak, and run
through symptoms, diagnosis and treatment have been set up in
Texas, West Virginia, Georgia and Florida (where the system is
used to treat state-prison inmates). Images are still jerky,
but consulting specialists can guide the doctor or nurse on
site through a physical exam and discuss the results. "It's
like learning to fly a plane with the pilot at your shoulder,"
observes Dr. Charles Driscoll, a family practitioner at the
University of Iowa.

    The future of telemedicine can be glimpsed in an
experiment combining satellite transmission and high-definition
television. Last December doctors in Boston used these
technologies to study patients in Belize suffering from
cutaneous leishmaniasis, a parasitic skin disease. The quality
of the images was "amazing," says Dr. Linda Brinck. Doctors
could clearly see the changes in skin texture and coloration
that characterize the ailment.

    The drawback: satellites and HDTV cost millions, and even
the more modest telemedicine networks that use ordinary phone
lines and two-way video are priced at $500,000. "For community
hospitals, that's an awful lot of money," notes Dr. Tony
Franken, head of radiology at the University of Iowa.

    Still, the costs of fiber optics and digital compression
are shrinking. Eventually, the projected savings from
telemedicine -- up to $1,500 for every patient who does not have
to be transported to an acute-care hospital -- are likely to
outweigh the price. For enthusiasts like Dr. Brinck, the
possibilities are limitless. She envisions U.S. specialists
teaching the latest diagnostic techniques to isolated medics in
Central Africa who, in turn, can inform American colleagues of
emerging health crises in their regions. Satellite ties with
doctors in Africa in the 1960s, she points out, might have drawn
attention to aids long before it exploded in the bathhouses of
San Francisco 20 years later. This is one way, at least, in
which a smaller world may become a healthier world.