STUART DAVIDSON : A Hand on Pulse of Medicine : Specialist Plots Technical Advances to Advise Hospitals
With medical technology developing at a furious pace, hospitals are frequently perplexed about what equipment to buy. With insurance companies putting pressure on them to control the cost of medicine, hospitals don’t want to be stuck with an expensive piece of equipment that becomes outdated in a year. Nor do they want to miss out on a new method of diagnosis or treatment that could save lives.
What to do? St. Joseph Health System, the Orange-based hospital chain operated by the Sisters of St. Joseph of Orange, has hired a consultant who spends all his time helping it plan for the future.
The consultant, Stuart Davidson, delves into the nooks and crannies of science. He reviews reports about research at projects at laboratories around the world that could influence medicine in the next decade and beyond.
Davidson was approached by St. Joseph Health System to take on this assignment just a few weeks after he had retired from a 30-year career with Beckman Instruments. He had been corporate director of government and technological affairs for the Fullerton-based maker of medical and scientific instruments. He also had served as a director of St. Jude Hospital and Rehabilitation Center, a Fullerton facility that is part of the St. Joseph Health System.
Davidson, who has an educational background in engineering, geology and mathematics, worked as a technological soothsayer for St. Joseph Health System on a volunteer basis for three years, after which he became a paid consultant. In an interview with Times staff writer Leslie Berkman, Davidson, 70, described his role as director of the St. Joseph Health System’s Center for Technology Assessment and why he believes other hospitals should pay closer attention to long-term trends in medicine.
He predicted that the purpose of hospitals will be dramatically changed by the development of more effective drugs and diagnostic techniques that will greatly reduce the need for major surgery.
Q. What is St. Joseph Health System’s Center for Technology Assessment?
A. It is me, a computer and data banks. I work out of the basement of my home in Reno, Nev.
Q. What is in the data banks?
A. I have 550 files containing information about anything in medicine from diagnostic and therapeutic devices to surgery.
Q. What is your mission?
A. My mission is to be able to tell the hospital system what new technologies will be appearing on the clinical scene and when, and what effect they will have on existing technologies or procedures. I conduct workshops for the medical and administrative staffs of all our hospitals and at the headquarters in Orange to get them to understand what is happening in science that they will have to be concerned with.
Q. Is this an innovative program?
A. It is the only program I know of in the world that looks at the future of medical technology, not just at what is on the market today. Most hospitals today look at existing equipment or existing drugs already approved by the Food and Drug Administration, or ones they believe soon will be approved.
Q. Does that shortsighted approach get hospitals into trouble?
A. Sure it does. Let’s use the gallstone lithotripters as an example. A lithotripter is a machine that uses ultrasound waves to break up gallstones. Some hospitals will buy it if they think they have enough gallstone patients to make it worthwhile.
But they are ignoring the fact that surgeons are suddenly having a love affair with a piece of technology called a laparoscope, which is inserted into the body through a one-quarter-inch incision and has tools on the end that can remove the gallbladder without open surgery. This also cuts down the need for the gallstone lithotripter. Also, hospitals that buy lithotripters may be overlooking new drugs coming on the market that will dissolve gallstones.
Q. Is one of your purposes to act as a communicator between medical disciplines?
A. Yes. Medicine and science are compartmentalized into specialties that do not talk to each other. Adding to the complexity are 8,000 medical journals that appeal to different specialties. It would take a person a lifetime to read just the titles of the papers that have been written. There are at least 8 million technical papers on subjects pertaining to medicine written since 1940 that are in data banks which I can access.
Q. What are some of the problems that result from a lack of communication?
A. Our failure to recognize existing possibilities for therapies that are already in the literature.
Q. What would be an example?
A. By collating articles that had been written, a librarian from the University of Chicago in recent years discovered the relationship between migraine headaches and magnesium deficiency and the possibility of using fish oil to relieve the symptoms of Reynaud’s disease, a circulatory problem. I am looking for similar linkages.
Q. Are new developments in medicine affecting the role of hospitals in the health-care delivery system?
A. The operating room as we know it will no longer be the economic and technical center of the hospital. The reason is that much surgery now is performed on an outpatient basis in surgicenters. In addition, some hospital operations will be done by means other than conventional scalpel surgery, such as the laparoscope and other less-invasive techniques.
In addition, many surgeries are being replaced by biologic therapeutics, one good example of which is the treatment of ulcerative colitis, which formerly required surgery but now can be treated with pharmaceuticals.
Another operation that will probably decline is the heart transplant. It is a new technique but already is being replaced by repairing the existing heart with new surgical techniques.
Q. If surgery becomes less important, what will be the hospital’s role?
A. The old hospital had walls, the purpose of which was to keep the sick people in and the well people out. The hospital was an entity unto itself. Today sick people are treated more often outside hospitals, which are now more frequently being called community wellness centers. Patients now go to hospitals only for very serious illnesses and major surgery. Another important role of the community wellness center is to educate patients how to take care of themselves with weight reduction and stress programs, for example.
Q. Will these wellness centers also be important resources for testing some of the new drugs you were talking about?
A. A new role for smaller community hospitals, which is now being played mostly by large medical research centers, will be to conduct clinical trials of new drugs for the very sick.
Q. Why will this happen?
A. We have diseases that are life threatening and we have drugs coming out of development that apparently will save a great many lives if they are used, but they are not yet approved by the U.S. Food and Drug Administration. Instead of waiting for a formal approval while people are dying, trials of these drugs are being moved out to the community.
Q. Why wasn’t this done in the past?
A. The FDA recently has recognized the importance of increasing the availability of experimental drugs. Also, because of the development of computer software, the local physician now can have at his fingertips the information necessary to conduct a clinical trial on a new drug to treat a life-imperiling disease on one of his own patients.
Q. Diagnostic machinery such as Magnetic Resonance Imaging (MRI) and Computerized Axial Tomography (CAT scan) are very expensive. Can hospitals continue to afford such technology in an era when insurance companies are pressing for cost control?
A. Actually the prices of this equipment are showing signs of coming down. The reason is growing competition among the manufacturers. There are 12 manufacturers of lithotripters, for example, and almost a dozen manufacturers of MRIs.
Q. How do you advise hospitals how to buy the right machine for them?
A. I usually don’t get involved in selecting specific brands. That is done by the medical and administrative staffs of a local hospital. But they might ask me for advice on whether to buy an MRI machine at all.
Q. Is there a danger that an MRI machine that costs more than $2 million to install today might be outmoded tomorrow?
A. No. The basic MRI configuration will not change. The changes in MRI will come through development of a greater variety of computer software that it uses to perform new functions. There is at least one brand new use for the MRI coming out each week. It is incredible.
Q. Are there other trends in medicine that health-care systems such as St. Joseph should know about?
A. They need to know about changes in the clinical laboratory that are coming because of the very high sophistication of diagnostic techniques using the new tools of molecular biology.
Q. What do you mean by new tools of molecular biology?
AI am referring to the Polymerase Chain Reaction, which is an extremely sensitive test that picks up information unavailable by any other means. It is done inside a new piece of testing equipment that is manufactured by Perkin-Elmer Cetus Instruments (a joint venture between Cetus Corp. and the Perkin-Elmer Corp.) The polymerase chain reaction finds hard-to-detect viruses in body fluids by causing them to reproduce in larger quantities.
Q. What kinds of diseases can you diagnose that way?
AAIDS would be one. You could detect the HIV virus associated with AIDS much earlier when very small quantities of it are present. It is also used in basic research into the cause of cystic fibrosis, multiple sclerosis, muscular dystrophy, cancer and arthritis. Now it is in the research laboratory, but one day, before the end of the century, it will be used in hospital clinical laboratories.
Q. How important is this new diagnostic tool?
AThe Polymerase Chain Reaction test is as important as the CT Scan or MRI. Some people regard it as the most important advance in medicine since the discovery of the structure of DNA in the early ‘50s.
Q. Did it take long to develop?
A. It took less than five years from conception to research use. By contrast, the CT Scan took a century to develop from the basic X-ray. And the MRI took 50 years to develop.
Q. Do you foresee medical technology will continue to develop at a faster pace?
A. Yes. It used to be that every 10 years or so we would double our knowledge of medical science. The doubling time is now about three years. That means in the next three years we will know twice as much as we learned from the time of the Pharaohs until three years ago. And we expect that doubling time to shrink to two years by the end of the century.
Q. Why is that happening?
A. Because of communication. (Alfred Russel) Wallace and (Charles) Darwin both studied and published on the subject of evolution at about the same time, but they didn’t know they had done that until about two years later. Today, through fax machines, computers and telephone networking, a scientist in a particular field in Paris knows what somebody in the same field is doing in New Zealand within 24 hours.
Q. But didn’t you say earlier that communication is still lacking?
A. Although scientists in the same field know what their peers are doing, there is a lack of shared knowledge between scientists in different specialties. That will be much more difficult to solve, and science writers will play a major role.
Q. Will technological development increase the cost of medicine?
A. I think it will reduce the cost of medicine. For example, a hemophiliac today pays $300 on the average for a dose of a blood factor produced in a laboratory to prevent hemorrhaging. But scientists have implanted a human gene in a female pig so it produces the same blood factor in its milk at a potential cost of less than $1 a dose. That one pig would supply the entire needs nationally of all hemophiliacs.
In addition, there is research being done with cows implanted with human genes that then produce human Tissue Plasminogen Activator (TPA) used to dissolve blood clots that can cause heart attacks.
Q. When will these new drug-manufacturing techniques be available commercially?
A. In a couple of years. They are going through the FDA testing cycle. That’s why I say medicine in the long term is becoming cheaper. At first the new medicines will have to be priced higher to recover the high cost of research. Nonetheless, they will be considerably less expensive than the present laboratory-manufactured drugs.
Q. How do hospitals make use of the information you give them?
A. I tell hospitals what the probable technologies of the future will be and when they will become available. The hospitals then have to decide whether they want to participate in various technologies. They must look at all the social and economic implications for their specific facilities. The local hospitals each exist in a different environment.
Q. What will be the major medical problems left to be solved in the future?
A. By the year 2010 I believe that heart disease, stroke, arthritis and cancer will be controllable diseases. Trauma and stress will be the largest medical problems, followed by geriatrics as people live longer.
Ethics will be one of the most important subjects that hospitals deal with . . . because we will have the technology to create and alter life at its start and prolong it at the end. But that is not in my area of expertise. I’m not wise enough to tackle that subject.
