THE ARRIVAL OF ELECTRONIC MEDICINE

...It can thus make readily available the profession's combined experience...

...There they are quickly read and evaluated, and the likely diagnoses, listed in the sequence of their probability, are flashed back by voice over the long-distance telephone...

...The computer's power, moreover, cannot be measured by its tremendous speed alone...

...As the coded information moves swiftly through the maze of tubes or transistors, all diagnoses with which it is not compatible are eliminated and channels are kept open for those diagnoses which fit the particular circumstances...

...The consensus among authorities is that computers provide prodigious tools for making medicine a more precise science, immeasurably increasing the speed and accuracy of medical examination and diagnosis, deepening the understanding of disease, and improving the quality of surgery...

...The first steam engines were about ten times as effective as animal power...

...The results of around-the-clock medical monitoring by these and other instruments can be fed into computers to sift out the extraneous data and provide a sounder basis for quick judgment by physicians...

...Radio pills, swallowed by patients, transmit a running account of conditions within the gastro-intestinal tract to an outside receiver...

...Computers, however, have in one sweep brought about changes of as much as seven magnitudes...

...The computer, with its astounding ability to store huge masses of facts and process them into logical deductions, promises to alleviate some of the perplexing problems posed by this huge stockpile of medical knowledge...

...They scan X-ray pictures by transforming the images on the film into a sequence of voltages and relating the value of each voltage to the density of...

...Surgeons and anesthesiologists receive similar warnings of impending trouble during operations, from a computerized monitoring system at the National Institutes of Health's Clinical Center at Bethesda, Maryland, the Federal government's major medical research center...

...What makes it unique is that it is a thought-saving device enlarging brain power just as other man-made machines enlarge muscle power...

...As medicine continues to grow in complexity, the application of automation techniques is beginning to clarify the relationships between cause and cure and illuminate the whole pattern of health and disease...

...The University of Chicago reports that it takes one of its computers—not the newest type—an hour's time to do the equivalent of a million hours of desk calculator work...

...Ultimately, many experts believe, electronic machines will be widely used in diagnosis to detect multiple correlations which the unaided mind cannot always encompass, to sort out the important from the irrelevant, to eliminate as much as possible, human errors of judgment and bias, and to pool the combined experience of the best diagnosticians so that it is readily available to all doctors...

...But few people realize, as yet, that the use of the wizardry of high-speed computers and a host of other electronic devices in medicine is beginning to portend dramatic advances in the battle against disease...

...Electronic data-processing devices are not only providing a substitute for mental effort but are enhancing and disciplining the brain power of men, forcing them to think with greater precision and clarity...

...From such information, doctors may be able to determine the safest drugs and techniques to insure a beneficial outcome for both mother and child...

...They screen the tapes of the electrical action of the heart and brain, instantly spotting any deviations from the normal pattern...

...They can relieve doctors and nurses of many routine tasks and enable them to devote more time to patients requiring special care...

...To use the nine-pound portable cardiograph, which is the size and shape of a small tape recorder, the nurse first tapes the attached electrodes to the patient's arms and legs...

...The sensors translate such body variables as temperature, blood pressure, and sound into electric signals for instantaneous recording...

...The principle involved in computerassisted diagnosis has been compared to the operation of the dial telephone system...

...light in the photograph...

...The computer's ability to gulp in information and problems, analyze them at an incredible number of steps per second, and pour out the answers makes it a powerful instrument for aiding doctors in the thought processes required for diagnosis and treatment...

...Automation and preventive medicine may provide at least part of the answer to the perplexing problems of pyramiding hospital and medical costs, the chronic shortage of nurses, and the scarcity of physicians...

...The machine's superiority lies in the fact that 1,000 men with desk calculators would be unable to duplicate the computer's performance because each man could not have ready access to the vast amount of data accumulated by all of the others...

...Over the centuries, man has gradually shifted much of the burden of physical labor to animals and machines...

...In all of medicine there is no more subtle blend of art and science than the process by which the doctor draws upon his accumulated store of knowledge, and supplements it with intuition, to identify disease on the basis of physical symptoms and laboratory findings—and then formulates the proper course of treatment...

...A computer programmed for diagnosis uses substantially the same medi-od in translating symptoms and related data into disease possibilities...

...The electronic control system keeps constant track of pulse, respiration, temperature, blood pressure, and arterial oxygen...

...The Arrival of Electronic Medicine by SELIG GREENBERG Much has been written in recent years about the computer revolution and its profound effects on our economy, on scientific research, and on military strategy...

...It could not even have been attempted without it...

...So vast has become the steadily growing accumulation of medical knowledge that no doctor, not even a specialist in his limited field, can possibly retain in his mind, and utilize, all the available information...

...A portable EKG machine, now being tested by the U.S...

...Using his knowledge and experience, he may sift numerous facts before drawing tentative conclusions and acting accordingly...

...When she hears an answering signal, she gives the patient's code number and inserts the telephone mouthpiece into a special receptacle which amplifies the minute electrical currents in the skin reflecting the motions of the heart and converts them into high-frequency signals for clear transmission...

...Upon dialing the second letter, nine-tenths of those remaining are eliminated...

...But it is far superior in rapidly detecting subtle combinations of symptoms and making multiple correlations...

...Clark Randt, professor of neurology at New York University's School of Medicine, has said, "tremendous data storage capacity, an equally vast ability to accept and remember complex instructions on what to do with the stored data, plus yes-or-no decision-making characteristics, plus a reaction time in microseconds [one-millionth of a second], and you have a truly formidable tool for medicine...

...The computer can store and remember far more information from many sources than the average physician can hope to acquire in a lifetime...

...In order to take advantage of the tools of the electronic age, some of the physicians of tomorrow will be trained not only in medicine but also in mathematics and engineering...

...When you dial the first letter of an exchange, possibly nine-tenths of the telephones in the local system are automatically eliminated from consideration...

...Automatic data-processing machines have been in use in medical research and practice for only a few years...

...While they have already chalked up some remarkable accomplishments, it is believed that their potential value in medicine has barely been tapped...

...Automatic monitoring devices, linked to computers, hold dramatic possibilities for improving patient care and hospital administration and reducing their costs...

...The tide of change impelled by the computers has often been called the Second Industrial Revolution...

...Public Health Service, enables nurses to take electrocardiograms routinely in patients' homes and have them immediately analyzed by a computer in Washington—all for one dollar a heart...

...When a doctor seeks to translate a set of physical symptoms and laboratory findings into a diagnosis, he resorts to the private data-processing system in his own brain...

...Fed simultaneously into the electronic data-processing equipment at MIT through a direct telephone hookup from the three hospitals are electrocardiograms and records of eye, ear, and motor coordination disorders which are stored in the computer's memory and diagnosed within a matter of seconds...

...Electrocardiograms are usually taken from different positions on the body, and each one may produce somewhat different information...

...They are expected to become standard equipment in every large hospital and research laboratory and to exert a far-reaching influence on the practice of medicine in the years to come...

...He has twice been honored by the Lasker Foundation for his writing...

...The scope and direction of medical research are being radically altered...

...The machine does the job in less than two-hundredths of a second, which is infinitely faster than the time it takes to fix the tissue on glass slides for study under the microscope...

...But the computer is not merely an improved version of labor-saving SEtIG GREENBERG is a prize-winning writer on medical and related problems for The Providence Journal and Evening Bulletin...

...Pacemakers are transistorized, battery-powered radio oscillators which are permanently implanted in the bodies of patients suffering from heart-block and connected by electrodes directly into the heart muscle to keep it beating regularly...

...He then observes what happens thereafter, to see if it confirms or refutes his initial decisions...

...The computer, into which electrocardiograms are fed after being converted by a special machine from a graph form into electrical impulses, has the advantage of being able to evaluate the recordings from different dimensions at the same time...

...This was all the more remarkable in that, in sifting through the information on 268 patients fed into it, the computer had to correlate twenty symptoms and laboratory findings which usually indicate thyroid problems...

...And by reducing many of the subtleties of diagnosis to mathematical formulas on the basis of past experience, it can quickly zero in on the probability that a given disease exists...

...Still another computer in the nation's capital is being used by the Public Health Service to scan tissue samples for the detection of cancer...

...The whole procedure, including the recording taken from the patient, requires less than ten minutes...

...Engineers at the Massachusetts Institute of Technology in Cambridge, Massachusetts, and doctors in three Boston hospitals are collaborating to sharpen the newest weapon, provided by the computer, in the war against disease...

...The ease with which they do this has tremendous possibilities for the early detection of disease...

...Steam locomotives and automobiles were about ten times faster than animal-drawn vehicles...

...At Georgetown University, in Washington, a computer receives impulses from sensors attached to women in labor, screens out the maternal heartbeat and other noises, and provides obstetricians with a continuous record of the fetal heart rate...

...If a mother with a complicating disease is expecting a baby, the machine can produce records of similar cases from all over the country...

...Using built-in directions based on the best available diagnostic criteria, computers avoid the errors of human prejudice or neglect, and process the recordings at enormous speeds...

...Since each physiological process involves a large number of components interacting with one another, the computer with its phenomenal capacity to store and correlate huge masses of information should provide a more integrated view of how the human body functions, and give new dimensions to medicine...

...In a number of tests the electronic apparatus has consistently provided diagnoses as accurately as a panel of experts, and has outperformed them as individuals...

...Next, she picks up the patient's telephone and dials a number...

...So far, at any rate, the computer cannot incorporate in its calculations the nuances of the doctor's clinical judgment and his assessment of the patient as an individual...

...Since the average doctor may see only a few cases of thyroid disease a year, he frequently lacks the judgment on the probability of association between one of these factors and a specific condition...

...The recorded signals are then transmitted into the computer which instantly reports whether there is any abnormality...

...An example is a study of 140,000 cancer records compiled over a period of seventeen years...

...This alerts them to the possible need for emergency action...

...Its capacity to store in its memory a large volume of medical observations, and to draw on it as needed, enables it to pinpoint early signs of disease and the complex interrelationships which are now all too often overlooked...

...Aside from the sheer drudgery of the task, it is not uncommon for doctors to differ among themselves in their interpretations of the findings...

...When a trend is detected, further research is directed toward pinpointing a cause of infant deaths which might be corrected...

...This disorder is difficult to detect because it occurs at irregular intervals and the electrocardiogram may miss it...

...Most of us have read with wonder and bafflement of how the scientists accomplish their feats, about the instantaneous electronic analysis of data which permits physicians to keep a constant check on the heart and pulse rate, and the temperature and respiration of astronauts telemetered from satellites orbiting the earth...

...One authority has compared the effect of the transfer of more and more tasks to the computer to the kind of change that occurred when written language appeared and made it possible to record man's doings, thus freeing mankind from dependence solely on memory in the accumulation of knowledge...

...The reading of X-rays and of the serpentine squiggles of electrocardiograph (EKG) and electroencephalograph (EEG) machines, which sometimes turn out literally miles of charts in measuring the heartbeat and the electrical activity of the brain, is a taxing and time-consuming job...

...The addition of the inanimate energy of steam and electricity to the muscles of men and animals, which began in England around 1760, brought about changes on the order of ten, which mathematicians call one order of magnitude...

...Many research projects now under way would have been impossible before the advent of the electronic apparatus which can solve, in less than an hour, problems that only about a decade ago would have required as much as 700 years of work by a skilled mathematician using a desk calculator...

...Significant leads to the causes of infant mortality are being provided through a study by the American Medical Research Foundation to which more than ninety hospitals throughout the nation have been supplying obstetrical records for the past five years...

...The electronic helpers are studying brain waves and electrical patterns of the heart, investigating obscure correlation-ships in a long list of diseases, scoring psychological tests, and even keeping track of the fetal heartbeat while a mother is in labor, so that it can be determined immediately whether the infant is in distress...

...The Lancet, the leading British medical publication, recently commented that the application of the computer "to problems of interpretation and decision traditionally left to the unaided human intellect begins to introduce a new dimension into the research worker's use of his brain—just as, for example, the microscope has transformed the range available to the use of his eyes...

...Add together," Dr...

...This massive reckoning was accomplished by four persons using a computer...

...Among these ingenious medical tools are tiny sensors for subtly detecting and measuring physiological functions, which are affixed to the skin or inserted in a body orifice, and pacemakers, radio pills, and devices for a continuous check on patients during critical operations...

...In turn, aircraft outsped land vehicles by another order of magnitude...

...In one of these tests, it came up with a record of ninety-six per cent accuracy in diagnosing thyroid abnormalities—a performance that a top specialist would be proud of...

...The MIT computer not only evaluates the EKG signals sent in from Massachusetts Memorial Hospitals but is also helping that institution study the causes of cardiac arrythmia, in which the heart occasionally skips a beat...

...Pouring by telephone into the same computer center in Washington are regular electrocardiograms of heart patients from a number of Veterans Administration hospitals throughout the country...

...It is then up to the doctor examining them to try to arrive at an overall picture of the heart's condition by a process of juxtaposition...

...Because of the computer's remarkable capacity to store information in its electronic memory and to analyze it through lightning-fast application of mathematical formulas, it can easily outshine the most brilliant human brain in the speed, and often, also, in the accuracy of such probability calculations...

...As computers are gradually adjusted to the language of medicine, and medicine to the language of computers, many of the concepts of medicine will be refined with greater precision to gain more penetrating insights into the cause-and-effect mechanisms of disease and to develop more potent weapons for controlling it...

...Electrocardiograms taken in a doctor's office, or a hospital, usually cost ten or fifteen dollars...

...These new powers are being used increasingly to screen diagnostic records, scan X-rays, monitor the condition of patients during surgery, test new drugs, and analyze and correlate large quantities of medical data...

...In a number of medical centers and laboratories, computers are analyzing mountains of data, testing the efficacy of new drugs, opening up new areas of research, sharpening the diagnostic insights of physicians, and providing guidelines to the streamlining of hospital care...

...At the other end of the line, a receiver automatically switches on a tape recorder when the nurse's call comes in...

...This process goes on until the last digit dialed eliminates nine of the ten remaining telephones in favor of the one desired...

...The computer has no peer in this ability to correlate and assess the interplay between many variables which has rendered practical many tasks that were impossible only a few years ago...

...Backing up the computers is an astonishing array of new electronic instruments which make possible continuous physiological monitoring—the automatic measuring, recording, and watching of the condition of patients...

...Although this process has always been surrounded by an aura of mystery, much of it is a matter of calculating the probability that a given constellation of symptoms, laboratory tests, and X-rays can be explained by a certain illness...

...They also open up new horizons for preventive medicine through the inauguration of regular health check-ups on a mass scale, and other programs designed to keep people out of hospitals...

...Automated search for the likely diagnosis can be particularly helpful in areas where the human capacity to remember and combine information is overtaxed by the need to consider large numbers of variables...

...This study, recently completed at the University of Texas Anderson Hospital and Tumor Clinic in Houston, produced important information on the bearing which follow-up treatment can have on the recurrence of malignancy...

...machinery...

...Some of the most advanced models are about 10,000,000 times as fast as the mechanical calculators they replace...

...Prompt detection is essential for an understanding of a disease and the ultimate development of effective methods of treatment...

...Electronic data-processing machines provide a powerful new tool for assisting with this intricate burden of association and deduction and improving the diagnostic results...

...Detailed information about each birth is stored in the computer for future use...

...While the use of computers for medical purposes is still sporadic and often on an experimental basis, the experts confidently forecast their wide application in clinical practice in the reasonably near future...

...A computer at the project's headquarters in Philadelphia culls through the data to find relationships between the age of a mother and the weight of her baby at birth, the type of anesthesia used, the number of weeks of pregnancy, and other pertinent factors...

...But a complete record of such heart aberrations can be obtained when the patient is continuously monitored by sensors attached to his body and the information is transmitted to a computer...