That's the system we had in the 1970s (government owned the patent to government-funded research). And what happened is that the government didn't know what to do with the patents, and the inventors, who were best positioned to commercialize their invention, could not justify spending time and money to commercialize something that they didn't own. So the Bayh Dole act of 1980 allowed universities to commercialize their federally funded inventions. The result was an explosion of startups, especially in the biotech industry.
Example: John Adler received some government funding to develop Cyberknife (image-guided radiation therapy). But he couldn't get follow up funding to commercialize this revolutionary new technology. So he took out a second mortgage on his house to commercialize the invention. And now image-guided radiation therapy is a standard treatment for many types of cancer. There's no way he would have taken out that large personal loan, if he didn't own the intellectual property.
There's a large gap between a patent, and a commercially viable product. And if you showed the patent to "experts" in the field, they would likely tell you that it's worthless. Great ideas are only obvious in retrospect. The inventor has the vision, motivation, and knowledge to make their invention a reality, but they can't quit their job and get external funding, if they can't own their invention.
The research results should not be patentable. If someone wants to then productize the research, they can patent any methods they can independently come up with, as long as they didn't use public money for that as well.
That is plenty of latitude for seeding start-ups and commercializing technology. There is no need to lock up the actual research so that only the researcher and their university can commercialize it, protected from competition. It does a disservice to the people who's money paid for the research behind it.
> Life would be simpler if only these hospitals could set aside their arrogance and just go with the recommended workflow!
This would be like asking programmers to standardize on the recommended programming language.
we would love to just use the recommended workflow, if it worked for our hospital. There are differences in the patients, doctors, local regulations, existing systems, etc between hospitals.
Patients: Top cancer hospital does a lot of clinical trials, so some of the forms require you to fill out clinical trial information for every patient. In a maternity ward, it would not be appropriate to ask about clinical trials for every patient.
Doctors: Hospitals are staffed differently. If the hospital has residents, some of the work can be delegated to residents. If not, someone else has to do it. The workflow needs to account for who is actually available to do the work.
Local regulations: Medicine is highly regulated, and each state and hospital has its own rules.
Existing systems: Hospital computer systems have been around for decades, and usually it's not possible to migrate everything to a new system, so the new system needs to integrate with the old systems that couldn't be upgraded.
In a hospital or healthcare system, all of the doctors can generally see all of the imaging, labs, and notes for all patients. The problem with "curbside consults" -- where another doctor provides an immediate opinion without seeing the patient -- is that 1. The other doctor often doesn't get the full picture without doing a full evaluation. 2. Increased malpractice risk 3. It's not billable.
I'm a doctor, and in my own experience, my first impression from just seeing the images and talking to the other doctor is sometimes completely different from my final opinion after reviewing the chart and seeing the patient.
Wait times are also a problem, because hospitals and clinics like to operate at close to 100% capacity. There are huge fixed costs in a hospital, and hospital profit margins are often <5%, so that's why they have to operate near capacity.
I suppose that all makes sense, and what to me seems like a simple "Look at x-ray, and tell me if you see a broken bone" operation may be more complicated than I am imagining. But I still have a hard to shake feeling that there has to be something better than "Start a whole new workflow with another doctor within the same system, beginning with an in person appointment".
Interventional radiologist here. The short answer is "no." I personally perform more than 100 different types of procedures, but there are lots of variations of each procedure, and different techniques for performing the same procedure. (And you need to know what to do when something unexpected happens in the middle of a procedure)
There are thousands of CPT codes, and even more procedures, since one CPT code could describe multiple different procedures, and some procedures involve combining multiple CPT codes. There is no formal approval process for new surgical procedures, and there is no comprehensive list. New procedures are invented all the time.
Your best bet is to pick a specific area, then find a surgeon to shadow. A lot of details of surgical techniques are not written down anywhere, and you learn by working with other surgeons. There are a few books that go through the basic procedural details. For example, Zollinger's "Atlas of surgical operations" is a good reference for abdominal surgery, and Kandarpa's "Handbook of interventional radiologic procedures" is a good reference for interventional radiology procedures. "Biodesign" by Zenios is a good introduction to inventing new medical devices.
How can there be no formal approval process for surgical procedures? This drives me crazy. Surgical procedures should have a high evidence standard just like drugs. Otherwise how can a patient be confident in the science?
My father was a neurosurgeon. Sorry to burst your bubble, but when you go to someone like him, it is not called medical science. It is medical practice.
The medical industry does not provide the information required to be confident in your personal outcome. At best they can provide statistics about populations. On an individual basis, it is an absolute crap shoot.
I think you can relax - because there is a very high evidence standard in surgery. It’s just not regulated in that traditional sense because there are way too many variations and caveats to everything. There are a million niches and each one is occupied by a tiny group of specialists who know everything about theirs. I know this because I’ve been to their conferences and they invest a lot of energy into collecting statistics, verifying hypotheses, trying out subtle improvements etc. And then they argue for ever and ever about which approach delivers an ever so slight advantage or improvement.
There was a study out of the UK on here recently that seems to indicate most Orthopedic surgeries are worse than no surgery. So I'm very not relaxed :)
Thanks, I did have the sense that it would be impossible to formalize all the variations. So, perhaps I should not have written "exhaustive". I just would like something more complete than my initial searches revealed.
I think that, yes, eventually we will need to have the robot surgeons watch operations and listen to / question human surgeons. The problem is that we're not really able to have a robust teaching / learning conversation and show/tell with and AI yet.
Another thing to keep in mind is that “one” procedure often involves multiple CPT codes. Sometimes the CPT codes change during the procedure, based on what the surgeon finds. The hospital should be able to give you an estimate of the cost. Ask your surgeon to help if you are having problems getting information.
My lab uses an engineering approach to develop new minimally invasive cancer therapies, and some of the new therapies are already being translated into early phase human trials:
http://www.edboas.com/lab/
We're hiring biomedical engineers, so please contact me if you're interested.
I'm pretty sure you are well compensated and all that (though probably not as well as your bosses), but also just personally, thank you to you and everyone in your lab.
Cancer killed my grandfather, my best friend, my aunt, and so many other people I know, and what you are working on isn't just making money, it's saving lives.
Yes, we induce pancreatic cancer in pigs, and then we try to treat the cancer.
One important question is why so many new cancer treatments are successful in mice and rats, but then fail in human trials. You could point to genetic differences between mice and humans, but I think another important factor is simply the size difference. Just like a scale model of an airplane won't fly the same way, there are also scaling laws in animals. Large animals have a lower metabolic rate (per kg), require lower drug dosing (mg/kg), have more defense mechanisms against cancer, and have differences in blood flow and many other variables. We suspect that cancer treatments that work in pigs will be more likely to also work in humans.
The size of the tumor likely makes a big difference too: a centimeter-sized lump contains 1000x more cells than a millimeter-sized one. It will contain 1000x more drug-resistant cells (given identical mutation rates). For example, a human brain tumor is likely to already contain hundreds of cells carrying a mutation for every amino acid in every protein. Thus for any inhibitor drug you try, hundreds of cells will already be resistant, and they will grow back the tumor in just a few months. That’s much less likely to be the case in a mouse tumor.
You could also say that induced cancers are somehow different from naturally occurring cancers so treatments targeted toward 'artificial' cancers fail to work on real things.
If the fluoro (X-ray) machine fails during a procedure, you can either bring in a portable C-arm, or move the patient (mid-procedure) to a different procedure room with working equipment.
If the power goes out and the backup generator fails during a procedure, people take out their cell phones and use the flashlight. If the patient is intubated, you can manually ventilate the patient.
If the equipment you need for an emergency procedure is not working, there is often an older, lower tech method to do the same procedure, or at least stabilize the patient.
If the electronic medical record system goes down, you can use pen and paper. Those records are then scanned in or entered into the EMR when it's back up.
Unexpected things happen a lot in medicine, so it's good to always have contingency plans.
This site has thousands of anonymized MRI and CT images of normal and abnormal scans, with clinical history in many cases. For example, here are annotated scans of normal anatomy:
One challenge with writing web DICOM viewers is the lack of full 16 bit image support in browsers. This requires writing custom code to properly handle window / level on 16-bit medical images.
Example: John Adler received some government funding to develop Cyberknife (image-guided radiation therapy). But he couldn't get follow up funding to commercialize this revolutionary new technology. So he took out a second mortgage on his house to commercialize the invention. And now image-guided radiation therapy is a standard treatment for many types of cancer. There's no way he would have taken out that large personal loan, if he didn't own the intellectual property.
There's a large gap between a patent, and a commercially viable product. And if you showed the patent to "experts" in the field, they would likely tell you that it's worthless. Great ideas are only obvious in retrospect. The inventor has the vision, motivation, and knowledge to make their invention a reality, but they can't quit their job and get external funding, if they can't own their invention.