Medicine sans doctors?




Geriatric care is not a depressing affair for 50 of the 70-plus senior citizens in Mumbai's north-western suburbs. Rather it has an excitingtechnological edge to it. They are enrolled in a pilot project with Nanavati Hospital's telemedicine programme which allows doctors to remote-monitor their health. From pulse rate to ECG to lung function, their vital parameters are transmitted in real time, thanks to a made-in-India kit that costs Rs 1.25 lakh. 

Tech is, it would appear, in a takeover mode in the field of medicine. The first thing you acquire in hospitals these days is a smart card. It's essentially your file number in an electronic avatar, allowing the hospitals and their doctors to instantly recall your medical history at a future date. At specialty clinics, you are likely to be handed a computer tablet to browse through health information before meeting the doctor. 

Mobile-based healthcare apps that allow people to keep tabs on their body are already in use — these can monitor fertility, map distance walked or calories burnt. But the tech revolution that is likely to unfold in the next five years is even more exciting. 

Heart surgeon Pavan Kumar who heads the telemedicine centre in Nanavati Hospital says heart care will see huge changes in the coming years. "At present, we give clot-busting medicine that is disbursed throughout the body, but we will soon have nano-robots that will deliver medicines specifically to the site,'' he says. 

Last September, Dr JS Rajkumar used Google Glass to live transmit a surgery he was performing at the Lifeline Hospital in Chennai. Google Glass has a voice-controlled, wi-fi-enabled computer that makes such medical use possible. Such devices, the doctor believes, can change the rural healthcare setup in India. 

Experts feel the march of technology will change medicine forever. At the sidelights of the NASSCOM meeting last September in New Delhi, Silicon Valley venture capitalist Vinod Khosla painted one such futuristic scenario: "I believe we don't need 80% of the doctors; technologies will take over many of the tasks.'' A lot of what he predicts is already happening — from measuring a patient's vital parameters to performing a prostrate removal surgery using a robotic arm. 

In the US, telemedicine is already at work monitoring those who cannot easily access medical services: for example, a driver on a remote highway. Closer home, a tie-up between Fortis Hospitals and GE Healthcare since July, 2012, manages critically ill patients in Raipur and Dehradun through an electronic remote monitoring programme called CritiNext. 

Can doctors truly become redundant in future as Khosla suggests? Trials are on in the West to use nano-robots to deliver medicines to the most inaccessible of brain tumours. An MRI machine fitted in some hospitals in India uses ultrasound to remove fibroids from uteruses. CT scanners already help perform some of the most difficult cancer and neuro procedures. Body sensors are already here. 

But experts maintain that technology can only remain a tool for doctors. IIT-Bombay's Dr Jayesh Bellare, who has been working on developing nano-particles for use in medicine, says a doctor is still needed to handle and direct technology. Cardiologist Sandip Rane who, in collaboration with IIT-Bombay, developed ECG monitoring using mobile phones in 2009, says technology can make medicine more accurate but not quite replace the doctor. 

Dr Rajiv Doshi, the Stanford University doctor listed among scientists who can change the world, concurs. "Technology has the potential to significantly improve the practice of medicine. Specifically, technology will lead to increased awareness about many medical conditions, facilitate more rapid diagnosis and lead to the development of less invasive and safer treatments,'' says Dr Doshi who has recently invented a device to help those suffering from sleep apnea. 

Experts say that India is in a position to do to medical technology what it did to generic medicines: provide easy and cost-effective solutions. "In the US, there has been an explosion of medical technology over the past three decades which seems to parallel a dramatic increase in prices for these technologies. I feel that in the Indian context, there is an opportunity to create cost-effective medical devices for the masses,'' says Dr Doshi, who heads the Stanford- 

India Biodesign programme, a collaboration between Stanford University and the Government of India. The programme has developed low cost, reusable hearing screening device for infants. 

What technology can do is to offer the priceless opportunity for less trained healthcare providers to perform more sophisticated functions. Given the global scarcity of doctors, technology couldn't have provided a better solution.

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