Minding Your Own Medical Business
By Andrea Braslavsky
Reviewed By Charlotte Grayson
Batman and James Bond, move over! Real-life guys have access to some pretty incredible gadgets and gizmos of their own, with medical devices being among the hottest of these "smart" products to hit the market.
Recent inventions run the gamut from whimsical and wacky to wise and wondrous. There are exercise and fitness trackers to monitor your daily steps and calculate calories burned. Some download the information onto special web sites that tabulate and calculate and offer advice. There are heart rate monitors, and blood pressure monitors, and fitness planners that show you the path to better health and nutrition. There are watch-size water monitors that keep track of how much water you drink and micro massagers that alleviate eyestrain with magnets and acupressure.
People with diabetes can even wear a GlucoWatch, a wrist-worn device that helps them keep tabs on blood sugar levels, supplementing but not replacing -- yet -- the accursed fingerstick method of monitoring glucose.
Among the more helpful products are devices that remind patients to take their medication. This is especially important for patients with complicated regimens (like multidrug therapy for AIDS) and for those with memory problems. Some are simple, sounding a tone when it is time to take a pill.
Others, like one being developed at Baltimore's Johns Hopkins University, are more complex. The Disease Management Assistance System (DMAS), as it is called, has voice recordings that instruct a patient on what drug to take, what side effects to expect, and what to do about them should they occur.
If the patient doesn't press a button signaling he has taken the drug when scheduled, the device continues to beep periodically. Even better, a physician can download this information to find out how well a patient is complying.
And no more need for Mom to nag you about brushing your teeth -- a new high-tech toothbrush will beep you when it's time to clean the pearly whites, and will make sure you do it the proper length of time.
"Studies show that people dramatically overestimate the amount of brushing time," orthodontist Douglas Ramsay, DMD tells WebMD. Two minutes is optimum, he says.
To help you keep you to that timetable, a new kind of toothbrush will emit a tone every 30 seconds, which alerts the brusher it's time to move on to another quadrant of his mouth.
"That way, it gets you to brush for a full two minutes and distributes brushing time throughout all the teeth," Ramsay adds.
"These microelectronics are built into the toothbrush, so they give people feedback about their use in order for them to regulate their own behavior," says Ramsay, an associate professor at the University of Washington School of Dentistry. It works, he says, because the features are built in to the toothbrush and don't add extra steps for you to remember.
Ramsay is working on his own smart device, one that tells patients, parents, and the orthodontist how much time a child is wearing a removable appliance -- for instance, a retainer.
"There is greater appreciation about the role that a patient's behavior plays in determining his own health outcomes -- whether it's exercise, smoking cessation, modifying diets, following regimens like taking pills, brushing teeth, and wearing orthodontic appliances," says Ramsay.
This has led to a growing recognition that devices, in addition to having their basic biological, physiological, or pharmacological therapeutic benefits, should also integrate the technology to help patients use them better and more faithfully.
"They have to help the person do what we want them to do," he says.
Don't Call These Gizmos Gadgets
"I think I have a concern about the word 'gadget.' When you put together the words 'medical' and 'gadget,' what you don't want to have are medical toys," says Cecelia Horwitz, MBA, associate director at the Center for Future Health at the University of Rochester in New York.
Rather, she says, think of these products as data-collecting devices intended to empower the consumer.
"It is not a gadget, but is something that is part of your life and gathers information for you. ... It is ubiquitous, integrated into your life, and you don't have to bend for it. Smart technology recognizes changes in a person's condition, and it provides information for them to take action on own behalf."
At the Center for Future Health, Horwitz says, scientists are working on several different products, including eyeglasses that can remind people with memory problems of the names of friends and relatives, and smart bandages that help physicians figure out which particular bacterium is causing an infection.
Home, Sweet Smart Home
Perhaps the mother of all gadgets -- for lack of a better word -- is what Horwitz calls "the smart home."
"Imagine your home being outfitted with equipment that [is] very friendly to you," she says. "For example, a medical advisor you could talk to and say, 'I don't know whether I took the right pills today' and you show it your pills and it's able to tell you. Or you could ask it, 'When was the last time I went to the doctor?' or 'How is my blood sugar level today?' and it could answer you in a way that is easy to understand.
"And what if, in that home, your bathroom mirror is a smart mirror and it scans your skin as you look in it to see if there are any hints of abnormalities that might lead to skin cancer?" she continues. All that data would go to the electronic medical advisor, for the patient to do with as he wants, she says.
"With smart medical technology, people will be able to monitor their health, take early action, and be much healthier, for much longer, in their own homes" Horwitz says.
And it's not just a pipe dream, she says. The technology for smart homes -- and even a prototype -- is already available. And soon it should be affordable.
"This is intended to be affordable. That is what our whole mission is about, to invent affordable technologies and products to help people stay healthy in their homes," she says.
Clothes Make the Man (Healthier)
Simplicity, information, and affordability are also the driving forces behind Sundaresan Jayaraman's research at the Georgia Institute of Technology.
Jayaraman, PhD, a professor of textile engineering at Georgia Tech, has been working on the smart shirt. This item of clothing contains a plug-in sensor that unobtrusively monitors a person's heart rate, ECG, respiration, temperature, and a host of vital functions, alerting the wearer or his physician if there is a problem.
One of the first applications for the product will be for babies at risk of sudden infant death syndrome (SIDS), Jayaraman says, and for patients who need around-the-clock monitoring, such as very ill geriatric and heart-bypass patients. But eventually he sees everyone wearing them -- and predicts they'll even come with lifestyle-enhancing options, like an MP3 player or a dictation machine.
Driving Jayaraman's research, he says, is his love -- and concern -- for his aging parents.
"One of the things I worry about is my parents who live in India," he says. "I want to be able to give them some shirts and monitor their health from Georgia Tech. That way I feel secure that they are in great shape. Should something happen to them, automatically it calls their personal physician and I am also notified, so whatever needs to be done can be done."
Like the smart home, the beauty of the shirt lies in its ease of use.
"My philosophy is: When you use a microwave oven, you just put in coffee and punch in a time; you don't have to know about what the microprocessor does," he says. "My ultimate goal is to turn clothing in something like that: You don't have to be an expert in either clothing technology or computing technology -- just put it on, and it does what you want it to do, under your control. This is what I call invisible computing."
And the learning curve needs to be a shallow one.
"When I am sick, do you expect me to use a manual to learn how to use a gadget? It needs to be intuitively obvious to the casual observer," says Jayaraman. "We need our medical gadgets to head in that direction."
While many of these devices sound promising, only time will tell if they destined to be embraced by the masses and the marketplace -- or if they'll end up gathering dust in Minneapolis, in the Museum of Questionable Medical Devices.
Originally published May 21, 2001.
Medically updated June 26, 2003.
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