Program Date: Good Friday, April 9, 2004
NBR Holiday Specal -- "Med-Tech: Where Technology is Taking Health Care"

Medical Imaging Comes Into Focus
Economist Frank Lichtenberg of Columbia Univ. On The Benefits To Cost Ratio Of Technology
The Outlook For Medical Technology
NIH director Dr. Elias Zerhouni On Exciting Areas Of Research

04/09/04: Medical Imaging Comes Into Focus

SUSIE GHARIB: Here at the NYU Medical Center, giant imaging machines like this one are proof of high-tech's key role in medical diagnosis and treatment. But while we now take technologies like MRIs and CT scans for granted, they've only been around for a relatively short time. Diane Eastabrook takes a look at the amazing progress that has been made in medical imaging over the past three decades.

DIANE EASTABROOK, NIGHTLY BUSINESS REPORT CORRESPONDENT: At Loyola University Medical Center, radiologists routinely use magnetic resonance imagining, better known as MRI scans, for a variety of diagnostic tests. Here they're trying to determine if a patient's pancreas is diseased. Down the hall, a computed axial tomography, or CT scan, is being used to see if cancer has spread in another patient. Thirty years ago, both patients probably would have undergone painful exploratory surgery because CT scans and MRIs didn't exist yet. Dr. Mary Olson, chairman of Loyola's Radiology Department, says over the years advanced medical imaging has saved doctors valuable time and thousands of lives.

DR. MARY OLSON, RADIOLOGY DEPT. CHMN., LOYOLA HEALTH SYSTEM: Basically, the clinicians were very dependent on physical exam which doesn't show many things that are going on in the body. We had limited plain X-ray, but really couldn't look at the intricacies of the anatomy.

EASTABROOK: Around 1975, CT scanners arrived in hospitals. While the machines use X-rays, they produce three-dimensional images of organs and bones. They also show slices of the body. MRI's arrived in the mid 1980s. They use magnetic fields to produce images of soft body tissues like the brain and cartilage. But MRIs also show how various body parts are functioning.

DAVID WEBER, MRI MANAGER, GE HEALTHCARE: We can look at the brain and see how it's laid out, but we can also create MR images of the brain actually thinking.

EASTABROOK: The Blue Cross Blue Shield Association estimates about half of all U.S. hospitals have MRI scanners and more than two-thirds have CT scanners. And while doctors say the devices speed up diagnoses and save lives, critics argue they have driven up the cost of health care. A CT scanner costs between $400,000 and $1.2 million. An MRI scanner costs between $650,000 and $2 million. But despite their high price tags, analysts' say demand for the machines remains strong. GE Healthcare makes about half of the CT scans and MRI scanners in U.S. hospitals. The company says it has significantly improved the machines so they produce faster, clearer images than they did even a decade ago. Newer CT scans can now produce color images instead of black and white ones. GE says upgrades can often be added to existing equipment at a fraction of the cost of buying a new one. But the company says when it does develop entirely new equipment it tries to make affordability paramount.

PETER ARDUINI, GM, GLOBAL CT, GE HEALTHCARE: Some of the earlier CT scanners were more expensive than the scanners are today. And we constantly work on making sure that, one, if the products aren't of the same price level that you actually can do more patients, that you can actually do more applications to make it more economical.

EASTABROOK: Medical imaging equipment has let doctors shorten their patients' hospital stays. But they say the most important benefit of medical imaging is the pain and suffering it has prevented.

OLSON: Frequently, with a cancer, patients would linger for quite a long time. And either between CT scan or MRI, depending on where that cancer is today, frequently we can make the diagnosis much more earlier in time.

EASTABROOK: Newer MRIs can help diagnose cardiovascular disease, breast cancer and some blood disorders. And GE Healthcare says future advancements in medical imaging could be used to diagnose more complex illnesses, like Alzheimer's Disease. Diane Eastabrook, NIGHTLY BUSINESS REPORT, Chicago.

Nightly Business Report transcripts are available on-line post broadcast. The program is transcribed by eMediaMillWorks. Updates may be posted at a later date. The views of our guests and commentators are their own and do not necessarily represent the views of Community Television Foundation of South Florida, Inc. Nightly Business Report, or WPBT. Information presented on Nightly Business Report is not and should not be considered as investment advice. Copyright (c) 2003 Community Television Foundation of South Florida, Inc. ALL RIGHTS RESERVED. Terms of use.

04/09/04: Economist Frank Lichtenberg of Columbia Univ. On The Benefits To Cost Ratio Of Technology

SUSIE GHARIB: Of course, medical imaging and most med-tech carry a hefty price tag which is passed along to patients and insurance companies. The question is, have the benefits of technology justified costs? Economist Frank Lichtenberg of Columbia University thinks so. And when I talked with him, he said, thanks to innovations in medical technology, people are living a lot longer.

FRANK LICHTENBERG, ECONOMIST, COLUMBIA UNIVERSITY: There are a number of factors underlying the increase and longevity, including higher incomes, better education, improvement in the environment and so on, but medical technology plays an important role in that. I've done a study that suggests that as much as 40 percent of the increase in life expectancy in about 50 countries is due to new drugs alone.

GHARIB: But a lot of those innovations come with a huge price tag. According to some studies half the increase in healthcare costs over the last 30 years was due to the cost of new technology. So from a purely economic point of view, was all that spending worth while?

LICHTENBERG: I wouldn't say that all of it was worth while. However I think we can say that on average it was worth while. People live longer than they used to. And also quality of life has improved. There's a lot of evidence that that's very important to people. People are willing to pay a lot to live longer, to improve their quality of lives, and that does represent a big pay off to society.

GHARIB: Would you go as far as David Cutler of Harvard who has said that with the overall improvement in health of Americans that there's no reason for anyone to complain about the rising healthcare costs?

LICHTENBERG: Well, we all like to complain. So - however, yes, I do agree with David that in general there has been a very good return on the investment. It's true that healthcare costs are rising as a percentage of GDP. However what is more important to spend our resources on than improved health? Should we buy more movies or clothing or should we lengthen and improve the quality of our lives?

GHARIB: In economics the general rule is that when the supply increases, the price for goods and services comes down. But that's not always the case when it comes to medical technologies. In some communities there are multiple MRIs and CT scans and still there's a high price. Why is there that disparity?

LICHTENBERG: I'm not sure that I really think that it is different. I think, for example, if we look at the pharmaceutical industry, look what happened when a patent expires and a lot of generic companies enter the market. The price of the drug generally falls by about 80 percent within a year. So competition actually works very well. It may be somewhat different for MRIs and those kinds of innovations, but in general, I think competition does reduce prices in the health care industry.

GHARIB: For authorities at Medicare and private insurers who have to decide whether a new technology is worth paying for, what criteria would you recommend that they use?

LICHTENBERG: Well, I think that the criterion that's commonly used is essentially something called the cost per quality adjusted life year. When we're talking about a technology that does improve and extend people's lives, we want to examine how much longer will people live as a result of this innovation, what will their quality of life be, and how much is it going to cost to produce that improvement? What is perhaps surprising is that economists increasingly have reached a consensus that the value of a year in perfect health is a very high number, a number like $150,000. In other words if an innovation can extend someone's life by one year and that year would be lived in very good health, then it would be worth it to pay up $150,000 for that innovation.

GHARIB: As you know, everybody is concerned by the rising cost of healthcare, and certainly this is going to be a hot topic in the upcoming presidential elections. Is it time to scale back? Is there a limit?

LICHTENBERG: Well, there is a limit and that's 100 percent of GDP. But I don't necessarily think it is time to scale back. I think that we need to focus not only on the cost of healthcare, but the benefits of healthcare. Now the benefits are less visible and are in some cases difficult to trace back to the investments. But I think that if one looks carefully, one sees that on average there has been a very high return on society's investment.

GHARIB: Professor Lichtenberg, thank you very much.

LICHTENBERG: Thank you.

Nightly Business Report transcripts are available on-line post broadcast. The program is transcribed by eMediaMillWorks. Updates may be posted at a later date. The views of our guests and commentators are their own and do not necessarily represent the views of Community Television Foundation of South Florida, Inc. Nightly Business Report, or WPBT. Information presented on Nightly Business Report is not and should not be considered as investment advice. Copyright (c) 2003 Community Television Foundation of South Florida, Inc. ALL RIGHTS RESERVED. Terms of use.

04/09/04: The Outlook For Medical Technology


SUSIE GHARIB: So what improvements in medical technology are on the way? If the technological changes over the next 30 years are anything like the past 30, we can expect some truly major developments. Angela Terrell Heath reports on some that are already in the works.

ANGELA TERRELL HEATH, NIGHTLY BUSINESS REPORT CORRESPONDENT: At first it looks like any other day at George Washington University Hospital. A team of doctors is preparing for surgery, scrubbing for seven minutes. But these hands won't actually do the most delicate work. That's left to a robot. The Da Vinci, seen here, is a high-tech surgical system that's becoming more popular in operating rooms across the country. It's part of a trend towards minimally invasive surgical procedures. Through punctures about the size of a dime, the Da Vinci is able to do the work of a surgeon, but with more precision. Dr. Manyak says this technology will revolutionize the way surgery is done in the future.

MICHAEL MANYAK, CHAIR OF UROLOGY, GW UNIV. HOSPITAL: Try to make things smaller, better, faster, more efficient; very similar to what the computer world went through. And with the combination of computer systems and engineering technology and material science, we now have things that we can apply in the standard world. And you're seeing the first of that in the surgical field with this very sophisticated Da Vinci system.

HEATH: Another area where technology could have a major impact is in the treatment of diabetes. More than 18 million Americans suffer from the disease. Medtronic (NYSE:MDT) MiniMed is currently testing what it calls an artificial pancreas. It is designed to automatically transmit glucose levels to a pump that then calculates and delivers the proper amount of insulin. The system can be placed externally or implanted within the body. Since heart disease remains the nations number-one killer, technological advances are expected in that area as well. Drug-coated stents are becoming more popular for treatment of blocked arteries because of their speed and efficiency in delivering medication. These new stents are used to prop open arteries and also release a drug that prevents the artery from rejecting the stent. AdvaMed, the Advanced Medical Technology Association, represents medical device companies large and small. The group says there's potential for new products in many other areas, including...

STEPHEN J. UBL, EXECUTIVE VP, FEDERAL GOVT. RELATIONS, ADVAMED: Gene-based testing, I think the diagnostics industry is on the cusp of a revolution. Soon we'll have the ability to have a gene-based test that will match the treatment with the patient in a much more specific way. Information technology, we're sort of seeing the bridge between implantable devices like pacemakers and defibrillators with information technology so that patients will be able to upload information directly to the physician and monitor those devices.

HEATH: To meet the growing needs of Baby Boomers set to retire, the Intel Corporation (NASDAQ:INTC) is researching and developing products to help seniors stay in their homes as they age. Wireless sensor technology is considered one way to do that. It's done through a combination of sensors and a glove that reminds seniors about everyday products in their homes. Eric Dishman leads a team of 10 researchers that is studying the application of this type of technology.

ERIC DISHMAN, DIR., PROACTIVE HEALTH RESEARCH, INTEL: We're going to have to develop remote technology so that your cell phone, your laptop, your television, all of those technologies connected with one another can deliver health and wellness information, diagnostic information based on real time diagnostics that you're getting from your mother or father's home. That's a very different paradigm than we have now, where we get all of our diagnostics based on sending somebody to hospital or clinic once every six months.

HEATH: Some of the biggest advances in medical technology are likely to be very small. Take nanotechnology. That's the manipulation of individual molecules and has tremendous potential for treating cancer and other diseases. Angela Terrell Heath, NIGHTLY BUSINESS REPORT, Washington.

Nightly Business Report transcripts are available on-line post broadcast. The program is transcribed by eMediaMillWorks. Updates may be posted at a later date. The views of our guests and commentators are their own and do not necessarily represent the views of Community Television Foundation of South Florida, Inc. Nightly Business Report, or WPBT. Information presented on Nightly Business Report is not and should not be considered as investment advice. Copyright (c) 2003 Community Television Foundation of South Florida, Inc. ALL RIGHTS RESERVED. Terms of use.

04/09/04: NIH director Dr. Elias Zerhouni On Exciting Areas Of Research

PAUL KANGAS: Of course, new medical technologies don't just happen. Generally, they are the end-product of years of extensive research. And the primary federal agency for directing and supporting medical research is the NIH, or National Institutes of Health. With 27 institutes and centers, the NIH pours $25 billion a year into various research projects. They are awarded through some 50,000 competitive grants that fund the work of 217,000 scientists across the country. The person who heads up that complex process is NIH director Dr. Elias Zerhouni. I spoke with him earlier, and asked what he sees as the most exciting areas of research, in terms of the potential for new medical technology.

DR. ELIAS ZERHOUNI, DIRECTOR, NATIONAL INSTITUTES OF HEALTH: Alot of the technologies you're going to see over the next 10 years are going to be applied technology like medical imaging which will go into functional imaging and molecular imaging where we understand molecular events in the brain, in the heart and other places. Also image-guided therapies that use imaging to do less and less invasive treatments are going to grow enormously over the next 10 years. And the other area that I see as a very promising area of technologies, how to deliver drugs in such a way that patients will comply with, for example, the ability to control the glucose in the patient with diabetes. This is what we call sensor-driven drug delivery. Those are going to happen next 10, 15 years. In the meantime, nanotechnolgy is going to grow as the next wave where we can replace completely biosystems that control, for example, renal function or heart function or any of the functions of our organs.

KANGAS: As we noted, NIH sets the priorities and direction for research that often leads to many important medical breakthroughs and products. With so many grant applications in so many promising areas of research, how do you decide which deserve to be supported?

ZERHOUNI: Two ways. One, we look at the public health impact of diseases as we know them today and as we think they will effect the population downstream. So a good example is heart disease. Over the past 30 years, we've reduced the mortality of heart disease by 50 percent. People live longer. Now we're worried about heart failure and we're investing a lot in heart failure. The second is diseases that are emerging, like obesity. So this year, for example, NIH is going to spend 10 percent more dollars for doing obesity research. That's one end of the spectrum: public health necessity. The other is when we look at science, and all of a sudden, there's a discovery that can be used to great effect. A good example is what we call RNA silencing, which was discovered three or four years ago, which has become a way of controlling the activity of genes within cells. And we're using this now extensively and we're funding it, because that's the key to understanding what happens in health and disease.

KANGAS: A few years ago, there was a lot of excitement over the potential for medical breakthroughs arising from the mapping of the human genome, as you've touched on earlier.

ZERHOUNI: Right.

KANGAS: Was that excitement really justified or was it premature?

ZERHOUNI: Oh, it was totally justified. Let me give you an example. This year alone we discovered 12 new genes for schizophrenia. Now, schizophrenia is the fifth cause of disability in men aged between 25 and 44 years old, prime time of life. We've never had an understanding of what was going on in schizophrenia. In Parkinson's Disease, we have four new genes. Last week, we announced the discovery of a master gene in diabetes, in type II diabetes. So the genome has allowed us, for the first time, to compare the parts list, if you will, of an individual who doesn't have a disease with an individual who has the disease, and find out which genes are abnormal in what disease. This is a completely new way of doing medical research.

KANGAS: Indeed, fascinating. Could you tell us about the NIH road map? I understand that you recently set this up to encourage higher risk projects in biomedical research than NIH normally supports. Why do you want to push this kind of risk-taking now?

ZERHOUNI: Because we think it's revolutionary times in medical research. The genome was never there before. The technologies that we have, the high through-put techniques. Right now it takes you about a week to detect a gene if you have the right patient population. You know, in 1985, it would take you five years to find the same gene. So we are putting an investment in a way that will allow innovators to make rapid progress across genomic research. That's why we want NIH to have a very specific road map to accelerate that progress and to change the institution from a traditional way of doing medicine, which was, wait until the patient is sick before you do something, to the 21st Century way, which will be, find out what is going to be wrong and do something about it before the patient is sick.

KANGAS: Turning to the relationship between the NIH and private industry, the NIH has been accused from time to time of stepping into territory that would be better left to private industry, as it was a few years ago during the push to map the human genome. At what point is the NIH supposed to get out of the way and let private industry take over?

ZERHOUNI: Well, let me tell you, as the director of an agency, I don't want NIH to spend any money that someone else is willing to spend to advance medical progress. So we focus on areas where we know no one is going to invest money: basic discovery, basic science. What we call "orphan" diseases, diseases that affect so few people that industry is not interested in investing in that. Where we stop is when we have provided enough knowledge that we know investment will flow in to continue that knowledge for applications.

KANGAS: Thank you, Dr. Zerhouni. And we thank you for speaking with us at this very exciting time in biomedical research. My guest, Dr. Elias Zerhouni, director of the National Institutes of Health.

Nightly Business Report transcripts are available on-line post broadcast. The program is transcribed by eMediaMillWorks. Updates may be posted at a later date. The views of our guests and commentators are their own and do not necessarily represent the views of Community Television Foundation of South Florida, Inc. Nightly Business Report, or WPBT. Information presented on Nightly Business Report is not and should not be considered as investment advice. Copyright (c) 2003 Community Television Foundation of South Florida, Inc. ALL RIGHTS RESERVED. Terms of use.