Mr. Cudahy, Ladies and Gentlemen:
I would like to thank Mr. Cudahy for the privilege of talking to you under the unique circumstances of this occasion. How often does one find a corporation with the big business clout of a Marquette Electronics with its fine reputation in the Biomedical Instrumentation field, its manufacturing facilities, its well organized marketing system, its competent, fast moving R & D and its interest in profitable diversification, that still, retains its small corporation agility in making new policy and product decisions wisely and effectively within weeks instead of years? It is even still able to relate individually to the professionals using and specifying its instruments and systems and to their patients and their societal quality of life trade-offs that must be considered in the delivery mass produced medical health care.
The special facility that we are admiring today obviously represents a deliberate effort to create an environment in which there is beauty and comfort, even a little license to stop and think about non-main-line intellectual offshoots of possible importance, without abandoning the healthy drive to get results properly and carefully but soon. My father, who was an informally educated, but intelligent and wise man, put it well in his repeated admonition to “Be careful and take your time to do it right, but for goodness sake hurry up.”
This is a wonderful opportunity to consider exciting new, but realistic, paths and targets in this ever changing field of biomedical engineering and, as I am slowly learning, the limited feasibility of launching them on a propitious trajectory. I hope, then, that I am not going beyond my licensed privilege in this limited time by introducing perhaps a half dozen morsels on which we can later chew. These are principles, not specific instruments or diagnostic procedures, about which we have already heard a great deal, I am relying heavily upon the “idea and algorithm repairman” phenomenon that I discovered some years ago.
If I present a valid and viable concept, device, or system design, in a somewhat
clumsy and not even completely accurate form, but with the central idea clearly
showing, it is remarkable how many physicians, engineers, programmers and computer
designers will rush to my aid in filling in weak spots and correcting detailed
errors or lack of absolute convergence.
My first major introduction to this idea came something like a quarter century ago. I was presenting, in a session on models of brain organization for information processing, a first version of my ideas of a topologically closed model comprising a paired message and code channel, with opportunity for examining meaningfully the dimensionality and scaling of such information with just a hint of the interpenetrating domain topology that is really only getting off the ground today. To my surprise, Norbert Wiener, who was at that time heavily involved in developing cybernetics as a scientific discipline, was in the audience. In the middle of the lecture, as I had just outlined my strategy, he made his way down to the platform, sort of pushed me aside and said “You have been saying something very important but saying it badly. What you should have said is — — — and then he went on to restate my idea in much more mathematically acceptable form that was surely incomprehensible to all but possibly two or three in the room.
Let me now introduce a few topics for you to mull over and return in tidy logical form — but not before the end of my prepared talk!
As a first attack, let me ask whether we have, or have not yet, grown up enough in modeling and in anatomical and physiological understanding, to abandon the homeostatic approach in favor of the homeodynamic. We have almost universally started with assumptions that humans are basically alike until diseased, constant over a short term and members of an ergodically stationary population. True, we will for some years continue to take sequential, non—time—coherent 12 lead ECG records and will analyze them, except for arrhythmias, as if each beat were equivalent to the next, and even average able by simple summation to reduce noise. We use central tendency statistics casually and without guilt. We do not even make multimodal measurements — flow, Doppler, EMG, hemodynamic, autonomic and patient induced patterns simultaneously and coherently. There is much to be learned and even taught to the patient with regard to VCRS and similar phase-lock-loop enhancement techniques. We should surely be learning to select the matching strand that most closely resembles our patient in an epidemiological library skein of lifelong histories. These should indeed be lifelong trajectories of multivariate measurements, medical interventions and their prognoses that we can examine panoramically to enrich our preventive, acute and rehabilitative medical procedures and technological instrumentation so as to give a high quality of life service to the patient. This will require new thinking, new models and displays in cardiology, utilizing fully our new CAD capabilities, new and more accessible records, including time—series data, and heavier computer usage, especially in transponsive tutorial mode.
This is obviously becoming available. As I sat listening recently to a presentation
on solutions to a forward—inverse cellular model of the heart involving a million
“unit cells” and some hours of number crunching by a moderately heavy duty fast
computer with array processor, I could not help but realize that that level
of computational effort and sophistication is now getting into medical practice
and that with a 32 bit CPU on a chip and fast RAM at $100 per megabit, we can
afford the luxury of this new thought style. Building these new “Figures of
Thought” is at least as important as building new computers and software.
Next I come to the proposition that we are social—tradition bound, not technologically limited, in our efforts to bring good economical computer—assisted technology to the front line of health and quality—of— life improvement. I find that we have a marketing, political and salesmanship job on our hands before we can use even the theory and technology that we have available, and are able to invent, essentially on demand.
Have you ever noticed that there are unspoken taboos in the sciences and engineering technologies that are carefully observed but never explicitly mentioned? Physicists don't ask about the dimensioning, scaling, the energetics and modulations of consciousness, even when the physical object being measured happens to be a living, time and environment perceiving human being. Similarly, it is in vogue to wave off with the stylized “Who can put a value on human life?” any even fairly accurate models of cost—benefit evaluation of quality of life so soon as we include components, other than dollars, such as comfort, productivity, longevity, social contributiveness. Good Santosha indices are at least a decade off, but we should be building our informational data base on which to document them, especially with respect to very interesting and cost effective alternative health care styles that are now appearing on the medical horizon and in the home.
Have you noticed the public swing in action and thought as the “medical supermarket” becomes a reality with whole new classes of tests, costs and interpretation?
As I see it, we are entering a new era of patient participating, do—it—yourself,
computer implemented home health care, driven by exorbitant costs of standard
physician, clinical and hospital care. New rules need to be formulated, new
means to automate calls for supplemental help from higher authority, human or
computer, in those few cases when the problem escalates. Otherwise we utilize
primarily the home facility with its real personal concern. Each time I ask
a group like this to propose practical, build able, saleable, legal useable
modules for such a system, in the diagnostic, health maintenance, monitoring,
therapeutic or rehabilitative areas, there are new and interesting proposals.
This is an obvious outcome of the penetration of the microcomputer into the
domestic scene. Do you want to add your ideas? You must see that we are opening
up a very complicated and highly rewarding era if we can design to avoid inhibition
by adversary policy inheritance.
Now — where will the tides of public attitudes and concern allow us to proceed with applied Biomimetic Engineering development during the next few years; and by that I mean 3 to 10 years?
1) “Invasive” is changing its meaning. Ten years ago anything that penetrated the skin instrumentally was “invasive” even though drug therapy and public education, penetrating to the very depths of heart, brain and other organs, was not really considered invasive. Now heart pacers are commonplace and we compare the merits of various designs for takeover of functions much as we compare the merits of prospective car purchases. Implantable automated or manually controlled drug infusers are coming into the market rapidly; we are seeing whole books on cochlear implants and other implantable electronic hardware. We can expect proliferation of implanted and external, attached human interface computing equipment even
though the “prestige” implant of a inultimodal physiological how—goes—it test and adjustment port is probably not expected until after the end of the decade.
2) The Mind—Body problem is just beginning to emerge as a Biophysical— Biomedical area of opportunity about which it is now marginally permissible to talk, much as it became permissible to talk functionally about sex about a dozen years ago.
Evidence builds and builds to indicate that we have elaborate but unrecognized mechanisms for programming our internal biochemical, hormonal and thought processes into our primary and adaptable life programs. You have probably heard of the quite new bi-directional traffic in specially constructed neurochemicals that seems to operate in the gentle old nerve axon, and of the suspicions that high frequency electrical processes may play important intracellular and cell ensemble roles. There are undoubtedly chronological windows of opportunity, when we can, and do, establish our internal communicational and control structure from language skills and muscular coordination to our allergies, disease susceptibilities and mind sets.
In a gentle peripheral way we can access some of these electronically and mechanically with minimal risk and increasing insight. Remember that “noise” in our measurements is largely signal that we do not yet understand. We need to reduce such folk wisdom and witchcraft to new biomedical utility. There is much yet to be done with surface potential and mutual impedance mapping beyond the Electrocardiographic.
3) As a final proposal — much more earthy than the last — I want to explore with you the possibility of linking the new Buzzword “in” area of “Robotics” with our need for systems development in bioengineering to make a triple threat success possible.
“Robotics” is now a favorite topic of discussion and of industrial implementation, largely in the image of the Unimation, Cincinnati Milcron, etc. industrial robots, seized upon and very rapidly and successfully exploited in Japan, and now being reimported back into the United States. Those of us brought up in close touch with biology, medicine, physiology, prosthetics, and bioengineering in medicine, have a tremendous lot of new technology to offer to Industrial Robotics in a simply translated form from human to adaptive machine.
Inversely, though, we have the whole package of Medical Robotics to develop and utilize. While some of these will undoubtedly result in robotic patient handling and services to the handicapped, much more will come of symbiotic robotic alliances with humans. We will learn that meta—linguistic communication in a form that is convenient for humans and for computers alike, is possible, and worth developing.
Much more on the program, for this year and next, is the systems designs, management and marketing plan to get the biotniinetic engineering revolution off of dead center.
Take the top of the bag package that has assured medical and health benefits, at great savings in dollars and personnel. This is the computer— implemented health network, with required data reservoirs, tutorial on—line transponsive programs for diagnosis, monitoring prognosis therapy and even instrument repair. It needs to serve potentially a thousand or so hospitals, and to back—up millions of nearly—self—standing home health computer modular installations.
This obviously needs one or another version of the Center for Innovation and Technology Utilization with its equal—handed participation for small industry, large industry, commerce, academia and government. Competitive—cooperative ventures are needed, with innovative new patterns of ret~ard sharing, regulation and standards. We need to learn new large scale system organization procedures, and marketing with governmental and regulatory assistance rather than primarily policing.
Taken as a target of opportunity, this field makes me think of a huge Smorgasbord
of hundreds of attractive opportunities, all exciting and inducing me to overeat,
but here and now is the New Marquette Facility, eager to go into action with
cur blessing and offers of cooperation. I am not quite sure which direction
it will go, but I am certain it will go and with rewarding results.