By Robert Bazell Chief science and health correspondent
NBC News
updated 6/20/2005 5:35:03 PM ET 2005-06-20T21:35:03

As part of the NBC News weeklong series on the "Future of Medicine," NBC chief science correspondent Robert Bazell explores how technological advances in computers and three-dimensional imaging are providing new alternatives to surgery. Training on robotic simulators promises to make doctors better at what they do while fiber optics help some patients benefit from less invasive operations. Deep brain stimulation is allowing some patients with Parkinson’s or other paralyzing diseases live normal lives.

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Yet no matter technological progress doesn’t always mean people are healthier, as scientists in the 21st century scramble to stay a step ahead of drug-resistant, flesh-eating bacteria.

Q. Medical simulators, or realistic robotic dummies, are increasingly being used at medical schools to train students. What are they and how do they make a doctor better?  

A. Simulator technology has really advanced in the last few years to the point where its become very much a part of training in many places for medical students. Traditional medical training has been done on a live patient, but there’s always that frightening moment when you do something for the first time.

Robotic dummies look like department store mannequins. Their jaws can move; their tongues can swell; their breathing feels more rapid and you can feel their pulse. You can bring them back to life with electric paddles. You realize that it’s a dummy, but they can respond in ways far beyond being a dummy.

They have a heart beat and they respond to drugs and medications. People speaking into microphones can have them complain of pains or moan or all sorts of other things. You could have different scenarios where the robot's breathing tube gets blocked.

How many times do you get to see a gunshot wound unless you work in a very busy emergency room in a high crime area? With a simulator you can learn to practice and encounter it.

All those things can be programmed into the computer so you can train for every situation.

It’s not just for physicians and nurses, a lot of training is being done for paramedics and other people who have medical skills that are needed in an emergency. They cost about a quarter of million dollars to a million dollars each depending on how many bells and whistles there are.

Simulators have become a teaching tool for the teamwork needed in the operating room to help avoid medical errors.

It’s a way to practice, practice, practice.

Q. Should they be used to retrain older doctors?

A. The big question is whether these will be used for older doctors who have been out of medical school for a while to test their competency in the way that airline pilots are tested in flight simulators. The concept of medical re-certification is going to become more controversial, but it’s going to happen. It’s very frightening for older doctors to have someone watch them do what they’re doing. But it is the wave of the future.

Q. How are brain science and medical technology coming together to treat disorders once considered untreatable?

A. There’s a technology called deep brain stimulation where electrodes are implanted in the brain to stimulate areas that are affected by movement.

There’s a case of a woman with a movement disorder called dystonia, which gives an extreme stiff neck, almost paralysis. We originally followed her through a treatment of Botox, which can relax muscles. But it wore off. We then followed her through deep brain stimulation. And, for now, she’s doing much better. She couldn’t even eat before and now she goes to the pizza parlor and back to a normal life.

It’s been dramatically successful for some people with Parkinson’s disease. The electrodes have to be precisely positioned and the patient is awake during the surgery. And there’s a long period of adjustment to getting used to the battery pack that’s implanted just under the skin. It doesn’t work for everyone.

Q. What other disorders could be treated with brain implants?

A. There is a lot of thought about using it for other things, including depression. It’s not clear how much it’s going to work or what the potential is. It goes back to lobotomies and electroshock. There have been a lot of crude attempts to implant things in the brain. This electrode implantation has the specificity that you can stimulate very precise areas of the brain. The more you know precisely what each part of the brain does, the more you can possibly stimulate it in this manner.

Q. What are the dangers?

A. Anytime you’re going into the human brain you have potential to do damage. If you’re off by a millimeter you can destroy something precious in the brain, so you have to put the electrodes in exactly the right way.

We’re understanding more about brain science and with this ability to position things in the brain, there’s a way of creating a three-dimensional space that’s almost like a GPS system. The imaging is so good that doctors know within a millimeter where everything is all the time.

Q. Radiologists have begun to perform procedures once done only by surgeons. What is interventional radiology and why is it an important development?

A. It’s a whole range of things that have been emerging for a number of decades. It starts out with the radiologist who took pictures and thought, 'Maybe I can fix things.'

The way they fix things is to stick long tubes called catheters through the blood vessels. They use the blood vessels like a highway system to get to almost every organ in the body. What this has done is created a whole set of alternative treatments for all kinds of conditions.

The best known example of interventional radiology done by cardiologists is putting in angiograms and stents. That’s where they’re operating under a live x-ray picture to put wire into the arteries of the heart to unclog them.

Interventional radiologists have a procedure where they repair uterine fibroids by putting a kind of "Crazy Glue" at the blood source to knock off the fibroid blood supply. The fibroids die. It could be an alternative to hysterectomy for a lot of women.

Other interventional radiology is done with blood vessels in the brain. They can use wire mesh screens for aneurysms and repairing venous malformations in the brain. These are both things that can lead to strokes. Bleeding in the brain can be life-threatening and dangerous.

Interventional radiology can be done for varicose veins and veins in the legs that get clogged and need amputation.

Some cancers that are being treated with interventional radiology, particularly liver and kidney cancers.

You can deliver drugs to the tumor or try to cut off the blood supply to the tumor in various ways. Interventional radiologists can either be guided by live x-rays or by live MRIs. It’s a lot of things at once and it’s a whole trend.

Q. You call minimally invasive surgery a big revolution in surgery in recent years. You're planning a segment this week on a University of Pittsburgh surgeon who operates on the brain by going through the nose. How will people benefit from that technique?

A. It goes under the heading of endoscopy where doctors operate by operating through two small holes—one with a fiber optic video camera and the other has tiny tool. This specific story is about a guy doing minimally invasive brain surgery, where he's removing tumors.

For the two ports into the brain he uses the two nostrils. He goes through the nose. It turns out he can reach an enormous amount of space in the brain. It takes an operation that would normally require days or weeks of recovery in a long hospital stay and makes it much shorter. There’s so much less cutting open of the body.

Gall bladder surgery is now done routinely this way as well as kidney removal. 

Q. Is it safer than traditional surgery?
There’s much less chance of infection, but there’s always a trade-off. You lose space of field. In other words, if you’re taking a tumor out of the colon, a very common operation, it can be done with minimal invasive surgery and it often is these days.

But the thing is, the doctor can’t feel it. You lose touch and that’s a big deal for a lot of surgeons. Especially when dealing with a tumor. You want to feel it and where it is.

But if you open someone’s stomach and intestines, you are risking a much bigger chance of infection than if you're going in through two small holes.

Doctors are operating by watching a TV screen. Once you’ve got these devices going in, you can hook it up to a robot. And by hooking up to a robot, you don’t even have to scrub because it can be automated and operated from a distance. You don’t have to worry about a tremor in your hand. A lot of surgery becomes like a complicated video game.

Q. But all the advances in technology don't always help when it comes to treating disease. What are medical scientists concerned about in the 21st century?

A. Drug-resistant staph has become an enormous problem in prisons and hospitals and gyms. In prisons, it’s very hard to control because prisoners are close together.

The first big outbreak was in the L.A. county jail and now they call it the "new normal." It's there all the time. It really terrifies prison guards. In some cases guards’ families get it. It’s very scary.

They would like to give the prisoners clean uniforms more often, but it becomes budget issues and no one wants to give more money to prisoners. Prisoners aren’t the most obedient people in the world, either. They don’t listen when you tell them to wash their hands all the time.

It goes to show that all the amazing computer technology that we’re talking about, we still have infectious disease threats.

Q. What is the illness?

A. The illness is a painful skin infection that doesn’t go away for a long time. When it started, they initially thought it was spider bites.

In one in ten cases, it can get in the blood and make people very sick. There have been some pediatric deaths. It’s not necessarily fatal, but anytime you have an infection you can’t treat, it’s very frightening.

Antibiotic resistant bacteria is an increasing problem in hospitals, in particular. It has been going on for a long time. It’s a reflection of who comes into the jails. It didn’t exist a few years ago. The new strains have only appeared recently because of overused antibiotics.

Q. What is the scientific community doing to try to overcome resistance to antibiotics?

A. There are a lot of campaigns to get doctors use fewer antibiotics and the public to accept that you can’t always have an antibiotic.

We use an enormous amount of antibiotics in this society. Because natural selection of bacteria will evolve to get around them, and they do, drug companies are trying to develop new antibiotics. But I don’t think anybody thinks the bacteria will lose that race.

Bacteria can mutate a lot faster than drug companies can develop antibiotics.

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