Wednesday, March 09, 2005

Rewiring The Body

Medicine is starting to shift from drugs to implants. The cyborgitization of humanity has begun.

Forty-five years ago, doctors successfully implanted a cardiac pacemaker for the first time in the U.S., providing long-term hope for millions of people with heart disease and creating what has become a hugely profitable -- and still fast-growing -- $10 billion-a-year business. Now, electrical therapy may be approaching an historic transition. Using advances in pacemaker technology, researchers and doctors are finding that rapid-fire bursts of low-voltage electricity can alleviate symptoms in an astonishing number of illnesses in many other parts of the human body. Scourges such as depression, post-stroke paralysis, migraines, sleep apnea, angina, obesity, tinnitus, and digestive tract disorders all may be treated with neurostimulators by the end of the decade. If early-stage experiments pan out, Alzheimer's disease, obsessive-compulsive disorder, Tourette's syndrome, bulimia, and other brain ailments could be next.

Any organ that a nerve can influence -- and that's every organ in the body -- can be affected using this technology," says Dr. Ali R. Rezai, who is director of functional neurosurgery at the Cleveland Clinic. "It's a new era in neurology."

The use of implantable mini-generators is more widespread than you probably think. Already, 190,000 patients are wearing electrodes in their heads to control Parkinson's disease tremors or spinal-cord stimulators to relieve pain or prevent urinary incontinence. Some 30,000 have wires threaded to the vagus nerve in the neck to treat epilepsy, while 60,000 have microtransmitters in the inner ear enabling them to hear. These numbers are likely to grow -- and quickly. One of the most promising devices is a $15,000 neurostimulator for chronic depression from Cyberonics Inc., which the Food & Drug Administration conditionally approved on Feb. 2.
Cool stuff but how the heck are we going to pay for it?
But if only a fraction get an implant, executives at medical-device companies project that overall sales of noncardiac pulse generators should balloon from $1.6 billion today to $10 billion in 10 to 15 years, depending on how quickly the FDA approves new uses.

Nevertheless, as more patients request implants for conditions that drugs can't treat, the creaky health-care system will have to brace itself for yet more financial strain. Today, a patient with migraines might get by on $10 a day for drugs. A neurostimulator, by comparison, typically costs $15,000, or about as much as a heart pacemaker or defibrillator. The total bill can hit $50,000 with doctors' and hospital charges. Equipping just 10% of the estimated 500,000 Americans with epilepsy that drugs can't help could cost $2.5 billion. Even amortized over the average 7 1/2-year life of a device, that $50,000 would cost about $17 a day.
via BusinessWeek Online

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