The medical community goes through phases, usually sparked by a technological advance or change in sociopolitical thought. The most recent, preventative medicine, evolved from the age-old idea that a stitch in time saves nine. This might be true…but conventional thinking is not going to make it so.
A case in point is the work of Dr. Robert Grant, a UCSF professor of medicine and researcher at Gladstone Institute of Virology and Immunology. Grant and colleagues proved more than a year ago that gay men who were HIV negative could substantially decrease their risk of contracting the AIDS virus by taking the antiretroviral drugs otherwise used for treatment. The same arguably might be accomplished by heterosexuals. The problem is money.
Antiretroviral drugs are not cheap. If their prophylactic use were applied widely at current drug prices, preventing HIV would be more expensive than treating its victims. Money aside, however, Grant’s research proved that prevention is possible. All it needs is a politico-economic catalyst. This got me thinking.
I was reminded of how great ideas start. From the light bulb to the airplane, early attempts have always produced less than practical results. Who of us would try to read beside a light bulb whose filament burned out in seconds or get on an airplane that crashes less than a minute after takeoff? The point is that first attempts are just that – starting points from which the underlying idea is refined. In most of these, it’s the technology that advances. But why not the politico-economics?
Medical imaging cannot play a substantial role in preventative medicine of the future, if applied conventionally. By definition, medical imaging is diagnostic. And it’s expensive. Efforts are underway to refine the use of PET to use biomarkers of disease that may appear years before clinical symptoms. But, like the antiretroviral drugs that prevent HIV infection, a new generation of PET agents will be deemed too expensive to use to screen for the earliest signs of disease.
If imaging is to be a tool in preventative medicine, more than just the underlying technology needs to develop. The imaging community has to think unconventionally to find cost effective ways to apply “diagnostic” technologies to prevent disease. We must define the advantages that the visualization of these biomarkers provide over simple in vitro tests and then come up with a strategy for their use as part of an intelligent approach to reducing the overall cost of medicine.
This is by no means impossible. Diagnostic imaging has already played this role, dramatically reducing the cost of healthcare while increasing patient safety compared to practices common only a few decades ago, when exploratory surgery was the go-to modality for resolving clinical unknowns. Succeeding at this next challenge could redefine medical imaging for generations to come.