Tiresias sees further

“Health isn't everything, but without it, everything else is nothing.”

Arthur Schopenhauer

My friends,

Today, Tiresias is in a slightly musing kind of mood. He wants to reflect on some things he's discussed before and will talk about again, but for today he would like to muse a little on his favourite topic, medical history. Please indulge him a little.

Today Tiresias wanted to discuss some topics he has addressed before, but also some he has not. He wanted to discuss some further radical revolutionary applications of Optiscan’s confocal in vivo Endo microscopy (CLE); to wit, in vivo digital molecular imaging. He also wanted to discuss the very special case of commercialisation of medical technology, in the current medical and medical regulatory environment. He has discussed these issues in historical terms starting with the introduction of anaesthesiology and antisepsis and compared the uptake of the two. He also wanted to discuss the valuation of medical technology and its comparison to valuations of other technologies. He however has decided that this will require many more posts and he does not want to tire his faithful audience. Today he would just like to muse on his own personal experience in observing intimately, firsthand, the introduction of two revolutionary technologies which have transformed medicine, and in particular cancer management. Today he would like to reflect on his view of the introduction of MRI scanning and PET scanning.

You see, Tiresias has been around. He has not always been blind. He has seen. He was a medical student when one of the first CT scans was brought into the major teaching hospital in his capital city in Australia. As a medical student he filed past and paid obeisance to the new technology. It was thought that each state would have one or two CT scans. These were just scans for the brain. Some of the senior doctors thought they were totally unnecessary, as a neurological examination was better.

In 1984, Tiresias was a young and up-and-coming doctor, when MRI scanning first came in. He sat in a meeting at the same major teaching hospital to have one of the first MRI scanners introduced into Australia. The Medical Superintendent of the hospital, for the younger readers these days this person will be called a CEO, was adamant that MRI technology was a research technology and there was no room or money for an MRI scanner in a clinical setting, and we were not going to have one. In 1988, after Tiresias had returned to Australia from the US, have obtained what was then regarded as an essential degree for a specialist, his BTA (Been To America), there was still no MRI scanner. The first MRI scanner in his hospital was introduced in 1989 and remained the only scanner in the town, for a number of years. It was thought this was quite enough for the demand. It was and still is highly regulated by the government. To get a scan in those days, a specialist, and only some specialists, could request the Head of MRI, to be considered. This was the case through the 1990’s and into the 2000’s. Today however, there is a scanner on almost every corner, and can be ordered by anyone. There is in fact competition and incentive for anyone to request MRI scanning. There are MRI scanners in the veterinary hospital and some of them will do MRI scans so you can have your cat or dog scanned. There is even insurance for it.

PET scanning went through a similar, though much slower uptake. PET (Positron Emission Tomography) has transformed treatment of cancer. It is of course a macro imaging tool. It can see cancer down to a centimetre or less. But of course, by the time a PET or MRI scanner can see a cancer spot, there are 10⁹ cancer cells (that is 1,000,000, 000). It is expensive and requires a cyclotron nearby to produce short lived radio nuclides. For decades it was said this was impossible for it to be used for anything but research. And then it was essential! Cyclotrons and PET scanners, and costing multiple millions of dollars, and millions of dollars per year to run, are now ubiquitous.

What can Optiscan take from this? Tiresias has noted Optiscan’s history. Optiscan’s management in the past has been naive in the extreme, in their understanding of the process of introduction of technology into the medical field. He knows that in the early 2000’s their modus of operandi, was to hire a booth at a medical conference, and stand by it and hope that some wondering medic, on a paid trip and hotel stay from a pharmaceutical company, would come and look. Tiresias shakes his head at the naivete. But then what would've one expected? They never had anyone commercial, and they never had anyone savvy medical. They were just boffins. Tiresias knows this has changed and is changing, and Tiresias is sure that lessons have been learnt. He will talk on this and the other issues that he's mentioned in his future posts, but for today, he is off to study some birds’ flights, the position of the stars, and examine entrails.