Challenges, perils of new media are nothing new in medicine, lecturer says

Jeremy A. Greene, M.D., Ph.D., gave this year’s Noback-Burton Lecture.

History is a valuable lens through which to view and evaluate the risks and opportunities new media pose throughout health care, Jeremy A. Greene, M.D., Ph.D., said April 27 at the UMKC School of Medicine.

Greene, a professor of medicine and the history of medicine at the Johns Hopkins University School of Medicine, delivered the 2018 Noback-Burton Lecture, titled “The Electronic Patient: Medicine and the Challenge of New Media.”

Among exciting current possibilities, Greene acknowledged the power of smartphones, giving physicians, clinics and millions of patients many ways to bridge distances and track health data. He also noted the World Health Organization’s mHealth initiative, dedicated to using mobile technologies to combat the world’s greatest noncommunicable killers including diabetes, COPD, cancer and heart disease.

But he also noted the “deep well of anxiety” around newer technologies, from threats to privacy to security concerns that were illustrated when a Baltimore hospital was virtually paralyzed by hackers who took down its computer servers.

Greene also argued for using history to evaluate current risks and rewards, and to see that current medicine’s hopes and fears are hardly unique to the 21st century.

New media have long been part of medicine, he said, and have always had wide-ranging effects, but seldom in the ways expected. Some examples:

— The stethoscope at one time was a new medium, “an object of fierce controversy,” through which information from a patient’s heart and lungs was transmitted to the ears of a physician. Medical literature at the time described it as “powerful but dangerous.”

— The telephone profoundly affected medicine, becoming an examination and diagnostic tool for various organs and ailments because of its ability to transmit sound. It also advanced remote medicine; for instance, allowing a physician to hear a child’s cough and lung congestion and determine whether it was croup, requiring immediate attention, or a less severe cough that could be followed up on later.

Telephones also became something of a scourge to physicians and their families as doctors were expected to always be reachable. But predictions that “telephone doctors” would become a whole subspecialty didn’t come to pass, just one example of how new media affect medicine, but seldom as predicted.

— Television, videotaping and the ability to transmit information over coaxial cables also affected medicine and medical education, setting the stage for telemedicine and other innovations.

Dr. Richardson K. Noback talked with Jeremy A. Greene after the lecture.

Greene noted that E. Grey Dimond, M.D., the founder of the UMKC School of Medicine, had made cable part of the school from the outset. The school has long recorded lectures, he noted, making remote and self-directed learning possible. And he said the school’s lecture archives were a great resource for studying the history of medical education.

Outside academia, Greene told about a pioneering telemedicine clinic at Boston’s Logan Airport, which allowed patients there to be “seen” by doctors at Boston Medical Center. The clinic was directed by Dr. Kenneth Bird, who coined the term telemedicine, and came about after some plane crash victims died just three miles from Boston Medical because it took ambulances too long to get through a traffic jam of accident spectators.

Now, Greene said, telemedicine combined with the Internet has made predictions that once seemed like science-fiction come true. But the same was true of the telephone, television and other new media, and such situations probably will keep occurring as technology advances.

In closing, Greene mentioned the Qualcomm Tricorder XPRIZE competition, designed to produce a portable medical device like those used on “Star Trek.” The latest winner can detect 34 health conditions, with the promise of bringing good health care to a wider population.

No doubt, such technology will change health care, he said, but it’s unclear exactly how. And, unfortunately, technology probably won’t change health care in ways that “reduce the practical and resource-based disparities” that keep care from millions of underserved patients.

This was the third year for the lecture series, endowed by James Riscoe, M.D. ’75, a member of the school’s third graduating class. Riscoe started the event to honor Richardson K. Noback, M.D., the first dean of the School of Medicine, and the late Jerry Burton, M.D. ’73, a classmate who is recognized as the first graduate of the medical school.

Riscoe was on hand to introduce Greene, Noback and Burton’s wife, Patricia G. Burton. The Burtons edited the 2014 book “A Proven Experiment: Looking Back at the UMKC School of Medicine.”