April 9, 2009

THERE ARE NO ADVANCES IN MEDICINE, JUST TWEAKS IN TECHNOLOGY:

Old, Brutal Surgeries Inspire Elegant Modern Devices (Alexis Madrigal, March 31, 2009, Wired)

Unlike pharmaceuticals, which depend on complex intracellular interactions and can be very expensive to develop, medical devices sit on a rich and long history of manipulating the plumbing of the physical body. For centuries, anatomists and physiologists have cut into cadavers, as well as live bodies, to figure out where the heart pumps blood, which nerves connect where, and how the physical materials of the body — flesh, blood, bones — act under human interventions. They figured out a lot about the mechanics of the corpse, long before they knew anything about cells or viruses or genomes.

The Foundry's glaucoma device is based on a treatment popularized in 1906. German surgeons discovered a simple solution for glaucoma — where the eyes' lubricating liquid gets blocked, creating pressure that kills off the optic nerves: They simply sliced open a hole in the eye to let fluid drain out.

It worked, according to the medical reports of the day. The pain was tolerable — it only required cocaine and adrenal shots, not general anesthesia — but it left patients with a hole in the eye that could be made too big, dangerously reducing eye pressure, or that spontaneously closed up, eliminating its positive effects.

So the technique was abandoned, despite a 1930s review that found the procedure, called cyclodialysis (.pdf), worked 80 percent of the time when used on the right types of glaucoma.

Now, rather than physically cutting a pathway for the fluid, a newly-designed implant could act as a tiny pipe that drains fluid out from the front of the eye. This might solve the problems long-associated with the procedure — and a spin-off company has $7 million in venture capital to give it a go.

The glaucoma treatment is one of a number of old, brutal surgical procedures that have been revived or modified by new technologies and materials. Inserting older materials into the body would create scarring or lead to infection, but increasing knowledge of what materials work best inside the body allows scientists to engineer new devices to solve old problems.

Posted by Orrin Judd at April 9, 2009 6:27 AM
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