Origins of Biomedical Engineering
During a cool morning in September 1816, two children were playing with a long piece of solid wood and a pin to send signals to each other. They were observed by Dr. Rene Theophile Hyacinthe Laennec, a French physician, who struggled to judge the heart rate of one of his obese patients. Through observing the children, Laennec was able to use a hollow tube of wood to amplify sound and create the world's first stethoscope. Several centuries of modifications and improvements would later culminate in the stethoscope we know today to universally represent doctors.
The integration of engineering knowledge into medical practices can be traced back to 1250, when Roger Bacon invented the first magnifying glass. Another early pioneering biomedical device was the mercury thermometer, invented by Gabriel Fahrenheit in 1714. These inventions spurred on research for a variety of useful medical advancements such as x-rays, antibiotics, and hypodermic needles. More medical devices were needed to solve various health problems, but most engineers only had high school level exposure to biology. This spurred on the emergence of biomedical engineering, a multidisciplinary field applying principles of engineering to medicine and healthcare. The Biomedical Engineering Society was created in 1968, which met regularly and published research to encourage collaboration for progress. Biomedical engineering would also emerge as an academic department in the 1970s with the help of the Whitaker Foundation.
Rationalization
The development of biomedical engineering has been impacted over time by the four dimensions of rationalization: efficiency, calculability, predictability, and control. These dimensions are key to the Mcdonaldization of Society, a term coined by George Ritzer to describe the increasing adoption of the fast food business model in common social institutions. Biomedical engineers have also experienced its various impacts.
Biomedical engineering is always in pursuit of increasing efficiency, both in medical devices and the means of education for prospective biomedical engineers. Predictability can be seen in the tendency to make medical processes and device usage more uniformed, standardized, and routine. Calculability has to do with constant record keeping and quantifiable goals, as well as the prioritization of quantity over quality of treatments and machines. Control involves having more power over medical treatments and the replacement of human workers by non-human technology.
Ritzer also described tendencies towards irrationality, where attempts to rationalize and increase efficiency led to the opposite effect. These can also be explored further, as the prioritization of science and engineering could have the tendency to leave human values behind. The effects of rationalization are key to analyzing the development of biomedical engineering, as well as painting a prospective picture of what lies ahead.
Efficiency
Medical Devices
In the past quarter of a century, diagnostic imaging and implanted therapeutic devices have greatly enhanced the quality of healthcare. Diagnostic imaging technology such as computer-assisted tomography (CAT) and magnetic resonance imaging (MRI) are used to non-invasively view abnormal anatomical structures. This has greatly reduced the death rate of patients compared to previous medical practices such as exploratory surgery. Medical implants such as prosthetic heart valves, implanted drug pumps, and neurological stimulators have also increased medical effectiveness. They often provide a more efficient alternative to treatments such as medicine or surgery, and are constantly being improved upon to increase longevity, capability, and safety of usage.
New Advancements
New technologies are constantly in development to increase efficiency. Point-of-care technologies allow for remote or automated monitoring of diseases, reducing the amount of time that doctors spend per patient. Surgical robotics could be developed to perform remote operations on patients that would be otherwise inaccessible. Additionally, increasing the computing power for diagnostics and analyzing patient health helps provide quicker, personalized treatments. Ritzer feared that the increase in efficiency would mean a loss in creativity as a trade-off; however, biomedical engineering views creativity and problem-solving as essential skills for developing medical treatments, as evidenced by their increased emphasis by many colleges. By constantly improving the efficiency of medical devices and means to learn about them, biomedical engineers save resources such as money, time, and lives.
Calculability
Numbers and Calculations
In hospital settings, clinical engineers are tasked with the application of technology to health care. They maintain computer databases of medical instruments for their purchase and usage, and may work with physicians to adapt medical instrumentation to the specific needs of the hospital. To facilitate the process of maintaining equipment, many clinical engineers use inventory to evaluate the equipment present in a hospital and keep track of factors such as model and quantity. This is one example of the prevalent need for record-keeping and quantitative information in biomedical engineering. Other examples include tracking the number of treatments carried out as well as patients helped, and using mathematical modeling to solve problems. With the arrival of of advanced computers, precise mathematical skill could decline in importance for biomedical engineers, but the focus on numbers remains prevalent.
Quantity Over Quality
According to Ritzer, quantity is now more frequently prioritized over quality, and people prefer instant gratification. This can be seen in how hospitals increasingly standardize medical equipment, which they buy in bulk to secure discounts from suppliers. Regarding patient care, quantitative aspects such as length of stay may be prioritized over details about subjective wellbeing, with patients being streamlined through the medical process for the sake of generating better statistics. Instant gratification has also taken root in biomedical engineering: artificial intelligence could be developed to diagnose diseases instantly, while distribution of medical devices and treatments have improved so that hospitals and patients receive services faster and efficiently. Calculability may raise the threat of shifting focus from humanistic care to speed, as a side effect and propagator of technological advancement.
Predictability
Standardization of Services
Increasing predictability involves having more standardized and uniform services. In many hospitals, greater predictability helps to cut costs. Physicians often have preferences on which devices they use or recommend to patients, such as hip and knee implants, cardiac stents, or mechanical devices used in surgery. These supplies tend to be the most expensive in the hospital, while the doctors' preferences are often unrelated to cost, instead having to do with personal experience. While doctors may initially put up resistance, standardizing these types of medical equipment greatly helps save money. Along with standardization of equipment, the methods to treat patients are also shared and spread to reduce errors.
Equipment Production
Production process are also streamlined to guarantee uniformity of product and efficient outcomes. Medical device manufacturers have their vital, life-saving products highly regulated and monitored. The need to sustain high levels of output while being error free has given rise to developments such as the Factory of the Future, an intelligent production environment that provides real-time information to maximize machine performance. Everything is connected, with individual machine components utilizing embedded sensors and access to cloud-based solutions. From ventilators for the ICU to implantable devices like pacemakers, the production of medical devices has become increasingly automated and uniform, with efficient methods being improved upon and propagated to increase the predictability in products.
Control
Machine Usage
As biomedical engineering rationalizes, more control is obtained over medical devices and treatments, often through the usage of non-human technology. Machines have undergone advancements to take on increasing roles in medicine, as they can be more precise and consistent than their human counterparts that require food and payment. Machines lack human error and can be used for tasks such as administering patient doses, providing emotional support, and even performing surgery. For example, the da Vinci surgical system was approved for use in the US in 2000, and over 7.2 million da Vinci procedures were completed worldwide by 2019. Robotic surgical systems provide benefits such as the ability to eliminate unwanted motion and improve surgical dexterity, decreasing complication and mortality rates.
Human Factors Engineering
Another aspect of the dehumanization of control has to do with human factors engineering, a subdivision of biomedical engineering. Human factors engineering deals with the design and development of human-machine systems. It works to integrate humans into machine systems through rigorous scientific methods rather than intuition or common sense. Human factors engineering takes into account humans' higher mental functions as well as their tendency to be influenced by the environment when optimizing the system. Human-machine models such as cars and vehicles aim to solve problems and achieve goals by focusing on the machine over human side of things. Utilizing human-factors engineering has helped increase control over machines and processes.
Resistance
Ethical Dilemmas
The rationalization of biomedical engineering has also led to irrationalities, to which people have put up varied forms of resistance against. One major point of tension has been finding balance between technological advancement and the human side of medical care. Ethical dilemmas arise as technology grows more complex, with growing needs for training for biomedical engineers regarding problems such as conflicts of interest, subject experimentation, and allocation of scarce resources. For instance, synthetic biology has advanced to the point where humans have the possibility to cheat death or alter life. Some people are in support of more research, while others believe that it isn't the job of biomedical engineers to play God. Public protests and opposition from religious institutions emerge, hindering further research and leading some biomedical engineers to question their own morals.
Drawbacks to Advancement
As the world becomes more interconnected and progressive, biomedical engineering tools and knowledge also become more open-source and widespread. Research and clinical practices previously only accessible to few are now being communicated through online papers, emails, and forums at unprecedented speeds. However, not everyone has equal access to the benefits of technology, and spreading biomedical tools requires public trust and cooperation. Sharing effective treatments and effective medical devices has the potential for worldwide benefit, yet mistrust might lead to additional complications, controversy, and conflict.
Future Developments
The forces of rationalization ensure that biomedical engineers are likely to stay relevant and grow in demand, whether in developing artificial organs and prostheses, improving healthcare technologies and therapies, or dealing with injuries and physical disabilities. An aging generation of baby boomers provides a market for biomedical devices and procedures, and there has been constant interest in new technologies and innovations. According to the Bureau of Labor Statistics, employment of biomedical engineers is projected to grow 5 percent from 2019 to 2029, which is faster than average compared to all occupations. There have also been increases in government funding and the number of research articles published (graphs listed below).
As biomedical engineering knowledge becomes more relevant and widespread, new avenues for employment might open such as gig work or freelancing. Freelancing biomedical engineers have the potential to work on research and development, manufacturing of medical supplies, or consulting on biomedical issues. Additionally, rather than being confined to hospitals, biomedical devices can also be developed in maker spaces with various resources and interdisciplinarity. The George H. Stephenson Bio-MakerSpace has become a hub for Penn student start-ups, encouraging collaboration between students of different majors to turn ideas into reality. KromaHealthTM is a point-of-care diagnostic device produced by Group K Diagnostics, one of the Bio-MakerSpace's most successful start-ups. This diagnostic device offers a variety of different tests based on a small input of the patient's blood, serum, or urine. It induces color change that can be detected through image processing, with its simple usage having the potential to help make healthcare simpler and more accessible for all populations. The Bio-MakerSpace helps students use interdisciplinary approaches to solve real world problems, paving the way for widespread medical innovation. Successful open source technologies generated from maker spaces can be propagated to aid places such as Africa which lack structured healthcare systems. Biomedical engineers form pillars of healthcare along with nurses and doctors; increasing their reach can greatly benefit global health.
Conclusion
Rationalization has significantly affected the growth of biomedical engineering, especially as technology constantly prioritizes efficiency and advancement. The field has aimed to increase predictability in services and treatments, which adds to calculability when aiming for more quantifiable results. Standardization has helped to cut costs as well as streamline processes for greater efficiency. More control in biomedical engineering is evident in the way that machines have taken on new and increased roles, such as aiding in diagnostics and surgery with greater precision than humans. As more jobs are automated, more effort can be put into further enhancing the quality of healthcare. Emerging irrationalities such as ethical dilemmas and new problems due to advanced technology may hinder rationalization, yet measures are being taken to amend issues regarding race and class disparity, and technological developments provide considerable benefits despite potential dehumanization. Biomedical engineering is in the process of becoming more globalized, with new innovations constantly in development to improve healthcare. In the future, new medical treatments and technologies brought about by biomedical engineering will grow alongside the forces of rationalization.
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Image Credits
Milestones in medical technology. (2012, October 10). Retrieved April 25, 2021, from https://archive.nytimes.com/www.nytimes.com/interactive/2012/10/05/health/digital-doctor.html?-r=#/#time15_375
Zhavoronkov, A., Debonneuil, E., Mirza, N. et al. Evaluating the impact of recent advances in biomedical sciences and the possible mortality decreases on the future of health care and Social Security in the United States. Pensions Int J 17, 241–251 (2012). https://doi.org/10.1057/pm.2012.28
Ksas. (2020, February 20). How the bioengineering Department's BIO-MAKERSPACE became a hub for start-ups. Retrieved April 28, 2021, from https://beblog.seas.upenn.edu/how-the-bioengineering-departments-bio-makerspace-became-a-hub-for-start-ups/
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