tag:theconversation.com,2011:/us/topics/pulmonary-hypertension-38007/articlespulmonary hypertension – The Conversation2022-09-28T20:13:23Ztag:theconversation.com,2011:article/1880412022-09-28T20:13:23Z2022-09-28T20:13:23ZWhy Viagra may be useful in treating lung diseases<figure><img src="https://images.theconversation.com/files/487160/original/file-20220928-6321-to39aq.jpg?ixlib=rb-1.1.0&rect=52%2C70%2C910%2C589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The blood vessel dilation caused by sildenafil (Viagra) can be beneficial in lung diseases such as pulmonary arterial hypertension or idiopathic pulmonary fibrosis.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>You may be surprised to learn that the medication sildenafil — better known by its brand name Viagra — has other medical purposes aside from treating male erectile dysfunction. It can also be used to treat lung diseases that often have poor prognoses.</p>
<p>Sildenafil works by inhibiting an enzyme called phosphodiesterase. Through <a href="https://doi.org/10.1038/nrd2030">a complex pathway involving other molecules</a>, sildenafil ultimately helps smooth muscles relax and blood vessels dilate. The latter effect is known as vasodilation. Vasodilation results in more blood flow to organs — whether that organ is the penis or the lungs.</p>
<h2>Lung diseases</h2>
<p>The vasodilation caused by sildenafil can be beneficial in lung diseases such as pulmonary arterial hypertension (PAH) or idiopathic pulmonary fibrosis (IPF). People living with PAH and IPF experience progressive shortness of breath and chronic cough. In addition to lungs, PAH and IPF can affect many other organ systems. </p>
<p>PAH is a disease causing breathing difficulties and heart strain due to elevated pressure in the arteries of the lung, which were designed for much lower pressures. Thankfully, <a href="https://rarediseases.org/rare-diseases/pulmonary-arterial-hypertension/">it is a rare disease, affecting one or two individuals per 1,000,000 persons each year</a>. </p>
<p>IPF is a more common lung disease with between <a href="https://rarediseases.org/rare-diseases/idiopathic-pulmonary-fibrosis/">two and 29 people per 100,000 developing the condition per year</a>. It occurs due to repeated and chronic thickening, stiffening and scarring (fibrosis) of the lungs. </p>
<p>Both diseases often do not have a clear etiology, meaning that doctors and researchers do not fully understand why these diseases begin and progress. Both diseases are incurable, and frequently get worse over time despite our best treatment options. There are currently few effective treatments, and there is always interest in finding more. </p>
<h2>Evidence for sildenafil in PAH</h2>
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<img alt="Illustration of human respiratory system with lungs in red and yellow against a blue background" src="https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There are currently few effective treatments for pulmonary arterial hypertension or idiopathic pulmonary fibrosis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The use of sildenafil in PAH is already well established, effective and approved in Canada. There are several high quality randomized controlled trials that have demonstrated its efficacy to <a href="http://doi.org/10.1056/NEJMoa050010">improve exercise capacity and symptom burden</a>. Sildenafil is usually branded as Revatio in PAH (instead of Viagra for erectile dysfunction), although there is little difference between Viagra and Revatio except that patients typically take Revatio <a href="https://www.drugs.com/revatio.html">three times per day in smaller doses</a>. </p>
<p>Our recent publication <a href="http://doi.org/10.1183/16000617.0036-2022">synthesized the evidence for multiple PAH treatments</a>. We looked at combinations of sildenafil or another drug in the same class — such as tadalafil (brand name Cialis) or vardenafil (brand name Levitra) — with another commonly used PAH medication. </p>
<p>The results showed the number of clinical worsening events such as disease progression or hospitalization were reduced by 12.7 per cent compared to placebo. Markers of exercise capacity, measured by a six-minute walk test, were also improved by almost 50 meters. </p>
<h2>Evidence for sildenafil in IPF</h2>
<p>The use of sildenafil in IPF is much less certain, as there have been few randomized controlled trials, which are considered the gold standard of evidence. Just four trials have investigated its use in IPF. <a href="http://newzcap.com/does-viagra-reduce-mortality-in-pulmonary-fibrosis-does-viagra-reduce-mortality-in-pulmonary-fibrosis/">A meta-analysis of this small number approached statistical significance, which suggests that benefits would become evident if more trials were completed</a>.</p>
<p>The most recent <a href="https://www.thoracic.org/education-center/ild/pdf/ATS%20Pocket%20Guide_v1.pdf">European Respiratory Society / American Thoracic Society guidelines</a> addressing the question recommended against the use of sildenafil in IPF due to a lack of data. </p>
<p>However, recently a drug (treprostinil) that acts similarly to sildenafil showed promise in patients with combined interstitial lung disease (an umbrella term of lung diseases that includes IPF) and pulmonary hypertension. The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2008470">greatest effect seen in patients with diagnosed interstitial lung disease</a>. </p>
<p>This further demonstrates the potential promise of drugs like sildenafil or similar vasodilation mechanisms in managing IPF.</p>
<h2>Why this matters</h2>
<p>For conditions like PAH or IPF that are incurable, re-purposing drugs like sildenafil has merit. For one thing, it is very expensive to develop new drugs. For another, there are more concerns about safety with new drugs; since Viagra is widely used, the side-effect profile is well known in the medical community. </p>
<p>For example, sildenafil is known to cause low blood pressure and should be avoided in people with conditions making them susceptible to hypotension or taking specific anti-high blood pressure medications. Other common side-effects include flushing, headaches and vision changes, among others. </p>
<p>While sildenafil may not be the magic pill for all lung diseases, it’s clear that it has promising uses that go beyond erectile dysfunction.</p><img src="https://counter.theconversation.com/content/188041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dena Zeraatkar receives funding from the Banting postdoctoral scholarship. </span></em></p><p class="fine-print"><em><span>Jasmine Mah is an Internal Medicine resident with Nova Scotia Health and receives scholarships supporting her PhD research from the Department of Medicine at Dalhousie University, Dalhousie Medical Research Foundation, Dr. Patrick Madore Foundation, and the Pierre Elliott Trudeau Foundation. She is affiliated with the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations (<a href="http://www.ccna-ccnv.ca">www.ccna-ccnv.ca</a>). The affiliations/funders had no input into any aspect of this subject or article.</span></em></p><p class="fine-print"><em><span>Tyler Pitre does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sildenafil — better known as Viagra — may be helpful in treating lung diseases like pulmonary arterial hypertension and idiopathic pulmonary fibrosis, for which there are few effective treatments.Tyler Pitre, MD (Internal medicine physician), McMaster UniversityDena Zeraatkar, Assistant professor, Health Research Methods Evidence and Impact and Anesthesiology, McMaster UniversityJasmine Mah, MD (Internal Medicine Resident) & PhD candidate (Focus on Geriatrics), Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1471172020-10-08T14:41:41Z2020-10-08T14:41:41ZPulmonary hypertension: why creating awareness is key in Africa<figure><img src="https://images.theconversation.com/files/362136/original/file-20201007-18-1x6jw6x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conditions like HIV, TB, and chronic obstructive pulmonary disease increase the risk of pulmonary hypertension.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Pulmonary hypertension is elevated blood pressure that occurs exclusively in the lungs. It is a deadly condition that affects an <a href="https://journals.lww.com/co-pulmonarymedicine/Abstract/2020/09000/Pulmonary_hypertension_in_majority_countries_.2.aspx?context=LatestArticles">estimated</a> 75 million people worldwide. Around 80% of them live in low- and middle-income countries. In a recent <a href="https://journals.lww.com/co-pulmonarymedicine/Abstract/2020/09000/Pulmonary_hypertension_in_majority_countries_.2.aspx?context=LatestArticles">literature review</a> my colleagues and I found that the prevalence of pulmonary hypertension in Africa can range anything from <a href="https://pubmed.ncbi.nlm.nih.gov/29221480/">10% to 68%</a>. </p>
<p>Pulmonary hypertension is completely different from <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410">systemic hypertension</a>, a disease many people develop between the ages of 55-70. With pulmonary hypertension, cells in the blood vessels of the lung become cancerous as they continue to multiply or grow uncontrollably. This makes the vessels narrower than normal, leading to high blood pressure in the lung. The difference between these two conditions means that conventional hypertension medications are not effective against pulmonary hypertension – a misconception among some primary healthcare doctors. </p>
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<a href="https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362138/original/file-20201007-22-u9tjh6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Geola Bergman</span></span>
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<p>It’s not understood why certain patients develop it and others not. Pulmonary hypertension is considered to be a medical consequence of several other conditions. These include left heart disease, HIV infection, tuberculosis (TB), bilharzia or schistosomiasis, and chronic obstructive pulmonary disease such as asthma, emphysema and chronic bronchitis. Patients with any of these diseases are at risk of developing pulmonary hypertension. </p>
<p>In South Africa, the risk of pulmonary hypertension is increased because of high levels of HIV, TB, and chronic obstructive pulmonary disease. Even if patients are cured from TB, some will later die of pulmonary hypertension. Many people with HIV are also at risk of developing pulmonary hypertension and dying from it. Thousands of people are at risk of dying from pulmonary hypertension considering the high prevalence of TB and HIV on the continent. </p>
<p>To complicate this even further, pulmonary hypertension is not easily picked up by primary healthcare doctors due to the unspecific nature of the symptoms. This could lead to the misconception that the patient might have a persistent cold or flu, to only later – when it is too late – find out that it was pulmonary hypertension. </p>
<p>With statistics suggesting that thousands of people might die from this disease, something has to be done. Advocacy could potentially increase awareness for, and clinical interest in pulmonary hypertension. This is especially important among clinicians and researchers in the primary, secondary, and tertiary healthcare sectors. </p>
<p>Raising awareness could lead to the much-needed shift in thinking similar to what has driven established pulmonary hypertension centres around the world. </p>
<h2>Challenges</h2>
<p>Symptoms of pulmonary hypertension include shortness of breath, inability to do simple physical activities such as picking up items from the floor or walking up stairs. Other symptoms can be chest pain and a persistent cough. These symptoms are not specific for pulmonary hypertension, and this means that the condition is often misdiagnosed or confused with other diseases, leading to a delayed diagnosis. </p>
<p>Delayed diagnosis of pulmonary hypertension has long been recognised as a significant challenge in low- and middle-income countries where there are limited resources. Patients could be seen by a primary healthcare physician for months or years and still not get the appropriate diagnosis. This delay is sadly fatal because even specialised treatments are ineffective at a progressed stage of the disease. The number of people suffering from pulmonary hypertension without getting a proper diagnosis or better treatment is unknown. </p>
<p>There’s a lack of awareness in the primary healthcare sector and gross under-diagnosis due to a lack of resources. The disease may be <a href="https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132018000300173">more prevalent</a> than is frequently described in the literature.
Many doctors are also overwhelmed with the burden of infectious diseases in low- and middle-income countries. These working conditions can draw attention away from detecting pulmonary hypertension at an early stage.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000867/">gold standard</a> for diagnosing pulmonary hypertension is right heart catheterisation. But this is an invasive technique, during which a catheter is inserted into the right side of the heart through an incision made in the neck of the patient. This procedure is not always conducted in less fortunate countries, and less accessible in remote areas where patients are far from a cardiologist with experience in right heart catheterisation.</p>
<p>In the past, patients with pulmonary hypertension have died within three to five years of diagnosis. But with advancements in drug development, this has changed, and the use of different <a href="https://www.revespcardiol.org/en-trends-in-pulmonary-hypertension-over-articulo-S1885585717301755">combinations of specialised</a> drugs can increase patient survival for up to nine years. </p>
<p>But there’s a challenge. Many of these specialised drugs are <a href="http://www.samj.org.za/index.php/samj/article/view/9307/0">expensive and not available</a> in low- and middle-income countries. Sadly, a lot of patients with pulmonary hypertension die as a result. This further highlights a global need for better treatment options. These options must be affordable and accessible to patients from low- and middle-income countries.</p>
<h2>Opportunities</h2>
<p>There is an opportunity to research, define and investigate factors that cause pulmonary hypertension in low- and middle-income countries. Here, the unique causes of pulmonary hypertension – uncommon in developed countries – are more prevalent. </p>
<p>In areas where access to investigations is limited, pragmatic and potentially non-invasive diagnostic and treatment methods could be adopted. This may lower the barriers to treatment. It is important that doctors adjust diagnostic protocols to determine an earlier diagnosis, especially in the context of low- and middle-income countries. This has led to <a href="https://pubmed.ncbi.nlm.nih.gov/27404676/">the observation</a> that a cheaper, non-invasive technique, heart scan (similar to an ultrasound scan done on pregnant women), is sufficient to confirm pulmonary hypertension in patients of countries where right heart catheterization is not possible.</p>
<p>An overview of the total number of pulmonary hypertension cases – newly diagnoses and existing – is important. This can be achieved by the use of national data registries and by doing frequent review of national patient-databases.</p><img src="https://counter.theconversation.com/content/147117/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Gerald J. Maarman receives research funding from The Faculty of Medicine & Health Sciences, Stellenbosch University, The National Research Foundation (NRF) of South Africa, The Medical Research Council (MRC) of South Africa, The South African Rooibos Council (SARC). He is affiliated with the Pulmonary Vascular Research Institute (PVRI), the Physiological Society of Southern Africa (PSSA), the South African Heart Association (SA Heart) and the South African Society for Cardiovascular Research (SASCAR). </span></em></p>Delayed or late pulmonary hypertension diagnosis is sadly fatal because even specialised treatments will be ineffective at such a progressed stage of the disease.Gerald J. Maarman, Lecturer & Principal Investigator, CARMA: Centre for Cardio-Metabolic Research in Africa, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/755912017-04-20T23:18:36Z2017-04-20T23:18:36ZWhy are we dragging our feet when more automation in health care will save lives?<figure><img src="https://images.theconversation.com/files/165698/original/image-20170418-32726-ro3ifj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">From closed-loop ventilators to smarter vital sign monitors, automation has untapped potential to improve medical outcomes.</span> <span class="attribution"><span class="source">From www.shutterstock.com</span></span></figcaption></figure><p>As a neonatologist, I worry about patients with <a href="https://pulmonaryhypertensionnews.com/pulmonary-hypertension-newborns/">pulmonary hypertension</a>. This unforgiving disease, sometimes seen after premature birth, can end with sudden death from constricting blood vessels in the lungs. One minute a baby in the neonatal ICU may be sleeping comfortably; moments later, doctors and nurses are giving chest compressions and rescue medications.</p>
<p>A pulmonary hypertension crisis, as these frightening episodes are called, starts with a drop in the blood oxygen level. That drop triggers a monitor to beep. It’s up to the nurse to hear the sound, come to the bedside and take action.</p>
<p>The first and most effective step in stopping a pulmonary hypertension crisis is simple: Give oxygen. But a nurse caring for another patient might be delayed for 30 seconds, and the loss of that time can lead to brain injury or death.</p>
<p>In an age of <a href="https://www.wired.com/2016/12/google-self-driving-car-waymo/">self-driving cars</a> and 400-ton <a href="http://www.usatoday.com/story/travel/columnist/cox/2014/02/09/autoland-low-visibility-landings/5283931/">airplanes that can land themselves</a> in blinding fog, it makes no sense that hospitalized patients are surrounded by lifesaving machinery that can be activated only by a person pressing a button or turning a knob. </p>
<p>Modern transportation augments human judgment and reaction times with a computer’s superior ability to continuously respond to dozens of fluctuating variables. Yet in medicine, safety remains stubbornly reliant on human intervention.</p>
<h2>FDA regulation impedes innovation</h2>
<p>My patients with pulmonary hypertension are often attached to a respirator with adjustable oxygen settings. The respirator sits inches below the monitor that indicates how much oxygen is in the blood. But the two machines can’t communicate with each other. If they could, it would be possible to increase the flow of oxygen automatically the moment a crisis is detected.</p>
<p>In 2009, engineers developed just this kind of <a href="http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2013-1834">closed-loop respirator</a> and introduced it in several hospitals as part of a feasibility study. It increased the time premature babies spent at a safe oxygen level by more than two hours per day. But no biotechnology company has marketed the idea.</p>
<p>There are other examples of automated systems with unrealized potential to save lives, and not just in the neonatal ICU. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26616400">Software that scans an ECG for subtle heartbeat variability</a> can identify patterns – undetectable to the human eye – that indicate an elevated risk of heart attack. <a href="http://cdn.laerdal.com/downloads/f2644/ReviewCPRdevices06_09.pdf">Hospital beds that play audible feedback during an emergency</a> promote more effective CPR. Yet patients are not benefiting because neither of these tools has been commercialized.</p>
<p>Why haven’t these innovations attracted the industry backing necessary to make them widely available?</p>
<p>One reason is that <a href="https://its.utmb.edu/documents/FDA-Medical-Device-Regulatory-Process-Timeline.pdf">the process of getting FDA approval for new devices</a> – particularly those deemed “life-sustaining” – is often <a href="http://progressivefix.com/wp-content/uploads/2011/06/06.2011-Mandel_How-the-FDA-Impedes-Innovation.pdf">even more complicated</a> and expensive than getting approval for drugs. In the Journal of Public Economics, Harvard Business School professor Ariel Dora Stern recently described how <a href="http://www.aami.org/productspublications/articledetail.aspx?ItemNumber=3807">FDA hurdles discourage companies from investing in innovation</a>.</p>
<p>Often, the more profitable strategy is to wait for someone else to spend the time and money required to get approval for a new device, and then enter the market later with something similar that will face less scrutiny. Dr. Stern estimates that regulatory obstacles add an average of US$6.7 million to the cost of introducing a new medical device. For a company developing an ICU monitor, for instance, that will ultimately sell for less than <a href="http://www.zdnet.com/article/how-philips-maintains-monitor-price-points/">$35,000 per unit</a>, this up-front commitment can be prohibitive.</p>
<p>A consequence is that small biotechnology firms (with annual revenue less than $500 million) rarely gamble on getting new inventions approved. Dr. Stern’s paper notes that less than 17 percent of novel device applications to the FDA come from small companies. This is different from new drug applications, the majority of which originate at smaller firms.</p>
<p>What’s behind this discrepancy? Research has shown that while companies pay a steep price for pioneering new medical devices, the first firm to market a new type of drug often gets <a href="https://academic.oup.com/jleo/article-lookup/doi/10.1093/jleo/ewp002">favorable treatment from the FDA</a>. This raises the incentive for pharmaceutical startups to pursue innovation. In contrast, when it comes to medical devices, the current system discourages all but the biggest players from entering the arena.</p>
<p>And even when a new device has been approved, there is no strong impetus for hospitals and clinics to buy in. Even if they can afford upgrades, medical sites are free to use older equipment, with fewer safety mechanisms, long after improved versions become available.</p>
<h2>A chance for Washington to improve health care</h2>
<p>In contrast, a variety of government initiatives prod transportation companies to modernize. For example, the Federal Aviation Administration <a href="https://www.faa.gov/nextgen/equipadsb/rebate/">offers rebates</a> to aircraft owners to offset the cost of advanced navigation technology that prevents midair collisions. The Federal Rail Administration is overseeing mandatory, nationwide installation of <a href="https://www.fra.dot.gov/ptc">a GPS-based system to slow down speeding trains automatically</a>.</p>
<p>There is an opportunity here – beyond the messy Obamacare debate – for the White House and congressional Republicans to stimulate economic growth in the biomedical sector while improving patient safety. Streamlining the approval process for new devices and offering financial incentives for early adopters would not threaten anti-regulatory groups, and would allow the new administration to claim progress in health care.</p>
<p>President Trump has expressed interest in <a href="https://theconversation.com/faster-access-to-new-drugs-doesnt-always-mean-better-treatment-74369">expediting pharmaceutical approvals</a>, something FDA commissioner Scott Gottlieb <a href="https://www.forbes.com/sites/scottgottlieb/2016/10/24/epipen-drug-pricing-challenge/4/#15f88b7146ad">also supports</a>. But most drugs help only a small segment of the population.</p>
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<img alt="" src="https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=642&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=642&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=642&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=806&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=806&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165711/original/image-20170418-20614-1khl4av.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=806&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dr. Scott Gottlieb, nominee for FDA commissioner.</span>
<span class="attribution"><span class="source">J. Scott Applewhite/AP</span></span>
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<p>The president and Dr. Gottlieb should commit to advancing commonsense technology that makes health care better for all.</p>
<p>I’m not suggesting that machines should take over for health professionals. As in the manufacturing industry, the medical field is experiencing mounting anxiety about job displacement. There are many perceived threats, from <a href="https://www.technologyreview.com/s/600706/ibms-automated-radiologist-can-read-images-and-medical-records/">artificial intelligence X-ray interpretation</a> to <a href="http://www.thedailybeast.com/articles/2016/09/24/robot-nurses-will-make-shortages-obsolete.html">robot nurses</a>.</p>
<p>Those things might become commonplace, but they will never supplant the human relationships and insights at the core of medical practice. Neither will the kinds of safety innovations I’m recommending. With help from our leaders, physicians can take better care of patients by bringing more automation into our wards and offices.</p><img src="https://counter.theconversation.com/content/75591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Hooven owns shares of Atricure, a biotechnology company.</span></em></p>In planes, trains and cars, we increasingly entrust our lives to automated safety systems. It’s time for medical technology to catch up.Thomas Hooven, Neonatologist, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.