I’ll admit it – when I was a kid, I admired Dr. Bones (McCoy) of Star Trek. He was a no-nonsense kind of guy who was very clear about his areas of expertise (“Damn it, Jim, I’m a doctor, not a spaceship engineer.”) But best of all, Dr. McCoy had special healing gadgets that he could wave over people for diagnostic and therapeutic purposes. Those “tricorders” fascinated me – and I always wished I could have one myself.
And now my dream could actually come true: advances in focused ultrasound technology (FUS) make non-invasive surgical procedures possible. I attended the very first international symposium about this new technology, and learned some very exciting things.
First of all, Dr. Ferenc Jolesz gave a riveting key note address about the history of focused ultrasound technology, and why modern advances have made this treatment modality feasible. Scientists have been fantasizing about heating tissues with sound waves since 1942 when the first ultrasound experiment was conducted on a liver tumor. Unfortunately back then, imaging studies (beyond X-rays) had not yet been developed – so it was virtually impossible to “see” one’s target.
However, now that magnetic resonance imaging (MRI) machines are capable of displaying our innards in exquisite detail (and can also calculate the temperature of tissues to within 1 degree Celsius) we can see exactly what we’re heating and we know when we’ve achieved the desired temperature. In addition, advances in probe technology have made it possible to target exact tumor boundaries, thus curing rather than “debulking” various cancers.
I asked Dr. Jolesz to explain why heating was such a powerful treatment option for cancer and other tumors and he replied,
If you boil an egg, you’re never going to get a chicken out of it.
In other words, focusing sound waves on an internal target can heat the desired area to such a degree that the cells and tissues are permanently destroyed. There is no need for surgical intervention. The patient simply receives the treatment via focused ultrasound beams through their skin – and best of all, it’s essentially painless.
MR guided focused ultrasound is truly a “Star Trek” level medical breakthrough. The first questions in my mind were: will insurance companies pay for such therapy? Can people actually have access to this technology? The answer to both, as you might expect, is “no.”
Let me explain.
First of all, because MRgFUS is relatively new, it has only managed to win one FDA-approved use so far: the treatment of uterine fibroids. Insurance companies generally do not pay for experimental or non-FDA approved treatments, so even though research has demonstrated its effectiveness in treating brain tumors, breast cancer, and blood clots in the brain (stroke), those are not covered. Now, in all fairness to the insurance companies, I can understand why they’d want to fund FDA-approved treatments only. If they paid for every test or procedure touted as the next “scientific breakthrough” (without sufficient evidence to support the claim) healthcare costs would skyrocket, making health insurance unaffordable for anyone.
However, in these difficult economic times, it will be up to patients (“consumers”) to put pressure on insurance companies to cover MRgFUS procedures. It will take time, and there will be resistance (there is always resistance to paying for new things) but in the end, I believe that non-invasive surgery will save far more than it will cost. We need to overcome this initial opposition in order to take medical science to the next level. To learn more about MRgFUS, please check out the Focused Ultrasound Surgery Foundation website.
In my next post I’ll interview Dr. Elizabeth Stewart, professor of Obstetrics and Gynecology at the Mayo Clinic, to discuss her experience with MRgFUS in treating uterine fibroids.