Modern medical tests and procedures are not always the result of iterative
progression and continual enhanced understanding of the subject matter.
Accidental discoveries or breakthroughs occur within the field of medicine as
they do in other areas of society. This paper will focus on two medical
procedures which are still in use today and have saved the lives of millions of
people, the pacemaker, and the Pap smear. Both were byproducts of medical
research or studies and not themselves the initial focus but their discoveries,
once realized, became a more significant product than the original subject
matter.
The development of the pacemaker was a byproduct of the medical research
conducted at the Banting Institute related to cooling and warming bodies
before and after heart surgery (Hopps, 1981). The researchers at the institute
were inducing hypothermia prior to conducting heart surgery as it has been
previously found this allowed the body to tolerate the lack of blood flow for
longer periods than if hypothermia had not been induced. Hopps was an
electrical engineer by education and his efforts were related to the
application of radio frequency to heating. Before his involvement in the
research at Banting related to the application of RF to warming bodies, Hopps
was utilizing RF pasteurize beer. Hopps was asked to apply his knowledge of RF
warming to subjects of Dr. Calaghan and Dr. Bigelow. It was during this
research where it was discovered that electrical stimulation applied to the
heart could cause a currently arrested heart to begin beating again (Hopps,
1981). This discovery was the basis upon which the creation of the pacemaker
was founded.
Hopps and the researchers were met with many challenges in the development and
refinement of the pacemaker. As it was 1950, the transistor was not available,
and circuitry was based upon vacuum tubes. The probes and methods to attach
the pacemaker to the heart required items which had to be created by a
separate team of craftspeople. Materials which the body would not reject such
as platinum had to be incorporated into the design. The first commercial
pacemaker created in 1951 was approximately the size of a sliced-bread pop-up
toaster and required constant power (Hopps, 1981). As with many firsts or
cutting-edge innovations, the designs and implementations are often held back
by current materials science and technical capabilities with miniaturization
advancing based on developments in other fields of science or technology. It
was another six years until a battery-powered pacemaker was utilized on a
patient in 1957 and a year later an implantable pacemaker was successfully
applied to an individual (Chaikhouni, 2010). These rapid advances in
capabilities were a result of the fast-paced development of circuitry due to
the use of transistors in electronic appliances.
Overcoming the challenges related to immigrating into a new country, Dr.
Papanicolaou was hired on to Cornell University’s Medical College Anatomy
Department in 1914 (Irish Times, 2011). Dr. Papanicolaou was charting the
reproductive cycles of research animals based on examination of vaginal
secretions. After success in animals, the research shifted to human subjects
in 1920. During the examination of the samples collected, Dr. Papanicolaou was
able to distinguish between normal and malignant cervical cells which would
indicate that the patient had cancerous cells present. While the first
findings were published in 1928, it was not until 1943 that a book covering
the topic of uterine cancer diagnosis was published by himself and Dr. Traut.
The procedure, which was relatively inexpensive, simple for medical examiners
to perform, and generated accurate results was a significant contributor to
early identification cervical cancer in a patient.
The development of the Pap Smear as method of cancer detection was the
fortunate byproduct of other research. It was due to Dr. Papanicolaou’s
previous knowledge and education related to reproductive cycles and anatomy
which allowed him to understand the significance of what he was seeing under
the microscope. The initial discoveries allowed him and others to continue
researching the impact hormones and other factors can impart onto the
development of cancerous cells. Dr. Papanicolaou’s collaboration with other
leading researchers aided in the rapid growth of research within the field of
cancer in not only the reproductive system but other organs as well (Irish
Times, 2011).
Comparing the rate of research and knowledge growth between the Pap Smear
method and the pacemaker demonstrates quite a difference. In less than ten
years the pacemaker transitioned from externally powered prototype to
implantable and internally powered unit. The publication of the research
conducted by Dr. Papanicolaou took eight years to materialize and another
fifteen after that until a more comprehensive text was published. The
life-saving implications of the pacemaker were a contributing factor to its
rapid development as prototypes were implanted into patients as soon as they
were available and deemed acceptable for use (Chaikhouni, 2010). The knowledge
and information related to cancers took much longer to develop as cancerous
cells and the types of cancer afflicting individuals may appear differently
and establishing definitive irrefutable evidence and documentation would take
considerably longer due to the number of patients and data which must be
collected as part of the research process.
In both instances, the education and knowledge held by the individual in a
non-related field had a direct impact on their ability to contribute to
research products which generated these ideas as a fortunate accident. Hopps
had an educational background in electrical engineering which may have enabled
him to consider the problem space from a different perspective than the
medical researchers who were also on the team. Dr. Papanicolaou was a trained
physician but his PhD in zoology earned from the University of Munich enabled
him to participate in the reproductive research on animals which ultimately
led to the development of the Pap Smear method (Tan, Tasumura, 2015). While
many important and significant discoveries are generated by individuals who
devote their life to a particular subject, these examples demonstrate that
outside perspectives or simply performing the right research at the right time
can also generate longstanding and impactful discoveries and innovation.
As both discoveries were well understood to have a profound and positive
impact on public health, they were able to receive support for research
universities and government programs to fund additional research and
development. Utilizing living beings as the focus of research or evaluation of
experimental products or procedures can be next to impossible for those
without the appropriate connections and knowledge of the regulations and
processes necessary to perform ethically and within the confines of accepted
medical practices. Innovation or discoveries in areas which are not related to
medical sciences or have a purely commercial applications would have far fewer
barriers to development, enhancement, and deployment. The application of the
product and how it can be developed is very dependent on its use and it if an
individual has ideas for products in these spaces, a collaboration or
partnership would be necessary.
Access to tooling, individuals with fabrication skills, or other skills which
allow drawings and designs to be converted into physical objects is also
vital. As discussed by Hopps, without the availability of the fabrication team
in another department, many of the components required for the pacemaker would
have been much more difficult to create, taken more time for development, and
would have resulted in more costs and delays to the research they were
performing in this area. Individuals with an idea or design who are not
capable of fabricating the product themselves may face considerable setbacks
in the release of their items or unfortunately, the ideas may never
materialize and someone else with the means to create may find their product
being first to market because of it. While patents and other such design
protections may allow for some credit or monetary compensation, there may be
requirements for evidence of function or proof of viability which would still
necessitate a working protype or physical manifestation of the concepts and
ideas presented to a patent office. Innovation is a collaborate process and
those who come up with ideas must have a strong network to leverage in order
for their thoughts to become known successes.
References
Chaikhouni, A. (2010). The magnificent century of cardiothoracic surgery part
8: Reviving the dead. Heart Views, 11(2), 85-91.
http://dx.doi.org/10.4103/1995-705X.73228
Hopps, J. A. (1981). The development of the pacemaker. Pacing and Clinical
Electrophysiology : PACE, 4(1), 106–108.
https://doi-org.coloradotech.idm.oclc.org/10.1111/j.1540-8159.1981.tb03682.x
Tan, S., & Tatsumura, Y. (2015). George Papanicolaou (1883–1962):
Discoverer of the pap smear. Singapore Medical Journal, 56(10), 586-587.
https://doi.org/10.11622/smedj.2015155
The pioneers who took on cancer. (2011, Apr 05). Irish Times
https://coloradotech.idm.oclc.org/login?url=https://www-proquest-com.coloradotech.idm.oclc.org/newspapers/pioneers-who-took-on-cancer/docview/860014651/se-2?accountid=144789
