Healing

By ANDREW PURVIS

A NEURORADIOLOGIST IN IOWA STUDies the swirling contours of his patient's cat scan and immediately books the man for surgery. An Atlanta cardiologist, glancing at an untouched bottle of heart pills, looks his patient in the eye and urges him to take his medicine. A psychiatrist notes the pallor on the face of an earthquake survivor in Armenia and counsels her on post-traumatic- stress disorder.

Typical encounters between doctor and patient? Perhaps. But in each case the doctor and the patient are not seated knee to knee in an examining room: they are hundreds -- in one case thousands -- of miles apart. The physicians are practicing telemedicine, an emerging hybrid of telecommunications and patient care in which people in medically underserved areas use ordinary telephone lines to consult with highly trained specialists whom they could not otherwise afford to see.

In the past two years, two-way video telemedicine projects have been launched in Texas, Georgia and West Virginia, while less sophisticated methods relying on still photography have cropped up in Iowa, North Carolina and Nevada, among other states. U.S. doctors via satellite have diagnosed conditions in patients in Armenia, the Philippines and Belize. "It's a way of cloning the specialist and sending him out to locations around the world," says Dr. Jay Sanders, a telemedicine pioneer now teaching at the University of Miami.

Since the first videophone was unveiled at the New York World's Fair in 1964, doctors have dreamed of healing by wire. But the reality of transmitting a detailed picture over a 1-mm-thick (.04 in.) copper cable proved elusive. Then in the 1980s engineers working with a technique called digital signal compression managed to boost the data-carrying capacity of ordinary phone lines 30-fold.

Specialists in radiology, cardiology and neonatology, whose high-priced services are in great demand in rural areas, have been quick to take advantage of the new technology. These doctors do much of their diagnosing with tests such as echocardiograms, CAT scans and fetal monitoring, which can be displayed electronically and sent over the wires with ease.

For towns like Indianola, Miss. (pop. 12,000), the technology arrived just in time. One evening last month, the physician on duty at the South Sunflower County Hospital admitted a five-year-old girl who had miraculously survived a brutal car wreck. Apart from cuts and bruises, she seemed O.K., although tests showed that she had lost some blood. A year ago, a doctor might simply have kept her under observation. But the hospital had recently hired Teleradiology Associates, a group of radiologists based in Durham, N.C. Just to be safe, the doctor sent them a CAT scan of the child.

Viewing the image on a TV screen in his dimly lighted office three states away, Dr. David Forsberg noticed that something was wrong. "You could see a / rupture in the integrity of the spleen." He immediately recommended surgery; her bleeding organ was removed and her life saved. "In the middle of the night, it's reassuring to know that you're bringing your patients the best care available," says Dr. Tony Kusek, a country doctor -- and teleradiology enthusiast -- in Albion, Neb.

Outfitted with new data-compression technology, telephone lines can also carry primitive video. Networks that allow doctor and patient to sit down face to face, so to speak, and run through symptoms, diagnosis and treatment have been set up in Texas, West Virginia, Georgia and Florida (where the system is used to treat state-prison inmates). Images are still jerky, but consulting specialists can guide the doctor or nurse on site through a physical exam and discuss the results. "It's like learning to fly a plane with the pilot at your shoulder," observes Dr. Charles Driscoll, a family practitioner at the University of Iowa.

The future of telemedicine can be glimpsed in an experiment combining satellite transmission and high-definition television. Last December doctors in Boston used these technologies to study patients in Belize suffering from cutaneous leishmaniasis, a parasitic skin disease. The quality of the images was "amazing," says Dr. Linda Brinck. Doctors could clearly see the changes in skin texture and coloration that characterize the ailment.

The drawback: satellites and HDTV cost millions, and even the more modest telemedicine networks that use ordinary phone lines and two-way video are priced at $500,000. "For community hospitals, that's an awful lot of money," notes Dr. Tony Franken, head of radiology at the University of Iowa.

Still, the costs of fiber optics and digital compression are shrinking. Eventually, the projected savings from telemedicine -- up to $1,500 for every patient who does not have to be transported to an acute-care hospital -- are likely to outweigh the price. For enthusiasts like Dr. Brinck, the possibilities are limitless. She envisions U.S. specialists teaching the latest diagnostic techniques to isolated medics in Central Africa who, in turn, can inform American colleagues of emerging health crises in their regions. Satellite ties with doctors in Africa in the 1960s, she points out, might have drawn attention to aids long before it exploded in the bathhouses of San Francisco 20 years later. This is one way, at least, in which a smaller world may become a healthier world.