Page 18 - Biomedical Engineering and Design Handbook Volume 2, Applications

PREFACE TO THE FIRST EDITION

How do important medical advances that change the quality of life come about? Sometimes, to be
sure, they can result from the inspiration and effort of physicians or biologists working in remote,
exotic locations or organic chemists working in the well-appointed laboratories of pharmaceutical
companies with enormous research budgets. Occasionally, however, a medical breakthrough hap-
pens when someone with an engineering background gets a brilliant idea in less glamorous circum-
stances. One afternoon in the late 1950s, the story goes, when an electrical engineer named Wilson
Greatbatch was building a small oscillator to record heart sounds, he accidentally installed the wrong
resistor, and the device began to give off a steady electrical pulse. Greatbatch realized that a small
device could regulate the human heart, and in two years he had developed the first implantable car-
diac pacemaker, followed later by a corrosion-free lithium battery to power it. In the mid-1980s,
Dominick M. Wiktor, a Cranford, New Jersey, engineer, invented the coronary stent after undergo-
ing open heart surgery.
You often find that it is someone with an engineer’s sensibility—someone who may or may not
have engineering training, but does have an engineer’s way of looking at, thinking about, and doing
things—who not only facilitates medical breakthroughs, but also improves existing healthcare prac-
tice. This sensibility, which, I dare say, is associated in people’s consciousness more with industrial
machines than with the human body, manifests itself in a number of ways. It has a descriptive com-
ponent, which comes into play, for example, when someone uses the language of mechanical engi-
neering to describe blood flow, how the lungs function, or how the musculoskeletal system moves or
reacts to shocks, or when someone uses the language of other traditional engineering disciplines to
describe bioelectric phenomena or how an imaging machine works.
Medically directed engineer’s sensibility also has a design component, which can come into play
in a wide variety of medical situations, indeed whenever an individual, or a team, designs a new
healthcare application, such as a new cardiovascular or respiratory device, a new imaging machine,
a new artificial arm or lower limb, or a new environment for someone with a disability. The engi-
neer’s sensibility also comes into play when an individual or team makes an application that already
exists work better—when, for example, the unit determines which materials would improve the per-
formance of a prosthetic device, improves a diagnostic or therapeutic technique, reduces the cost of
manufacturing a medical device or machine, improves methods for packaging and shipping medical
supplies, guides tiny surgical tools into the body, improves the plans for a medical facility, or increases
the effectiveness of an organization installing, calibrating, and maintaining equipment in a hospital.
Even the improved design of time-released drug capsules can involve an engineer’s sensibility.
The field that encompasses medically directed engineer’s sensibility is, of course, called bio-
medical engineering. Compared to the traditional engineering disciplines, whose fundamentals and
language it employs, this field is new and rather small, Although there are now over 80 academic
programs in biomedical engineering in the United States, only 6500 undergraduates were enrolled in
the year 2000. Graduate enrollment was just 2500. The U.S. Bureau of Labor Statistics reports total
biomedical engineering employment in all industries in the year 2000 at 7221. The bureau estimates
this number to rise by 31 percent to 9478 in 2010.
The effect this relatively young and small field has on the health and well being of people every-
where, but especially in the industrialized parts of the world that have the wherewithal to fund the
field’s development and take advantage of its advances, is, in my view, out of proportion to its age and
size. Moreover, as the examples provided earlier indicate, the concerns of biomedical engineers are
very wide-ranging. In one way or another, they deal with virtually every system and part in the human

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