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VCU/MCV's new chief of surgery brings space-age medical research to Richmond.

Digital Doctor

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On April 13, a 15-member team of scientists and climbers began a trek to reach Mount Everest base camp.

After a weeklong hike, aided by 50 sherpas and 75 yaks, the team reached the 17,500-foot-high base camp. Everest's extreme altitude presented a host of health concerns for the team members, but the altitude and brutal weather of the world's rooftop didn't have any effect on the team of doctors who were assigned to monitor the health of the climbers.

The doctors were comfortably ensconced in a lab in New Haven, Conn.

The doctors, members of Yale's Commercial Space Center for Medical Informatics and Technology Applications (CSC/MITA) were part of a NASA-backed research laboratory. In the Everest mission, the lab tested technology NASA hopes to use to diagnose and treat medical problems over great distances by using computers and Internet hookups.

Last month, that NASA-sponsored research facility moved to Richmond when its leader, Dr. Ronald C. Merrell, accepted a position as Stuart McGuire professor and chairman of surgery at Virginia Commonwealth University. Merrell is a pioneer in the science of telemedicine, which he defines as "the use of telecommunications to practice medicine at a distance." On Aug. 9 and 10, Merrell and VCU will host a conference on telemedicine. The conference will showcase the latest advances in treating patients miles and miles away and will set the telemedicine agenda for the next year.

The Everest mission, for example, was a test run for some of the latest technology: Climbers wore small packs which enabled doctors to monitor the climbers' location, blood pressure, pulse and body temperature.

"We were interested in utilizing a remote and hostile environment to keep track of the physiology of people," Merrell says. "[Everest] is pretty remote and awfully hostile."

Merrell says the gear was put through its paces, and performed well. Along with basic health monitoring, Merrell says the team of Yale doctors was able to adjust one team member's thyroid medication for Everest's altitude, and diagnose an eye hemorrhage in another team member.

Merrell says the data from the expedition will be passed along to NASA, which is very interested in telemedicine as a way of treating astronauts. The eventual goal of this work is to make it possible to treat the members of a three-year NASA expedition to Mars that has a tentative launch date of 2010.

Merrell's office in the downtown campus of the Medical College of Virginia is still being assembled. He sits at a round table squeezed in beside an expansive wooden desk, and aside from a few certificates and a photo of Apollo 11 framed and hung on the wall, the office holds little else.

While working with NASA on developing the technology to diagnose and treat medical problems at a distance, Merrell realized that "there's a lot of terrestrial applications for that."

One of those terrestrial applications will be on the Discovery Channel this December. Merrell has developed a telemedicine system that reaches into the jungles of Ecuador's Amazon basin. He says that remote clinics in the jungles used to be served intermittently by a truck that traveled from clinic to clinic. But now, all of the clinics are linked by computer to VCU. Doctors in the jungle, advised online by doctors here, can now hold regular office hours and effectively treat emergencies as they occur.

Merrell also is working on establishing similar computer clinics in Brazil and Ukraine, where doctors will treat the elderly and victims of exposure to radiation during the Chernobyl disaster.

And Merrell hopes that remote technology will also help speed up a new surgeon's learning curve by allowing instructors to virtually "sit in" with their operating pupils. The teacher will be able to see, from many miles away, just what the pupil is seeing on the operating table in front of him, and offer advice. Merrell also says a robotic arm in the operating room will be able to receive commands from the distant teacher, and perform instructions. "I like the idea of an ongoing support for the people I train," Merrell says. With telemedicine, he can "go with them as a virtual presence."

In addition, he says that in the past 40 or 50 years, medical breakthroughs have driven up the cost of care exponentially, but telecommunications advances have made that industry's products ever cheaper. "Is it not our challenge to take these economic realities of telecommunications ... and combine that with medical care?" Merrell asks.

Almost in passing, Merrell mentions that a tiny, pill-size thermometer swallowed by the Everest team members that could transmit body temperatures back to Yale was also taken by Sen. John Glenn on his recent space trip. Contemplating the space program, Merrell, 53, remembers that as a teen-ager in Alabama, Wernher Von Braun, father of the American space program, spoke at his science fair.

"Maybe that's how I got started," reflects the physician who is in charge of ensuring that the astronauts of the future will receive adequate medical care from a base on Earth.

He says that just because someone is in a jungle, or on a mountaintop, far from a state-of-the-art hospital, the patient should not be denied state-of-the-art care. "Distance," he says, "should not determine

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