The Heroism of Incremental Care by Atul Gawande in The New Yorker
We devote vast resources to intensive, one-off procedures, while starving the kind of steady, intimate care that often helps people more.....
Surgery was a definitive intervention at a critical moment in a person’s life, with a clear, calculable, frequently transformative outcome. Fields like primary-care medicine seemed, by comparison, squishy and uncertain. ...
Observing the care, I began to grasp how the commitment to seeing people over time leads primary-care clinicians to take an approach to problem-solving that is very different from that of doctors, like me, who provide mainly episodic care.... "It's the relationship."
We’d begun collecting the data, developing the computational capacity to decode the patterns, and discovering the treatments that could change them. Seemingly random events were becoming open to prediction and alteration. Our frame of medical consideration could widen to encompass our entire life spans.
There is a lot about the future that remains unpredictable. Nonetheless, the patterns are becoming more susceptible to empiricism—to a science of surveillance, analysis, and iterative correction. The incrementalists are overtaking the rescuers. But the transformation has itself been incremental. So we’re only just starting to notice.
"Essentially, we can manipulate wound healing so that it leads to skin regeneration rather than scarring," said one of the team, "The secret is to regenerate hair follicles first. After that, the fat will regenerate in response to the signals from those follicles."
If you've ever wondered why scar tissue looks so different from regular skin, it's because scar tissue doesn't contain any fat cells or hair follicles. ...If hair follicles were induced to grow where a wound was healing, the resulting skin was found to be indistinguishable from pre-existing skin.
On the horizon. Revolutionary burn treatment uses stem cell spray Spray heals with little to no scarring
“Burns are absolutely one of the most devastating diseases known to man," said Dr. David N. Herndon, chief of staff and director of research at the Shriners Hospitals for Children in Galveston. When they're over 30 percent of the body they can be lethal. The list of physical and emotional complications from burn wounds goes on and on, and Herndon said with standard care (mesh skin grafting), the pain can last for weeks or even months.Posted by Jill Fallon at January 30, 2017 5:38 PM | Permalink
The SkinGun claims to take a postage-size sample of skin and extract the patient's own stem cells, then spray them onto the wound, avoiding skin grafts entirely. Plus, RenovaCare said, this does not have any legal limitations because the stem cells are not manipulated. “I think this should work, in my mind, without exposing the patients to risk," Herndon said. "(There's) nothing but benefit, so I feel strongly this will be approved."
The company that makes the product is based in Berlin. By Skype, the CEO and president of RenovaCare, Thomas Bold, said the treatment is not yet available in the United States, but it should be. “Normally, a wound heals from the edges to the middle, and the larger the wound and the longer the process takes, the higher is the risk for inflammation and scarring," Bold said. "What we are doing with our system, we are placing thousands and thousands of little regenerative islands throughout the wound. Those islands, those stem cells, connect to each other and close the wound really faster."
Next steps “Our next steps will be figuring out the efficiency and safety of the product and with the relevant clinical studies, but this we need to discuss and negotiate with the FDA, but these will be our next steps,” Bold said.