A Mechanist's heaven or hell depending on the Warranty, man and his 'Junk' machine is our reaction to Expiration date. Isn't it obvious that the human being are not machines but it is the medical industrial complex that treats humans like a machine with changeable parts. We all know that the parts are made to wear out! Who benefits from planned obsolescence Big Bigness, surprise,surprise!!
Expiration date
As Americans age, so do the implants that keep them going
Da Vinci, it turns out, got it right when he rendered man as blueprint: We are marvels of ancient engineering, a latticework of levers and pulleys and fulcrums, ligaments and muscles and bones.
Sometimes, the parts break down. So, during the past few decades, millions of patients have had hobbled hips and clunky knees replaced. They have had devices installed to make slow hearts beat faster, erratic ones beat steadier.
Now, even the replacement parts are wearing out. It was inevitable, really. Once, only old people got new hips and pacemakers, and most of the patients died before their new parts wore out. Not anymore. Today, orthopedic surgeons and cardiac specialists regularly operate on middle-aged patients, who have decades of wear and tear ahead.
And those younger patients demand more from their replacement joints and repaired hearts. They want to play 18 holes of golf, not watch it from the sedentary comfort of their La-Z-Boys.
''These replacements are machines, and they actually wear," said Dr. Thomas S. Thornhill, chief of orthopedics at Brigham and Women's Hospital. ''Whether it is a tire tread or brake lining or joint replacement, there is going to be some wear."
Just ask John Piotrowski. He had a defibrillator put in his chest in 1998 to stop his heart's propensity to beat wildly.
For seven years, the defibrillator did its job well enough -- in fact, the device lasted a couple of years longer than his doctors expected. But one Saturday morning a few weeks ago, as he got ready to go to his job as an express mail clerk at Logan Airport, the device delivered a jolt to his heart.
And then another.
''It feels like getting kicked in the chest with a boot," said Piotrowski, 43, who lives in Melrose.
That's bad enough when the jolt is necessary to keep his heart beating properly. But it turned out there was nothing wrong with Piotrowski's heart that Saturday morning -- it was the wire snaking from his defibrillator to his heart.
''They're sort of the weak link of the whole system," said Dr. Laurence M. Epstein, the Brigham and Women's specialist who wound up removing Piotrowski's frayed wire, and replacing it with a new one.
''Think about it," Epstein said. ''It's a man-made thing and you're putting it in the body and asking it to work for years in an environment where it's subjected to the beating heart."
The result: The wires can kink, they can disintegrate, they can simply stop working. Epstein estimated that up to 15 percent of patients with defibrillators and pacemakers experience problems with the wires. And taking them out can prove more difficult than implanting them in the first place.
That's why whether it's pacemakers or defibrillators, hips or knees, scientists are working to develop more durable replacement parts.
The need is especially great when it comes to joint replacements. Upward of 800,000 US patients each year have their hips or knees fixed with an implant.
Operations to replace or fix existing artificial joints have risen dramatically: From 1991 through 2002, the number of redos on knees doubled, and the growth was almost that fast for hips, too, according to figures from the American Academy of Orthopaedic Surgeons. In 2002, the same data shows there were 43,000 operations to replace or repair earlier hip implants, and 35,000 to replace or repair knee implants.
''Early on, this operation was reserved for elderly individuals who were looking for pain relief, and their functional level and their expectations were at a level appropriate to their age," said Dr. David C. Ayers, chairman of orthopedics at UMass Memorial Medical Center. ''Over time, the operation has been sought by younger patients who are inherently looking to be more active."
So Ayers is presiding over a medical study examining whether the use of a new metal in hip implants is superior to the current standard.
The socket that's widely used is made of the metal titanium. The 80-patient trial at UMass involves a socket made with a different metal called tantalum. (The study is underwritten by a company that makes both kinds of sockets, Zimmer Inc.; Ayers said he has no financial connection to the firm.)
Researchers want to know if the new metal will reduce chances that the implant will come loose -- one of the prime reasons hip implants have to be done over -- and if it will be less prone to shedding microscopic fragments that can deteriorate nearby bone. Using dual beams of X-rays and tiny markers on the implant, scientists will periodically examine the patients' new hips to determine if their implants have shifted.
Dalton Bickford got a new right hip May 2 and is among the first participants in the study. He'd been bedeviled by a throbbing, rickety hip for years. Why didn't he get it fixed sooner?
''I kept putting it off, putting it off until I couldn't stand it anymore," said Bickford, 62, who lives in Worcester, and has resumed climbing ladders since his surgery.
Bickford hopes his new hip will last well into retirement. He knows one buddy who's had an artificial hip more than two decades, but another who had to have his replaced after 10 years.
Those surgeries aren't cheap. Federal figures show that the average US hospital charges about $36,000 for hip surgery, though most insurers negotiate payments substantially below that. For instance, UMass officials said they're reimbursed $16,500 for hip and knee surgery by Medicare, the federal health plan for the elderly.
At some point, American society will have to decide whether to keep paying for replacement hips and joints for patients well into their 80s and 90s, said Dr. Lachlan Forrow, director of ethics programs at Beth Israel Deaconess Medical Center.
''Who's to say to this person that in the last year of their life, walking around isn't worth it to them?" Forrow said. ''That is a very clear crystallization of money issues that almost everyone in our country today is trying to run away from."
Dr. Harold L. Lazar, a cardiothoracic surgeon at Boston University, said if patients are otherwise healthy and expected to resume a quality lifestyle after surgery, he is willing to put replacement heart valves in patients even in their 80s.
He remembers one woman who was 88 or 89. She had a reason other than just her health for wanting to get a replacement valve made from animal tissue: It turned out she had a cache of so-called Wampum points, credits Foxwoods Resort Casino gives loyal gamblers that are redeemable for hotel stays and free meals.
The woman told Lazar she wanted to make sure she lived long enough to cash in all those Wampum points. She got the surgery.
Stephen Smith can be reached at stsmith@globe.com.
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