Laser Medicine and Surgery as a Single,Comprehensive,and Multi-Disciplinary Field

Abstract

Since lasers were first used in medicine in the late 1960s, a body of theoretical and practical specialized knowledge has been accumulated and is becoming standardized. The structural transformation of the empirical approach to the use of lasers in medicine has gone hand in hand with the tremendous advances in technology and the improved interpretation of their effects on biological tissue. This has given rise to a new medical field or discipline that, under different names, has become firmly implanted in the international scientific and medical setting. I refer to what has been called medical photonics, photomedicine, or laser medicine and surgery, as a single, comprehensive, and multi-disciplinary specialty in its own right. The adoption of a variety of names is a determined effort to unite the many aspects and effects observed in practice, which are the result of the interaction of different specialties with an interest in lasers. The technological production phase together with the observation of effects has encouraged the development of theses for improved and better defined work that has seen optimized results.

Some years ago, an editorial in the journal Nature stated that there are many ways of measuring the importance of a scientific discipline, but cited five requisites as follows: (a) when it generates many specialist publications in the scientific press; (b) when it sustains new and “vibrant” businesses; (c) when it generates stereotypes in the public imagination; (d) when it enjoys a good flow of money for research and for grants; and (e) when it boasts of a large number of experts or practitioners, united by a common view of the speciality.¹

We should therefore examine these five aspects, one by one, to determine the importance of laser medicine and surgery in the current setting.

Specialist Bibliographic Production

There are more than 10 quality scientific publications on Medline, with a notable impact factor, dedicated exclusively to the study of light sources and lasers for diagnostic, medical, and surgical purposes. An excellent example is this publication, Photomedicine and Laser Surgery, the official communication medium of the World Association for Laser Therapy (WALT),² the North American Association for Photobiomodulation Therapy (NAALT), and the World Federation for Laser Dentistry (WFLD). Other journals are the official communication media of other medical societies on the topic in different countries and regions. For example, we have the Boletín de la SELMQ, belonging to the Spanish Society for Laser Medicine and Surgery, ³ the journal Lasers in Medical Science, the medium of the European Laser Association (ELA)⁴ and other societies, and the journal Lasers in Surgery and Medicine, associated with the American Society for Laser Medicine and Surgery (ASLMS).⁵

Ability to Sustain New and Vibrant Businesses

The industry has developed a wide range of lasers and related devices that move millions of dollars each year in public and private medicine throughout the world. These are usually clinical devices, particularly in the area of esthetics, but are also found in many other medical and surgical specialties.

Ability to Generate Stereotypes in the Public Imagination

Society has idealized operations with lasers. Laser treatment is seen as an outpatient intervention that is rapid, effective, accurate, safe, painless, and free from complications. Countless patients want to undergo laser operations and usually refuse other types of potential treatment.

Investment for Research and Grants

Public and private bodies, the industry itself, and scientific societies for laser medicine and surgery dedicate major resources to research and development of laser technology with medical purposes, providing notable prizes and grants that often appear in the news and in frontline media. In this regard, the upcoming generations need opportunities that will allow them to follow their dreams. This will require quality and standardized training without distinctions and with good dissemination. This is now easier thanks to the digital media that contribute to the generalization of information and to achieving greater excellence in professional practice. The young are awaiting their turn, pushing forward with enthusiasm, and will achieve successes that will even transform the way we currently view the medical use of lasers.

Medical Experts United by a Common View of the Specialty

If you visit the websites of the main medical societies on photomedicine and laser medicine and surgery, you can see similar interests and goals: http://waltza.co.za/; www.selmq.net; www.europeanlaserassociation.com; and www.aslms.org

The shared interest is the study of the applications of light-emitting devices and lasers in the diagnosis and treatment of disease. The raison d'être of these societies is similar: to teach the experts, who form the majority of the readership of this journal. It is the experts who must fight to further the specialist domain in this area of knowledge and act against encroachment by unauthorized parties that make improper use of these technologies.

Thus, these five requirements are easily met, and the reductionist or instrumental use of the laser as just another gadget in the tool kit of each specialty is no longer acceptable. Indeed, these five aspects would seem to be of importance in highlighting the relevance of a scientific discipline and, by extension, defining the importance of a medical specialty. But the final aspect—that of the shared and united vision of all experts in the specialty and the solid, active, and corporate unity of these experts—is undoubtedly the most important. Unity breeds strength and from strength comes everything else as follows: organizations, publications, promotion in patient care, and the recognition of the healthcare authorities on this topic. I therefore think it important to highlight the work of some of the societies and organizations that I have come to know very well and which have made decisive contributions to a body of doctrine associated with the clinical use of lasers in medicine and surgery.

The medical experts in laser medicine and surgery must have a sufficient theoretical grounding regarding the physical, technological, and preclinical aspects, but, above all, they must have a thorough mastery of interventions in patients. In Spain, the Spanish Society for Laser Medicine and Surgery has taken part in designing two specialist training programs in this field: the certificate of competence in laser medicine and surgery (Diploma de Competencia en Medicina y Cirugía Láser), taught at the Centre for Studies of the Barcelona Medical Association, and the Master's degree in lasers and phototherapy in dermatological and esthetic disorders (Máster en Láser y Fototerapia en Patología Dermato-Estética), a qualification of the University of Barcelona. The teaching contents include basic aspects of the physics of light and the electromagnetic spectrum, basic ideas on the engineering behind clinical lasers, a thorough study of the interaction of light sources and lasers with biological tissue, and, finally, a compendium of the main applications of lasers in the main medical and surgical specialties.

Now, in our globalized world, supraregional organizations are becoming the norm. In the European Union, the European Laser Association is an umbrella organization for societies from different, mainly European, countries, with the effect of standardizing and normalizing contents and communicating to the healthcare authorities the need for development and legislation to facilitate the optimum use of photonic technology in different medical specialties. The same is happening on other continents and in other regions with shared historical roots. And as part of this macroglobalization, in its maximum expression, we find international and world associations, such as the World Association for Laser Therapy (WALT) and the International Society for Laser Surgery and Medicine (ISLSM).

Using the above arguments and combining the work of many other organizations, societies, and publications in the field, with which I am not as familiar but which are no less important, we should think about the title of this editorial, which considers laser medicine and surgery as a single, comprehensive, and multi-disciplinary specialty. We say that it is single and comprehensive because most of the knowledge needed to understand and handle lasers is transversal, that is, common to all specialties. The foundations of the physics of light and the electromagnetic spectrum, the basic knowledge of the structure, engineering, and features of the equipment sold, the interaction of light emitting devices and lasers with human tissue, the regulations on protection and safety, the aspects relating to calibration and maintenance of the equipment, and many other aspects are common and of interest to all physicians who use these technologies, regardless of their speciality. The meaning of dosimetric parameters, of selective photothermolysis, of photocoagulation, of a photochemical or photodynamic reaction, or what a thermodynamic ablation is, is exactly the same in dermatology as it is in ophthalmology, gynecology, urology, and digestive surgery, to mention just a few examples.

When we say that laser medicine and surgery is also a multi-disciplinary specialty, we mean that its use extends to practically all medical and surgical specialties, with their many differences, and requires specific longitudinal training to obtain a thorough mastery of the interventions carried out in each specialty. However, when solid transversal training is available, the longitudinal training, focusing specifically on each medical practice, is much simpler.

References

Policing ourselves. Nature, 2006; 441:383.