Abstract
This past February 20th, we celebrated the 50th anniversary of John Glenn's historic flight aboard Friendship 7. This mission marked the first time that an American orbited the Earth. The Soviets had already beaten the United States in the early space race with the launch of Yuri Alekseyevich Gagarin on April 12, 1961, aboard Vostok 1. There were many underlying issues and perceptions in the late 1950s and early 1960s from a geopolitical, military, and technology perspective. Beginning in the late 1950s with the Soviet launch of Sputnik 1, followed by Sputnik 2, it was clear to the Eisenhower Administration and then Kennedy's that the United States was facing an unprecedented challenge and falling behind. Technical superiority could be seen as a strength leading one nation to gain an advantage over another, and therefore influence the geopolitical landscape—a Cold War and a Space Race.
Prior to either nation putting people into space, there was a paucity of data and information on whether humans could even survive in the extreme environment of space. In the late 1950s, the aerospace medicine physicians in the Space Task Group at Langley Field in Virginia began to develop technology for monitoring animals and then humans during spaceflight. The application of biotelemetry in monitoring a primate named Gordo in December 1958 led to the concepts we now refer affectionately to as telemedicine in the United States. The Soviets used biotelemetry to access the condition of a dog named Laika in November 1957 during Sputnik 2. In both cases, these early developments enabled Earth-based physicians the ability to monitor the health status of Gagarin, Glenn, and hundreds of others who have traveled into space since those early days.
Throughout the 1960s, the United States and the Union of Soviet Socialist Republics raced to the moon. The United States won that race by placing Neil Armstrong and Buzz Aldrin on the surface of the moon on July 20, 1969, less than a decade since President Kennedy had committed the United States on this “very hard” mission. This effort and subsequent activities pushed advances in medicine, communications, computing technology, and many other technologies. Glenn's successful flight ushered in unprecedented growth in the technical capability of the United States, and the impact of this has been global. The concepts of telemedicine and the technology used to support it also grew.
Today, space exploration is becoming multinational and commercial. The United States now pays the Russians for a ride to the International Space Station. While some may say “what's the big deal?,” consider how investment in the future (pre-1960) led to a technological explosion and environment for innovation and discovery. These investments have reaped untold growth worldwide in healthcare and many other areas we all take for granted. These “winds of change” are not limiting growth but bringing more people to the table.
Telemedicine growth and application are growing much faster in the rest of the world. While barriers still exist, they are quietly being overcome. Here in the United States, we continue to struggle with many of these barriers. It often takes events that cause “winds of change.” The Space Race and Cold War obviously brought about change. War itself, while inflicting pain and suffering to life, limb, and treasury, also pushes the boundaries. As Operation Iraqi Freedom has come to a close and Operation Enduring Freedom begins to transition, there is a growing need to support healthcare needs of returning veterans. One area of significant concern is in telemental health. Recently the National Defense Authorization Act, which was passed by the U.S. Congress and signed by President Obama on December 31, 2011, provides an expansion of federal exemptions for behavioral telehealth across state lines. As reported in Army Times, this will permit the application of technologies like video-teleconferencing and smartphones to address mental health needs. Maybe it is finally sinking in that telemedicine works. Winds of change indeed! This response to an event not only will benefit the immediate individuals but will impact people worldwide.
Strength and direction come from effective leadership and integrity, but innovation comes from a sense of purpose or need or at least a perceived need. We recently lost Steve Jobs, a giant in innovation. The technologies that Apple developed as well as a host of others can trace their roots to ingenuity, which was the number one driving force behind the success of Friendship 7 50 years ago. Today, many individuals worldwide tinker along and develop new technologies and new methods for doing things. Imagine where we would be without John Glenn's historical flight. Winds of change indeed! Imagine how healthcare could actually become better and have “meaningful use”!
Whether the goal is to get to the moon before the decade is out or provide the best care that can be delivered to the patient regardless of location, innovation, and discovery will be a foundation from which to grow. Telemedicine and e-health have been around a long time. There is a growing base of data and knowledge that they work and work well. The world community is facing a shortage of behavioral specialists as well as other specialties, especially in rural areas. The application of telemedicine and e-health is ideal and is now available by eliminating barriers. The winds have changed!
As we look back on the development of telemedicine and its rich history, we are reminded of why and how it has been applied. This issue of Telemedicine and e-Health has an excellent presentation of peer-reviewed research that exemplifies “hard” work. The contents come from around the world from research and clinicians looking for better ways to ease the burden of disease and make healthcare more accessible. Change is coming, and the wind is blustery!