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3 PHYSICIANS AND PHYSICISTS: THE INTERDISCIPLINARY INTRODUCTION OF THE LASER TO MEDICINE
3 PHYSICIANS AND PHYSICISTS: THE INTERDISCIPLINARY INTRODUCTION OF THE LASER TO MEDICINE
Pages 41-66
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From page 41... ...
What institutions and relationships resulted in the development of the laser photocoagulator? The answer to this question lies in the story of the laser's development.
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From page 42... ...
Radiation Laboratory and the Columbia University Radiation Laboratory in the physics department. These research sites were enormously successful, and in 1946 the Joint Services Electronics Program (JSEP)
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From page 43... ...
The military was interested in having a portable generator of a frequency standard for guided missiles and the Army Signal Corps Engineering Laboratory provided funding to the Jet Propulsion Laboratory in Pasadena, California, to research this.4 Hughes Aircraft's Research and Development Laboratory hired the former chief of the Microwave Standards Section of the National Bureau of Standards to improve Hughes' competitiveness for military contracts. A result of maser research was a closer relationship between engineering and 3The trait of a narrow band of wavelengths being emitted is often called the ``pureness of the frequency of the maser.
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From page 44... ...
. He began to create design ideas for an "optical maser" and contacted Arthur Schawlow of Bell Labs, where Townes was a consultant.6 They agreed to work together and Bell Labs filed a patent application for their optical maser proposal a year later.
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From page 45... ...
paper on the optical maser, a race had begun to construct the first working laser. At least six laboratories, most in private companies, were involved in this research: Columbia University, Bell Labs, TRG, IBM, Hughes, and American Optical Corporation.
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From page 46... ...
Ophthalmologists wanted a better light source for photocoagulation, and several companies experimented with improved lamps. Photocoagulation was highly publicized, so it is not surprising that some developers of the laser recognized that their invention might provide an appropriate light source for ophthalmological treatment.
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From page 47... ...
He had been trained as an engineer during his military service in World War II and had written a graduate chemistry thesis on the structure of the atom, a subject that would now be in the realm of atomic physics. This interdisciplinary scientific education enabled him to fully understand the laser and its effects on human tissue; every ophthalmologist who developed laser photocoagulation systems in the early 1960s had a similarly strong knowledge of physics.
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From page 48... ...
Charles Koester of the above-mentioned American Optical Corporation in Southbridge, Massachusetts. The other group was based at Stanford University and was headed by Drs.
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From page 49... ...
Lastly, Charles Campbell, Milton Flocks, and Christian Zweng had conducted research with the Zeiss photocoagulators their medical centers received in 1959. American Optical established its laser research program in 1959 by hiring Elias Snitzer.
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From page 50... ...
Shortly after this meeting, Flocks and Zweng contacted someone in the physics department at Stanford who built a ruby laser for them to conduct preliminary research. Zweng also consulted with Milton Zaret, as Zaret was assisting several researchers in the development of laser research laboratories.
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From page 51... ...
Zweng also co-authored the first book on laser photocoagulation in 1969 (see Zweng et al., 1969~. As mentioned earlier, Optics Technology, Incorporated, was founded in 1960 by Narinder Kapany, a physicist educated in India.
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From page 52... ...
According to Kapany, Optics Technology and American Optical "didn't have any competitors until almost the year 1968 when Coherent Radiation came out with an argon photocoagulator" (reported in Cunningham, 1986~. The argon laser was invented in 1964 and within a year researchers used this light source for photocoagulation.
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From page 53... ...
Further, most ophthalmological laser researchers, according to Elias Snitzer, "were aware of the fact that it was necessary to shift the wavelength into the green" (reported in Bromberg, 1984~. American Optical did not pursue the argon coagulator because they did not have a research program on argon lasers in place (personal communication, Charles Koester, April 29, 1993)
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From page 54... ...
Goldman's laser research began in 1962 when the Occupational Health Division of the U.S. Public Health Service and the Hartford Foundation provided funding to the department of dermatology at the University of Cincinnati to establish a medical laser laboratory.
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From page 55... ...
The particular interest of the Hartford Foundation, NIH, and Goldman was to develop surgical instrumentation for basic research and clinical studies. By 1965 the new medical laser laboratory was considered "one of the best-equipped laser research laboratories in the U.S.A." (Laser Focus, 1965~.
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From page 56... ...
Medical laser research developed an audience from the large number of medical and laser conferences in the 1960s. It was through these events that the medical profession informed laser developers of their needs.
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THE MEDICAL LASER INDUSTRY TODAY Even over 30 years after Zaret's preliminary paper (Zaret et al., 1961) on the laser, new medical uses for the laser are announced frequently.
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From page 58... ...
Leroy Sutter of Directed Energy, Inc., and Kenneth Nilsson of Cooper Lasersonics, Inc., agree that "FDA regulations have been of minimum detriment" to the success of lasers in medicine (Akerley, 1985~. Federal policies for financing health care also affect the medical laser device market.
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From page 59... ...
THE INTERDISCIPLINARY INTRODUCTION OF THE LASER TO MEDICINE 59 TABLE 3-2 Judgments of Effectiveness of Medical Applications of Lasers Procedure Established Clinical Experience Randomized Probably Controlled Cost Trial Effective Proven Cost Effective Dermatology Port-wine stain Tattoos Telangiectasia Warts Ophthalmology Diabetic retinopathy Retinal detachment Retinal vein occlusion Trabeculoplasty for glaucoma Senile macular degeneration Posterior capsulotomy x x x x Otolaryngology Respiratory papillomatosis Pharyngeal pouch Tongue resections Pulmonology Palliation of advanced lung cancer Gastroenterology Hemostasis of gastric ulcer Hemostasis of intestinal vascular malformation x Cancer palliation of esophagus x Cancer palliation of colon Sessile villous adenomas Hemorrhoids Urology Bladder cancer Penile carcinoma Condyloma Laser lithotripsy Gynecology x x x x x x x x x x x Cervical intra-epithelial neoplasia excision x Fallopian tube reconstruction x Endometriosis Condyloma x x x x x x x x x x x x x x x x x x x x x x x x x x SOURCE: Banta et al., 1992.
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From page 60... ...
Despite institutional hurdles, the medical sector is one of the fastest growing segments of the laser industry (see Table 3-3~. Collaboration between laser manufacturers and clinicians has boosted medical research and equipment sales, TABLE 3-3 Laser Sales (in million dollars)
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From page 61... ...
In 1987, C Breck Hitz described the medical laser market as being "profitless" (blitz, 1987)
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From page 62... ...
ACKNOWLEDGMENTS I am grateful to the late Milton Flocks, Nar~nder Kapany, Elias Snitzer, and Milton Zaret for allowing me to interview them, to Charles Koester for his correspondence, and to the Neils Bohr Library, Center for History of Physics, at the American Institute of Physics for a transcript of Joan Bromberg's interview with Elias Snitzer and a questionnaire from Charles Koester. Nathan Rosenberg and Victor Fuchs provided many useful comments.
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From page 63... ...
1973. Argon laser photocoagulation of diabetic retinal neovascularization (a five year appraisal)
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From page 64... ...
1964. Experimental laser photocoagulation.
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From page 65... ...
This idea was essentially ignored until Charles Townes proposed the maser, which was a feedback oscillator from which microwaves were emitted. By bombarding deuterated ammonia with energy, Townes forced many of the electrons of the ND3 atoms into higher quantum states than they normally exhibit.
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From page 66... ...
66 Absorption energy (I)
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