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Outfitted with new data-compression technology, telephone lines can also carry primitive video. Networks that allow doctor and patient to sit down face to face, so to speak, and run through symptoms, diagnosis and treatment have been set up in Texas, West Virginia, Georgia and Florida (where the system is used to treat state-prison inmates). Images are still jerky, but consulting specialists can guide the doctor or nurse on site through a physical exam and discuss the results. "It's like learning to fly a plane with the pilot at your shoulder," observes Dr. Charles Driscoll, a family practitioner at the University of Iowa.
The future of telemedicine can be glimpsed in an experiment combining satellite transmission and high-definition television. Last December doctors in Boston used these technologies to study patients in Belize suffering from cutaneous leishmaniasis, a parasitic skin disease. The quality of the images was "amazing," says Dr. Linda Brinck. Doctors could clearly see the changes in skin texture and coloration that characterize the ailment.
The drawback: satellites and HDTV cost millions, and even the more modest telemedicine networks that use ordinary phone lines and two-way video are priced at $500,000. "For community hospitals, that's an awful lot of money," notes Dr. Tony Franken, head of radiology at the University of Iowa.
Still, the costs of fiber optics and digital compression are shrinking. Eventually, the projected savings from telemedicine -- up to $1,500 for every patient who does not have to be transported to an acute-care hospital -- are likely to outweigh the price. For enthusiasts like Dr. Brinck, the possibilities are limitless. She envisions U.S. specialists teaching the latest diagnostic techniques to isolated medics in Central Africa who, in turn, can inform American colleagues of emerging health crises in their regions. Satellite ties with doctors in Africa in the 1960s, she points out, might have drawn attention to aids long before it exploded in the bathhouses of San Francisco 20 years later. This is one way, at least, in which a smaller world may become a healthier world.