Howard L. Enfiejian, PhD.
Director of Research and Medical Communication
Derma Sciences, Inc., Old Forge, PA
Healthcare in late twentieth century America is undergoing changes as profound as those wrought upon the rest of the economy during the Industrial Revolution of the nineteenth century. These changes are arising in part from the tension developing between countless innovations in technology and therapy on the one hand and pressures for cost containment in the other. Never have physicians been able to do so much for so many people. However, if current trends in the cost of care continue, then these benefits will be available to increasingly few patients.
This tension can be daunting when one considers the cost of wound care. The cost of treating venous ulcers, decubiti, and amputations for refractory diabetic foot ulcers alone is between 3.3 billion and 11 billion dollars, depending on one's statistical assumptions. The prevalence of these wounds and the problems inherent in treating them may predispose caregivers to assume that wound healing is an inefficient biological process that must be prodded along with costly therapy.
If this is true, then physicians are certainly between a rock and a hard place. But it is not necessarily true, and herein lies an opportunity. The tension between cost containment and scientific progress does not simply pose a threat to the existing order. It also creates fresh avenues for new research. In the case of wound care, one response to this challenge may arise from a deceptively simple observation: wound healing is actually a preferred biological process. The healing wound is a biological priority. In many cases, wounds do not heal because they are not provided with the proper environment. Simple measures such as debridement, the maintenance of moisture and acidic pH, the prevention of infection, and the use of nutritional supplements facilitate the closure of many wounds.
There is a simple lesson in these observations. Given the proper environment, the body has an exceptional capacity for rebuilding itself. Cost-effective research should therefore focus on fully understanding this potential. One practical outcome of this research should be the creation of what has been called a "smart dressing." This is an interactive product that would create conditions in which innate biological processes operate optimally in repairing damaged tissue.
These and other issues will be described more fully in a review article that will be distributed in 1996 by the Internet's Wound Care Information Network at http://medicaledu.com