What does a blood pressure cuff have to do with a Brain Gauge?

Climate change is not unique in scientific skepticism – there is a long history of early disbelief in new techniques or ideas: germ theory and sterile surgery, the earth not being at the center of the universe (Galileo got in trouble for that one!) and the blood pressure cuff as a relatively easy tool that anyone could use.

The task of measuring one’s blood pressure today is standard and is easily measured in the doctor’s office, a drug store, or even in your own home. The units of measure are standard across all devices and in all doctors’ offices. If you go to one doctor who takes a measurement, and then go to another and have your blood pressure checked, the two results can be directly compared. The results are clear and simple to understand, even to the average person.

That all seems like common knowledge and shouldn’t be a surprise to anyone. But did you know that all of the features that make the blood pressure cuff so accessible and useful today were adamantly opposed by doctors when the device was first introduced? But a doctor’s job is to help people, so why would they oppose a new device that would help them to do that?

Let’s take a look back in history—

Until the early 1900’s, the only way to measure a patients blood pressure was by very subjectively feeling the pulse on a patient’s wrist and determining the “fullness of the vessel…the tension of the artery…the size of the [pulse] wave…the force of the wave…[and] the duration of the wave” (Crenner 1998). There’s no question that being able to feel and interpret all of those elements takes skill and practice, but it’s also not questioned that there is no way to quantify the measure and standardize reported results between physicians. Which is why when the US surgeon Harvey Cushing came across the first model of the current blood pressure cuff on his travels in Italy in 1901, he knew that the device had the potential to improve the measurement of this important piece of any physical exam. However, when he brought the device back to the US and tried to share his excitement for it with other physicians, he was met with much pushback. Not because the doctors didn’t think that it worked or that it wouldn’t be a helpful tool for caring for their patients, but because it made their skills less important and made the task of measuring blood pressure one that was capable of being done by a nurse. Even when the push to use the device became inevitable, doctors still found ways complicate its use so to make it less accessible to an untrained doctor. Different physicians would report different measurements made with the same instrument, making comparisons between different physicians unreliable, all in an effort to make sure the patient was reliant on their one doctor in order to maintain cohesiveness in measurements made over time. It wasn’t until decades later that methods were finally standardized and nurses were allowed to administer the test (for more details on the story, see Crenner 1998).

What does this have to do with the Brain Gauge? We see the two devices as being more similar than you might at first think. Both fill a void in the medical examination process where, prior to their invention, measurements were extremely subjective and not at all standardized. As the Brain Gauge has been introduced into the medical system, we have seen some reluctance to accept it by some (but certainly not all) physicians, not because they don’t think that it works, but because they either don’t see the point in tracking a patient’s progress (one MD actually commented “if a patient tells me that they are in pain, I just give them more drugs – why would I need to know their cognitive status?”) or perhaps – and this is purely speculation – it makes them speculate that they would be less important in the diagnostic process (the parallel with the BP cuff is pretty strong on that – clinicians routinely use BP data regardless of how it was obtained to aid in their diagnosis). Current neurocognitive tests are extremely subjective and are most reliable when a single physician follows a patient over time to note subtle differences. When it comes to more acute trauma like concussions, we find that at colleges and universities, athletic trainers will use the standard tests, but will also decide if someone is ready to begin their return to play progression if the athlete subjectively “seem like themselves again.” With the Brain Gauge, trainers can see quantified neurocognitive scores and make an objective decision on whether an athlete is safe to return to the field.

The main difference between the two devices is that Brain Gauge scores do take a bit more knowledge to interpret and understand than blood pressure does, but in terms of scale, what we knew in the early 1900s pales with what we know today. While we do provide much of that information in articles on this blog (hopefully in a way that is easily understandable by the general public), a trained physician could be helpful to someone overwhelmed with result interpretation. Brain Gauge tests track many different processes going on in your brain, with each score indicating different imbalances that may be present. Thus, there is an element to the Brain Gauge that does keep the doctor as an important part of the system for those who want extra help interpreting results—provided that the doctor is willing to learn and take advantage of all that the Brain Gauge has to offer! As seen with Dr. Cushing back in 1901, even when the medical system as a whole may not have the best interest of the patient in mind, there are individual doctors out there who are motivated by doing what is best for the patient.

So if your doctor acts skeptical of a new medical device like the Brain Gauge, don’t jump to the conclusion that it means the device doesn’t work. Realize that many other devices that we can’t imagine the medical field without (like the blood pressure cuff and even a stethoscope!) were originally rejected by the medical field. On the contrary, if something new is rejected by the mainstream medical world, there’s a good chance that it’s because it DOES work – but it will upset the apple cart, so to speak. There is a fundamental inertia that tends to keep new ideas from being accepted, simply because they are different. We’ll keep posting articles so that our readers can help us overcome the inertia and push the Brain Gauge into the mainstream.

References

Crenner CW. Introduction of the blood pressure cuff into US medical practice: technology and skilled practice. Annals of internal medicine. 1998 Mar 15;128(6):488-93.