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Interviewer: Wave therapy for erectile dysfunction. We're going to learn more about that today, including what is it and are all wave therapy machines created equal. Dr. John Smith is a urologist at University of Utah Health.

So I've heard of this thing called wave therapy for erectile dysfunction. Can you tell me a little bit how that works? What's going on?

Dr. Smith: Yeah. So the wave therapy machines, there's a few different types and we'll get more into that later. But the idea is, these machines put off a wave similar to like an ultrasound machine where there's a wave coming out of the machine and those waves are meant to help stimulate the tissue for regrowth of blood vessels is what you hear a lot of times on a lot of the advertisements.

And that's what a lot of the research has been shown to do is as these machines are used, that it causes the body to have an increase in the factors that cause regrowth of blood vessels and that's how they work.

Interviewer: All right. And how does that help somebody who is suffering from erectile dysfunction?

Dr. Smith: So a lot of times with erectile dysfunction, you know, it can be as simple as, you know, the blood flow issues. It can be not enough going in, too much going out, those types of things. But a lot of times these wave machines will help to regrow or regrow blood vessels to help more blood go into the penis. Because the erection is pretty much the two chambers on the top of the corporate cavernosa get filled with blood. They become very erect, they become stiff and rigid and that's what gives a good quality erection. And so the more blood flow you have and the more quality blood flow you have, the better quality erections you have.

Interviewer: So individuals that have erectile dysfunction, some of them, it might be because they're not getting enough blood flow. So the sound waves, if I'm correct on this wave machine, actually it helps stimulate more blood vessels. You get more blood in there and then it's just hydraulics. You fill that up and you get a better, more sustainable erection.

Dr. Smith: There's couple of different types of machines and you mentioned sound waves. The most of the literature has been done on the mechanical wave, more of the ESWL machines, a similar type wave that they use to break up kidney stones.

However, there's multiple types of machines. Some of the machines do use acoustic waves or sound waves versus these mechanical waves to do it. And the research has been done with the mechanical wave machines, which have been shown to do a lot more. And the acoustic wave machines haven't really shown to be super beneficial in the research.

Interviewer: So an acoustic wave-like when you get super close to a speaker and you can feel the vibrations, is that what we're talking about with those machines?

Dr. Smith: Similar, yeah. It's an acoustic style wave machine, whereas a mechanical type wave machine uses more of a mechanical pulse wave similar to like I said, breaking up a kidney stone with the shock wave. So they'll call that a shockwave treatment versus the acoustic treatment. And the shockwave treatment has been the one with a lot of the research done over in Europe and other parts of the world to show improvement in regrowth of blood vessels.

Interviewer: So not all wave machines for treating erectile dysfunction are created equal. Now, how do you know the difference? How would a consumer know which machine they're getting when they show up?

Dr. Smith: You would want to be very, you know, you'd want to ask the right questions. What type of machine do you have? There's quite a few different types of machines. And, you know, you'll hear a lot of different things from different people, but the acoustic machines, if you look at the research and actually looked up the studies, the studies have been done with the shock wave machines.

And the shock wave is not new, it's been around for quite a bit of time. It started with kidney stones, where they used to put people in a big bathtub to break up kidney stones. And now they have handheld units with this shockwave therapy and it's actually used quite a bit and is FDA approved in the sports medicine arena for things like plantar fasciitis and other issues that way.

And it's still experimental and not FDA approved for erectile dysfunction, but it is being used for erectile dysfunction as kind of an off-label use because there has been good data that shows increased growth, increased rejuvenation, or neovascularization where there's new blood flow in the area.

Interviewer: And what kind of wave machine does University of Utah Health have?

Dr. Smith: We just actually got a new wave machine and it is the shockwave machine. We made sure we did as much research as we could, knowing that this is kind of a hot topic. A lot of people are very interested. And I get asked about it quite a bit.

And so, in the men's health department, we had a lot of patients who came in and asked quite a bit about it so we did the best research that we could to find a machine that could possibly give us the best benefit.

Now we're very selective with our patients at the University of Utah, for who we would recommend this to because it's not covered by insurance, it's relatively expensive. And again, you have to pick the right folks in order to get a good result. For someone who has a mild erectile dysfunction, someone who's taking pills and doing rather well with them, they may be able to come off the pills completely or need a lower dosage of the pills.

This isn't for someone who has a severe erectile issue after they've had a surgical procedure like a prostatectomy or something like that. It's not going to give them their erectile function back in those instances. This is for a very mild to mild-moderate erectile dysfunction. Those are the people who've really seen a benefit from this machine.

Now, if someone really wanted to say, hey, can you do it? We could do it, but I would very much caveat that to this likely is not going to help you.

And that's really the biggest thing for me is making sure that patients understand the expectations because this is not an FDA-approved treatment for erectile dysfunction yet. However, in the future, it may be as long as the research continues to look promising.

Interviewer: And after those treatments, you said you continue to monitor the patient to see how things go. Generally, are there a lot of follow-ups after that or once the treatments are done and those new blood vessels have grown, generally they survive pretty well and things work out?

Dr. Smith: So depending on the patient's medical history, but a lot of times, right now, we're still working out our protocols because this is relatively new that we have this machine. But again, you know, a lot of these folks, if they're rather healthy individuals who may have just had a blood flow issue, you know, they should be good and it should continue to be beneficial for them for a duration of time.

For folks who may have other medical problems, like people who are diabetics, who are going to have vascular issues, people with cardiovascular disease who are going to continue to have progression of those things over time, those would be people who are going to continue to follow up with us and make sure that, you know, things continue to stay well.

Interviewer: If somebody is having success with the pills, why would they choose the wave machine? Why are people choosing to come off the pills?

Dr. Smith: That's a long discussion that I have with patients, because the big thing is, is people are always looking for the easy, quick fix. And a lot of times the advertisements that they've heard make the wave therapy seem like a quick fix. And, you know, with the shockwave therapy, it can be beneficial, but again, a lot of these people don't understand that, you know, sometimes they may not be a good candidate or it may not be beneficial for them.

So after that discussion, a lot of them will continue with the pills, knowing, you know, the cost of the procedure is relatively, it's not covered by insurance so it costs a little bit more than everything else.

But the main people who will come in and just say, I want to get off of pills, I don't like taking pills, and if there's any possible way I can not have to take pills or not have to do that because erectile dysfunction pills can be somewhat cumbersome. If you have to take them an hour before sex on an empty stomach that can be kind of less spontaneous or, you know, other things, if you've had side effects to the medication, those would be the people who would generally look for another alternative.

I would talk with a professional. Talk with them, ask the right questions. What kind of machine is this? What can I expect? And look at the literature, you don't have to be a scientist to be able to look at it and see, but look at what's been done. And there is some good information out there about it but the shockwave machine has been the one that's shown the most promise of being able to improve erectile dysfunction. I would just say, make sure you're getting what you think you're getting.

Scot: Have you ever seen one of those defibrillation machines on the wall and wondered "huh, I wonder how that works"? We're going to find out next on The Scope.

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Scot: So you're starting to see them pop up more and more in public places-defib machines-in case somebody's having a heart attack or heart failure. But have you ever wondered boy, would I know how to use one? We're talking with Dr. Troy Madsen, emergency medicine at University of Utah Hospital. How do you use those machines?

Dr. Troy Madsen: You know, it's one of those things where fortunately they've made them easy enough to use that, you know, I'd like to say they're foolproof. They're probably not quite foolproof but pretty close to it.

Scot: Okay.

Dr. Troy Madsen: So, you know, the big scenario where I would use it would be where someone didn't have a pulse and they weren't breathing. So someone falls down. And you're going to find these machines in lots of different places, lots of different public sort of locations. But if someone falls down, they're not responding to you, they don't have a pulse, number one-start CPR. Call for 911. But meanwhile ask someone to go get one of those machines.

Scot: So can you get them? I thought they were permanently mounted on the wall.

Dr. Troy Madsen: They are, but usually you can just break through that just like, you know, you would break through some sort of thing for a fire extinguisher or something like that or get it open.

Scot: And then carry them?

Dr. Troy Madsen: And just bring it over.

Scot: Oh, they're battery powered?

Dr. Troy Madsen: They are. They are battery powered.

Scot: Oh, I thought they were mounted permanently.

Dr. Troy Madsen: No.

Scot: Oh, okay.

Dr. Troy Madsen: Fortunately you can just pull them right off the wall, bring them to wherever you are and wherever you need help.

Scot: Okay, all right. So somebody goes and gets one. They bring it on over.

Dr. Troy Madsen: Yeah.

Scot: And the only time you'd use it, if somebody doesn't have a pulse, that's the only time?

Dr. Troy Madsen: Yeah, exactly.

Scot: Okay, all right.

Dr. Troy Madsen: This is something for CPR.

Scot: Okay.

Dr. Troy Madsen: You're going to use if you're doing CPR. Ideally, you know, if you're in a situation where someone goes down and you don't have any experience with CPR, just start chest compressions but ask "hey, does anyone here know how to do this?"

Scot: All right.

Dr. Troy Madsen: Get the most experienced person in there, but it's something where you can pull that thing off the wall, get it down there, and start using it. So once you open it up and turn it on, it'll tell you what to do. It'll tell you "place pads," and it'll show you where to place the pads. You're putting them on the person's chest.

Scot: Really? So it's a little video screen?

Dr. Troy Madsen: It'll speak to you. It actually talks to you.

Scot: It talks to you.

Dr. Troy Madsen: It will talk to you.

Scot: Wow.

Dr. Troy Madsen: Yeah, these things are programmed just so they talk to you, and they'll tell you what to do.

Scot: Okay.

Dr. Troy Madsen: And then they'll tell you "Do chest compressions" because that's the most important thing you're going to do in any of these situations. Just do good chest compressions. Keep pushing on that person's chest at 100 beats a minute. Just keep going.

Scot: Staying alive.

Dr. Troy Madsen: Staying alive.

Scot: Bee Gees song.

Dr. Troy Madsen: Yeah, think staying alive.

Scot: Sing it in your head.

Dr. Troy Madsen: Because that is 100 beats a minute. And then it will tell you "Stop compressions" and then it will say that it's analyzing the rhythm, and what that means, it's looking at the person's heart rhythm to decide is this something it can shock or not. And there are certain heart rhythms when a person's heart is not beating, but it still has some electrical activity where it can shock that, and by shocking it, it can put it back in normal rhythm. So that's what the machine's looking for.

Scot: Okay.

Dr. Troy Madsen: And then if it can shock it, it says "shock," and it tells you "push this button," and you push it, and it shocks the person, and that shock might be the thing that saves that person's life.

Scot: So it sounds really easy to use this machine.

Dr. Troy Madsen: It is.

Scot: Just do what it tells you to do.

Dr. Troy Madsen: Exactly.

Scot: Wow.

Dr. Troy Madsen: They've really designed it so it just walks you through the steps. So, you know, if you're in that situation and you don't have any experience or there's just no one there who knows how to use it, that's okay. Just jump in and do it, and it will walk you through the steps. Keep in mind that this person if they don't have a pulse and they're not breathing, for all intents and purposes, they are dead. So you are doing something to try and help them, so just jump in and do it, and it'll tell you what to do.

Scot: In that instance, you're not doing harm.

Dr. Troy Madsen: You are not doing harm. We always tell ourselves "Do no harm." You're not doing harm. Without your help, this person is dead, so just jump in and see what you can do, and the machine will tell you how to do it.

Scot: And then you just keep doing what the machine tells you until when?

Dr. Troy Madsen: Exactly. It'll just keep telling you until the ambulance gets there. That's the most important thing. Until they get a pulse back. It'll tell you to check for a pulse, so you can feel the best places on the neck. Feel for the carotid pulse. It's the big artery there on the neck. If you don't feel a pulse, then it'll just tell you "Keep doing chest compressions." And it'll tell you "Stop chest compressions." And it'll tell you again if it can shock, and you push the shock button. So it'll walk you through the steps very nicely.

Scot: So, to the best of your knowledge, are these machines in a lot of places? Just a few places? Is it publicly owned places?

Dr. Troy Madsen: You're going to find them in most large places where people are congregating, meaning airports, arenas, concert venues, schools, certainly hospitals. You know, all these places are usually going to have a defibrillator or an AED, an automated external defibrillator. So wherever you are, if you're in a public place, look for one if you need it, if you're in that situation . . .

Scot: Sure.

Dr. Troy Madsen: . . . or ask someone "can you go find something?"

Scot: Just be aware that there could be something that could help you.

Dr. Troy Madsen: Exactly.

Scot: Because that would be terrible after the fact to realize that that tool was there and you didn't use it.

Dr. Troy Madsen: It would be, yeah.

Scot: What if you're in a situation where you have to make the choice of doing the chest compressions or going to get the machine because there's nobody else around at that point?

Dr. Troy Madsen: That's a tough situation.

Scot: Would you run and get the machine or should you do the chest compressions?

Dr. Troy Madsen: My number one thing there would be calling 911, and if I didn't have a phone there with me, I would go to a phone and call 911 because they're going to give the most help. But I would do chest compressions. If I were in that situation, chest compressions are going to keep that person alive long enough for the ambulance to get there.

Scot: But first call 911 before you do anything.

Dr. Troy Madsen: Number one-call 911. Yep, that is the first step before you do anything because they're going to get the advanced care and get that person where they need. But you can keep that person alive, keep at least some blood going to their brain and their body by doing chest compressions.

Scot: All right. Any final words of advice on using one of these things?

Dr. Troy Madsen: Final word of advice would be, you know, if you're in this situation, think chest compressions first. Do that. Call for 911. But if you've got access to it, don't be scared of it. Just jump in and use it. It'll walk you through the steps.

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Interviewer: Today we're speaking with Dr. Carl Wittwer, University of Utah Professor of Pathology, who recently was made a Fellow in the National Academy of Inventors, along with two other University of Utah faculty. You came to the University and one of the directives for you, in your position here, was to find new technology. What did you invent?

Dr. Carl Wittwer: I was a new professor, first academic job. And I had a small laboratory but I had a need that I wanted to do the PCR process. That involves changing temperature, usually between two or three different temperatures. And the equipment to do that, although common today, did not at that time exist. So being somewhat naive and energetic, we decided to build our own instruments. Initially they were somewhat comical instruments, derived from heaters off of hair dryers and fans off of vacuum cleaners. But with a lot of trial and error and a number of prototypes that did not work at all, or not very well, I came up with a very good replication of what was then starting to come out as PCR machines. With one exception. We were able to do it fast. We were able to change temperature very quickly. And if you think about some of the diagnostic applications for PCR, faster answers are always more useful. Typically, at that time, PCR was on a two to four hours with the rapid system. So we developed, we cut the time down to 10 to 15 minutes.

Interviewer: Okay, can you tell us what polymerase chain reaction is and what it does?

Dr. Carl Wittwer: Certainly. Long name but simple concept. Cells in your body replicate after they've made two copies of DNA. Now, you can do this in vitro or in a test tube by the polymerase chain reaction.

Interviewer: And what's the advantage of replicating DNA?

Dr. Carl Wittwer: The advantage would be to amplify that DNA so you can test the sequence of the DNA much easier. So there's only very minute amounts of DNA in most cells, and the process of amplification allows you to interrogate or look at it, ask questions about what it is doing. What the bases are, what it's coding for. And whether or not there's any variance in the DNA. So ,it's like a large magnifying glass.

Interviewer: And what then can you learn from all this DNA that you've amplified and made, I take it, millions of copies of?

Dr. Carl Wittwer: Millions of copies. You'll of course be familiar with the forensic applications that you see on television in terms of identity or ancestry. In the clinical laboratory the major applications are in three different areas. Infectious disease, DNA that should not be there in a sample from an individual. Oncology or cancer, which of course is made, or is caused by changes in DNA. And finally, in genetics. To test for genetic diseases, characteristics that you may have that other people don't have.

Interviewer: From this first invention of yours, a company called Idaho Technology was eventually born.

Dr. Carl Wittwer: Correct, yes.

Interviewer: And Idaho Technology then manufactures these devices?

Dr. Carl Wittwer: Yeah, the initial device, again, we're back in 1990 or so, so it's quite a while ago. We called it, not surprisingly, a Rapid Cycler. A niche product but people were interested in doing things quickly. And it kept the company alive for quite a while. One other thing that we developed was looking at DNA melting. So if you remember the double helix form of DNA, it's got two strands. And if you heat it up, eventually those two strands fall apart. And if you watch very carefully, about how they fall apart, you can tell an amazing amount about what that sequence is and what it does. And any changes that may have occurred in that DNA. Later on the company, which eventually changed its name to BioFire, has been very successful in getting FDA approved products that look for syndromes that are caused by infectious agents. And even though it might be a common syndrome, like a flu-like illness or gastrointestinal symptoms, there's only a limited number of organisms that can actually cause those things. So this particular device will identify the caused organism of a syndrome. All within an hour. If you think back to your experiences at the doctor's office and how long it might take to get results back to you, this has all been encapsulated in to a one hour test. In terms of genetic and infectious disease diagnostics.

Interviewer: It seems to me there's a very creative process going on when you're inventing. What makes you so creative in that area? Or what makes you want to be so creative in that area?

Dr. Carl Wittwer: Yeah, so the old catch phrase of need is the mother of invention, you have to want something. You have to want a goal. You want to be able to achieve something. Whether it's doing PCR fast, which is still one of our, one of my major goals. To take the speed of amplification as an example, at the time that we changed a multi-hour process down to 10 or 15 minutes, that was pretty extraordinary. And I remember someone had a cold call from the blue who criticized me on the phone severely and said, "Wittwer, how can you lie to the public in your scientific publications?"
So, when you really do something that's different, people will not believe what you've done. The next step usually is they'll say, "Okay, I admit that you've done it but it's not worth anything. What are you going to use it for?" Right? And then eventually you'll get some adherence. Some people who say, "Ah-ha, this actually really works." And eventually it might penetrate the market and you might be very successful in terms of company products. Of course, at that stage, usually the original inventors get forgotten. But what you need to remember is that's part of the process and it's actually success when that happens.

Interviewer: What does the future have in store for you and your research?

Dr. Carl Wittwer: We started by making PCR faster than it was at that time. And although it's taken us 20 years to revisit the speed of amplification, the speed of PCR, we now have systems that take that 10 to 15 minute process and can actually produce robust, efficient, quantitative PCR in less than a minute. So start thinking about point of care applications, where you're actually waiting for the answer. So, when you can potentially get results out in under a minute timescale, it changes the way you think about providing diagnostics. Particularly at the point of care. So, of course I'm very excited about this again. Again, currently the state of this is in prototypes that no one, that are not commercially feasible and that very few people would have the patience to work with. But in terms of proving the point, the limits of, be it, in this case, speed, you end up with those prototypes that hopefully other people will pick up and make more commercially practical.

Interviewer: And are you confident that at some point technology will be commercially available that allows physicians or whatever other providers, organizations, to come up with results in a minute or less?

Dr. Carl Wittwer: Yes. It'll happen. It has to happen because of your need, because of your desire to want things quickly. And there's no reason, once the technology has shown that you can do it, the population will drive the companies to make it available.

Interviewer: What else can we cover that you would like to, or we didn't?

Dr. Carl Wittwer: You know, most true inventions don't happen in large groups. They happen with individual people. And often they happen with individual people who don't have a lot of resources. So what that means in terms of the roll out of inventions, they usually don't happen in large companies. They happen either in small companies that are struggling to survive. Or they happen in academic labs, often small academic labs. Where someone latches on to an idea, commits themselves to it and makes it happen.

Interviewer: Which sounds like is what you did.

Dr. Carl Wittwer: Yeah, it's a lot of stubbornness. And belief in what you're doing. Even when other people don't believe in what you're doing. And believe me, they will not believe. I've had that experience.

Male: We're you're daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.