HW: PET and SPECT measure molecules in the body. And moving the disease orientation down to the cellular and molecular level is a very important advance. People today are doing more [molecular imaging] studies but are recognizing that they are very costly. The combination of PET and CT, where you have both the chemistry and the structure combined, is really great but it's expensive. But people don't realize that, although it increases the cost of putting a PET or SPECT system into an institution such as a hospital, if you approach it at the individual patient level, it decreases the costs of taking care of specific patients. That's called productivity. So as productivity goes up, costs go down and the availability [of health services] to more people goes up.

People have emphasized that these [scans] are expensive but small [research] studies show that [molecular imaging] can decrease the cost of caring for an individual patient. Smarter health care lets you decrease the cost of caring for a specific patient and makes more money available for taking care of more patients.


[DM: What about pharmaceutical breakthroughs?]

HW: There are 20,000 different types of molecules in the body. So you can see that the future is fantastic for studying these molecules in relationship to disease. Either the cells are putting out the wrong message or not receiving the right messages properly. This idea of recognition of molecules binding to recognition sites is a broad field that will continue for hundreds of years. Personalized medicine from a molecular imaging standpoint is putting the patient's problem in terms of manifestations of disease at the molecular level. The pharmaceutical industry and drug development ties right into that because then you can operate on the molecules. So you operate on the molecules rather than operating on the organs.

Another thing being presented at the [SNM] meeting is that you have to have radiation involved-radionuclide therapy to really cure cancer. It is now becoming clear that you not only have to get the molecular messages to the tumor cells but they need a radionuclide attached to them to damage the cancer cells and few surrounding cells. Radionuclide therapy is a field coming into its own and will only increase.

[DM: What about the subspecialties that overlap into nuclear medicine? Does that cause friction? Maybe we shouldn't go there.]

HW: I want to comment about that. I have long believed that a major human failing is territoriality. And I have been in the field 50 years and have always fought people who want to limit the technology to a particular specialty. From the early days I encouraged cardiologists to do nuclear medicine procedures. Excessive territoriality limits the field and taking care of the patient. I think these techniques should be used by qualified people whatever specialty is written on their pad.

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