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Shedding New Light on Lasers for Medical Use : Euphoria Over the Beam's Potential Dimmed by Concerns About Marketing

August 29, 1986|ALLAN PARACHINI | Times Staff Writer

The bright, warm red light beam swirls through the glass fiber tube carrying it from the laser generator in another room, spilling onto the hand of UC Irvine researcher Michael Berns, who observes that there is persuasive--if not final--evidence the laser may help cure cancer.

It is a heady, gee-whiz kind of thing, perfect for the evening news on television--not coincidentally where such magic light beams have repeatedly starred. But with the stardom there are now starting to come questions--not necessarily about the laser itself but about the means being used to market and promote it.

Dye Laser

This little demonstration of a device called a dye laser occurs in an outpatient operating room inside the new $7-million Beckman Laser Institute on the Irvine campus. It is a facility just opened this June but it has already established itself as one of the three most important centers in the country for research on how these futuristic light beams can play a role in medicine and surgery.

There are green argon lasers that can vaporize warts on the skin--a point Berns unintentionally emphasizes by accidentally inflicting a minor burn on his hand during a demonstration. And there are invisible carbon dioxide lasers capable of extraordinarily precise incisions in their role as a so-called "light scalpel."

Something called a YAG laser (an acronym drawn from its full name, neodymium:yttrium-aluminum-garnet) can play a role in cataract surgery and a wide variety of other eye operations.

Fascination for Public

They're captivating, these lasers, and since the first such beam of light was shot in a laboratory in about 1960, they have emerged as a fascination for the public. They act as speed-of-light pipelines for millions of telephone conversations and they may eventually be able to shoot guided missiles from space. They have certainly revolutionized some branches of medical care and they may revolutionize others.

This kind of publicity has been good for lasers, Berns thinks, but it also has been the basis for growing concern that lasers are being oversold and perhaps overused by doctors and hospitals eager to cash in on the laser's value as a marketing gimmick.

The dermatologist who advertises he will use a laser (cost of machine: $20,000) to remove a simple wart from the hand, for instance, may not tell a patient that the wart can be removed at least as effectively by three other less expensive and more conventional means. One of them is the cheap, pedestrian, disposable $3 metal scalpel.

Sitting in his office at the institute, Berns chuckled at a question about lasers and warts, using his own son as an example of how patients have come to equate the laser with cure. "He's having a plantar's wart taken off his foot," Berns said of the boy. "They're using cryosurgery (a now comparatively old-fashioned process in which a wart is frozen under controlled circumstances). But he (the youngster) says to me, 'Dad, why can't it be done with a laser?' "

The laser has become the treatment of choice for warts at some body sites--most notably in the ano-genital area. And even for routine wart removal, the laser has its adherents who, like Harvard Medical School's Dr. Kenneth Arndt, a nationally known laser expert, argue that in many cases if a dermatologist or plastic surgeon has become proficient with a laser and feels more comfortable using it than other methods, there is little reason to avoid use of the laser, "as long as the charges aren't absurd."

Laser's Premium Price

But like many other doctors, Arndt said he is concerned that some physicians may charge a premium for using a laser when a cheaper means of treatment would substitute. Such practices, he contended, are inexcusable.

The plastic surgeon who advertises he uses lasers to make wrinkles disappear in a "laser face lift" may not explain to patients that there is no evidence the effects are long-lasting. The practitioner offering "laser acupuncture" or touting lasers as a means to promote wound healing might not point out that acceptable proof of such effects has yet to emerge in scientific circles.

"I think those things (such claims) are bordering on fraud," Berns said. "They represent an abuse of lasers where there is no scientific evidence the laser is having any benefit."

So with the understandable hope engendered by the varied present-day capabilities and possibly greater future potential of lasers, there is a zapping by frustration and worry, too. If is felt by people like Berns, who is president-elect of the American Society for Laser Medicine and Surgery, and Dr. George Bohigian, an ophthalmologist at Washington University in St. Louis who headed a special American Medical Assn. panel studying the established and emerging roles for lasers--as well as their potential for abuse.

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