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Health Care's Fantastic Voyage

Robert LangerRobert Langer is an Institute Professor at MIT. This is his first piece to be published on Webdiary.

by Robert Langer

One of the most important efforts in health care research over the next decade will be to integrate advances in biology, material sciences, and chemical and bioengineering to create a revolutionary new generation of medical devices and drug delivery systems. Indeed, the main challenge facing researchers in these diverse fields may not be a lack of scientific progress, but rather a shortage of adequate interdisciplinary training.

A key area for research will involve tissue engineering, which generally involves combining the cells of mammals (including stem cells) with polymer-materials to create new tissues or organs. It is now estimated that nearly half a nation‘s health care costs can be attributed to tissue loss or organ failure. The ability to create new livers, spinal cords, hearts, kidneys, and many other tissues or organ-based systems could radically decrease hospitalization time, relieve suffering, and prolong life.

The challenges here are, of course, huge. In particular, an appropriate source must be found for producing a large enough supply of differentiated cells quickly enough. Stem cells represent a potentially important potential source, but problems in controlling their differentiation and growth must first be overcome, as must rejection by the human immune system.

Another path to be pursued involves the development of micro-electrical mechanical systems (MEMS) that can be used in drug delivery. These microdevices would be made of silicon or other materials that can be loaded with drugs (or sensors) and covered with caps made of gold or other substances. An electrical signal to the implant would dissolve the gold cover to release the drug.

Such systems have the potential to deliver new kinds of drugs in complex regimens which might be useful for cancer chemotherapy, for example. They could also provide new means of localized drug delivery that might be useful in several areas, including delivery of multiple drugs. Finally, such systems might also create new opportunities for bio-sensing devices that could be placed on a computer chip.

New kinds of biomaterials for medical devices are also on the horizon. Currently, most biomaterials are off-the-shelf materials that were originally used in consumer applications. For example, the material in the artificial heart was originally used to make girdles for women. Some breast implant materials were originally used in mattress stuffing.

A potentially important area here is the development of materials that have a “shape memory.” For example, a surgeon might place something like a string
through a small endoscopic hole; in the presence of an appropriate stimulus (for example, temperature or light), it would then convert itself into an appropriately shaped medical device such as a stent, or a sheet to prevent adhesion. Another potential use for such materials might be self-tying sutures that could be employed in minimally invasive surgery.

New materials will also be necessary to overcome one of the main obstacles to successful gene therapy: the absence of appropriate delivery systems. While viruses are a highly efficient means, they pose safety risks. Likewise, the non-invasive delivery of complex molecules such as peptides or proteins remains a major challenge. Currently such molecules are given by injection. But if scientists can develop better delivery systems or synthetic agents that are safer, cheaper, and easier to manufacture, enormous opportunities will be created for complex drugs that could be given without injections.

New advances in engineering medicine may help in targeting drugs at specific cells, particularly cancer cells, which has been extremely difficult to do for several reasons. One challenge is to design micro or nano particles that can travel throughout the bloodstream without being absorbed by other cells along the way. If that can be accomplished, “magic bullets” to fight cancer, heart disease, and other disorders might someday be possible.

All of these looming changes will likely have an enormous impact on drug development and diagnostics.

However, developing and exploiting the full array of potential new disease-fighting weapons will require outstanding scientists and engineers, including those with interdisciplinary training. 

Copyright: Project Syndicate, 2007.

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Basic training and prevention

Technology has done much to advance health care, but the key issue is training. It is no good having all that expensive equipment if there is no one who knows how to use it. The 25,000 people in the city of Goulburn cannot even get an old fashioned ultrasound at the city hospital. The machine is there but when my sister took an elderly person to the hospital she was told there was currently no technician to work it.

As for medical care out in the bush, well I have found out just how far away that is. The doctors have long gone from the small towns, but even many of the larger towns of 2-3 thousand people no longer have doctors to staff their hospitals.  Even in Canberra local practices are losing GPs regularly and are not able to find replacements.  Many other GPs are ageing with the population and will soon retire so things are going to get a whole lot worse in the next decade.

It is time trained nurses were allowed to take over some of the basic work of GPs. They have had to do a lot more in the past than they are currently now allowed to do, particularly in the country, and that should be revisited.  I am sure most could be taught how to do an ultrasound.

The point of this article is valid. Lack of both people and training will likely delay many of the benefits that could flow from future medical advances and technology. As for those dying in their millions in impoverished countries, they will not be in the race. The best they can hope for is assistance to improve living standards,  wider programs to protect against preventable diseases, and greater access to drugs at affordable prices. 

Preventative health and safe working practice in our own backyard should also be given a much higher priority. We all have a responsibility to take the pressure off medical services as resources decline so that those who are most in need can get help. 

I myself have become much more proactive in ensuring safe practice on the farm. We simply cannot afford to have accidents, or get bitten by snakes any more, or have eye injuries for failing to wear protective gear.  I used to be very careless, racing off after cattle on the quad bike, only to come to grief quite frequently. Now I travel quietly and look where I am going as I know that I cannot expect medical help to be accessible anymore. When one is forced to travel to three separate country towns through the night over 300kms for an eye injured for failure to wear safety gear, then it is time to change one's ways. But I still see a lot of unsafe work practice on farms so I have become a safety nagger at least to my family.   Prevention is the name of the game as far as I am concerned these days. It is that or put up with the consequences.  

Sowing seeds on rocky places

Aspirin is hardly a breakthrough, C Parsons, being used from at least the time of  Hippocrates. It was trademarked by Bayer in 1899, and the name was looted by the allies after the first world war. Being an old man, I now take aspirin to thin my blood. It wasn't on the advise of my doctor, since aspirin has not been a treatment that the pharmaceutical companies are making sure that doctors promote. I have however, moved to Cartia, a branded drug which is aspirin with a simple coating to prevent stomach irritation, since I couldn't find a similar generic, and am paying four times the price I used to.

Genetic modification to fight diarrhoea, dehydration and other ailments that kill many infants sounds very much like capitalist bullshit. Diarrhoea and dehydration are caused by poverty and poor sanitation. The technology to treat these plagues has been around for over a century, and society has the resources, also thanks to technology. The problem is that capitalism doesn’t distribute the resources in a way that they provide the optimal benefit, and genetic engineering will not solve the root cause. It may actually drive them into further poverty, if these seeds are genetically engineered not to produce fertile seeds. Or, the seeds won't be freely sold, but closely held and the processed rice sold at a goodly profit.

Tampering with Mother Nature's breast milk

Jay Somasundaram: "Firstly, these breakthroughs are unlikely to filter down to the masses. They will be patented and copyrighted to make a lot of money for the 'entrepreneurs'."

You mean, like Aspirin?

A plan to grow the first crops genetically modified to produce human proteins has been given preliminary approval in the United States.

Commercial production of rice implanted with genes contained in human breast milk could begin later this year.

It would be used in medicines to fight diarrhoea, dehydration and other ailments that kill many infants.

But Bill Freeze from the US Centre for Food Safety claims there is a danger of contaminating other crops and possibly harming human health.

"I'm really concerned about this because I think there's, one, the potential for this rice to get into the food supply, and two, it hasn't been tested, it hasn't gone through a drug review process," he said.

"So we're dealing with an unknown here, something that could cause harm to human health."

The wonders of Capitalism

The breakthroughs in health would be great news if I wasn’t worried about two scenarios:

Firstly, these breakthroughs are unlikely to filter down to the masses. They will be patented and copyrighted to make a lot of money for the “entrepreneurs”. The fundamental research, though, would likely be paid for by our taxes. One wonders – if capitalism is working well, why aren’t our scientists being paid well, and why aren’t our brightest students flocking to these disciplines? One reason may be that the bulk of the money goes into court battles, and financial dealings and marketing ploys.

Secondly, we know that significant improvements in health are achievable through lifestyle choices. Unfortunately, discovering and promoting such choices in an economical and sustainable manner doesn’t generate much wealth for entrepreneurs. We end up with a system that is lopsided. We have government departments called ‘Health’. They typically spend 98% of their budget on illnesses, and only about 2% of their budget on preventive and public health.

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