DISRUPTIVE MEDICINE

Remember Thomas Edison? Wrongly thought to be the inventor of the electric lamp, but actually the creator of the electric grid? Or Graham Bell, who rang in the first telephone? These men created products that changed civilisation. These, amongst some others, were disruptive technologies: technologies so outrageous that they are considered daring, provocative, and extraordinary. Today, we are on the threshold of possibilities so outlandish that science fiction sounds pretty ho-hum.
Nothing exemplifies this as fundamentally as the field of ‘disruptive’ medicine and, arguably, nobody in the field of medicine understands the future of this ‘outrageous’ medicine as well as Richard Satava. ‘Rick’ Satava is a Professor of Surgery at Washington University Medical Center, Seattle and has written several books and articles on futuristic ‘disruptive’ medicine. Apart from being a surgeon of world repute, Satava was part of the team that developed the first robotic and Virtual Reality systems, before joining DARPA (Defence Advanced Research Projects Agency), the brain bank of the US military. He is soon to take over as the Chief Scientist of theUS Army Medical Research and Command. It is here that he will be funding and overseeing more outrageous medical research. So, what earth shaking developments are afoot in the world of medicine?

A NEW AGE

Satava starts off, “A glimpse of what the future might become was given by Alvin Toffler in his 1976 book ‘The Third Wave’, in which he described the three different ‘ages’ – the Agriculture Age, the Industrial Age, and the Information Age. There appears to be a new age emerging – tentatively called the Biointelligence Age.” But one thought the Information Age is the future? He says, “The Information Era is here and is getting over. Over the past 20 years, there have been no new discoveries. The cell phone, computer, etc. are fundamentally the same as they were 20-30 years ago, the only difference being their level of sophistication and add-on features like small size, Internet access, cameras, etc.”
The Biointelligence age features a slew of radical technologies that are set to change the entire way of treating health and disease issues. We examine some of the main issues here.

THE IMPOSSIBLE FUSION OF LIFE AND MACHINE

Scientists have implanted sensors and radio transmitters in bees and cockroaches to control them. The cockroach can be controlled with a joystick, allowing a possibility for cameras to be implanted in the creature for use in the detection of earthquakes and tsunamis. Bees fitted with sensors for biological weapons can transmit the information to the military. This is the beginning of the man-made fusion of living and non-living.
In man, brain implants are promising enormous hope for patients of paralysis, epilepsy and Parkinson’s disease. John Donoghue, a neuroscientist who also owns a biotech company called Cyberkinetics in California has begun implanting the Braingate device in the heads of patients that allow them to mechanically move an attached robotic arm with the power of electrical impulses generated by thought. The brain’s electrical impulses generated from thinking of an action go to a robot that then interprets these signals and performs an appropriate action.
How realistic is it to expect intelligent machines to perform radical functions in place of diseased body parts? Says Ray Kurtzweil, a global authority on science and future technology, “The latest generation of the implant for Parkinson’s disease (a slowly paralysing nerve disorder) is not an experiment, and it is an FDA approved therapy”. Rameez Naam says in his book ‘More Than Human’, “In Lisbon, Portugal, there is a group of blind men and women who can now see. In place of eyeglasses, they wear cameras connected to electrodes implanted in the visual parts of their brains. Some of them were blind for twenty years or more before the surgery. The same research that gives them sight could beam images from one person’s mind into another. “
Aubrey de Grey, a world-renowned scientist at the Department of Genetics, University of Cambridge, says, “There are non-biological organs such as cochlear implants already, and rapid progress is being made on more advanced things like artificial hearts. What will be more dramatic is when we start to be able to make machines that can replace some parts of the brain. For well-understood parts like the hippocampus (the part of the brain that stores memory), this may be only a couple of decades away. At that time we may wonder if ‘non-living’ is really the right word – non-biological, yes, but performing a living, cognitive function.”
de Grey looks even farther: “If we end up being able to replace the hippocampus with a machine that works just as well, there’s no reason why we couldn’t replace it with something that does more than the natural one. One additional function could be to use it as a knowledge base, an inbuilt Internet. In the more distant future we will probably understand the cerebral cortex well enough to start replacing parts of it too, and that is possible.”

CHANGING LIFE’S BUILDING BLOCKS

Conventional medicine looks at organ systems and deals with disease at the macro level. The dizzyingly fast developments in nanotechnology and genetic engineering are set to make this obsolete, if experts are to be believed.
Nanotechnology deals with molecules at the scale of a few nanometers, and banks heavily on the creation of an atomic ‘assembler device’ or molecular machine: a concept of scientist Eric Drexler that pertains to a group of molecules arranged to perform the functions of a machine or even a computer. Says Kurtzweil, “The golden era will be in about twenty years from now. The real Holy Grail of nanotechnology are nanobots, blood cell-size devices that can go inside the body and keep us healthy from inside.” Molecular machines can clear out clots in arteries, go into cells and correct abnormalities, and kill germs or cancer. Kurtzweil reiterates, “If that sounds very futuristic, let me point out that we’re doing sophisticated tasks already with blood cell-size devices in animal experiments.
One scientist cured Type 1 diabetes in rats with a nano-engineered capsule that has seven nanometer pores. It lets insulin out in a controlled fashion and blocks insulin antibodies. This is what is feasible today. MIT has a project of a sub-cellular nano-engineered device that is capable of detecting specifically the antigens that exist only on certain types of cancer cells. When it detects these antigens, it latches onto the cell, and burrows inside the cell, where it releases a toxin that destroys the cancer cell. This is a sophisticated nano-engineered device in that it is created at the molecular level. So that’s what is feasible already.”

CHANGING GENES OR SPECIES?

The era of transgenic animals is upon us already. Michael Crichton’s latest book ‘Next’ deals with apes that speak Dutch and French, because of experiments in crossbreeding with humans.
Genetic engineering can prevent inherited disorders, but more radical is transgenic genetic engineering. Satava cites the example of rhodopsins (color detecting eye pigments). Man has four rhodopsins for vision of which he uses only two. The pit viper snake has one of the same rhodopsins that is unused by humans, and which gives the snake the ability to seek its prey in infrared. He asks, “ Should we genetically engineer our children to give them such abilities, so they can see in the dark? Should they have abilities that others do not have, giving them an enormous advantage? Moreover, who will decide which children can be ‘enhanced’? Are we on a threshold of designing our children to a point where there will be a whole class of enhanced individuals?”
Troubling questions, these! The ethical issues of genetic engineering are being debated fiercely in scientific and political circles, with more questions than answers.
With the establishment of ‘intelligent’ prostheses that function even better than a normal body part (as in amputees who can climb mountains or play), and with all possible organs (except the brain) being replaceable with biosynthetic ones, it is possible to conceive of an ‘enhanced’ man with 95% of his body replaced by artificial ones. “Would such a man be ‘humanoid’ or human?” asks Satava.
Talking of humanoids, a parallel development has been the creation of intelligent robots that help impaired patients. Satava remarks, “Advanced programs such as fuzzy logic can help the robot or computer to learn from tasks. This meets the definition of ‘thinking’. There are machines with life-like robotic faces which can answer verbal questions and attempt to make facial expressions that show six specific emotions”. Robotics is expected to be a $50 billion industry by 2025, with countries like South Korea set to become leaders in domestic multifunctional robots (with a target of one domestic droid for every home by 2013). Companies like Microsoft are working on the same lines. With such research, a thinking and emoting robot is not going to be mere science fiction. It is already reality in research!

WILL MAN HIBERNATE AND REJUVENATE?

American scientists have new insights into the phenomenon of hibernation, with stunning implications for medical care. Animals like the Arctic ground squirrel can turn their entire system off, effectively living with minimal heart rate, breathing, and circulation, owing to a molecule that blocks energy generation in the hypothalamus of the brain. Scientists have been able to create a block in mice such that they are put into a state of suspended animation for about 6 hours – no respiration, heart rate, blood pressure, ECG, EEG, and even no activity on functional MRI of the brain. After 6 hours, they are awakened and they behave normally. Satava points out “while this is an early experiment, it points to the possibility of using these molecules or drugs for anesthesia. If successful, in surgery a patient could be put to ‘sleep’ with no heartbeat, no bleeding when incised (bloodless surgery), unaware of pain and unable to move. When the surgery is over, he can be awakened.”
Drexler confirms, “It is possible to discover a drug that causes biostasis (putting life in pause). A method of producing reversible biostasis could help astronauts on long space voyages to save food and avoid boredom. In medicine, biostasis would provide a deep anesthesia giving physicians more time to work. When emergencies occur far from medical help, a good biostasis procedure would provide a sort of universal first-aid treatment: it would stabilize a patient’s condition and prevent molecular machines from running amok and damaging tissues. 

But no one has found a drug able to stop the entire metabolism the way anesthetics stop consciousness – that is, in a way that can be reversed by simply washing the drug out of the patient’s tissues. Nonetheless, reversible biostasis will be possible when repair machines become available.”
With much research involving other areas like human cloning, prolonging longevity of man, and tissue synthesis modern science is helping evolve a new breed of professional: the scientific ethicist.