Do Cells Have an IP Address Yet?

Ali-Ansary_12

In the future, implanted chips will have the ability to stop food absorption when caloric intake reaches 2200. Cells in our forearm will be able to monitor our glucose levels and adjust our insulin appropriately. These implantable cells or “chips” have their own IP address with their own circuitry that is connected to a network 24/7. Through this network, cells communicate with real-time super computers to synthesize the next step for an individual’s body. If Dr. Anthony Atala can utilize 3D printers to create a new kidney, then it is only a matter of time before we can incorporate the circuitry within an organ necessary to monitor its function wirelessly.

This was the future I was challenged to paint in my talk at TEDMED 2012 at the Kennedy Center for the Performing Arts in Washington, DC. As TEDMED 2013 commences, I ask myself, where are we one year later?

A caveat: The following are simple overviews on novel technologies I had been tracking over the past year and does no justice to the many amazing leaps we have made in innovative science and medicine during this time.

Implantable Sensors
Thomas Goetz beautifully discusses in The Atlantic that diabetics, although “loath” it, have been self-monitoring for years. Goetz goes on to say that the“….distaste falls into three categories: self monitoring for diabetes is an unremitting and unforgiving labor; the tools themselves are awkward and sterile; and the combination of these creates a constant sense of anxiety and failure.”

However, what if we had an implantable sensor that simply monitors an individual’s glucose? In 2010, Dr. David Gough from the University of California, San Diego demonstrated that you could potentially monitor an individual’s glucose by wireless telemetry. A patient can be in San Francisco with his or her physician having access to the data in Los Angeles.

And what if the immune system renders the chip incapable of functioning? Dr. Melissa Grunlan at the University of Texas A&M has been working to develop a self cleaning mechanism that prevents implantable glucose sensors from being “shielded” by the body’s immune system.

Dr. Giovanni de Micheli and Dr. Sandro Carrara at the École polytechnique fédérale de Lausanne in Switzerland have developed a 1.4 cm implantable device that can measure proteins and organic acids in real time. Imagine a signal being sent to your cell phone, and your doctor’s phone, indicating an increase in cardiac enzymes- potentially a heart attack. This device functions on a battery-less system that connects to a patch resting on the surface of the skin.

Natural anatomy acts as a barrier to implantable batteries. Yet, as Dr. Ada Poon and her team at Stanford University have developed a medical device that can be powered wirelessly using electromagnetic radio waves. Now, the tiny devices we envisioned can circulate into the depths of our vascular system without fear of losing power. Reminds me of “The Magic School Bus” episode when Ms. Frizzle takes her class on a field trip through the human body.

A personal favorite of mine: At the Massachusetts Institute of Technology, Dr. Konstantina Stankovic has demonstrated the ability to use the natural electric potential from electrolytes in the inner ear to power devices that can monitor biological activity in people with auditory and balance issues.

Early detection is fundamental in many of these devices, especially for cancer patients who have aggressive diseases prone to metastasis. Take, for example patients with malignant melanoma, one of the deadliest cancers and one that has seen little progress in its treatment. Dr. Shuang Hou and his team at UCLA have demonstrated a proof of concept of a “nanovelcro” chip that can capture highly specific and isolated circulating tumor cells.

And what about regulating food intake and nutrient absorption? Intrapace has created Abiliti, an implantable gastric stimulator and food detection system that is implanted into the stomach. As soon as food is detected, it stimulates the stomach to create a sense of fullness. I can see eventually a system that can monitor an individual’s caloric input over, say, 24 hours. This would allow us to eat normally without overindulging.
Wearable Sensors
A quick mention on a hot topic. As popular discussions emphasize trends like the Nike+ FuelBand, one step closer to wearable sensors are what Dr. John Rogers at the University of Illinois at Urbana-Champaign has developed: An electronic sensor that can be directly printed onto your skin using a rubber stamp and last for up to two weeks as highlighted in MIT’s Technology Review. The potential for this goes beyond saying.

The Fine Line
This is just a short list of exciting new innovations. Of course many people may be taken aback by such technologies, which is fine. The purpose of my talk was to create discussion while painting a potential future that may be upon us soon. It is important for all of us to be active in our own healthcare. If we aren’t, then someone else will be.

Knowledge about our glucose or hemoglobin and hematocrit in our time is just as important as knowing whether or not to fuel our cars with unleaded or diesel. But we still need an expert mechanic’s help. Let me explain. I do believe that growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the empowered and informed patient, but also via healthcare providers.

Old mechanics would drive a problematic car themselves to assess damage. Simple things such as hearing a funny sound or seeing the car pull to the left would give them enough information to diagnose the problem. Today the engineering of a car is so sophisticated that sensors continuously monitoring the “health” of the engine alert the driver when something is wrong. That unwelcome signal – a picture of a wrench, perhaps, or a flat tire – notifies the driver and the mechanic what part has gone wrong, what’s wrong with it, and what needs to be done.

So the mechanic had to evolve the way he (or she) fixed a car. The physician today is much like that mechanic. While the human body is far more sophisticated than even a brand new Mercedes Benz, newly trained physicians need to adjust how they care for their patients’ health.

Growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the e-patient, but also via tech-savvy healthcare providers.

Original presentation at TEDMED 2012

This piece also appears on the The Huffington Post, TEDMED.com, and The Health Care Blog.

| if I knew all the words I would write myself out of here. |

 

 

America’s Healthcare Crisis: A Prescription for Breaking the Cycle

Originally published in the Huffington Post.

By Jacob Scott MD, Sandeep Kishore PhD, Ali Ansary

At the turn of the 20th century, we built a healthcare system on responding to acute, curative, episodic issues. This system saw the eradication of many diseases and the advent of vaccinations and new treatments. The model was truly developed to be a “sickcare system,” which was what we needed at the time, and saw huge successes.

Fast forward 100 years and Americans are sicker than ever — but with different illnesses. What’s more, there is finally a national consensus that our healthcare system is broken. With increasingly tragic consequences, the reactionary medical paradigm has not provided the preventive care or chronic illness management that our culture needs. Healthcare spending currently consumes 17 percent of our GDP and without a radical shift in thinking, this number may grow even higher.

Sadly, patients are not the only ones suffering. The status quo is breeding a morale crisis among our nation’s doctors. If you asked one of the many thousands of medical students who are just beginning their fall semester why they chose medicine, many of them would give you confused, anxious responses about the field they are entering. This does not bode well for the health of future generations.

Last Spring, we met at TEDMED, an annual “grand gathering” in Washington, DC where forward thinkers from all sectors explore the promise of technology and the potential of human achievement as it pertains to health and medicine. Here, we presented our respective positions. One of us, Ali, argued that new technologies will actively change our health behavior. Another, Sunny, argued that we needed systems thinking in public health, focusing on the causes of the causes. Yet another, Jacob, argued for stopping the “imaginectomies” and fostering creativity in medical training by rethinking selection criteria and curricula for entrance to medical school.

This led to conversations across the country — with trainees and senior leaders — with all trying to imagine (and reimagine) what would be different for this generation, the generation of millennials (and beyond). What are the expectations that we, and our patients, have about how we practice medicine in the 21st century?

The short answer is we don’t know yet — but the conversation has begun.

On Sept. 10, an intimate discussion was co-sponsored by the Institute for Healthcare Improvement (IHI) and the Young Professionals Chronic Disease Network in Boston on medical education in the 21st century. Here we began to define four questions:

1. What should be the image of the 21st century physician?
There is no doubt that health and medicine attract the most dynamic thinkers in the world, many of whom come with a love of science and art, a yearning to improve health and well-being and an appreciation for thinking differently. To us, the creative enterprise of imagining what could be is a central competency of the 21st century physician. It provides a new platform, value and principle that allows us to unlock gains in technology, in public health, in discovery and in mapping new connections to the full gamut of knowledge that can help help our species not just to survive, but to thrive. We think it should be someone who is, above all, creative, imaginative and compassionate.

2. What should be the new quality standards for training?
We think they should be the ability to work on a team (to put collective rather than individual interests first) and to always focus on the needs of the patient. We believe that protected time for exploring creative endeavours in medical school, graduate medical education and in practice, is essential for transforming our health. Taking a cue from Google’s successful policy, we recommend that medical schools create the space for students to spend at least 20 percent of their time exploring. And for those who doubt that we can spare 20 percent of the time during the medical school curriculum, we suggest that at least this much of the curriculum is now no longer worth committing to memory, in our new world defined by information at our finger tips.

3. What are the models?
The traditional classroom model where one professor lectures to a room of over 100 students is changing. We think that providing didactic lectures online would allow students to maintain focus on their core medical education while freeing up time to discuss relevant topics not always covered in their textbooks. Take, for example, longitudinal ‘concentrations’ such as the Yale System where there are no required exams, no mandatory courses, a pass-fail curriculum and a requirement for a thesis. At Duke, the second year of medical school focuses on core clinical competencies while the third and fourth years allow students to explore clinical investigations and complete elective rotations. We think these models begin to provide the requisite space for creativity.

4. What does the disruptive innovation look like?
With viral movements via Youtube, the ability for students to create their own content and mentor each other online, and new platforms like TEDMED, which challenge medical standards, we have a new way of sharing information — of creating a vision and executing it together. Students themselves could create curricular content — they could become each others’ teachers in partnership with physician educators.

Conversations like this must continue — not only at places like TEDMED or the IHI, but inside classrooms and teaching hospitals, between mentors and students, and between patients and physicians.

As we adopt a 21st century vision of where we are headed, we must adapt and adjust our training so that it meets the challenges facing the patients of tomorrow. Creativity — the spark behind imagining the structure of DNA, in vitro fertilization, the pacemaker — must be valued to unlock major health gains. It will be these new innovations and new models of healthcare and delivery that will continue to push medicine forward.

Even as physicians reimagine the practice of medicine, we must adhere to the same principles that we swore an oath to — to practice medicine ethically and honestly, and to serve humanity. And unless we, as healthcare professionals, take the time to do this reimagining, it will be done by those who have not taken the same oath, and whose approach to reimagining medicine is driven by other motivating factors.

We submit that the best source to imagine the new mental model is from within medical education and it must be accompanied by forward thinking changes in practice and delivery. We need to stop the “imaginectomies” and help, collectively, step by step, to make creativity, imagination and compassion the 21st century standards of medical education.

This century, your future and your health may just depend on it.

Share with us your vision of a 21st century doctor at
www.tomorrowsdoctor.org.

Dr. Jacob Scott is a research fellow at the H. Lee Moffitt Cancer Center and Oxford University Centre for Mathematical Biology. Sandeep Kishore is an MD/PhD student at Weill Cornell Medical College/Rockefeller University/Sloan Kettering Institute. Ali Ansary is a medical student at Rocky Vista University.