Do Cells Have an IP Address Yet?


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,, and The Health Care Blog.

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



Innovative Technologies that Address Global Health Concerns…

There was a recent call by the World Health Organization for innovative technologies that address global health concerns. The enteries were reviewed by an expert panel and narrowed down to a handful that met the criteria for the call. Applicants were graded on the type of device, health concern, developmental stage, whether or not the product can be commercialized, the purpose of the technology, where it can be used (i.e. users or health centers) and the list continues…

All of the following address major health concerns, yet I believe it would have been great to see technologies that address the issue of clean water, containment of TB from becoming drug resistant, and even remote disease management (aside from SMS to prevent smoking).
My personal favorites include: the isothermal nucleic acid amplification system for TB diagnosis, the decision support system for paediatrics HIV and the transcutanous  anaemia monitoring system.


Selected technology category 1: commercialized/-isable stage

1.1 Stool sample collection and preparation kit
The intended purpose* of the stool sample collection and preparation kit is to simplify faecal examination by reducing the number of consumables and steps required for the procedure. The kit could therefore facilitate the diagnosis of parasitological diseases. Additionally, the kit does not appear to require water or electricity, and is claimed to prevent recontamination of the environment.

1.2 LED phototherapy unit
The intended purpose* of the LED phototherapy unit is to treat hyperbilirubinaemia in newborn infants by phototherapy. The unit could increase the safety of the procedure by using a radiation source that produces blue light and minimizes the exposure to harmful ultraviolet radiation. Further potential advantages are that the unit measures the actual output of light at the useful wavelengths and is claimed to have lower energy consumption than previous designs.

1.3 System for on-site production of wound irrigation solution
The intended purpose* of the system for on-site production of wound irrigation solution is to produce aqueous solutions for the topical treatment of wounds and infections using a power source, demineralised water and salt. Solutions produced by the system could be used to treat a host of conditions including traumatic injuries, post-natal infections and neglected tropical diseases that cause ulcerations and infections.

her potential advantages are that the unit measures the actual output of light at the useful wavelengths and is claimed to have lower energy consumption than previous designs.

1.4 SMS smoking cessation system
The intended purpose* of the SMS smoking cessation system is to provide tailored SMS-based smoking cessation support to its users. According to preliminary research submitted, the system facilitates self-management of smoking cessation and increases the likelihood of user adherence to smoking cessation programs. The interactive system claims to be capable of answering messages about craving to support the user.

1.5 Reusable neonatal suction system
The intended purpose* of the reusable neonatal suction system is to remove obstructive mucus from the air passages in newborn infants to reduce the risk of asphyxia and to support neonatal resuscitation. The device is claimed to be reusable and capable of being cleaned and boiled between uses. The device is claimed to be made of durable silicone and not to require electric power.

1.6 Fluorescence visualization system for cancer screening
The intended purpose* of the fluorescence visualization system for cancer screening is to use the natural fluorescence of mucosal tissues when excited by a violet/blue light, to inform clinicians about the presence of abnormalities in the mucosa in the oral cavity. This system could aid in the early detection of oral/oropharyngeal cancers and thereby reduce morbidity and mortality associated with these diseases.

1.7 Transcutaneous bilirubin measurement system
The intended purpose* of the transcutaneous bilirubin measurement system is to provide an alternative to blood sample analysis for the diagnosis of hyperbilirubinaemia in newborn infants. The system uses spectral analysis of light reflected from the patient’s vascular bed to determine levels of bilirubin in the blood. The device is claimed to be non-invasive and to rapidly give a read-out.

1.8 Isothermal nucleic acid amplification system for tuberculosis diagnosis
The intended purpose* of the isothermal nucleic acid amplification system for tuberculosis diagnosis is to offer a point-of-care alternative to sputum smear microscopy for the diagnosis of tuberculosis. The technology is claimed not to require any additional equipment and to yield a rapid visual read out of the diagnostic result.

Selected technolgies category 2: non-commercialized/-isable stage

2.1 Simplified anaesthesia unit
The intended purpose* of the simplified anaesthesia unit is to function as an anaesthesia machine for surgical use in low resources settings. The device features an innovative valve system with reduced technical complexity compared to traditional devices. The device is claimed to function with oxygen from different sources, including ambient air and therefore would not require compressed oxygen.

2.2 Single use assistive vaginal delivery system
The intended purpose* of the single use assistive vaginal delivery system is to assist fetus extraction in cases of prolonged second stages of labour without having to use forceps, to use a vacuum extractor or to resort to caesarean sectioning. The lack of rigid instruments in the system is claimed to reduce the risk of injury to both mother and child.

2.3 Portable on site cell sorter and counter for HIV and malaria diagnosis
The intended purpose* of the portable on site cell sorter and counter for HIV and malaria diagnosis, a lab-on-a-chip device, is to monitor AIDS in HIV-infected people as well as blood cell alterations indicating malaria. The system appears to be a small and portable device that would allow for rapid automated screening of a blood sample for indicators of AIDS and/or malaria.

2.4 Decision support system for paediatrics HIV
The intended purpose* of the decision support system for paediatrics HIV is to move away from paper-based medical records while ensuring easy and reliable access to patient-centred information. This electronic health records system is targeted at paediatric HIV cases and is intended to aid clinical decision-making processes such as weight-based dosing support for antiretroviral drugs.

2.5 Transcutaneous anaemia monitoring system
The intended purpose* of the transcutaneous anaemia monitoring system is to screen populations for insufficient levels of haemoglobin in the blood and to carry out diagnosis of severe anaemia. The system is claimed to be based on spectrophotometric analysis. The device appears to be portable, non-invasive and is claimed to give a read-out in less than a minute.

2.6 Solar-powered autoclave
The intended purpose* of the solar-powered autoclave, is to sterilize medical instruments. It is claimed to run solely on solar power. This technology could allow sterilization of medical instruments in remote rural areas with no access to electricity and hence reduce the risk of infections associated with carrying out medical interventions with dirty equipment.

2.7 Portable infant warmer
The intended purpose* of the portable infant warmer is to improve the care of premature and low-birth-weight babies by providing heat at a constant temperature in order to prevent hypothermia. This portable device is claimed not to require electricity and would allow for close mother-to-baby contact. The product is targeted for use in urban and rural healthcare settings, and in home settings.

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

PowerPoint gave me C…

You walk into class, pick up a copy of (or have printed out) the slide handouts for today’s presentation and sit down to wait for the class to begin. What you haven’t realized yet is that the PowerPoint slides that you have in front of you are affecting the way you learn and exercise your mind.

The classic argument of whether or not technology has made our life easier or more difficult is definitely not going to be answered soon. Yet, the role of technology in the classroom is a whole other issue to explore. As I continue to round off my education, technology has had a greater presence in my educational growth. I love the fact that I can have wireless Internet at the tip of my fingers, computers in every room, and now even an LCD projector for every single room in a building. However, whether or not technology is contributing to the enhancement of my education is a completely different conversation.

Epson and Acer are both companies that dominate the production of the LCD projector with record shattering profits in the last half decade. My guess for why the increase? Every hospital, business and classroom has now adopted the “digital lecture hall.” Tucked away on the ceiling of these rooms, the LCD projector is now a standard in classroom equipment, just like any other desk, chair, and ….white board…maybe.

Cambridge is an amazing university, however, I began to notice after a week that the white boards and overhead projectors were beginning to disappear. Not physically, but the use of white boards and overhead projects as a tool for teaching has almost completely diminished. All my lectures all of a sudden were based on a PowerPoint. There has yet to be a complete lecture where a white board was needed, which must be pleasant for Microsoft to hear.

After doing a literature search and reviewing case studies on the use of PowerPoint in the classroom, I can definitely say that the results go both ways. On one hand, Powerpoint lectures have shown drawbacks. On the other hand there are no changes or some improvement on test scores and student participation.

Learning without slides

I had an opportunity to hear Michael  van Swaaij , PayPal Interterm CEO, speak on Monday when I mistakenly walked into the wrong class (PowerPoint dementia), and I listened to him deliver a great talk without once using PowerPoint. To top off this experience, I had an opportunity to meet and hear Professor Roger Penrose speak about this theory of what was before the big bang. [Penrose is famous for many things as well as his Penrose stairs and being a close colleague/friend/co-author of Stephen Hawkings]

What I was most amazed about Penrose is his ability to capture a room over 600 students and professors, explain his theory of which about 25% of it I understood, and effectively communicate it all with simply a dozen transparencies and an overhead projector.

Okay, so these were just general lectures, but what about the sciences? I took a three-day course on neuroscience and the set of lectures was done on the overhead. It was beautiful, taking notes, paying attention in anticipation of what is going to be discussed next and essentially actively getting involved with my own education.

You’re never too young to learn

The use of PowerPoint is now replacing middle and high school classrooms. I remember watching my little cousin prepare her book report presentation obsessed with different fonts and themes without realizing what she was writing about. I believe that as our minds develop with age and by always seeing PowerPoint lectures we limit our thinking skills. If students are given PowerPoint slides, they don’t learn how to take notes properly and retain information for their own growth and development.

The use of PowerPoint in the classroom will depend on the subject, professor, and students. A PowerPoint based lecture can only be as effective as the professor who is presenting it. Yet, their ability to lecture using PowerPoint has to become a skill and art. Like any teacher, the most important thing is to be able to effectively connect with your students and convey your lecture in a way that your students will learn and grow. I am afraid, however, that the general context of the lecture becomes a delicate balancing act with conveying your message and not reading from the PowerPoint. In all honesty, there have been some bad professors that would have been more effective with PowerPoint slides, so again, the benefits of using of technology in the classroom can outweigh the drawbacks if delivered properly.

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