Bionic eyes? Artificial organs? Robotic surgery conducted from opposite sides of the globe? We frequently come across these in science fiction films, but they may not be as far off from reality as we may currently think.
Let’s take a look at an example: Neuralink is a company founded in 2016 that preaches to be able to aid and maybe even cure blindness, deafness, paralysis, memory and stroke tendency - amongst others. With the use of neural implants consisting of a 2 cm bottom-like “link” and a neural thread, Neuralink engineers nanotechnology to interface with the brain through neural stimulation. Its founder - Elon Musk - has even referred to future applications like improving one’s memory and analytical capabilities.
You may be wondering - how could this be true? Well, the answer lies in new technologies.
Precision medicine – tailormade medical treatment?
Precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." In other words, it allows every patient to have more personalized care. As one drug can produce different responses within different patients, precision medicine is opening a great research opportunity to treat diseases more effectively and efficiently with fewer side effects, while reducing the amount of medical waste.
Age is a key factor in determining how effective a drug’s response is. As we age, our pharmacokinetic (i.e. how a drug is processed by our body: absorption, bioavailability, metabolism, and excretion) and pharmacodynamic (i.e. the physiological and molecular effects of a drug in our body) abilities substantially decrease along with it our capability to properly process certain medications.
Besides age, other factors can have similar effects. These include genetics, diet and previous medical conditions. Thus, it would be apparent that the same drug may sometimes not work in an identical way within children and adult patients.
Figure 1: Representation of precision medicine. Factors like exercise (1), mutagens (2), diet (3), family genetic history (4) and the external environment (5) has an influence on the physical characteristics of every individual. Taking all these into account, a personalised medical record can be created. When thousands of these records are gathered, doctors would be able to determine how to treat different groups of people more effectively, ultimately leading to customised prescriptions for each patient. Figure created using BioRender.
Let’s take asthma as an example. In the United Kingdom alone, one in every 11 children, as well as one in every 12 adults, suffer from asthma. In particular, an estimated 8% of the total British population have displayed asthma symptoms at some point in their lives. These patients come from highly diverse socioeconomic backgrounds, was brought up in very different environments and vary widely in terms of age. Still, most patients are treated with an inhaler and a type of drug known as Albuterol despite different severities of the condition.
Prescribing medicines that are ineffective to a certain group of individuals can lead to very dangerous consequences. One of the main consequences of this would be the development of antibiotic resistance.
Antibiotic resistance refers to bacteria undergoing adaptation to fight off an antibiotic. When we are constantly exposed to antibiotics, especially beyond our prescription window, this may lead to more bacteria developing resistance to the drugs. As a result, this renders antibiotics being completely useless as a treatment option. If this becomes the case, even a small bacterial infection could be lethal to the patient – which could be equivalent to the 1800s where no antibiotic existed.
Figure 2: A schematic diagram showcasing the development of antibiotic resistance within a bacterial population. Due to mutations, certain bacteria are more resistant to an antibiotic. Therefore, only those resistant bacteria will survive as they lack competition, so they can either reproduce asexually. Over time, the resistant gene becomes more and more frequent, leading to a whole population of resistant bacteria. They can also transfer their antibiotic resistance genes to others through the process of horizontal gene transfer, thereby becoming an even greater threat.
In order to avoid all these, precision medicine is therefore becoming increasingly important. All the information that is necessary to create personalized diagnoses comes from biological factors that you were wired with, such as your family’s medical history (and thus, genomics), your current age and your prior medical background as well as from external factors you have been exposed to. For instance, the place where you currently live and/or grew up (including pollution, sunlight and air temperature), your diet and your physical activity are examples of such environmental variables. This information can be obtained through surveys, wearable technologies such as fitness trackers, or by gathering data regarding demographic and geographical information.
When all this information is combined with that of thousands of patients, a database can be generated, whereby more specific medical intervention can be given to a certain patient profile. What’s more, it would allow scientists to better understand diseases and conduct more focused research. Only 20 years ago, the recompilation and processing of such large amounts of data would seem nearly impossible. However, big data and artificial intelligence are now being used for this purpose.
In other words, precision medicine allows each patient to have individualized care as a result of the utilization of genomics, big data analytics and population health data. It can also significantly impact the success of treatment; whereby precision medicine may permit the effective use of resources and therefore a reduction in costs.
Virtual reality and augmented reality – to be or not to be?
Augmented reality (AR) overlays reality and fiction on a screen through spectacles. More specifically, the users see the world surrounding them as it is, but with computer-generated images. In contrast, virtual reality (VR) uses fictional images to make the users believe that they are immersed in a different scenario altogether.
You probably have heard of virtual reality before as it is becoming very popular in the video game industry. With the use of VR glasses, the players can see themselves in the middle of a battlefield or even have a scuba diving adventure with sharks!
Similarly, augmented reality has been widely used in phone games such as “PokémonGo”. These two technologies have and will continue to play a big importance in the entertainment industry, as well as design and architecture, art, military and education amongst others.
As a matter of fact, what could be used as a game could also potentially improve and save many lives. Arguably, both VR and AR could have similar applications for healthcare.
For example, they can allow medical students studying anatomy to visualize body tissues and structures in a more interactive manner, as opposed to viewing 2D textbook illustrations. This could also potentially reduce the educational costs for doctors as well as offer better medical training, thereby resulting in better-prepared doctors. Meanwhile, it could also allow surgical training without risking harming a patient.
Furthermore, AR and VR could help anxiety patients by recreating calming environments. Similarly, they might also help the visually impaired live a more independent life or assist children with autism to engage better in school activities.
There are various companies developing these technologies to be applied in many areas of healthcare. For instance, companies like SentiAR provide are providing clinicians with real-time 3D holograms using AR, allowing them to view the patient’s anatomy before an invasive procedure. The holograms are created combining CT (computer tomography), MRI (magnetic resonance imaging) and real-time mapping (using catheters), giving a real-time extensive field of view. The doctor would then be able to interact with the hologram to better understand the problem and thus determine the best procedure moving forward. It would also allow for safer and less invasive surgical procedures since the doctor would have seen the problem and develop an intervention strategy.
Meanwhile, Accuvein is using AR to help nurses identify veins in a faster, more accurate and safer manner, claiming that a nurse is 3.5 times more likely to correctly locate a blood vessel using Accuvein as opposed to not using any technological assistance. Likewise, other types of software allow patients to take better care of their wounds. This is done by offering information regarding the likelihood of their wounds getting infected as well as advising possible treatment regimens. For instance, EyesDecide allows patients to describe their eyesight symptoms better.
As Tim Cook once stated, “AR is going to take a while […], but it will happen, it will happen in a big way, and we will wonder when it does, how we ever lived without it. Like we wonder how we lived without our phone today.”
With that in mind, we may soon witness these technologies revolutionising healthcare and medical training!
Nanotechnology – from macro to nano, size can matter
In a time where everything seems to get larger, why do we want to go in the opposite direction?
Nanotechnology involves the concept of controlling, understanding, measuring and manipulating matter at a nanoscale level. It paves the way to new materials being created, new devices being implemented, and new ideas being realised. From the everyday waterproof clothing to a more efficient drug delivery tactic, nanotechnology has already surrounded us in more ways than you could have imagined.
The goal of any treatment is to make the patient’s life easier. This is exactly what nanotechnology could be used for as well. Nevertheless, one of the biggest challenges regarding the delivery of drugs into our bodies through nanoparticles – is the fact that our own immune system, especially the liver, tends to filter them out.
Why take in a particle that our body doesn’t know anything about and could be dangerous? There have been some advances regarding this in the past few years.
A team at the Mayo Clinic, led by Joy Wolfram, PhD, discovered that the use of Chloroquine, a 70-year-old malaria drug allows for nanoparticles to pass through the liver and move within a mice body to reach its target, usually a tumour. The methodology consisted of injecting Chloroquine into mice, followed by an injection of nanoparticles. The malaria drug was able to stop the macrophages from internalising the nanoparticles in the liver.
Another clever way to allow the nanoparticles to pass the liver is to use our body’s own nanoparticles. In particular, the nanoparticles from our saliva, pancreatic juice, blood, and even urine could be utilized as transporters for the treatment of nanoparticles. As these are already a part of the body, our bodies wouldn’t activate our immune system to remove them, which is a neat way to cover things up!
While still in its development phase, the applications of nanoparticles could very well lead to strong advances in the fields of prevention, detection and treatment of cancer. There has been optimism surrounding nanotechnology as an efficient way to detect cancer-related cells, even if a change occurs in just a little number of cells. Not to mention, not only does nanotechnology provide a way to detect these defective cells, but it also allows for a way to create novel therapies such as stem cell therapy or cancer therapy.
Nanotechnology has allowed the creation of bionic eyes by 3D-printing light receptors onto an eye-shaped crystal object. It has led to the development of contact lenses that measure glucose levels in tears– which is a new alternative to the traditional blood glucose test. Moreover, others are developing nanorobotic drones as substitutes to gastroscopy (a procedure where an endoscope is used to inspect the digestive system), whereas other robots allow a safer and more effective drug delivery mechanism, thereby maintaining a greater bioavailability.
The ethical implications of these technologies
As with any new practice, there are always ethical concerns that we must bear in mind.
It is argued that AR and VR could lead to a distortion of spatial presence (confusion between fiction and reality), in which the surgeon may lose track of reality and believe that a real surgery is just training. On the other hand, if a computer is able to accurately predict what medication a patient should take, would that significantly reduce a doctor’s capabilities and the level of expertise required for one to become a doctor today? And in the case whereby the technology gives a false prediction, could the doctor recheck the information or end up blindly following the computer’s instructions? What’s more, due to the costs of these technologies, it could expand the socioeconomic and educational gap between first- and third-world countries.
Looking back at our first example on Neuralink, if nanotechnology creates a device to improve human capabilities, who is the right person to determine how we should make use of it? Could this further deepen socioeconomic differences - whereby if only the rich have access to these “super brains”, wouldn’t the world be further dominated by only the affluential individuals, whilst the rest will not be able to compete?
New technologies will be the future of health, but precautions should be taken
It goes without saying that these technologies, along with many others that are being developed, will radically change the way healthcare is being practised. They can lead to much more effective use of resources, reduced medical expenditure, better treatment strategies, and all together – a better quality of life for patients.
Nonetheless, it is imperative that these technologies are used to build bridges between the educational, social, economic and health fields of development today. Many of these technologies can be implemented in several different ways – whereby the same technology could have an impact on healthcare but also create a larger influence in education or military training. In short, the applications of these technologies are wonders of today but may become a reality of tomorrow.
Intrigued by all these and want to learn more about new technologies and healthcare? Here are a few resources to supplement your learning:
Covadonga Piquero Lanciego
BSc Biological and Biomedical Sciences
University of Dundee
Disclaimer: All figures created using BioRender are intended solely for educational purposes and not for profit.