Top 10 Medical Breakthroughs

Sorry for the delay between posts; life ambushed me for a few weeks there.

I haven’t talked about general breakthroughs in medicine recently, and I have a considerable backlog of cool stories on the topic, so let’s explore that a bit today. These breakthroughs aren’t necessarily transhumanist in nature, but they certainly all contribute to the general goal of better healthcare and are but a few steps away from some truly amazing technologies. So, without further ado, the Top 10 Medical Stories in My Queue:

10) The explosion of personalized medicine. The Wall Street Journal wrote a piece earlier this year about the idea of a “doctor in your pocket.” The idea is to have cheap, quick, accurate medical screening on a device that people can carry with them. Daniel Kraft has been very vocal about the explosion of this sort of technology in a limited sense, and Peter Diamandis recently announced an X-Prize for essentially the same concept; a lab on a chip that can diagnose a patient better than a group of board certified physicians. While diagnosis itself is not necessarily transhuman, clearly other transhumanists are interested in the idea, and if successful this sort of technology ought to keep people healthier for longer. With a $10 Million prize pool, there ought to be plenty of incentive to stuff Watson into a cell phone and make med students everywhere cry crocodile tears. The next step: An AI doctor in every house.

9) Likely to be included in these new personalized medicine machines: A cancer sniffing sensor for early detection. Gizmodo has a great article detailing what NASA’s been up to recently, including sensors that can detect toxins in the air and cancer. The really cool thing about this sensor is that it’s virtually production ready and can be attached to a cell phone right out of the box; that is, this isn’t a theoretical device, it’s all but here. Despite all the grumping about the government that frequently goes on, two federal programs (the Department of Homeland Security is the other) are pushing hard to get this technology into circulation. DHS, however, is mostly interested in the toxin and bomb chemical detecting properties while, for our purposes, the cancer detecting ability is probably more interesting (although if bomb making chemicals -are- detected near my cell phone, I sure wouldn’t mind a heads-up!) I don’t know what technology this sensor is using exactly, but it seems reasonable to include the sensor that MIT recently reported on that detects lung cancer through a breath test at an astounding 83% accuracy. There is room for improvement, as trained dogs can detect lung cancer with 98% accuracy, but as Gizmodo quipped, at least you won’t have to carry a Labrador around in your pocket.

8) Intelligent pills. Nature ran a story about them earlier this year, and both Scientific American and Pop Bioethics picked up the story long before I got around to it. The pills will have included along with the medicine a placebo that houses a small sensor. When the sensor interacts with stomach acid, the current will transmit information a very short distance; ideally to a Band-Aid-like device that can be worn on the skin and will measure heart rate, respiration, temperature and the like. This skin sensor, in turn, could wirelessly transmit health information to your doctor, allowing them to check in on your vitals without you needing to visit the office. If you frequently forget to take your pills, (a “problem area” in current medicine) your doctor (or, more likely, a digital secretary) can give you a quick call to remind you. Other pills that include cameras and other sensors are also in development, though those probably wouldn’t be used outside of particular contexts.

7) Wirelessly controlled ‘pills’. Science Daily posted an article about a month ago claiming that MicroCHIPS Inc. successfully tested a device that, once implanted into a patient, can deliver medication when it receives a wireless signal to dispense the drug. The device delivered amounts of the drug comparable to an injection (without needles, which I’m a fan of). Like the pills that alert the doctor when they’ve been taken, these devices help to ensure patient compliance with the doctor’s proscribed drug regimen. Unlike those pills, these devices can automatically deliver the proper drug dose, requiring the patient to neither swallow pills nor suffer injections. Although the initial device only carried 20 doses of the drugs, the final product ought to have hundreds. Further clinical trials will follow.

6) Continuing the pill trend, scientists are working on a special type of aspirin that doesn’t cause ulcers. Oh yeah, and it seems to fight cancer, too. In mice, at least, the drug fights colon, lung, breast, prostate, pancreas and blood cancers. Although the drug seems years away from human clinical trials, the lack of side effects and the bolstered cancer fighting properties show a lot of promise for the future.

5) Rounding out the pill discussion, researchers at Oxford University have discovered something curious about common beta-blockers, normally used to treat heart disease. They seem to also lesson racist associations. Although the sample size was small (18 white college students) the results occurred at a “statistically significant” rate as compared to those who received the placebo. The current theory is that the beta blockers affect the portion of the central nervous system that regulates fear and emotional responses. If the study is repeatable, interesting ethical questions arise about medicating out racist beliefs.

4) Chips for humans. MSNBC reports that the FDA recently approved an RFID chip for humans. Although similar technology has been used for years in pets to help reunite lost pets and their owners, human trials go rather a lot more slowly. There’s also some security issues to work out; RFID isn’t the most secure technology in the world (though it does take someone with some know-how to get to the data, and they need to be in fairly close proximity.) Ultimately, I imagine these sorts of chips will carry a lot more than patient information; credit card info, for instance, has been tried elsewhere in the world and offers a unique way to pay. Either the cost will have to come down from its $150-$200 price point, or the functionality is going to have to drastically increase to justify the costs.

3) Someday, we might be able to replace limbs with bionic equivalents that don’t break, in the meantime we’re stuck with the bones we have. Well, that and some new fracture putty if the Department of Defense has their way (those pesky government types again!) The DoD has commissioned research that already is beginning to bear fruit; the fractures bones of rats healed enough within two weeks that they were up and running around again. Next step; pigs and sheep (sheep bones have already been restored within a month.) Following those trials, the putty may be farmed out to the university veterinarian clinic and, if that goes well, to human trials afterwards. It’s not quite the nutrient bath from the movie Wanted, but it’s better than a cast for months.

2) While your bones are being healed by putty, the doctors might as well patch up your internal organs with some new gummy adhesive. Researchers from UCSD have developed a self-healing gummy (meaning the gummy repairs itself when it’s torn or broken) that becomes super adhesive when it comes into contact with acid; acid like that, say, that resides within the stomach. Perhaps the gummy will be useful for organs other than the stomach, but it seems well suited already to help treat stomach wounds.

1) Finally, for the poor sap that’s -really- undergone some punishment, there’s one last piece of tech that’ll help put Humpty Dumpty back together again. San Diego start-up company Organovo is printing muscles, layer by layer, and then placing it into a mold that allows the muscle to grow into something just like that which comes out of a human being. So far, Organovo has printed cardiac muscle, blood vessels, and lung tissue. Right now the company is focusing on creating tissue identical to natural human tissue so that scientists can experiment on the tissue without having to experiment on attached humans, but it hopes to use the same technology to print whole organs for transplant in the future. Between these last three technologies, then, even the worst accident victim ought to be in pretty good shape in the near(ish) future.

Thanks for sticking with me through the hiatus; the next post ought to be coming more quickly next time.

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Free Will and Legal Culpability

In the April 2011 issue of Scientific American (subscription required), Michael Gazzaniga presents a survey of emerging neuroscience research and analyzes the legal issues that those breakthroughs might lead to. Most of the article discusses the legal view of new technologies like fMRI (functional magnetic resonance imaging) as complicated polygraphs. Most judges currently exclude fMRI evidence intended to (for instance) show that a witness is lying or an accused murderer has a brain defect likely to cause insanity because reliable predictions of behavior based on fMRI currently require samples of scans on other brains, and researchers can describe the results of such scans only in terms of what the scans are likely to mean based on those groups of similar scans. Put another way, X-brain-activity is likely to mean that the witness is lying based on the brain activity of other people that have been scanned, but the presence of X-brain-activity does not conclusively prove that the witness is lying (and anyway could only show that the witness believes that they are lying, or intends to tell a lie, not that the propositional phrase spoken by the witness is, in fact and devoid of belief, false.) Correlation, as my undergraduate professors liked to reiterate, is not causation.

That said, however, even in criminal trials the law does not require absolute certainty. Thank goodness for that, because skeptical philosophers continue to point out that about the only thing we can be certain of is that “I exist” (for whichever I happens to be thinking the proposition at the time) and little else. Thanks, Descartes. We’ve decided, as a society, that punishment is proper where some defendant likely committed some wrong (or really, really, likely committed some wrong in the criminal context) and that as a result we accept that some (actually) innocent people are going to be punished when we think it likely that they’re guilty. Given that we don’t require absolute certainty, should brain scans be excluded just because they, too, are not 100% accurate? If the accuracy of a brain scan is tied to the sample size that the results are being compared to, shouldn’t we get larger sample sizes rather than wait on the technology to get better? If a researcher could testify that a sample size of 10,000 subjects reliably detected lies in 85% of cases, it seems (to my underdeveloped understanding of burdens of proof) that the civil ‘preponderance of the evidence’ standard is certainly met, and that the criminal ‘reasonable doubt’ standard is also likely met. If that’s right, then on what basis are these scans being excluded?

Gazzaniga also asks “Would it erode notions of free will and personal responsibility more broadly if all antisocial decisions could seemingly be attributed to some kind of neurological deviation?” He states, as a follow up: “People, not brains, commit crimes.” What could the second question possibly mean, given the current scientific understanding of how the universe works, and, based on that understanding isn’t the first statement likely to be true anyway? To vastly oversimplify a raging philosophical debate, most philosophers and (presumably) scientists ascribe to a roughly physicalist view of the universe. That is: Science tells us that everything is made of physical stuff (quantum mechanics aside) and that everything is a relation between that physical stuff. If we accept the premise that the universe is made of all and only physical stuff, then “we” can be little more than our brains. Our brains, made of physical stuff as they are, are themselves controlled by complicated chemical interactions that present to each of us, individually, as personality and consciousness and to the scientists studying them as brainwaves and chemical activity. Put more simply, we just are our brains, and our brains just are a long chain of chemical reactions. If a deviant chemical reaction causes (what we consider to be) aberrant behavior, then doesn’t it make more sense to fix the chemical reaction than to assign notions of blameworthiness based on outdated information?

I oversimplify, of course, and gloss over interesting ethical questions to make my point. The practice, however, works in the real world. We have little difficulty reserving moral judgment where John accidentally trips and injures Jane so long as John was being reasonably careful and didn’t intend to hurt anyone. We currently (though not frequently) send murders who are clinically insane to treatment facilities rather than jail when they kill someone while insane. We accept that diabetics require insulin because their chemical reactions are deficient, not because they are morally deficient. Why should our brain be treated any differently?

My questions are not condemnations of Gazzaniga, or of his fascinating article. I just wonder at the implications of our judicial policy and a lingering belief that we are something other than our brains when we’ve abandoned such pretenses for less personal organs.