Startling technologies promise to transform medicine
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39049.453877.BE (Published 21 December 2006) Cite this as: BMJ 2006;333:1308
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We congratulate the Author on an really inspiring discourse on the
startling technologies.We would still like to add, that the Nano-medicine
is actually "nano" enough for its recognition the nano(billionth) scale.We
say this on the basis of recent works in Nanoparticle Drug Delivery
Systems(DDS), which allows more control over the pharmacokinetics and
pharmacodynamics of drugs, especially in cancer chemotherapeutics.(1)
Another cause, for a name worth its "scale", is the novel nano-
particle imaging agents being developed, which could provide high-
definition functional and structural details.(2)
References:
(1)Allen TM, Cheng WW, Hare JI, Laginha KM.Pharmacokinetics and
pharmacodynamics of lipidic nano-particles in cancer.
Anticancer Agents Med Chem. 2006 Nov;6(6):513-23
(2)Lanza GM, Winter PM, Neubauer AM, Caruthers SD, Hockett FD,
Wickline SA. (1)H/(19)F magnetic resonance molecular imaging with
perfluorocarbon nanoparticles.Curr Top Dev Biol. 2005;70:57-76
Competing interests:
None declared
Competing interests: No competing interests
The article has focused on the various major Technology Advances that
could transform Healthcare in the years to come. However one other area
where tremendous strides are being made is in the area of IT Applications
that can take control of the Decision making process in Diagnosis and
Treatment. While some level of Clinical Decision Support is already a part
of the Healthcare Delivery Process in many Hospitals the level of support
is a little more than primitive compared to the potential that exists.
Teams of Doctors along with large IT Organizations are now working at a
frenetic pace to come up with Medicine's equivalent of Deep Fritz, that
Super Computer that beats the Champion of Champions at Chess. Work on
Decision Support systems has been frustratingly slow and the world is
still searching for systems that can make the grade consistently. However
with greater computing speeds, advances in artificial intelligence,more
advanced pattern recognition algorithms and newer data mining tools the
first cut version of Medicine's Super Computer is probably less than 5
years away.What such a system would do is to make diagnosis unneringly
accurate and reduce the variability in the treatment options. It would
potentially be possible to deploy the system and have at least the
diagnosis made without the intervention of a doctor, a task which if
accomplished has as much potential benefit as many of the other
technologies discussed in the
piece. The benchmark for such a system would possibly be that it would
need to make a diagnosis better than between 98% to 99% of all the doctors
that it is benchmarked with. One must remember that a system that is even
better than 75% of the doctors in,say,the UK could save thousands of lives
in countries around the world where the quality of medical expertise tends
to be uneven with great geographical disparities.
So,anyone fancy naming this system?
PS: As one of those working in this very area,I would add that systems
that are unneringly accurate for diagnosing and suggesting treatment
options for specific disease are already nearing deployment, its the one
that is the master of all diseases that still has some way to go.
Competing interests:
A Medical Specialist I work in the Healthcare IT area as a Domain Consultant.My work also includes the type of Decision Support application being described in the response.
Competing interests: No competing interests
Nanotechnology more 'startling' than we may think
Editor, we were fascinated, enthused and filled with hope on reading
Dr Combs’ synopsis1 of the cutting edge of technology with (realised and
potential) relevance to medical intervention. We were however, surprised
at the use of general tissue engineering as examples of nanotechnology.
The article does not reflect the true wonder and importance of the
properties conferred by the size involved. It is true that tissue
engineered structures can involve manipulations at the cellular level, but
nanotechnology specifically refers to materials smaller than 100
nanometres – this distinction is critical as this size allows exploitation
of esoteric quantal properties which are observed when considering the
molecular, atomic or even sub-atomic level. These properties are in direct
contrast with the bulk properties familiar to all and explained by the
traditional laws of physics. An example is the distribution of an electron
cloud around the proton-containing nucleus – traditional physics would
predict that the electrons would be driven straight at the positive
nucleus. These same quantal properties result in engineered molecules with
unique properties which are often unpredictable. As these properties are
realised, medical roles involving specific cell targeting (eg. drug
delivery) and synthetic prosthetic materials are being developed. Our
group have used engineered siloxane octahedral cage molecules primarily to
improve the biostability of polyurethanes for long term implantation and
found the resultant nanocomposite to additionally show anti-thrombogenic
properties in vitro2. This suggests a potential use in low flow vascular
bypass, where current synthetic grafts have poor long term results.
Intriguingly, the belief that traditional synthetics cannot simultaneously
provide the multiple desirable characteristics of an artery has stimulated
a vast body of research into the tissue engineered vascular graft –
another startling technology.
Reference List
1. Combs CD. Startling technologies promise to transform medicine.
BMJ 2006;333:1308-11.
2. Kannan RY, Salacinski HJ, De Groot J, Clatworthy I, Bozec L,
Horton M et al. The antithrombogenic potential of a polyhedral oligomeric
silsesquioxane (POSS) nanocomposite. Biomacromolecules 2006;7:215-23.
Competing interests:
None declared
Competing interests: No competing interests