Healthcare, medicine & pharmaceuticals

Bringing the Doctor Back Home

One advantage of using telecommunications in medicine is the ability to treat people in remote locations. An extreme example of this was in 2001, when a surgeon in New York removed the gall bladder of a patient in Paris using robotic surgery. But true advances in telemedicine will move towards prevention rather than cure, and will be able to monitor people before they get sick and attend to them when they are. For example, BodyTel, in Germany, can measure glucose levels, blood pressure and weight using Bluetooth wireless technology so patients can monitor themselves at home. Honeywell gives patients similar abilities to monitor ECG, oxygen levels, and blood pressure, while doctors continually review the data. The value in this system is that patients can stay at home and remain independent and this reduces medical bills.

For patients who cannot monitor themselves, eg, Alzheimer’s patients, there are technologies to do it for them. For example, a smart cane can calculate the gait of the patient after, say, a hip replacement. Or sensors around the home, for example, on pillboxes or on a wristwatch, can help carers know what is going on when they are not around.There may come a time when well people wear sensors that will act as an early warning system for diseases. If diseases are detected at early stages, they are cheaper to treat and have less impact on the patient. On the other hand, if sensors are constantly detecting symptoms in a population, there will be reams of data to analyse and doctors will be under constant pressure to attend to data, rather than people. This means programming computers to analyse the data before alerting a doctor as needed. In the future, the doctor will call the patient, rather than the patient calling them

The Trivialisation of Genetics

When Wilson and Crick defined the structure of DNA, it was inconceivable that companies would sell DNA testing. This is another example of marketing trying to make the most out of science (eg, neuromarketing), but not everyone thinks that testing is accurate or clinically useful. After all, not all tests are done in certified labs and just because genetic markers for certain conditions may be present, does not mean that a person with those markers will get that condition. It fails to consider that lifestyle, family history, and even undiscovered genes, will play their part too. Some of the American companies involved in genetic testing are Navigenics and 23andMe, but there will be others trying to muscle in for a share. There is an almost inexhaustible market for people wanting to know more about themselves, particularly the baby boomers who want to stay young as long as they can – and they have the money to do it.

The New Coffee

The busy society is always on the lookout for a drug that will make it more alert, focused, and smarter. The obvious choice is coffee, which has become very fashionable, as well as effective, for waking us up. But cognition-enhancing drugs could be the next drug of choice, if they were made available. They are already used for Alzheimer’s, attention deficit disorder and schizophrenia but, like Ritalin and Provigil, healthy people could use them “off label” to boost performance. Also, like Ritalin, it is easy to get them from doctors or the Internet. Some people might ask whether if it is fair for some people to benefit from being smarter just because they can afford a certain drug. But many people already benefit from surgery that makes them younger or more attractive, so is there any difference? Pharmaceutical companies say that they want to minimise harm while maximising the freedom to choose, which is a compelling argument for people who need to perform and have the money to choose. This is why the smart money is on smart drugs.

Why Scientists Love Your Bacteria

One way to learn about a person’s habits is to sort through their garbage. In the same way, scientists are starting to analyse a person’s metabolites, the products of chemical reactions in the body. Metabolic changes in blood or urine can signal the presence of disease, and people with existing conditions have different patterns of metabolites from healthy people. With this vision, the Human Metabolome Project at the University of Alberta, Canada, released a database of the chemical patterns of 3,000 metabolites, 1,200 drugs and 3,500 food components in the body. Another focus of attention is the Microbiome Project, which collects faecal, vaginal, oral and skin samples to classify the genetic material of bacteria. For example, the bacteria in the guts of fat and thin people are quite different and, when obese people lost up to a quarter of their body weight, their gut bacteria changed too. This suggests that probiotics may be more important than, say, eating low fat food. One researcher at Imperial College London (UK) even suggests that looking for genetic links to chronic diseases may be less important than looking at the role of diet and culture, as these elements change the type and variety of metabolites. One metabolic marker may even have a role in regulating blood pressure. If this kind of information saves a life or prevents a disease, you might come to love your bacteria too.

How to predict and prevent pandemics

One of the unfortunate findings of epidemiologists is that the countries that are most at risk of diseases are those who are least prepared to spot them. These are places of rapid population growth, agricultural and industrial changes, deforestation, heavy used of antibiotics, and there is contact with diseased animals. For example, Nigeria and India are high risk, but Australia is not. As a result of these risk factors, there is evidence that some old diseases – plague, rickets, and tuberculosis – are on the rise again. The World Health Organization reports 1,000 to 3,000 plague cases a year, carried by rodents, mostly in Africa. In Britain, up to 1% of children from ethnic minorities may suffer from rickets, mostly because they have come from sunny countries to a grey climate. Tuberculosis is more likely to be brought in by African or Indian immigrants who then live in poor and deprived areas where resistance to disease is lower. Migration ensures that even lower risk areas are still susceptible to pandemics so it is important not to think that modern life is immune to old diseases.