Real-Time Monitoring of Your Health Is the Future of Medicine
The same way that it's harder to lose 100 pounds than it is to not gain 100 pounds, it's easier to stop a disease before it happens than to treat an illness once it's developed.
In Morris' dream scenario "everyone will be implanted with a sensor" ("…the same way most people are vaccinated") and the sensor will alert people to go to the doctor if something is awry.
Bio-engineers working on the next generation of diagnostic tools say today's technology, such as colonoscopies or mammograms, are reactionary; that is, they tell a person they are sick often when it's too late to reverse course. Surveillance medicine — such as implanted sensors — will detect disease at its onset, in real time.
What Is Possible?
Ever since the Human Genome Project — which concluded in 2003 after mapping the DNA sequence of all 30,000 human genes — modern medicine has shifted to "personalized medicine." Also called, "precision health," 21st-century doctors can in some cases assess a person's risk for specific diseases from his or her DNA. The information enables women with a BRCA gene mutation, for example, to undergo more frequent screenings for breast cancer or to pro-actively choose to remove their breasts, as a "just in case" measure.
But your DNA is not always enough to determine your risk of illness. Not all genetic mutations are harmful, for example, and people can get sick without a genetic cause, such as with an infection. Hence the need for a more "real-time" way to monitor health.
Aaron Morris, a postdoctoral researcher in the Department of Biomedical Engineering at the University of Michigan, wants doctors to be able to predict illness with pinpoint accuracy well before symptoms show up. Working in the lab of Dr. Lonnie Shea, the team is building "a tiny diagnostic lab" that can live under a person's skin and monitor for illness, 24/7. Currently being tested in mice, the Michigan team's porous biodegradable implant becomes part of the body as "cells move right in," says Morris, allowing engineered tissue to be biopsied and analyzed for diseases. The information collected by the sensors will enable doctors to predict disease flareups, such as for cancer relapses, so that therapies can begin well before a person comes out of remission. The technology will also measure the effectiveness of those therapies in real time.
In Morris' dream scenario "everyone will be implanted with a sensor" ("…the same way most people are vaccinated") and the sensor will alert people to go to the doctor if something is awry.
While it may be four or five decades before Morris' sensor becomes mainstream, "the age of surveillance medicine is here," says Jamie Metzl, a technology and healthcare futurist who penned Hacking Darwin: Genetic Engineering and the Future of Humanity. "It will get more effective and sophisticated and less obtrusive over time," says Metzl.
Already, Google compiles public health data about disease hotspots by amalgamating individual searches for medical symptoms; pill technology can digitally track when and how much medication a patient takes; and, the Apple watch heart app can predict with 85-percent accuracy if an individual using the wrist device has Atrial Fibrulation (AFib) — a condition that causes stroke, blood clots and heart failure, and goes undiagnosed in 700,000 people each year in the U.S.
"We'll never be able to predict everything," says Metzl. "But we will always be able to predict and prevent more and more; that is the future of healthcare and medicine."
Morris believes that within ten years there will be surveillance tools that can predict if an individual has contracted the flu well before symptoms develop.
At City College of New York, Ryan Williams, assistant professor of biomedical engineering, has built an implantable nano-sensor that works with a florescent wand to scope out if cancer cells are growing at the implant site. "Instead of having the ovary or breast removed, the patient could just have this [surveillance] device that can say 'hey we're monitoring for this' in real-time… [to] measure whether the cancer is maybe coming back,' as opposed to having biopsy tests or undergoing treatments or invasive procedures."
Not all surveillance technologies that are being developed need to be implanted. At Case Western, Colin Drummond, PhD, MBA, a data scientist and assistant department chair of the Department of Biomedical Engineering, is building a "surroundable." He describes it as an Alexa-style surveillance system (he's named her Regina) that will "tell" the user, if a need arises for medication, how much to take and when.
Bioethical Red Flags
"Everyone should be extremely excited about our move toward what I call predictive and preventive health care and health," says Metzl. "We should also be worried about it. Because all of these technologies can be used well and they can [also] be abused." The concerns are many layered:
Discriminatory practices
For years now, bioethicists have expressed concerns about employee-sponsored wellness programs that encourage fitness while also tracking employee health data."Getting access to your health data can change the way your employer thinks about your employability," says Keisha Ray, assistant professor at the University of Texas Health Science Center at Houston (UTHealth). Such access can lead to discriminatory practices against employees that are less fit. "Surveillance medicine only heightens those risks," says Ray.
Who owns the data?
Surveillance medicine may help "democratize healthcare" which could be a good thing, says Anita Ho, an associate professor in bioethics at both the University of California, San Francisco and at the University of British Columbia. It would enable easier access by patients to their health data, delivered to smart phones, for example, rather than waiting for a call from the doctor. But, she also wonders who will own the data collected and if that owner has the right to share it or sell it. "A direct-to-consumer device is where the lines get a little blurry," says Ho. Currently, health data collected by Apple Watch is owned by Apple. "So we have to ask bigger ethical questions in terms of what consent should be required" by users.
Insurance coverage
"Consumers of these products deserve some sort of assurance that using a product that will predict future needs won't in any way jeopardize their ability to access care for those needs," says Hastings Center bioethicist Carolyn Neuhaus. She is urging lawmakers to begin tackling policy issues created by surveillance medicine, now, well ahead of the technology becoming mainstream, not unlike GINA, the Genetic Information Nondiscrimination Act of 2008 -- a federal law designed to prevent discrimination in health insurance on the basis of genetic information.
And, because not all Americans have insurance, Ho wants to know, who's going to pay for this technology and how much will it cost?
Trusting our guts
Some bioethicists are concerned that surveillance technology will reduce individuals to their "risk profiles," leaving health care systems to perceive them as nothing more than a "bundle of health and security risks." And further, in our quest to predict and prevent ailments, Neuhaus wonders if an over-reliance on data could damage the ability of future generations to trust their gut and tune into their own bodies?
It "sounds kind of hippy-dippy and feel-goodie," she admits. But in our culture of medicine where efficiency is highly valued, there's "a tendency to not value and appreciate what one feels inside of their own body … [because] it's easier to look at data than to listen to people's really messy stories of how they 'felt weird' the other day. It takes a lot less time to look at a sheet, to read out what the sensor implanted inside your body or planted around your house says."
Ho, too, worries about lost narratives. "For surveillance medicine to actually work we have to think about how we educate clinicians about the utility of these devices and how to how to interpret the data in the broader context of patients' lives."
Over-diagnosing
While one of the goals of surveillance medicine is to cut down on doctor visits, Ho wonders if the technology will have the opposite effect. "People may be going to the doctor more for things that actually are benign and are really not of concern yet," says Ho. She is also concerned that surveillance tools could make healthcare almost "recreational" and underscores the importance of making sure that the goals of surveillance medicine are met before the technology is unleashed.
"We can't just assume that any of these technologies are inherently technologies of liberation."
AI doesn't fix existing healthcare problems
"Knowing that you're going to have a fall or going to relapse or have a disease isn't all that helpful if you have no access to the follow-up care and you can't afford it and you can't afford the prescription medication that's going to ward off the onset," says Neuhaus. "It may still be worth knowing … but we can't fool ourselves into thinking that this technology is going to reshape medicine in America if we don't pay attention to … the infrastructure that we don't currently have."
Race-based medicine
How surveillances devices are tested before being approved for human use is a major concern for Ho. In recent years, alerts have been raised about the homogeneity of study group participants — too white and too male. Ho wonders if the devices will be able to "accurately predict the disease progression for people whose data has not been used in developing the technology?" COVID-19 has killed Black people at a rate 2.5 time greater than white people, for example, and new, virtual clinical research is focused on recruiting more people of color.
The Biggest Question
"We can't just assume that any of these technologies are inherently technologies of liberation," says Metzl.
Especially because we haven't yet asked the 64-thousand dollar question: Would patients even want to know?
Jenny Ahlstrom is an IT professional who was diagnosed at 43 with multiple myeloma, a blood cancer that typically attacks people in their late 60s and 70s and for which there is no cure. She believes that most people won't want to know about their declining health in real time. People like to live "optimistically in denial most of the time. If they don't have a problem, they don't want to really think they have a problem until they have [it]," especially when there is no cure. "Psychologically? That would be hard to know."
Ahlstrom says there's also the issue of trust, something she experienced first-hand when she launched her non-profit, HealthTree, a crowdsourcing tool to help myeloma patients "find their genetic twin" and learn what therapies may or may not work. "People want to share their story, not their data," says Ahlstrom. "We have been so conditioned as a nation to believe that our medical data is so valuable."
Metzl acknowledges that adoption of new technologies will be uneven. But he also believes that "over time, it will be abundantly clear that it's much, much cheaper to predict and prevent disease than it is to treat disease once it's already emerged."
Beyond cost, the tremendous potential of these technologies to help us live healthier and longer lives is a game-changer, he says, as long as we find ways "to ultimately navigate this terrain and put systems in place ... to minimize any potential harms."
Scientists experiment with burning iron as a fuel source
Story by Freethink
Try burning an iron metal ingot and you’ll have to wait a long time — but grind it into a powder and it will readily burst into flames. That’s how sparklers work: metal dust burning in a beautiful display of light and heat. But could we burn iron for more than fun? Could this simple material become a cheap, clean, carbon-free fuel?
In new experiments — conducted on rockets, in microgravity — Canadian and Dutch researchers are looking at ways of boosting the efficiency of burning iron, with a view to turning this abundant material — the fourth most common in the Earth’s crust, about about 5% of its mass — into an alternative energy source.
Iron as a fuel
Iron is abundantly available and cheap. More importantly, the byproduct of burning iron is rust (iron oxide), a solid material that is easy to collect and recycle. Neither burning iron nor converting its oxide back produces any carbon in the process.
Iron oxide is potentially renewable by reacting with electricity or hydrogen to become iron again.
Iron has a high energy density: it requires almost the same volume as gasoline to produce the same amount of energy. However, iron has poor specific energy: it’s a lot heavier than gas to produce the same amount of energy. (Think of picking up a jug of gasoline, and then imagine trying to pick up a similar sized chunk of iron.) Therefore, its weight is prohibitive for many applications. Burning iron to run a car isn’t very practical if the iron fuel weighs as much as the car itself.
In its powdered form, however, iron offers more promise as a high-density energy carrier or storage system. Iron-burning furnaces could provide direct heat for industry, home heating, or to generate electricity.
Plus, iron oxide is potentially renewable by reacting with electricity or hydrogen to become iron again (as long as you’ve got a source of clean electricity or green hydrogen). When there’s excess electricity available from renewables like solar and wind, for example, rust could be converted back into iron powder, and then burned on demand to release that energy again.
However, these methods of recycling rust are very energy intensive and inefficient, currently, so improvements to the efficiency of burning iron itself may be crucial to making such a circular system viable.
The science of discrete burning
Powdered particles have a high surface area to volume ratio, which means it is easier to ignite them. This is true for metals as well.
Under the right circumstances, powdered iron can burn in a manner known as discrete burning. In its most ideal form, the flame completely consumes one particle before the heat radiating from it combusts other particles in its vicinity. By studying this process, researchers can better understand and model how iron combusts, allowing them to design better iron-burning furnaces.
Discrete burning is difficult to achieve on Earth. Perfect discrete burning requires a specific particle density and oxygen concentration. When the particles are too close and compacted, the fire jumps to neighboring particles before fully consuming a particle, resulting in a more chaotic and less controlled burn.
Presently, the rate at which powdered iron particles burn or how they release heat in different conditions is poorly understood. This hinders the development of technologies to efficiently utilize iron as a large-scale fuel.
Burning metal in microgravity
In April, the European Space Agency (ESA) launched a suborbital “sounding” rocket, carrying three experimental setups. As the rocket traced its parabolic trajectory through the atmosphere, the experiments got a few minutes in free fall, simulating microgravity.
One of the experiments on this mission studied how iron powder burns in the absence of gravity.
In microgravity, particles float in a more uniformly distributed cloud. This allows researchers to model the flow of iron particles and how a flame propagates through a cloud of iron particles in different oxygen concentrations.
Existing fossil fuel power plants could potentially be retrofitted to run on iron fuel.
Insights into how flames propagate through iron powder under different conditions could help design much more efficient iron-burning furnaces.
Clean and carbon-free energy on Earth
Various businesses are looking at ways to incorporate iron fuels into their processes. In particular, it could serve as a cleaner way to supply industrial heat by burning iron to heat water.
For example, Dutch brewery Swinkels Family Brewers, in collaboration with the Eindhoven University of Technology, switched to iron fuel as the heat source to power its brewing process, accounting for 15 million glasses of beer annually. Dutch startup RIFT is running proof-of-concept iron fuel power plants in Helmond and Arnhem.
As researchers continue to improve the efficiency of burning iron, its applicability will extend to other use cases as well. But is the infrastructure in place for this transition?
Often, the transition to new energy sources is slowed by the need to create new infrastructure to utilize them. Fortunately, this isn’t the case with switching from fossil fuels to iron. Since the ideal temperature to burn iron is similar to that for hydrocarbons, existing fossil fuel power plants could potentially be retrofitted to run on iron fuel.
This article originally appeared on Freethink, home of the brightest minds and biggest ideas of all time.
How to Use Thoughts to Control Computers with Dr. Tom Oxley
Tom Oxley is building what he calls a “natural highway into the brain” that lets people use their minds to control their phones and computers. The device, called the Stentrode, could improve the lives of hundreds of thousands of people living with spinal cord paralysis, ALS and other neurodegenerative diseases.
Leaps.org talked with Dr. Oxley for today’s podcast. A fascinating thing about the Stentrode is that it works very differently from other “brain computer interfaces” you may be familiar with, like Elon Musk’s Neuralink. Some BCIs are implanted by surgeons directly into a person’s brain, but the Stentrode is much less invasive. Dr. Oxley’s company, Synchron, opts for a “natural” approach, using stents in blood vessels to access the brain. This offers some major advantages to the handful of people who’ve already started to use the Stentrode.
The audio improves about 10 minutes into the episode. (There was a minor headset issue early on, but everything is audible throughout.) Dr. Oxley’s work creates game-changing opportunities for patients desperate for new options. His take on where we're headed with BCIs is must listening for anyone who cares about the future of health and technology.
Listen on Apple | Listen on Spotify | Listen on Stitcher | Listen on Amazon | Listen on Google
In our conversation, Dr. Oxley talks about “Bluetooth brain”; the critical role of AI in the present and future of BCIs; how BCIs compare to voice command technology; regulatory frameworks for revolutionary technologies; specific people with paralysis who’ve been able to regain some independence thanks to the Stentrode; what it means to be a neurointerventionist; how to scale BCIs for more people to use them; the risks of BCIs malfunctioning; organic implants; and how BCIs help us understand the brain, among other topics.
Dr. Oxley received his PhD in neuro engineering from the University of Melbourne in Australia. He is the founding CEO of Synchron and an associate professor and the head of the vascular bionics laboratory at the University of Melbourne. He’s also a clinical instructor in the Deepartment of Neurosurgery at Mount Sinai Hospital. Dr. Oxley has completed more than 1,600 endovascular neurosurgical procedures on patients, including people with aneurysms and strokes, and has authored over 100 peer reviewed articles.
Links:
Synchron website - https://synchron.com/
Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients (paper co-authored by Tom Oxley) - https://jamanetwork.com/journals/jamaneurology/art...
More research related to Synchron's work - https://synchron.com/research
Tom Oxley on LinkedIn - https://www.linkedin.com/in/tomoxl
Tom Oxley on Twitter - https://twitter.com/tomoxl?lang=en
Tom Oxley TED - https://www.ted.com/talks/tom_oxley_a_brain_implant_that_turns_your_thoughts_into_text?language=en
Tom Oxley website - https://tomoxl.com/
Novel brain implant helps paralyzed woman speak using digital avatar - https://engineering.berkeley.edu/news/2023/08/novel-brain-implant-helps-paralyzed-woman-speak-using-a-digital-avatar/
Edward Chang lab - https://changlab.ucsf.edu/
BCIs convert brain activity into text at 62 words per minute - https://med.stanford.edu/neurosurgery/news/2023/he...
Leaps.org: The Mind-Blowing Promise of Neural Implants - https://leaps.org/the-mind-blowing-promise-of-neural-implants/
Tom Oxley