The Future of Medicine

Greg BoydMay 3rd, 2000

• 1952 EDVAC• 1952 Hydrogen bomb• 1953 Color television• 1954 FORTRAN• 1960 Laser• 1961 Yuri Gagarin is the first human in space• 1969 July 20th Apollo II• 1971 Food processor• 1980 Pac Man

Advances outside medicine in the last 50 years

• 1981 April space shuttle Columbia• 1981 IBM PC• 1982 Compact Disc• 1982 TCP/IP• 1983 Cellular Telephones• 1986 Challenger disaster• 1990 Hubble• 1992 Web Browsers• 1998 International Space Station

Advances outside medicine in the last 50 years

Advances inside medicine in the last 50 years

• 1953 DNA is discovered• 1953 John Gibbon heart operation with a

heart-lung machine• 1955 Polio Vaccine• 1956 Merrill, Murray, and Harrison kidney

transplantation• 1967 Bernard heart transplantation• 1968 Mc Devitt and Tyan elucidate the

immune response to MHC

Advances inside medicine in the last 50 years

• 1978 Tonegawa discovers the genetic mechanism of antibody production

• 1982 DeVries artificial heart implantation • 1995 Wilmut clones Dolly• 2000 Celera Genomics announces

completed sequencing of the human genome

• 2000 Artificial eye spliced to optic nerve, by Claude Veraart in Belgium

•2000 First full success of gene therapy in SCID

Gene Therapy

• Richard Boucher: Cystic Fibrosis

Severe Combined Immuno Deficiency (SCID)

"Both enjoy normal growth and psychomotor development. No side effects have been noted” April 28 Science.

Each boy has been home for nearly a year withouttreatment. They have normal levels of T, B, and naturalkiller immune cells and have been successfully vaccinatedagainst tetanus, diphtheria, and polio.

• Dr. Alain Fischer of the Necker Hospital in Paris

Medical Cybernetics

Kevin Warwick

University of ReadingCybernetics programwww.cyber.rdg.ac.uk

Artificial Eyes

Artificial Hearts

Artificial Joints and Limbs

Cryopreservation of heart valves for transplant,porcine islet cells, sperm, eggs.

CryonicsThe first man ever frozen was James Bedford, Ph.D., who was suspendedin 1967.

www.alcor.com

Cryonics and Cryogenics

Merging of Pharmacology and

Nanotechnology

Enzymes are incredibly efficient natural nanomachines.

www.foresight.org

“Nanotechnology is technology based on the manipulationof individual atoms and molecules to build structures to complex,atomic specifications.” (Drexler)

• Molecular modeling and drug design

• Nanogen and Clinical Microsensors handheld gene scanning technology

• Building transcription factors and other designer proteins and amino acid sequences.

Merging of Pharmacology and

Nanotechnology

“Coupled with the principles of nanotechnology,we may contemplate miniature molecular machinescontaining directed drug factories, circulating thebody and capable of self-targeting against defectivecells and pathways -- the ultimate ‘drug delivery machine.’”(Triggle)

Merging of Pharmacology and

Nanotechnology

“The artificial red blood cell or ‘respirocyte’ proposedhere is a bloodborne spherical 1-micron diamondoid1000-atm pressure vessel with active pumping poweredby endogenous serum glucose, able to deliver 236 timesmore oxygen to the tissues per unit volume than naturalred cells and to manage carbonic acidity. An onboard nanocomputer and numerous chemical and pressuresensors enable complex device behaviors remotelyreprogrammable by the physician via externally appliedacoustic signals.” (Frietas)

Merging of Pharmacology and

Nanotechnology

Cloning and Stem CellsSome Important Dates in the history of Cloning

1970 Dr. John B.Gurdon (U.K.) clones a frog bytransplanting the intestinal cell of a tadpoleinto an enucleated frog egg, which developsinto an adult frog.

1978 Birth of first child, conceived by in vitro (literally “in glass”) fertilization to Leslie Brown (U.K.).

1984 Dr. Steen M. Willadsen (Denmark) clones a lamb froma developing sheep embryo cell. His experiment isrepeated by other scientists who clone a variety of animals.

1993 First humans cloned (U.S.). Cells taken from defective humanembryos that were to be discarded in infertility clinic are grownin vitro and develop up to 32-cell stage and then are destroyed.

1994 Dr. Ned First (U.S.) clones calves from cells of early embryos.

1995 Drs. Ian Wilmut and Keith Campbell (U.K.) create the world's firstcloned sheep, Megan and Morag, from embryo cells.

1996 Dr. Ian Wilmut and his team clone the world's the firstsheep from adult mammary cells. The lamb born inJuly 1996 is named Dolly.

1997 Scientists at Oregon Regional Primate Research Center (U.S.)create first primates—two rhesus monkeys named Neti and Ditto fromDNA taken from cells of developing monkey embryos. They arenot genetically identical because two different embryos were used.

1997 A team led by Drs. Ian Wilmut and Keith Campbell (U.K.) create thefirst sheep with a human gene in every cell of its body. The geneticallyengineered lamb is named Polly.

Cloning and Stem Cells

Oh My God,you’ve gone too far!!

Uploading Consciousness

Dan Dennet in Consciousness Explained

The concept of a lifelong narrative comes aboutin the theory that the mind is a Von-Neumann type machinerunning in emulation on the parallel distributed processorthat is the brain. This machine keeps a linear track ofthought (our memories and the ineffable quality to them)that defines who we are. Since the Von Neumann-typevirtual machine is running in emulation, Dennett contends,it is software. And, this software could theoretically betransferred, thus transferring consciousness.

Uploading Consciousness

Moore’s Law and Neurons

Each new chip contained roughly twice as much capacityas its predecessor, and each chip was released within 18-24months of the previous chip.

In 26 years the number of transistors on a chip has increasedmore than 3,200 times, from 2,300 on the 4004 in 1971 to 7.5million on the Pentium® II processor (1998).(Intel Museum Online)

Machrone's Law

"Gordon Moore just plain got it right . . . I should also mention that Moore's Law has also givenrise to Machrone's Law, which was true for many years,which is that the machine you want always costs $5,000."

Machrone’s Law

Moores Law and Neurons

100 billion neurons in the human brain(Neuroscience for Kids)

So, if we want a transistor for every neuron,we should have it before 2028 if Moore’slaw continues to hold. (assuming a 24 month cycle)(123 billion transistors per chip)

Other Medical Prophecies:

• Medical imaging advances• Blending of psychiatry and neuroscience• Medical computing including computerized medical records and billing• World wide web, realtime, video medical consults• Integration of modern western and complimentary (alternative) medicine• More individualized medical care • Computer and robot assisted surgery• Tissue made-to-order (stem cells)• New Diseases

Most Importantly!Advances and terrors currently unimaginable

Everything that has ever been scientifically possible,from wonderful ideas like antibiotics to horrificideas like nuclear weapons has been made into reality.Discussion, morality, or legislation has neither haltedtheir coming nor substantially slowed the pace of their arrival.(Boyd UNC History of Medicine 2000)

What if you don’t want someof these advances to occur?

Resolving Conflicts in MedicalTerminology

An example of how not to name discoveries:

Mast Cell is from the English and German. Mast is anut food for swine. “When the true nature and functionof these cells are discovered, a new name will be needed.At present it is suspected they form heparin, andheparinocyte has been suggested as a name for them.”(Pepper)

The infant Achilles was dipped in the river Styxby his mother to render him impervious to wounds.She held him by the heel, which remained vulnerable,and it was in the heel that he was fatally wounded byan arrow at the battle of Troy.

The name is first used in anatomy by Verheyden in1693, while dissecting his own amputated leg.(Pepper)

Achilles Tendon

He deserves to name it:

ReferencesWWW.CNN.COM in Specials section for 20th Century History

Dennett, Daniel, C. Consciousness Explained. Little, Brown, and Company.New York. 1991.

Drexler, Eric. Engines of Creation: The Coming Era of Nanotechnology. Double Day Publishing New York 1990. 

Freitas RA Jr. Exploratory design in medical nanotechnology: a mechanical artificial red cell. Artificial Cells, Blood Substitutes, & Immobilization Biotechnology. 26(4):411-30, 1998 Jul.  

Kids Almanac web page http://kids.infoplease.com/ipka/A0770279.htmlThe history of cloning.

Naik S. Santangini HA. Trenkler DM. Mullon CJ. Solomon BA.Pan J. Jauregui HO. Functional recovery of porcine hepatocytesafter hypothermic or cryogenic preservation for liver support systems.Cell Transplantation. 6(5):447-54, 1997 Sep-Oct.

Neuroscience for Kids web page http://faculty.washington.edu/chudler/introb.html

Pepper O.H. Perry, Medical Etymology: The History and Derivationof Medical Terms for Students of Medicine, Dentistry, and Nursing.W. B. Saunders Company Philadelphia 1949.

Timeline of philosophers http://www.trincoll.edu/depts/phil/philo/timeline.html

Triggle DJ. Rho Chi lecture. Pharmaceutical sciences in the next millennium.Annals of Pharmacotherapy. 33(2):241-6, 1999 Feb.

Just the beginning. . .