Vol 111: A matter of time
All living things eventually die. Some embrace that inevitability while others run from it for as long as they can. In medicine, we do what we can to prolong this invariable fight but in reality, it’s nothing more than a delay tactic. No manner of intervention can change the fact that the time will come when we will all die. It’ll be our faces in a death announcement and our bodies that lie in a coffin. Just another tombstone amidst a graveyard of thousands.
Knowing that, there is something quite beautiful about dying with no regrets. Nothing left unsaid; no desire left unfulfilled. Living life to the fullest should be a part of everyone’s legacy but in order to do that for as long as possible, a healthy body and mind is essential. And yet, it almost seems counterproductive since living life for some people means partaking in food, drugs and alcohol in such excess that health becomes compromised. That’s why I’ve always believed that medicine is a balancing act between providing care while making room for patients to enjoy life as best they can.
Fortunately, modern technological advances in medicine are reshaping how physicians diagnose and treat patients and we’re at the cusp of seeing quantifiable changes in how the human race ages. The length and quality of life we get to enjoy as we get older is at the forefront of research initiatives and results are promising enough for me to predict that it’s only a matter of time before both life expectancy and quality of life improve substantially across the globe.
This past week, in one of the greatest mechanical feats of this decade, SpaceX was able to recapture a starship rocket booster at its launch pad using mechanical arms referred to as chopsticks. It was an unprecedented feat that left onlookers in awe and set the engineering world ablaze with excitement. According to founder Elon Musk, this was just another step closer for them to develop fully reusable and quickly re-launchable rockets for multiplanetary life. The same company now has working robots and is hoping to have over a billion humanoid robots by the year 2040, some designed specifically for space exploration. A billion humanoids is hard to fathom, but that is now part of a reputable business plan.
Advancements like that garner significant media attention with worldwide fanfare and applause while other technological feats can sometimes, for years, go relatively unnoticed. In light of SpaceX’s recent achievement, I wanted today’s report to focus on some of the medical advancements currently underway that many in the general public may not be aware of.
Surgical robotic systems, for example, already currently offer increased precision and improved visualization for minimally invasive surgeries. Their use in general, cardiac, orthopedic and neurosurgical procedures is sure to proliferate in upcoming years. A surgical robot that has the MRI and X-ray images of the patient already uploaded will be able to overlay those images precisely onto a patient, enabling it to work seamlessly with less chance of human error.
More specifically what that mean is that the fully-informed robot, programmed with all the information about the bones, cartilage, muscle or tissue it is working with is less likely to err than the best surgeon performing the same procedure with all else being equal (uninterrupted blood supply, anesthesia, surgical team and operating room team assistance). That’s not to say that the robot would be prepared, at least not at this point in its advancement, to respond instantly should something go wrong, say with a patient’s heart. But we should be willing to accept that the new normal is accepting the fact that in its purest form, robotic surgery is more accurate than that performed by a human.
Just this month, Johnson and Johnson, the American pharmaceutical, medical and biotechnology corporation, announced that they’d submitted a biologics license application to the US food and drug administration (FDA) for a potential new treatment of Myasthenia Gravis. The drug, called Nipocalimab, marks the first treatment of its kind to exhibit long term effectiveness in this patient population. Myasthenia gravis is a chronic autoimmune disorder where patients exhibit severe muscle weakness because antibodies destroy virtually all communication between the muscles and nerves. Muscles in the eye, mouth, throat and limbs are particularly affected and currently there is no cure.
I’ve also been closely following the ‘Symplicity’ blood pressure procedure, which is an impressive novel technological advancement where a spiral multielectrode cathode and generator is inserted into the artery leading to the kidney. It sends radiofrequency energy to the renal nerves to disrupt the overactive sympathetic signaling that occurs with high blood pressure between the kidneys and the brain. The electrode is then removed. The procedure takes one hour and most patients go home on either the same or the following day. It’s been performed in over twenty-five thousand patients worldwide to date and over 50 percent of patients who’ve received the procedure saw a sustained 10mmhg drop in blood pressure regardless of whether they were on medication or not.
During the 25th International AIDS Conference held in Munich, Germany this year, a seventh case of someone with HIV being cured was reported. The cure occurred after the infected patient underwent a stem cell transplant from a donor with a genetic mutation known as CCR5-delta 32. Stem cell transplants are dangerous but researchers are hopeful that through gene editing techniques the results can be more easily duplicated. Since the beginning of the epidemic, approximately 42.3 million people have died of HIV according to The World Health Organization and they hope a universal cure for HIV is found and the AIDS epidemic ends by the year 2030. Imagine if a similar gene editing advance could be found to end influenza.
Also in Germany, a group of researchers is currently studying a designer cytokine (Interleukin-6) that has been proven to reverse paralysis in mice by regenerating nerves. Paraplegic mice began to move after a single injection and were able to walk after two to three weeks. Trials are now being conducted on mammals with the hope that human trials will commence shortly thereafter. While many years of further study will be needed before a safe and effective treatment is developed for humans, this research is incredibly promising for patients who previously had no hope to ever walk again.
Almost six thousand miles away from Germany, and as recently as last month, Japanese researchers are conducting clinical human trials of a new drug with the hope that it will be able to successfully regrow teeth. The study will last nearly a year and include up to 30 men, all missing at least one tooth. If all goes as well as during their animal (ferret) clinical trials, the human trials will expand with the hopes to have a drug available for mass production in another six years.
Image property of Metromed International Cardiac Center
Many years ago, I was given the opportunity as a student to watch as a pacemaker was implanted into an older gentleman who’d had multiple heart attacks. At the time I couldn’t imagine the pacemaker they used getting any better because it was already thin and smaller than the center of my palm. Today, however, Micra is the world’s smallest pacemaker and it measures the size of a large vitamin capsule. Unlike ordinary pacemakers which are implanted in the chest with multiple leads that connect to the heart, Micra has no leads because it’s implanted directly into the heart. Battery life span is between 16-17 years and it’s already being used at major hospitals throughout the US.
Beyond these studies, there are others being conducted on drugs to cure near-sightedness, drugs to slow down and even reverse Alzheimer’s disease, drugs to prevent cancer and drugs that dramatically improve outcomes and prevent disability in patients who’ve had a stroke. Artificial intelligence is being increasingly used to assist in diagnosing conditions like cancer and eye diseases, enhancing accuracy and speed. In fact, that last sentence was written by the OpenAI generator, ChatGPT.
One hundred years ago, the notion of travelling from one country to another in an aircraft flying at an altitude of twenty thousand feet in the air seemed impossible. Electronic televisions didn’t come out until 1927 and it took another 27 years before it was available in color. Today, because of the internet, we’re able to send an email and text message anywhere in the world or simply videocall the recipient in real time. In another hundred years, humanoid robot assistants readily used to shop and cook for us, chauffeur our cars, clean our homes and babysit our children is quite possible. A built-in Ring camera system that allows us to see and speak through them is almost certain.
If past is at all prologue, the next one hundred years will usher in exciting and transformative technological advancements that our ancestors never dreamed of. We are at the cusp of a brave new world and, for better or worse, it’s only a matter of time before we know if that new world is better than the one we have today.
This is The KDK Report.
