As part of our series on the future of work, Victoria Chang discusses the ethics and impact of technological innovation in medicine.
It’s no secret that medicine is a hotbed for innovation. The impact of medical research on society can be world-changing; it affects everybody, no matter if you’re a medical student, a patient, or a regular citizen. The frontier of current medical technology is where the line begins to blur between fantasy and reality. Robotic surgery, brain chips, and 3D printed organs sound like concepts from your favourite sci-fi film, but doctors and scientists are trying to make these dreams come true.
Robots are nothing new to the industry. We’ve incorporated machines like the da Vinci Surgical System since 2000, to allow for minimally invasive surgical procedures. However, the role of robots in healthcare is expanding, and people are beginning to fear for their jobs and their safety.
Can a robot ever completely replace the job of a surgeon? The current opinion is that man and machine must work together to efficiently care for patients. Robotic surgical procedures allow for more accurate operation sites in hard-to-reach areas. For example, machines are able to move in different planes and axes to operate on the prostate gland — a small, often problematic organ tucked away in the complex abdomen.
In my opinion, nothing can replace the trust that patients place in their doctors. A machine could never offer the same care and empathy a human can. Doctors should always have control of machines in the surgical room, since they are able to fully grasp the consequences and implications of their actions.
There is perhaps one case in which it would be beneficial for robots to act on their own. The United States Army is embracing robotic surgery and other high-tech procedures on the frontlines. Instead of putting medical professionals at risk by sending them into dangerous situations, they can act via a robot and save soldiers in critical condition. This concept could be extrapolated in the future to serve patients in space. In fact, robotic surgery was initially funded by NASA for the purpose of caring for astronauts. We have yet to see this in action, although there have been experiments with long-distance and zero-gravity surgery. The obstacle they have yet to overcome is the transmission lag between imaging and acting systems. Scientists today are working on minimising this lag to implement these robots in their designated original role. In the end, we should be able to embrace robotic surgery with the comfort that it is controlled by a medical professional we trust.
Brain Sensors and Microchips
Upon hearing the words “brain chip”, people often explode into paranoia. In a medical context, however, these chips can help to monitor the organ we know the least about. New inventions are exploiting potential beneficial uses. Wireless, bioresorbable brain sensors can monitor the temperature and pressure of the brain after a traumatic injury. After fulfilling its job, the device then dissolves and is absorbed by the body, reducing the risk of infection, and requiring no further operations. The medical team pursuing bioresorbable brain sensors have already tested their technology in saline baths and on rat brains — both were successful. They are now in the process of testing on human patients, and prototypes could appear on the market within the next ten years.
Tech titan Elon Musk and his neurotechnology company Neuralink have also turned their attention to the potential benefits of brain chips. In a presentation this past July, Musk revealed a microchip that would treat brain disorders and injuries by sensing and rerouting the electrical environment of the neurons. It would be implanted behind the ear and have electrodes running up to the brain. Musk even dared to extrapolate his concept into building towards a human-machine hybrid, where your thoughts would be able to control technology. He was eager to announce that in an earlier trial, a monkey had been able to control a computer.
Scientists were impressed with the concept of Neuralink, praising its use of floppy wires and the “sewing machine” insertion into the brain. Neuralink proposes trials on humans as soon as 2020, but many critics deem the project’s timeline as too ambitious. Neurobiology researchers note that the presentation from Neuralink was mostly conceptual and the longevity of the device was not fully addressed. Realistically, these devices need to be tested on humans for an extended period in order to perfect their design. We may not encounter widespread use of the Neuralink microchip until several decades from now, but will we ever be able to embrace the concept of doctors inserting chips in our heads?
Gene Editing with CRISPR
Genes shape our whole lives, and yet we have no say in how they are comprised. We can’t control that we’ve inherited crooked teeth or, more seriously, a genetic chronic disease. CRISPR and the Cas9 complex offer a way to edit our genes, but presents many ethical issues.
CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeat. This is essentially a fancy name for specialised DNA sequences which can be easily recognised. The CRISPR mechanism includes the Cas9 protein and its guide RNA. It is a naturally occurring process in organisms, first discovered in the way bacteria fight against viral infections. Any DNA sequence can be found with the guide RNA, and then cut open to be edited. CRISPR fixes the opened sequence, making sure the edited gene stays intact.
The opportunity to change any sequence in the genome has potentially huge applications. A special machine using the CRISPR mechanism was invented to correct point mutations which lead to sickle cell anemia (abnormally shaped red blood cells) or progeria (rapid aging of a child’s body). CRISPR could be life-changing once applied as a treatment or a cure for genetic diseases. Applications of CRISPR could be expanded to include fixing the genome in advance of the presentation of disease. In China, a scientist has claimed to have edited the genes of the embryos of twin baby girls to prevent them from contracting HIV. This is just the beginning of endless possibilities for CRISPR, and it raises moral and ethical issues over guidelines to regulate its use. Could we alter embryo genes to change their hair colour or eye colour? Should we be able to edit genes in germ cells? In treating a genetic disease, scientists are correcting the genome in somatic cells, which are the cells of your body (e.g. skin cells, immune cells). If scientists dare to edit germ cells, they are changing the DNA in reproductive cells (e.g. sperm and egg cells) which gets passed down to your children, grandchildren, and so on. The altered DNA is then present in the rest of your descendents, which could be problematic, since they did not consent to have their DNA altered, for better or for worse.
The CRISPR mechanism is still a relatively new discovery. Scientists are only now perfecting the process of cutting and fixing small mutations related to genetic diseases. They have not even begun to understand which DNA sequences code for hair and eye colour, let alone begun to approach how to alter these. However, this is a rapidly growing topic for medical research, with numerous biotech companies jumping on the bandwagon. The science might be ready in a couple of years’ time, but with the ethics dredged in controversy, it’s hard to say when it might become available to the general public.
The revolutionary three-dimensional printer, commercially available since 1988, has endless applications in the medical field. It can change the production of prescribed drugs or treatments by personalising dosage and delivery devices for different individuals. It can even create 3D models from two-dimensional picture scans, such as X-rays.
The most important benefits of 3D printed medical applications are for products that are customised and personalised. The 3D printer is a solution for the varied presentation of patients, allowing for the production of singular, one-of-a-kind products. For example, while planning for a surgery to remove a tumour in the liver, doctors must evaluate the exact location of the tumour in relation to the important blood vessels, nerves, and lymphatics. The issue, as any struggling medical or anatomy student will know, is that these vessels will vary in size, location, and off-branchings in each body. By producing a 3D model of the patient’s liver, surgeons can accurately practise and operate for the individual.
Other benefits of 3D printing are the speed and quality of production and the sharing of data files in an open database. Accurate and high quality products can be made within several hours. The National Institute of Health in the US has created the 3D Print Exchange to promote open-source sharing of 3D print files for anatomical models and replicas of proteins, viruses and bacteria. This type of sharing can allow the production of exact designs to mainstream medical research.
The zenith of the 3D printing movement would be the bioprinting of whole human organs. Instead of creating an anatomical model with resin and metal, this process would use biomaterials to create tissue layers in any shape or form that function inside the body. Early projects had no trouble using stem cells from a patient and introducing them to growth factors, fluids and nutrients. The produced tissue then specialises into a specific organ, such as a liver or a kidney.
Bioprinting could revolutionise the way patients receive transplanted organs. Matching a donor to a patient is a notoriously complicated process, with the outcome often being the rejection of the donated organ by the patient’s immune system. Even if there is no immediate reaction from the body, the patient must take anti-rejection drugs for the rest of their life, leaving them more susceptible to contracting infectious diseases. Creating a new organ for the patient by bioprinting it with their own stem cells would surpass all the complications of matching and rejection. The new organ would function perfectly and the host body would welcome it as its own.
The current hurdle bioprinting faces is that of producing blood vessels inside the organ. Arteries and veins form a very complex network and are invaluable to the organ tissue. They provide oxygen to the cells, which enables them to function as they are supposed to. Without oxygen, the tissue will die and become a wasted product. In the past couple of years, research centres in the past couple of years have been able to inlay blood vessel networks in the layers of tissue, experimenting with how well the oxygen diffuses into cells.
A bioprinted lung-mimicking air sac gained international media attention this past summer, demonstrating the full range of oxygenated, dynamic tissue via the 3D printer. However, this would only be one of the 600m air sacs which comprise the two lungs. In short, 3D printing has come a long way, but there’s still a long road ahead. Scientists are only just perfecting the production of bioprinted organs and have not yet tried to transplant an organ into a patient. Once the technical issues of production have been sorted, we may witness the dawn of a new era in transplantation and regenerative healthcare.
All of these technological innovations are new and exciting, but it can be easy to get carried away with fads and trends. We want to be able to focus on the overall enhancement of medical care and whether the beneficial uses outweigh the ethical risks. In the long run, will these technologies become outdated, or will they become essential to healthcare? In my opinion, most of these inventions will be adaptable to the future of the human population. Each one solves a massive health problem faced by the whole world. As we continue our exploration into space and perhaps begin to colonise other areas of the universe, robotic surgery could standardise healthcare across the galaxy. CRISPR solves virtually incurable genetic diseases, while 3D printing gives a better chance for end-stage organ disease patients to survive. However, I doubt the future of the brain chip, especially the one toted by Elon Musk. It seems to be aimed towards a more commercial audience and purpose, with minimal health benefits. In the future, I believe other methods will surface to monitor brains without invading the privacy of the individual. Overall, medical innovations are directed towards an exciting new work environment to help improve the care of each patient.