In the future, implanted chips will have the ability to stop food absorption when caloric intake reaches 2,200. Cells in our forearm will be able to monitor our glucose levels and adjust our insulin appropriately. These implantable cells or "chips" have their own IP address with their own circuitry that is connected to a network 24/7. Through this network, cells communicate with real-time supercomputers to synthesize the next step for an individual's body. If Dr. Anthony Atala can utilize 3D printers to create a new kidney, then it is only a matter of time before we can incorporate the circuitry within an organ necessary to monitor its function wirelessly.
This was the future I was challenged to paint in my talk at TEDMED 2012 at the Kennedy Center for the Performing Arts in Washington, D.C. As TEDMED 2013 commences, I ask myself: Where are we one year later?
A caveat: The following are simple overviews on novel technologies I had been tracking over the past year and does no justice to the many amazing leaps we have made in innovative science and medicine during this time.
Thomas Goetz beautifully discusses in The Atlantic that diabetics, although "loath" it, have been self-monitoring for years. Goetz goes on to say that the "distaste falls into three categories: self monitoring for diabetes is an unremitting and unforgiving labor; the tools themselves are awkward and sterile; and the combination of these creates a constant sense of anxiety and failure."
However, what if we had an implantable sensor that simply monitors an individual's glucose? In 2010, Dr. David Gough from the University of California, San Diego demonstrated that you could potentially monitor an individual's glucose by wireless telemetry. A patient can be in San Francisco with his or her physician having access to the data in Los Angeles.
And what if the immune system renders the chip incapable of functioning? Dr. Melissa Grunlan at the University of Texas A&M has been working to develop a self-cleaning mechanism that prevents implantable glucose sensors from being "shielded" by the body's immune system.
Dr. Giovanni de Micheli and Dr. Sandro Carrara at the École polytechnique fédérale de Lausanne in Switzerland have developed a 1.4 cm implantable device that can measure proteins and organic acids in real time. Imagine a signal being sent to your cell phone, and your doctor's phone, indicating an increase in cardiac enzymes -- potentially a heart attack. This device functions on a battery-less system that connects to a patch resting on the surface of the skin.
Natural anatomy acts as a barrier to implantable batteries. Yet, Dr. Ada Poon and her team at Stanford University have developed a medical device that can be powered wirelessly using electromagnetic radio waves. Now, the tiny devices we envisioned can circulate into the depths of our vascular system without fear of losing power. Reminds me of the The Magic School Bus episode when Ms. Frizzle takes her class on a field trip through the human body.
A personal favorite of mine: At the Massachusetts Institute of Technology, Dr. Konstantina Stankovic has demonstrated the ability to use the natural electric potential from electrolytes in the inner ear to power devices that can monitor biological activity in people with auditory and balance issues.
Early detection is fundamental in many of these devices, especially for cancer patients who have aggressive diseases prone to metastasis. Take, for example, patients with malignant melanoma, one of the deadliest cancers and one that has seen little progress in its treatment. Dr. Shuang Hou and his team at UCLA have demonstrated a proof of concept of a "nanovelcro" chip that can capture highly specific and isolated circulating tumor cells.
And what about regulating food intake and nutrient absorption? Intrapace has created Abiliti, an implantable gastric stimulator and food detection system that is implanted into the stomach. As soon as food is detected, it stimulates the stomach to create a sense of fullness. I can see eventually a system that can monitor an individual's caloric input over, say, 24 hours. This would allow us to eat normally without overindulging.
A quick mention on a hot topic. As popular discussions emphasize trends like the Nike+ FuelBand, one step closer to wearable sensors are what Dr. John Rogers at the University of Illinois at Urbana-Champaign has developed: An electronic sensor that can be directly printed onto your skin using a rubber stamp and last for up to two weeks, as highlighted in MIT's Technology Review. The potential for this goes beyond saying.
The Fine Line
This is just a short list of exciting new innovations. Of course, many people may be taken aback by such technologies, which is fine. The purpose of my talk was to create discussion while painting a potential future that may be upon us soon. It is important for all of us to be active in our own healthcare. If we aren't, then someone else will be.
Knowledge about our glucose or hemoglobin and hematocrit in our time is just as important as knowing whether or not to fuel our cars with unleaded or diesel. But we still need an expert mechanic's help. Let me explain. I do believe that growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the empowered and informed patient, but also via health care providers.
Old mechanics would drive a problematic car themselves to assess damage. Simple things such as hearing a funny sound or seeing the car pull to the left would give them enough information to diagnose the problem. Today, the engineering of a car is so sophisticated that sensors continuously monitoring the "health" of the engine alert the driver when something is wrong. That unwelcome signal -- a picture of a wrench, perhaps, or a flat tire -- notifies the driver and the mechanic what part has gone wrong, what's wrong with it, and what needs to be done.
So the mechanic had to evolve the way he (or she) fixed a car. The physician today is much like that mechanic. While the human body is far more sophisticated than even a brand new Mercedes Benz, newly-trained physicians need to adjust how they care for their patients' health.
Growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the e-patient, but also via tech-savvy health care providers.
This piece also appears on the blog at TEDMED.com.
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