Scientific advancements are gaining pace and continuously offering us new ways of dealing with a multitude of diseases. These innovations range from very big, such as big data, to very small, such as nanotechnologies. As a part of Pint of Science, a varied mix of enthusiastic members of the public gathered in The Safari Lounge, not to participate in the pub quiz next door, but to learn more about what modern medicine can offer. We started with the very small.
Part I. Nanotechnologies and fight against cancer
Dr Michael Chen from the Edinburgh University School of Engineering specialises in material design. One of this research topics is advanced drug delivery systems – something that he is striving to apply to cancer treatment. Why cancer? Because it is not a disease but a group of diseases that should be treated differently. The most common methods that we have to our disposal now are surgery, chemotherapy and radiotherapy. Or, how Dr Chen put it, when it comes to cancer we can cut it, poison it or burn it. Unfortunately, healthy cells and tissues share the same fate, making current cancer therapies extremely harmful, with a potential of causing more cancer. When a drug is administered, it travels all over the body and hurts not just cancer cells, but any cell. Moreover, narrow therapeutic windows make dosing a challenging task. And with the short action time of current drugs, they may not even reach cancer cells and would poison some healthy tissues that happened to be nearby.
Dr Chen highlighted a potential solution to these problems: clever particles that we design, so that they know exactly where to go to. Naturally, they should be very small. In fact, they are thousands of times smaller than diameter of a human hair (that is what makes them nano – being 1,000,000,000 smaller than a meter). But the scale does not preclude bioengineers from putting various accessories on the nanoparticles. You can attach a molecule that would recognise a specific receptor, and you can make them more resistant to the body’s metabolism, prolonging their action. You can send cancer cells a ‘present’ (like a Trojan horse): send them a nanobox filled with a drug and make them open it. You can optimise their design to increase the particles’ responsiveness to heat or X-ray. Irradiating a patient with a radiation dose much lower than that of a traditional radiotherapy will be enough to activate nanoparticles that reached their destination – thus, a more targeted treatment is achieved.
Dr Chen showed endless optimism for this field. However, the reality is, as usual, less bright. There are already numerous nano medications approved for clinical studies. But there is still uncertainty regarding their safety. Whole research groups dedicate their work to study potential toxicity of nano drugs: as with radio- and chemotherapy, nanoparticles have the potential to cause DNA damage. But, as it is widely acknowledged, any medication is potentially toxic, and if we could keep the doses small, nanoparticles may be among the safest treatments for cancer.
Part II. Oh data, where art thou?
We have a great amount of trust in computers. Surely, we’ve reached the point when they should be able to calculate and predict anything, including a diagnosis. But Dr Maria Wolters for the Edinburgh University School of Informatics warns us from rushing into this trusting attitude. She reminds us that computers deal with data points – meaningless on their own. What is required for a diagnosis is context. Is he not responding because of dementia or because he can’t hear? Or maybe he is depressed and can’t be bothered to reply? Is she pacing because she is agitated or energetic? Does the cause determine the symptom, or the symptom determine the cause?
They are many illnesses with similar symptoms. Remember, Dr House’s constant suspicion for lupus – and it turned out to be lupus only once! To make things even more confusing, many symptoms can be caused by events other than illness. For instance, grief, which is a temporary state, can be confused with depression, which can be life-long, but in a case like this doctors should pick up the difference. Another complication is that illnesses, going by Dr Wolter’s observation, are like Lothian buses: they come in groups. A person can be depressed and anxious because he or she has a life-threatening disease. Or a person can be breathless because of either a chronic-obstructive pulmonary disorder, or a problem with the heart. And now the job of creating a disease-recognising algorithm that only recognises binary notations becomes a much more complicated task.
But this concept relies on self-reporting symptoms. Perhaps, if we have an unbiased monitoring device, things will fall into place. If only it were so simple. As Dr Wolters points out, there are multiple problems with wearable diagnostics. There is a stigma around them, and some people don’t feel comfortable sharing their personal information. Often wearables simply break, or the battery life is short, or they are so hideous you just want to tuck them away and never monitor yourself again. Another dimension to this issue is that there can be a tendency, often by healthy people, to over-monitor. In the meantime, people that are ill don’t have enough energy to charge their device, or they just don’t care anymore.
Perhaps our reliance on computers is too optimistic. The multidimensional art of diagnosis is still in the scope of doctors’ expertise. Every diagnosis is a working hypothesis that requires active engagement and monitoring by a medical practitioner, and so far, even computers haven’t managed to beat humans in that.
This article was written by Alina Gukova and edited by Bonnie Nicholson.