By Gia Miller
The year is 2040 and you receive a stage four cancer diagnosis. Your oncologist says you’ll need surgery, possibly an organ transplant and chemotherapy … but you should make a full recovery. She assures you she will virtually practice the surgery prior to your operation, and she tells you to make an appointment for stem cell harvesting so the hospital can 3D print your new organ and it can begin to grow. Finally, they’ll customize a chemotherapy treatment based on your specific genetic code. Sound crazy? It’s the future. In fact, some of it is already here.
We’re on the cusp of receiving highly personalized treatments and even predicting disease. So much is happening, and healthcare will likely look very different in 20 years. Here’s a peek into a few of the things that are happening right now in our own backyards.
“Imagination is more important than knowledge.” – Albert Einstein
What do a carrot, a house and a jet engine all have in common? They’ve all been 3D printed, and they all work. And now, 3D printing is impacting healthcare, too.
In 2012, the first 3D jaw was printed and implanted into an 83-year-old Belgian woman. In 2021, Skåne University Hospital in Sweden became the first hospital to create and use a 3D-printed skull implant; it repaired a massive head injury in a 40-year-old woman.
Before 3D printing, a patient’s body needed to conform to an implant. Now, 3D implants are designed specifically for a patient’s body. And just like the Danish company Upprinting Food, which uses food waste as the “ink” to 3D print edible food, scientists are researching how to use your own stem cells to 3D print organs, a technology known as bioprinting.
“It’s very complicated to create a fully functional organ that will work immediately when implanted into the body,” explains Todd Goldstein, PhD, the director and assistant vice president of the 3D Design and Innovation at Northwell Health’s Center for Learning & Innovation. “We’re not there yet, but the idea is to harvest multiple types of cells, including stem cells, from the patient’s body to create the correct structure of the organ. It will then be placed in an incubator so it can grow and function properly before being implanted into the patient’s body.”
There are numerous benefits to bioprinted organs, such as reducing the number of men, women and children on the national transplant waiting list (it’s currently over 103,000) and preventing the 17 daily deaths of those waiting for an organ transplant. Goldstein says bioprinting will also eliminate the need for immunosuppressant drugs because there won’t be a risk that a patient’s body will reject an organ made of its own cells. But we’re not quite there yet.
“We’ll see bone or cartilage bioprinting first because, unlike organs, they don’t require nerves and blood vessels,” Goldstein explains. “To print new cartilage for your joints, they would select the type of cell to make your cartilage and mix it with some sort of extracellular matrix, which is kind of like the support structure for the cells. Then, that will be used to print the new cartilage. But the standard 3D printing technologies don’t take the bio aspect into account. When you’re printing living cells, you must consider how you will keep them alive during printing; they require a certain temperature, nutrients and oxygen, just like you need to keep yourself alive. Once printed, the new bone or cartilage would be placed into an incubator to grow and become strong before it’s implanted.”
Goldstein says this process is currently in development, and he’s read about lab-grown bone and cartilage, but it hasn’t been implanted into humans yet. He says it’s possible we’ll see this technology in five years or so (don’t hold him to that—it was an educated guess), but bioprinting organs will take much longer.
Here, the heart is the holy grail, because while a living person can donate a lobe of their liver or one of their kidneys, they cannot donate a piece of their heart. And bioprinting a heart is extremely complicated.
“Not only is there the soft tissue, the muscle part, but there’s also the electrical that must connect to your nervous system and the plumbing, which is what the heart does,” Goldstein explains. “The heart must grow to the proper size and work perfectly in unison before it’s implanted. Then, once implanted, it must be ‘turned on’ immediately.”
This, obviously, is going to take some time, and Goldstein says he cannot predict when we will see a working, bioprinted heart.
“The very nature of science is discoveries, and the best of those discoveries are the ones you don’t expect.” –Neil Degrasse Tyson
“What if, when a person is born, or even before they’re born, the parents learned that they carried one of the two BRCA genes, which cause breast cancer,” ponders Lyndon Mitnaul, Ph.D. and executive director of research initiatives for the Regeneron Genetics Center in Tarrytown. “Then the parents will have an opportunity to say, ‘Hey, let’s use CRISPR [a gene editing technology] to correct that right now,’ while the child is young, or even in vitro. We could see that type of evolution in this field. But, first, we’ve got to take baby steps.”
Precision medicine (tailoring specific drugs to a person) is in its infancy, and predictive disease is in the works.
For a moment, please put aside your fears about “big brother” and summon your innocent, childlike curiosity. Thank you. Now here’s why genetic sequencing is important.
Currently, just because a medication has been prescribed to you, it doesn’t necessarily mean that medication will work for you. Perhaps your liver enzymes (which metabolize drugs) don’t work well, resulting in too much of the drug remaining in your system, causing some toxicity. Or maybe they work too well, causing the drugs to metabolize too quickly, meaning you don’t get the full benefits of the medication.
Just one small vial of blood could remove so many of these “what ifs,” allowing scientists to understand, and possibly design, medications that will work specifically for you.
“This is happening now,” says Mitnaul. “It’s not something that’s futuristic; it’s actually happening in real time. And it’s evolving right now. We’ve sequenced 2.3 million people at the Regeneron Genetics Center, and there are genetic medicines and cell therapy medicines in development right now.”
Eventually, that one small vial of blood will also be used to develop your polygenic risk scores, which will measure your level of risk for developing certain diseases.
“In the optimal world, we would collect genetic information on everyone at a very young age, and not only would we have precision medicine, but we’ll have predictive disease,” Mitnaul explains. “Your polygenic risk score will be able to predict, for example, whether you’re going to have asthma. And while it won’t be 100 percent accurate, it will be a very, very good indicator.”
“So,” he continues, “if your polygenic risk score says you have an increased risk of asthma, for example, you’re probably not going to want to start smoking as a teenager or an adult because you have that information. But if you do, then that’s when precision medicine will come in. It will look at all the treatment options available and, based on your genetic information, it will indicate which one will work best for you. As we sequence more people, we’ll uncover more polygenic risk scores for a variety of different diseases.”
“Science and everyday life cannot and should not be separated.” –Rosalind Franklin
The pandemic fast-tracked telehealth services, but digital therapeutics go far beyond an online conversation with your physician. And they’re far more extensive than virtual conversations. Digital therapeutics also include advancements like smarter chatbots, wearables that monitor your health (like fitness trackers) and medication delivery (like insulin pumps), to name a few.
Let’s start with chatbots. Love them or hate them, they’re likely here to stay. And while you may not trust a chatbot to diagnose you, they can be helpful tools. While it’s predicted they’ll (hopefully) be able to accurately diagnose you one day, a more immediate use will likely be symptom tracking. With the proper prompts, chatbots can help you avoid frequent checkups for chronic conditions by providing your physician with a more accurate accounting of daily symptoms. They’ll also be able to alert you when your symptoms do warrant an appointment, eliminating the guessing game we all hate playing.
When it comes to health-monitoring apps, you might already count your steps, track your heart rate while exercising or even monitor the quality and duration of your sleep—but that’s just the beginning. Currently, several devices have received FDA approval for their electrocardiogram (ECG) apps, many of which can detect and record irregular heart rhythms, a condition known as atrial fibrillation (or AFib). Popular brands include Apple, Google Pixel, Samsung, Fitbit, Garmin and Withings. However, even though they may feature tools like blood oxygen sensors, many of these devices have FDA clearance only for health tracking purposes, which is different from using them to collect medical information for yourself and your doctor.
But let’s take wearables one step further. Several brands have already released “smart clothing,” including t-shirts to monitor your heart rate, vibrating yoga pants that will adjust your downward dog, bathing suits with reminders to apply sunscreen, numerous skin patches and even baby socks that can monitor your infant’s sleep. Currently, there are companies developing (or attempting to develop) a vest to measure fluid accumulation in the lungs (which could indicate a heart condition), clothing with integrated robotics to support those vulnerable to falls and even t-shirts that can reduce back pain.
Additionally, there’s self-medication via electronic devices. Your friends with diabetes can likely tell you all about their glucose monitors and insulin pumps or patches that have saved them countless needle pricks over the years. This technology, which is almost 20 years old, is finally coming to help people with other chronic diseases, such as anti-seizure medication for people with epilepsy. Other potential beneficiaries include those diagnosed with dementia, rheumatoid arthritis, cancer, chronic pain, depression or anxiety. But the possibilities are endless.
“Science is the best idea humans ever had. The more people who embrace that idea, the better.” – Bill Nye (The Science Guy)
Well said, Mr. Nye. Let’s leave it at that.
This article was published in the May/June 2024 edition of Connect to Northern Westchester.
“I’m the doctor, and I save people.” – Doctor Who
Step aside video games, artificial reality and virtual reality have bigger plans. One of them is already here: preplanning for complex surgeries.
“We have surgeons now that use and practice their surgeries with AR headsets,” says Goldstein. “They’ll load the CT scan or MRI into their headset and then, while in their office, they can immerse themselves into the patient’s anatomy. They can look around; they can cut the virtual skin and move the virtual bone or blood vessel so they can remove the tumor. They’re practicing the case ahead of time, so they get it right when they’re operating on the actual patient.”
Goldstein hopes to bring a similar technology to the classroom in the not-too-distant future.
“Imagine a room of people training to become paramedics,” says Goldstein. “They’re in a bright, sterile classroom with mannequins so they can practice administering CPR, starting an IV or whatever is necessary to save that person’s life. Before they begin, they put on their VR glasses, and now they’re at the scene of a terrible car crash on the highway. The person is lying on the side of the road, cars are driving by, it’s dark and there are other distractions. This will be the future.”
Gia Miller is an award-winning journalist and the editor-in-chief/co-publisher of Connect to Northern Westchester. She has a magazine journalism degree (yes, that's a real thing) from the University of Georgia and has written for countless national publications, ranging from SELF to The Washington Post. Gia desperately wishes schools still taught grammar. Also, she wants everyone to know they can delete the word "that" from about 90% of their sentences, and there's no such thing as "first annual." When she's not running her media empire, Gia enjoys spending quality time with friends and family, laughing at her crazy dog and listening to a good podcast. She thanks multiple alarms, fermented grapes and her amazing husband for helping her get through each day. Her love languages are food and humor.
