Santa Clara University

STS Nexus

Technology Benefiting Humanity in Health Care

Peter A. Facione

Introduction: Worldwide Health Issues

The World Health Organization estimates that over one million deaths result each year from malaria. Malaria is a public health problem today in more than 90 countries, inhabited by a total of some 2.4 billion people, 40% of the world’s population. Worldwide prevalence of the disease is estimated to be in the order of 300-500 million clinical cases each year. If we could learn the genetic expression of the cells of the malaria parasite, we could target drug therapy to disable or destroy those parasites. But what kind of technology would enable us to access the genetic information we would need?

The World Health Organization estimates that 125 million people worldwide suffer from diabetes, with the number having increased 15% in the last decade. Better management of glucose levels can reduce many of the serious diabetes-related health complications. But this requires more frequent monitoring of glucose levels, a demand many people with diabetes find too difficult and distressing. What if there was a way for persons to do this without having to draw blood?

Each year approximately 93 billion pounds of food is wasted in the United States. At the same time an estimated 31 million Americans do not have regular access to the food needed for an adequate diet. What if we had a better, more efficient way of getting the food that would otherwise spoil or be discarded by major manufacturers and wholesalers into the charitable food distribution networks sooner, to reduce spoilage, and to make more available for distribution?

Children and adolescents hospitalized with chronic illnesses, such as cancer, cystic fibrosis, HIV, asthma, and sickle cell, can suffer psychologically and socially, not just physically. What if there were a means of creating a virtual community whereby we could link those persons with others like themselves for companionship and mutual encouragement?

Everyone knows that blood transfusions save lives, but with certain risks attached. Viruses, such as HIV or hepatitis B and C, can enter the world’s blood supply through any of the estimated 90 million blood donations made each year. And even then, the need for blood worldwide is difficult to meet, for if blood is tested and found to be contaminated it is discarded. Instead of discarding contaminated blood, what if there was a way to clean that blood, perhaps by destroying the reproductive ability of pathogens?

The Applications

These questions are typical of the relevancy and technical expertise evident in the applications for the 2001 Technology Benefiting Humanity award in health care. The applications for this award included three broad types. Some focused on the development or novel application of innovative scientific instrumentation. Many of these ideas offered wonderful potential for a number of practical uses and great promise for addressing global health problems. Some applications focused on applying an existing bio-medical technology in a novel and exemplary way, again with profound potential impact on world health problems. And some applications described the innovative adaptation of worldwide communications technologies to problems in health care and healthier living.

A national panel of eight judges reviewed forty-seven applications. The panel included five scientists working in microbiology, genetics, health psychology, and medical research. Other members of the panel were persons active at the national and international level in health policy, education, and pharmaceuticals. The panel was most impressed with those applications that addressed problems affecting millions of persons worldwide. Although it is a cliché, when it comes to health we really do live in a global village. HIV AIDS, malaria, and many other diseases can and do spread with devastating affects from one region of the world to another without respecting the artificial boundaries of nations and states. The computer keyboards and mouse technologies that are exported and used around the world can induce repetitive stress injuries in their users, without regard for gender, race, or religion.  And matching the supplies of fresh, safe, and wholesome food, blood, or vaccinations with the millions in need is a logistical and communications problem of massive proportions. Technologies that can arrest the development of pathogens in the blood supply or food supply can extend the useful lives of those essential commodities.

The panel was impressed as well with the technological merit, the promising preliminary results, and the strong potential of many of the innovations to be replicated and to be extended beyond the initial problem or application. The networking that links hospitalized children with one another can also link their parents and their teachers. A vaccine delivery system that is needle-free and non-invasive potentially can be applied to many different health care uses. The research instrumentation that expedites the investigation of gene expression can be used to identify complex genetic diseases, to explore new drugs and toxicology, to detect mutations, to analyze pathogens, and to map the differing expression of genes over time in different tissues and disease states.

The majority of the applications for this year’s award for health care technology can be categorized into four areas: DNA microarray technology, noninvasive medical technical technology, medical communication technology, and computer mouse technology.  Within each of these four categories, the following summarizes the exciting and innovative work of the applications in health care technologies that are being applied to problems and questions of potential worldwide significance.

DNA Microarray Technology

DNA microarrays are perhaps the single most important tool developed for genetic analysis in the past decade. Micro-arrays are critical for the new science of Genomics – the study of the dynamics of whole genomes. Traditional techniques permitted scientists to measure the expression of only one gene at a time. DNA microarray technology enables the measurement in a parallel fashion of the expression variations of thousands of genes simultaneously.  By analogy, the difference is not unlike being able to view an entire building all at once as compared to being restricted to viewing it one brick at a time. The whole is much more than the sum of its parts. Although in concept DNA microarray technology can be traced back to the early 1980’s, it was a publication out of the lab of Patrick Brown and his research team at Stanford in 1997 that first demonstrated the practical feasibility of representing a whole genome using this technology.

In its simplest form, a DNA microarray consists of a substrate, such as glass, onto which thousands of individual DNA samples have been deposited. Thirty thousand unique DNA samples may be arrayed on a single one-inch by three-inch microscope slide, for example. Multiple genes that are co-regulated often participate in the same process or function. Examples might include developmental pathways, metabolic pathways, signal transduction pathways, and macromolecular complexes. By examining genes with known roles, the genes in the co-regulated set can be discovered. Dozens of biochemical and transcriptional pathways can be examined simultaneously, thus allowing researchers to identify the genes that are likely to be essential for various functions.

Joseph DeRisi, University of California, San Francisco

Joseph DeRisi of the University of California, who was instrumental in the development of DNA microarray technology at Stanford, has begun applying the technology to the worldwide health problem of malaria. He is searching for the malarial genes that are likely to be essential to the survival of the parasite that causes that disease. As genes are isolated that encode proteins that have no human counterpart, these become the most likely targets for genetic drug therapies. In the true spirit of scientific collaboration, since 1998 Dr. DeRisi has been disseminating information on all aspects of DNA microarray technology through http://cmgm.stanford.edu/pbrown/myguide.  To learn more about malaria and other infectious diseases go to statistical facts pages provided by the World Health Organization at http://www.who.int/health-topics/ idindex.htm. Dr. DeRisi’s work was selected as a finalist.

Non-invasive Medical Technologies

While we’re not yet aboard the Starship Enterprise with Dr. McCoy’s no-touch surgical tools, the newest medical technologies enable health care professionals to provide an increasing number of noninvasive diagnostic and treatment procedures. MRI and CT scan diagnostics are in widespread use today. Add to these a new diagnostic data gathering approach for monitoring glucose, something of significance to the tens of millions of diabetes sufferers worldwide. Two of this year’s finalists have done outstanding work in this area.

Cygnus, Inc.

Cygnus Incorporated has developed a noninvasive technology to measure glucose levels by collecting glucose through the skin, rather than from the blood. Called the GlucoWatch Biographer, this technology measures and displays glucose levels automatically as often as every twenty minutes for up to twelve hours. Because it can store up to four thousand readings, it can create a personal electronic diary giving people with diabetes the ability to see how day-to-day activities affect their glucose levels. The user and their health care team can use this information to tailor treatment regimens to each person’s individual needs. A built-in alert system allows the user to detect acute changes in glucose levels, thus reducing the risk of a dangerous hypoglycemic event, for example while exercising or driving. In March 2001 Cygnus was approved by the FDA to market its GlucoWatch Biographer, which looks like a wristwatch, as a prescription device for adults. For more information go to http://www.glucowatch.com/. To learn more about the diabetes at the planetary level go to the World Health Organization’s diabetes Web site.

Cerus Corporation

This finalist’s work is on non-invasive medical technology that offers significant potential for improving the safety of the world’s blood supply and reducing the risk of blood-borne infections to a level never before possible. The Helinx™ technology of the Cerus Corporation is used to treat, rather than test, donated blood products. The Helinx™ technology seeks to prevent the replication of viruses, bacteria, and other pathogens by targeting and locking DNA and RNA. Helinx™ uses compounds that react with light or chemical catalysts to prevent replication at the genetic level. After the reaction is complete the pathogens die and the residual is removed from the blood product so that the blood can be safely transfused. The first clinical trial applications of this technology are in conjunction with the INTERCEPT Blood Systems, developed in conjunction with Baxter Healthcare. Late stage clinical trials are currently underway to measure the safety and efficacy of the INTERCEPT technology for inactivating blood-borne pathogens while maintaining the therapeutic benefits of transfused blood products. For more information, go to http://www.cerus.com and, when the site is completed, http://www.baxterhealthcare.com.

Making the Right Connections

Getting surplus food supplies before they spoil to the right outlets, and getting people who can help one another into personal communication with each other is all about making the right connections as quickly and easily as possible. The needs are real, as are the opportunities. What it takes is the vision and the persistence to build the linkages and then to get the right organizations and individuals to use them.

America’s Second Harvest

America’s Second Harvest, the nation’s largest domestic hunger-relief charity, has developed ResourceLink, which was selected a finalist for this year’s awards. Through a partnership with Hewlett- Packard and America’s Second Harvest, ResourceLink was designed to automate the offering, acceptance, and receipting of food and grocery donations on-line in real-time. Nine major donor companies including Pillsbury and Kraft, for example, can enter product information into the ResourceLink database. America’s Second Harvest moves approximately 1.5 billion pounds of food each year, serving an estimated 26 million people in need though its network of 214 food banks and food rescue affiliates. Through ResourceLink these outlets have immediate access to information about available foods in quantities that

The STARBRIGHT Foundation

The STARBRIGHT Foundation is another not-for-profit that is making a difference using communications technology, and this organization was selected as the fifth finalist for its STARBRIGHT World™, a private, broadband computer network that creates an online community of hospitalized children across the nation. The STARBRIGHT World™ addresses the psychosocial needs of children and adolescents with long-term serious and chronic illnesses, such as cancer, cystic fibrosis, HIV AIDS, asthma, and sickle cell disease. Often these children find valuable support in connecting to others like themselves. At the present time STARBRIGHT is a private broadband network serving 90 children’s hospitals around the USA and Canada with T-1 access. STARBRIGHT is partnering with America Online to extend the application to children’s homes around the nation. To learn more go to http://starbright.org. While you are there, view one of the “videos with attitude,” designed to assist teenagers to live with serious illnesses.

Summary

Some of the innovations nominated for recognition this year hold great promise. Some will ultimately be refined and brought to fruition for the benefit of humankind. Some will not work out as hoped, and ultimately be abandoned for other, more promising, approaches. Collectively, the 2001 nominations for Tech Awards in Health Care manifest technological creativity, scientific excellence, perseverance, and the desire to make a positive difference. Individual scientists, non-for-profit organizations, and for-profit companies, each with their somewhat different interests, are, nonetheless, all contributing to better health for millions of persons. Things that we thought to be science fiction are becoming a reality. Treatment strategies we had not dreamed possible are being explored. With luck and hard work, and with the kind of collaborations and cooperation some of these award nominations demonstrate to be possible, advances like those described above will become available to the world sooner, rather than later.

The Panel

Peter A. Facione, Chair, Dean, College of Arts and Sciences, Santa Clara University

Marie Barry, Director, International Business, ALZA Corporation

Wm. David Burns, Senior Policy Director (Principal Investigator and National Director, Program for Health and Higher Education), Association of American Colleges and Universities

Leilani Miller, Assistant Professor of Biology, Santa Clara University

Thomas Plante, Associate Professor of Psychology, Santa Clara University

Jon Showstack, Professor of Medicine and Health Policy, UCSF School of Medicine

Patricia Simone, Associate Professor of Psychology, Santa Clara University

Craig Stephens, Assistant Professor of Biology, Santa Clara University

 

About the Author

      Peter Facione

Dr. Peter Facione, who directs the Project on Evaluat­ing and Analyzing Reasoning and Decision-Making, has served as Dean the College of Arts and Sciences since 1990 and Dean of the Graduate Division of Counseling Psychology and Edu­cation since 1996 at Santa Clara University. In 1999 he was President of the American Conference of Academic Deans. Currently he is a Board member of the American Association of College’s and University’s Project on Health and Higher Edu­cation, and, as a dean, he was selected to be a member of the American Council on Education’s Presidents’ Task Force on Teacher Education. Professor Facione maintains an active writ­ing and research agenda, with over 100 publications including essays, books, articles, case studies, and testing tools. Since 1986 he has been a Senior Research Associate and the CEO of the California Academic Press LLC. He joined Santa Clara University in 1990, and has been a Scholar of the Markkula Center for Applied Ethics since then. Dr. Facione earned his Ph.D. in 1971 from Michigan State University.

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