The Future of Health Care: Regenerative Medicine and Stem Cells

When an octopus is injured and loses one of its limbs, it will grow back after several months. When a starfish loses an appendage, not only will the starfish grow a new arm, but the severed arm will grow a new starfish! Even among vertebrates, regeneration is not unknown – salamanders can regrow lost body parts. Yet when a human loses an appendage, it is forever lost. What do these animals do that we don’t? Many scientists believe that the capacity for regeneration is lying dormant within our biology, and we may soon be able to activate it.

Most complex organisms including humans contain a huge number of different types of cells that each perform a specific function within the body. For the most part, these cells cannot do anything else; a brain cell can never become a white blood cell, or vice versa. But in addition to these specialized types of cells, we have stem cells – “wild card” cells that have no specific function of their own, but are able to become whatever type of cell the body needs. Stem cells show great promise in treating a wide range of diseases, rejuvenating our organs and tissues, and replacing entire body parts.

For several decades, the organ transplant process has been horrendously inefficient. The standard procedure has been for patients to beg their friends and family to donate an organ…if they can even find a compatible donor. If not, they enter their name onto a hopelessly long organ wait list, where they may die before finding a suitable replacement. If they are lucky enough to receive a transplant, patients will spend the rest of their lives taking a strict regimen of drugs to prevent their body from “rejecting” the organ (i.e. viewing it as a hostile invader to be eliminated).

Regenerative medicine will soon transform this process. People will be able to grow their own replacement organs in a lab, and since the new organ is their own, there will be no worries about their body rejecting it. Substantial progress has already been made in many areas. In 2006, doctors first created a human bladder from scratch. They extracted a few bladder cells from patients, and pasted them onto a three-dimensional mold shaped like a bladder. To their delight, the cells quickly grew into a new, fully-functional bladder, which they then transplanted into the patient. In 2010, doctors first performed a similar procedure using stem cells instead of bladder cells. Regenerative medicine is quickly becoming the standard for treating serious bladder diseases. Clinical trials are underway for similar procedures for other organs including the heart, although these procedures are at least a decade from being used in hospitals. In June 2010, scientists successfully grew a liver in the laboratory for the first time.

But replacing entire organs is not the only promising use for regenerative medicine. There is no fundamental reason why tissues and organs that have been badly damaged – by disease, injury, or natural wear and tear – cannot gradually be rejuvenated by replacing the damaged cells with healthy stem cells, allowing our body parts to remain in excellent condition throughout our lives. This has ramifications for slowing the human aging process, and possibly even reversing it. When people are able to replace their organs with newer versions of themselves, “old age” will need not be regarded as a time of enfeeblement and illness.

Our stem cells are essentially a blank slate, which can become whatever type of cell we want them to become. Their potential applications to regenerative medicine are practically limitless, as practically every major non-infectious, non-genetic disease results in some form of cellular damage. Regenerative medicine treatment will be a relatively slow and non-disruptive transformation – we will gradually see more and more of these therapies over the next few decades – and is not a cure-all by any means. However, it is one of the most promising new treatments (along with genomics) which will eventually radically extend the human lifespan.

Political Issues on the Horizon, Part 1

Americans went to the polls last Tuesday and, for the third time in as many election cycles, delivered a sharp rebuke to the incumbent party. No doubt concerned that the economic recovery seems to be stagnating and that unemployment remains high, the voters gave the House of Representatives back to the Republican Party. In the wake of the midterm elections in the United States, this is a good time to consider political issues on the horizon.

I generally shy away from making specific predictions about politics or the economy. Voters are fickle and economies are unpredictable, especially compared to the relatively simple trends that scientific and technological developments usually follow. However, I think we can at least speculate on the types of issues that are likely to become important, if not the precise way that they will be resolved by the voters and the government. In my next few blog posts, I’m going to explore some of the political issues that I think will grow in importance over the next decade, as well as a couple of oft-cited (and perhaps overblown) issues which may soon fade from the American political landscape.

Privacy. For the past couple decades, whenever a political gasbag has asked a judicial appointee about his or her views on “privacy,” it has typically been a code word for abortion. However, I believe privacy will soon become a political issue in its own right, spurred on by technological advances which encroach more and more on our privacy and demand access to sensitive information. Already, there have been court cases to determine if police can tag an automobile with a GPS tracker without a warrant, but this is just the tip of the iceberg of what is to come. RFID chips, which will soon replace bar codes on products, will be embedded in nearly everything we buy, allowing for constant surveillance and tracking of products (and by extension, of customers) from their point of manufacture to their point of disposal.

Additionally, we are probably no more than a decade from the point where sensors and face-recognition technology are commonplace in many public establishments, as in Minority Report, making it virtually impossible to step out of our own homes without appearing in a database somewhere. In the slightly more distant future (probably 10-20 years), insectoid-sized robots are on the horizon. DARPA is already designing them for use in military and spying applications, but eventually their spread to the general public is a virtual certainty as the cost of computing drops, allowing for practically anyone to monitor practically anyone.

In light of all of these emerging technologies, some erosion of our privacy seems almost inevitable. The extent of it remains open to debate. Will our governments pass privacy laws regulating how all of this information can be obtained and used? Or will our governments be part of the problem? Only time will tell.

Bioethics. The first decade of this century saw two important bioethical debates in the United States and Europe. In the United States, stem cell research was hotly debated in the first few years of the Bush presidency, but now seems to have decisively concluded in favor of scientific progress, as the huge benefits of stem cells become more obvious and the moral objections have fallen by the wayside. In Europe, the main bioethical debate of the past decade – genetically modified foods – is still ongoing. Many Europeans are concerned about the possibility of genetically modified foods wreaking unintentional havoc on the environment and public health. Although these fears do not have much scientific support, the controversy has nevertheless succeeded in quashing the industry in Europe, at least temporarily.

These are merely the first of many bioethical debates we will face in the 21^st century. Some will be relatively trivial. For example, concerns about athletes on steroids may soon give way to concerns about professional athletes with enhanced body parts. A few years ago, Tiger Woods opted to get superhuman 20/15 vision through Lasik surgery, and the range of upgrades available to those who can afford them will soon be much wider. If athletes are able to buy improved bodies, it will make it difficult for “natural” athletes to compete. Will we have separate leagues for enhanced athletes and natural athletes? Will we ban these superhuman enhancements entirely, and if so, what qualifies as a superhuman enhancement?

Other bioethical concerns will be much more profound, and the government will have to take a stand. For example, if the technology exists and is widely available to screen for genetic abnormalities, would it be child abuse to not tinker with a fetus’ genome to prevent birth defects? And if preventing birth defects is morally acceptable (indeed if it is the ONLY morally acceptable option), why not preventing other undesirable traits like ugliness, propensity to violence, or low intelligence? Where does one draw the line? Eugenics, long discredited due to its ties to Nazism, may make a comeback in a world of easy access to genetic therapy.

Many of the questions related to human augmentation and genetic engineering have no easy answer, and any government decision is bound to leave many people feeling morally queasy. Look for political parties to become increasingly divided along the lines of these bioethical questions, with conservatives preferring a more restrictive approach to avoid creating ghastly new moral quandaries, and liberals favoring a more open approach to improving humanity through reengineering our own biology.

To be continued in another blog post…

The Future of Agriculture - In Vitro Meat

With the speed at which biotechnology is progressing, it seems very likely that by the end of the decade, we'll be able to grow meat in laboratories at a price that is competitive with meat grown in ranches. It is already possible to produce it, but as of now it is horrendously expensive and has the texture of runny eggs. Not exactly appetizing. Scientists have learned that they can manually "stretch" the cells in a laboratory to mimic the muscle movements of a live animal. By the end of the decade, it is likely that scientists will have the ability to produce lab-grown versions of meats like hamburgers and hot dogs, for which texture is not as important. It will probably take several years longer before we get to taste any lab-grown steaks.

New Harvest is a non-profit dedicated to the research and development of in vitro meat. PETA has offered a $1 million reward for the first team that can develop lab-grown chicken with the taste and texture of real chicken (although their 2012 deadline makes it highly unlikely that anyone will claim the prize). How would the world change if we switched from farm-grown meat to lab-grown meat? The benefits of this are hard to overstate.

The environmental impact will be enormous. Every pound of beef requires 30 or more pounds of crops to feed the cow. Pork and chicken aren't quite as crop-intensive as beef, but nevertheless consume a very large amount of resources. This is a huge drain on our water supplies and farmland. If our meat was grown in a lab, it could completely eliminate these problems, freeing up our land and water supplies to be used for other productive things or returned to nature. Along with solar energy, this is the emerging environmental technology that I am most excited about.

The health impacts of lab-grown meat could be very large too. As it stands now, red meat is extremely unhealthy. It has been linked to heart disease, diabetes, obesity, and cancer. Growing our meat in the laboratory would enable us to tinker with the genes to make it more nutritious, and to control how much fat is in the meat. Imagine eating something that tastes like a cow, with the nutritional content of a fish. We would be able to eat some of our favorite foods as often as we wanted, without any guilt or negative health consequences.

Furthermore, those with moral or religious qualms about eating meat could sleep easily at night, knowing that no animal was killed just so that they could eat dinner.

I think that right now, the "yuck" factor might dissuade people from trying it. But this is really just a matter of how the lab-grown meat was marketed. If it had the same taste and texture of actual meat, I definitely could see this becoming very popular. And after it became commonplace, the "yuck" factor would disappear on its own. What do you think? Would you eat lab-grown meat, assuming it had the same taste and texture of regular meat, at a reasonable price? I certainly would. It could save the world.

(Donations to New Harvest are tax deductible under US law, and are spent on university research on in vitro meat. It's a great cause with enormous potential to transform the world.)

PREDICTIONS:

By 2022 - Lab-grown hamburger (with the taste and texture of real hamburger) is sold commercially, for the same price or less.

By 2029 - Lab-grown steak (with the taste and texture of real steak) is sold commercially, for the same price or less.