Remote Control Medicine

Friday, May 11, 2012
By Axel E. Thieke G.P.

Implanted medical devices have been in use for decades: pacemakers, ports, metal rods and tubes of all sorts and sizes, stents, etc.

Now, a multi-institutional team reports that it has developed an implantable chip that can release precise amounts of various (!) drugs over many days and at specific times in response to wireless commands.

Chips were implanted in eight volunteers and results were comparable to daily injections of the drugs. Immune responses of the patients led to the formation of a tissue capsule around the chip, but this did not interfere with drug release. Implanting and explanting of the chip required a tiny skin-cut in local anesthesia and was well tolerated. Sci Transl Med 2012 Feb 22; 4:122ra21. (http://dx.doi.org/10.1126/scitranslmed.3003276).

Welcome to the world of the Formula-1-patient:
Your boss thinks you should work harder – press 1 for stimulant;
Had a row with your husband – press 2 for anti-hypertensive medicine or 3 for Tranquilizer – make sure though your PIN-code is well protected.

Eerie scenario, but as long as patients have to consent implantation it is not more than fascinating.

But useful? Useful for technical progress maybe, but Medicine relies on the patients’ willingness to cooperate. If a patient decides otherwise we medics have to respect his/her motives and find acceptable alternatives. There is always more than one way to happiness as much as to health.

Take booze for example: More than 1 million participants in various studies were assessed for the effect of alcohol consumption on cardio-vascular-disease (CVD) related mortality. Active drinkers (? – what would be an inactive drinker ?) had significantly lower risks of CVD. That’s the good message.

The bad message is that the lowest risk was amongst the group which had 1 to 2 drinks a day.
Risk reduction was 25% for all-cause-mortality (BMJ 2011 Feb 22; 342:d636 + d671) (http://dx.doi.org/10.1136/bmj.d6736).

One knows that moderate alcohol consumption favorably affects biomarkers such as HDL-cholesterol levels, apolipoprotein-A1 and fibrogen-levels. It has not been possible to determine if certain types of alcoholic drinks were more protective than others (thank heaven – imagine if it would have been tequila-marmite).

Without too much exaggeration one can say that alcohol is a natural remedy. It occurs in nature even without human interference, for example in rotting fruit.

After a rich meal one could either have a mushy pear or a brandy – depending on one’s point of view. Differences between the two might be marginal…

Human stomachs and livers are extremely adaptable and one can live 90 years on a vegetarian diet as much as on a meaty diet – possibly bad news for fundamentalists.

More important seems to get adequate amounts – quantity rules quality in this case.
We need tolerance not only on football fields, bar counters and behind steering wheels, but also in our kitchens and at our tables (not meant to be a hidden message to the ladies!).

(Features: Doctor Column, Axel Thieke)

Tags: , , , , , ,

Leave a Reply

You must be logged in to post a comment.