A New Hope….The “Wow” Of Stem Cell Treatments

A New Hope….The “Wow” Of Stem Cell Treatments

Stem Cells under High Magnification

 There I was sitting in the audience of the darkened convention center staring at the slides running on the screen feeling a slight tinge of envy and an odd sense of disappointment thinking that it could have been me there presenting these results, if only. Ah, that "if only" plays a major part of all our lives doesn’t it?

Anyway to start from the beginning I had spent the last three days at a specialty national conference as part of my commitment for annual medical education to learn what’s new in the field of regeneration. Too many times we get caught up in the everyday worries of clinical practice and forget that there is a whole lot of innovation taking place out there in science some of which may be a game changer to how we practice medicine in the near future.

Take for example stem cells. Those who follow this blog regularly know that i have in the past been dismissive of what I have thought was the highly inflated claims of the stem cell propagandists in touting it as a cure for all diseases (read here and here). Well I am happy to confess that i have now changed my mind. I too believe in stem cells now. I believe that soon, very soon we might have actually workable stem cell therapies at hand- something which i would have argued against a few months ago.

There is a thin line separating skepticism and cynicism- what with all the false stuff floating around in the name of miracle cures - science needs us to be ever vigilant and skeptic and believe any claim only if it is proved or disproved with reliable evidence. But to reject the hypothesis without examining the evidence at all is a sign of a closed mind and cynical in the extreme. Thankfully I am not a cynic and if you show me the evidence and it stands rigorous examination then I am happy to change my mind and jump onto the bandwagon too. That’s the advantage of having an open mind.

As I said earlier, I sat there (for three days) in the darkened auditorium staring rapt in attention watching slide after slide of before and after treatment photographs and micro-photographs (histological slides under high magnification) of various diseases where stem cells had been used and I came away impressed. I could see jaws which had been amputated halfway- hemi-mandibulectomy done- grow back into normal jaws with stem cells. And i saw unhealed diabetic ulcers and amputation wounds close down normally with no sweat at all and I couldn’t help thinking that this stem cell therapy thing is definitely a breakthrough in medicine.

Best of all these were all mesenchymal stem cells harvested from routine menstrual blood and not embryonic stem cells with all its hassles (complicated procedures) of cord blood collection and storing even as the child is being born. That old adage of women being life givers is once again being reinforced with even their menstrual blood which is usually discarded as unsanitary -being put to life giving use. And it made me think of that quaint old Indian habit of women being considered as untouchables during their three days of menses and often set apart from the pooja rooms and other religious ceremonies. Science is now providing a fitting reply to religious obscurantism isn’t it?

If you think I am painting too rosy a picture i would be the first to agree that there are still a lot of steps to go through- there are unresolved issues in collecting the stem cells, culturing them (growing them) in the lab and making use of them in the proper way for the proper disease to get the proper result - for the cure should not be worse than the disease, right? There are also worries about stem cells helping cancer cells to grow faster along with normal cells and their cessation of growth by contact inhibition is yet to be elucidated- that is how does the stem cell know that your kidney is only this big and it stops growing further once your size is reached? What if it decides to keep on growing in size till you have the mother of all kidneys? What stops it actually? Food for thought right?

But anyway all these are technical issues and once the proof-of-concept is validated then these can be tackled by multiple people working simultaneously everywhere. Its like somebody inventing the first car and showing that it can indeed run on the road and then people everywhere get in to solve the practical issues- like one person inventing the accelerator, someone else somewhere inventing the brake and someone else inventing the gear box- none of which was possible till people believed that a car could actually run as said.

And as the researchers stressed again and again they were still only dipping their toes in using stem cells  for treatment, exploring the possibilities of its application in a blind "let’s try this and see what does happen" way and it was still in the experimental stage with no long term results available YET. But if the initial results are anything to go by then we are just that nearer to growing back lost or damaged organs- like a kidney, liver or even an amputated limb. We can hopefully cure diabetes, restore lost memory in dementia cases and even make sure that those with spinal cord injuries and paralyzed in bed can take up their beddings and walk again- as the bible says

It might take us another ten years or fifteen for the treatment to go through all the approved regulatory agencies and for all the working mechanisms involved to be studied fully - for we still don’t know much about how/why it works - just that it works but eventually we are going to be able to get commercially mass produced stem cells which can be injected in a wound site and the damaged part is going to heal over nicely without any sign of the original injury or scar.

I even got offers from one or two companies which are early pioneers in this business (start-ups) offering to supply me with stem cells for competitive rates at RS------for a million cells- the total dosage to be determined by the wound size and disease. Of course if I did buy them and use them on my patients it would have to be an experimental trial (clinical study) only and i would have to go through all the prescribed procedures for conducting such a trial prior to doing the treatment. Or I could wait till it becomes mainstream in a few more years and then start using it on my patients along with every other doctor.

As I said right at the beginning of this post, over the three days I was there at the conference I did feel slightly (well, a lot) envious of all the cutting edge advances taking place, more so from the fact that i too could have been one of those up on the podium getting the applause from the audience if only i had not been chased away from all research by the memory of my bitter experiences during college days.

For those readers who have been with this blog for some time I have in some of my past posts mentioned how when I was a promising young researcher working on my thesis some of my results were stolen in the pre-publication stage by a trusted mentor and I had to practice a scorched earth policy in making sure that no one, including me, could ever use that research anywhere. Not the wisest of options I guess- wasting two years of my hard work in the bargain but I simply wasn’t willing to sit back and allow myself to be cheated without fighting it to the bitter end.

Come to think of it now when i have a far more mature head on my shoulders I feel that I overreacted and let the shock of betrayal lead me to burn down the entire house to deal with a backstabbing rat but for good or bad I swore off research forever and decided to stick to clinical practice (and making money) for the rest of my life. So for years and years i have been happily practicing my cutting and sewing working with real patients instead of petri dishes and microscopes and making me a comfortable living in the bargain- but there is always a tiny bit of regret buried somewhere in my heart that i did not follow through with my research ambitions, especially when i attend conferences like these and see such cutting edge scientific advances.

I know it’s just presumptuous to assume that I might have been a success as a researcher but who knows? The future is a closed book to us and if destiny guides me to a path of research again I might even chuck my scalpel away and start ogling at microscopes. Even if I have to sacrifice some/lot of my current income and get accustomed to a lower standard of living just so future generations can benefit from my research findings. Besides there is a hidden thrill in research - that moment when you see the first evidence of your hunch being proven right- a sense of winning against your own doubts which is almost an orgiastic experience and it pays off for all the sacrifices you made till then.

So that’s all about the stem cell therapies i learned about recently which might provide a far more brighter and enriching life (disease-free) to future generations of humanity- so much so that I am tempted to label it "A New Hope" - a phrase familiar to all Star Wars fans. The future, ladies and gentlemen, looks far, far bright than the present. God bless us all.

No Red Lights – The Unstoppable March Of Technology In Healthcare

No Red Lights – The Unstoppable March Of Technology In Healthcare

(Disclaimer: This post was written for a competition organized by Indi-blogger and Apollo hospitals on the topic of “How does modern healthcare touch lives” – please check this link for further details: http://www.apollohospitals.com/cutting-edge.php)

The other day I was at a swanky new private medical college on the outskirts o the city, the venue for a surgical workshop. They had invited me over for a small live-demo surgery of the trapdoor technique of harvesting connective tissue. For those who don’t know what a trapdoor is (go Google it) - sometimes when you need a bit of skin to graft someplace you can take it off from the patient by cutting up the patients skin on three sides, lifting up the patch of skin and then by cutting off the layers underneath (the skin has many layers) you can take them and use them elsewhere and meanwhile stitch back the upper layer of skin in the same place with no hint of anything missing underneath. The technique is first taught to youngsters by asking them to cut an orange by peeling off a little bit of the skin carefully and getting the pulp out from underneath without damage and then putting back the skin of the orange so that no one who looks at the orange should ever suspect that it’s hollow inside.

I trained in a government hospital which has a big reputation for many, many years and so we used to get a lot of patients from all over the state and even from our neighboring states. We used to get such a surfeit of patients that after a few times practicing surgery on oranges, we immediately shifted over to real patients and real skin. But unfortunately the same cannot be said for the kids in some of these newly started private colleges. The students (who have often paid extremely large amounts of money to get a seat) have to keep on practicing on oranges for a long time and wait and wait for a chance to do it on real patient’s skin. 

Being fairly familiar with this technique I had been invited to visit one such college and do a small demonstration surgery to teach the kids there the differences between an orange skin and human skin. As my surgical workshop was scheduled for the afternoon and the lectures in the morning session were boring me, I took to wandering all over the swanky new campus taking in the sights. And that’s when I noticed something which really brought home to me the advances in health care from the times I had studied and the situation now.

Impact On Hospitals –Tablet Computers In Wards

As I wandered around the bright and gleaming wards, i could see that there were ward rounds going on with the chief issuing instructions and the students taking down notes diligently. But unlike in my student days when we had small scribble pads for jotting down the chiefs muttered instructions (one of this and two of that etc) these kids were using tablets for note taking, real tablets of the electronic kind - i-pads and galaxy tabs etc. The students were taking photos of the patient with their tab cameras, attaching it to the case notes and whenever there was something they didn’t understand or when the chief asked them a sudden question they were checking for it on Google, like the values for sodium or potassium in normal human body. We on the other hand used to mug up the entire values table and carry all that useless information around on our brains for instant recall but these kids were just storing it all on the cloud- on Google’s servers and accessing the relevant info when needed. That was quite a revelatory moment for me when I realized how much new technology can impact on health care.

Impact on Investigations –Digital X-rays

Take x-rays for instance. Previously any x-ray we got from the radiology department was iffy at the best. On some days the radiography technician would send us clear x-rays, some days they would send us cloudy x-rays with nothing visible depending on their moods (or what their wives said to them at breakfast). The only way to get a guaranteed good x-ray (for any complicated case) was to personally go to the x-ray department, take an x-ray by yourself, head into the dark room (pinch a few girls there- under the red lights) and develop the x-ray by yourself by alternately dipping them into the large tanks full of developer and fixer solutions. If you were skilled at it, you could make even an average x-ray gorgeous by timing the developing (by under or over developing) and fixing processes.

But now all that’s become superfluous for you have digital x-rays. Now it’s all about pixels and values and the results can be seen in seconds on a monitor. Every digital x-ray is standardized to the same incredible level of detail and clarity- by idiot proofing (removing the human being off the loop). Of course when you press a button and get an x-ray immediately, you are tempted to order more and more x-rays sitting in your chair compared to when you had to haul your ass off to the radiology department every time you wanted to get an x-ray. So digital x-rays do have the drawback of tempting doctors to order more x-rays then necessary. That and missing out on all the fun and romances which used to take place in the x-ray dark rooms, behind the developer tanks, under the red lights.

Impact on Surgeries –Using Simulation Software

The same kind of technological ease of use is seen with surgical planning nowadays. With all the modern CT’s- with their various slices of info- 64/128 etc, you get all the info as bits and bytes which you can take and feed into a simulation program to recreate the CT as a 3-D human dummy and virtually practice the surgery. If you have ever played Microsoft Flight Simulator, then you would understand how awesome it is do a simulation practice before doing the actual thing. Previously we used to lie back with our eyes closed and imagine the entire thing in our minds from cutting to stitching in a step by step imagination. Now we just switch on the simulation program and start cutting. But again with all this wealth of detail available, it’s so tempting to order more and more CT’s for every stage of diagnosis rather than being satisfied with just one preliminarily.

On a related note, I know that a lot of patients feel that doctors nowadays order a lot of useless investigations and tests. But the best person to decide the necessity of that test is the person who might ultimately be held responsible for the consequences- your doctor is the best judge for what is needed or not. And for every extra investigation ordered by the doctor, which you feel is useless, think how you would feel if the doctor had not ordered that test and you ended up getting that disease. And how thankful you should be that your test results came back negative, rather than cribbing about paying for that test.

Using Robotic Surgery Machines – Da Vinci Robots

When it comes to the actual surgery, only the best surgeons were said to be confident enough to make their incisions (cuts) in one long fluid single stroke at the correct length, depth and angle. But now with robotic surgical machines and lasers replacing scalpel blades even mediocre surgeons can make the cuts with the same precision as, hey they aren’t actually making it, they just have to set the depth and length on the touchpad screen and the laser does it for them – thereby leveling the field between good surgeons and great surgeons. But there are also drawbacks to these robots, for we hear that the Da Vinci Surgical Robot has been known to freeze up halfway during surgery – once with a patient’s liver grasped tightly in its clamps- due to a software glitch (or virus attack) and they had to shut down the whole system (the robot) and re-boot it again to get the robot to release the patients liver. So if you ever have a robot doing your surgery and it stops suddenly- don’t panic, just press Ctrl+Alt+Del to have it re-start (if its windows based).

Using Stem Cell Therapy- Via Star Trek The Series

Finally we come to the big daddy of medical technology- stem cell therapy for organ replacement. Let me share a small personal anecdote here. When I was a little kid they used to show Star Trek the original series on Television. One episode of which was quite an unforgettable experience for me. The episode I am talking about involves the Star Trek crew coming back in time to the 20^th century to save the whales from destruction. In one point in the serial as Captain Kirk, Spock and the rest of the crew of Starship Enterprise rush through the corridor of a typical 20^th century hospital Dr.Bones is stopped by an old woman who asks for some relief from her severe pain. The surprised Dr.Bones hangs back (while the others leave) to ask her what she is suffering from and she says that both her kidneys had failed and she was going to die soon.

Dr.Bones looks around carefully to see that no one is observing his actions and pulls out a pill and gives it to the old woman to swallow. At the end of the episode we are shown a television reporter standing outside the hospital and talking about a medical miracle where an old woman with kidney failure suddenly grew two new kidneys inside herself and everyone turns to stare at Dr.Bones. That decided me in my career – that exact moment. I wanted to be the guy who handed over such magical pills to cure patients in pain- I wanted to be a doctor. I wanted to be Dr.Bones. With today’s technology I know that we are very far from such instant organ replacements. But who knows about the future? A breakthrough might happen any time or any day. We can always hope.

The Future Is Here- As Google Glass.

And some of those hopes might even be coming true in our own times- example – Google Glass. Do you recall those medical students I was jealous of? The ones using i-pads to review notes? Now imagine using Google Glass to get real time information about all the medicines being taken and test results of each patient who is lying on the bed as we walk down the wards – is there any way we can miss anything important about the patient?. Imagine using Google Glass to layer a real time surgical simulation as we do the actual surgery- is there any way we can miss any important step? I am very, very excited about Google glass and its effect on how we practice medicine. Off-hand I can think up a dozen new ways I can use Google glass in my daily practice to help my patients.

So to come back to the premise of this post. Technological advances stop for no person. Technology keeps developing at a rapid pace and it is up to us to evolve to keep pace with the advances in technology. This is as true for the healthcare profession as it is for any other profession. We cannot close our eyes and insist on practicing medicine the old way, for the old ways are dead. Evolve or perish is the new mantra. As wise master Yoda once said "There is only Do, there is no Try"

And finally, technological advances can make a mediocre doctor a good doctor, a good doctor into a great doctor and a great doctor into, ahem, ahem, me…(just kidding).