September 06, 2011

Itty-Bitty Medicine

By: David Ollier Weber

Source: Hospitals & Health Networks

At home in England, watching television images of the aftermath of the Indonesian tsunami in 2004 and Hurricane Katrina in 2005, engineer Michael Pritchard was appalled by the human misery — dehydration, diarrhea, fungal and parasitic infestations, cholera — that ensues when disaster survivors are reduced to drinking dirty water.

He was astonished that even in a First World country it took five days to get safe drinking water to the 14,000 refugees sheltered in New Orleans' Superdome — ironically stranded in a sea of river water, albeit too contaminated to be potable. In the best of times, as many as 30 million Americans annually develop a gastrointestinal illness from consuming polluted water, according to the Centers for Disease Control and Prevention. Some 1,000 of them, many infants, perish as a result.

Pritchard was convinced that technology could be brought to bear to alleviate this age-old, seemingly intractable problem. He went to work in his garage and his kitchen ("much to the dismay of my wife," he quips). Several failed prototypes later, he emerged with an unprepossessing cylindrical metal canteen capable of turning the foulest water fresh — completely clear, pleasant to tongue and nose, healthy to drink no matter what may have been floating in it moments before, from raw sewage or animal poop to the tiniest bacterium or deadly virus.

On a Nano Scale

The secret of Pritchard's remarkable bottle, which he trademarked under the name "Lifesaver," is the combination of a replaceable activated carbon filter to screen out chemical residues like pesticides, endocrine disrupting compounds, medical wastes and heavy metals; and a second filter cartridge whose outer membrane is a filigree of micropores only 15 nanometers in diameter.

Fifteen nanometers! That's the width of a few DNA molecules. And it's almost half the size of the smallest pathogen.

Run liquid through the Lifesaver nanofilter and every impurity is trapped on the exterior of the cartridge membrane. All it takes is a few easy strokes of an integrated hand pump at the bottom of the Lifesaver bottle to force input water — perhaps scooped out of a roadside ditch, a rice paddy fertilized with night soil, a garbage seep or a beaver pond — through the nanopores. Then pop the rubber cap and quaff without a care.

You can buy a Lifesaver bottle online for about $150. It holds up to 750 milliliters, the contents of a wine bottle. The canister weighs only 22 ounces empty. It can quench your daily thirst for three months before the $7 carbon filter needs to be replaced. The ultrafiltration cartridge will process 4,000 liters of water before automatically shutting down lest wear finally permits dangerous bugs to slip through. A new cartridge costs about $100.

Backpackers, survivalists and adventure travelers — affluent First Worlders — are the primary retail market today. But the U.S. and British armies also have become enthusiasts because the bottles, and larger Lifesaver jerry cans, allow soldiers to scavenge water on the battlefield for drinking and, with a few extra pumps for a pressure boost, to irrigate wounds.

Many relief agencies and charitable organizations have begun stocking up as well. Thousands of Lifesaver bottles and jerry cans were airlifted to Haiti following the earthquake of 2010.

Indeed, notes Pritchard, a C-130 cargo plane loaded to capacity with containers of clean water can ferry in enough to sustain 350 people on two liters a day for a month. Loaded with empty Lifesaver bottles, that plane could enable 2.4 million people to survive safely on shared local water for the same period!

The Doctor Is In — and He Has a Ph.D. in Nanoscience

Pritchard's adaptation of extreme microfiltration — an elegant mechanical rather than chemical solution to the unsafe-water scourge affecting nearly 4 billion people worldwide — is just one of a growing list of contributions of industrial nanotechnology to public health and medicine, points out Sara Brenner, M.D.

Brenner, an enthusiastic 31-year-old Iowa native with residencies in internal medicine, preventive medicine and public health already under her belt (and a master's degree in the latter to go with her medical doctorate), is the newly named assistant vice president for nanohealth initiatives at the State University of New York University at Albany College of Nanoscale Science & Engineering.

CNSE, part of the SUNY system, bills itself as "the first college in the world dedicated exclusively to education, research, development and deployment in the emerging disciplines of nanoscience, nanoengineering, nanobioscience and nanoeconomics."

Founded in 2004 on the University at Albany campus, CNSE's 800,000-square-foot complex houses a fully integrated state-of-the-art computer chip prototyping and demonstration line, and 80,000 square feet of Class 1 clean rooms. More than 2,500 scientists, researchers and engineers from companies like IBM, Advanced Micro Devices, Sematech and Toshiba have clustered there to work on their own nanoscale pilot projects side by side with students and faculty. A major expansion is in the planning stage.

This spring, CNSE announced a pioneering partnership with SUNY's Downstate Medical Center in New York City. Elite undergraduates at Downstate's med school can commute to Albany to simultaneously train in and explore the implications of nanoscale science and engineering for human health. After three additional years of work/study at CNSE, they will leave with both an M.D. and a Ph.D. in whatever aspect of nanomedicine they choose as their focus. The first two candidates are enrolled; they and those who follow, says Brenner, are meant to assume leadership roles in industry and academic medicine in "translating nanoscale research into bedside tools.

"At CNSE we don't refer to departments, because they tend to come with walls," she says. "We use the term 'research constellations' — physicists talking with chemists talking with biologists … . We're trying to break down silos."

Equipped with a doctorate and hands-on expertise in nanoscience, the physician graduates will go on to clinical residency in a traditional medical specialty, where they will apply the research they embarked on at CNSE. For example, suggests Brenner, a resident in radiology might continue work on refining nanoscale contrast agents.

"Nanotechnology will truly change how medicine is practiced and how it's delivered," predicts Steve Janack, vice president of marketing and communications at CNSE. "Physicians need to understand how these tools can be used and what the risks and benefits are. The idea is to use our resources to educate physician researchers who will drive health care innovations in the 21st century."

Nanobots to the Rescue?

In June, Dave Ellis wrote in this space about Watson, the IBM supercomputer that became a celebrity by defeating two champion human contestants on the TV game show "Jeopardy."

But Watson, Ellis noted, harbored a more serious ambition; this nonphotogenic rack of 90 hardware and software servers is destined for a career as a physician assistant. Run a patient's history and symptoms through Watson's databases and it can spit out an accurate diagnosis faster than, say, TV's fictional Dr. House and his team can cause a nosocomial complication.

The silicon-wafer nanocircuitry that enables Watson to "integrate and contextually analyze" a welter of data points at blazing speed was refined by IBM at CNSE. Adapted by and teamed with physicians, nanoelectronics like those at the heart (brain?) of Watson will make huge contributions to health care quality improvement, Janack foresees: "Humans, being imperfect, and computers, being imperfect, working together can overcome some of the liabilities of each."

Nanomedicine has a mystique that has inflamed many imaginations. Visionaries have conjured a therapeutic future in which "nanobots" course through the bloodstream repairing RNA strings and zapping cancer viruses. Less fanciful and closer to realization, though, are nano-based "antibiofouling" coatings that will inhibit bacteria from adhering to keyboards, door handles, tabletops and other surfaces, cutting health care-associated infections.

How exposure to nanoscale materials might affect the health and safety of people who make them or use them (some sunscreens, for example, contain nanoscale ingredients) or encounter them in their environment is itself a medical issue needing careful investigation, says Brenner. That's her own research focus at CNSE's NanoHealth and Safety Center.

Meanwhile, as the Lifesaver bottle attests, nanotechnology already underpins many humble but potentially momentous contributions to human population health.

"A lot of high tech," says Brenner, "infiltrates First World countries before the Third World. But things like nanopore purification will advantage countries with dirty drinking water far more." (A family of four with a 20,000-liter Lifesaver jerry can enjoy clean water for three years at a cost of half a cent a day, figures Pritchard. For just $20 billion, so could everyone in the world.)

The same argument holds for nanoscale vaccine adjuvants for diseases like HIV and tuberculosis, Brenner proposes. Agricultural and veterinary applications of nanotechnology that help crops and livestock thrive will improve nutrition globally. "Food safety, water safety, infectious diseases," she muses, "nanotech can be integrated into the standard of care for any of those conditions."

"What are the social justice implications of disruptive technologies?" she asks rhetorically.

In the case of nanomedicine, in its broadest sense, she says: "Hundreds of thousands of lives will be saved." Rather than succumbing prematurely to malnutrition, dysentery or schistosomiasis, "people will live long enough to get cancer."

Then, perhaps, we can deploy the nanobots.