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Sometimes, we have to look to the future in order to better understand the present, even the past. What we can do now, or what we must do to reach a target in future is apparent while perceiving the future. Not crystal ball gazing, that’s not an option for science. In science, there are processes, indicators, systems, guidelines to take us on the path to tomorrow, or, the day after. And just as much as how we got here is fascinating, it is perhaps a tad more exciting to see where we could be later, years down the line. That is also because the realisation of goals takes us a few steps closer to the triumph of humans over what were once unsurmountable hurdles. This week, let’s walk down the road to the future and see where that takes us.
This invention is truly in the future. Researchers at TU Graz, the varsity in the Austrian city of Graz have gone where no human touch has, before. Their “SmartCore” artificial skin, about seven years in the making, is reputedly more sensitive than human skin itself. It closely resembles human skin by simultaneously sensing pressure, moisture and temperature and converting them into electronic signals. The team argued that by reacting to these three human sensory impressions, the smart skin prototype surpasses all electronic skin materials on the market to date which only react to pressure and temperature. The team lead on this project Dr. Anna Maria Coclite explains: “Human skin has a resolution of one-millimetre square. So this means that if you have an object that is one millimetre square or bigger, you can feel it with your finger. With the device that we have produced, we were able to even measure the electrical current from a pixel that was 0. 25-millimetre square, smaller than one-millimetre square. So, this means that you can get information also on smaller areas than human skin. How is this beneficial? First of all, it could give maybe a more integrated response with a more precise response than the human scale. And also it could be used, for example, sensing smaller objects.”
The next stage of course is to get this entirely wireless and connected to the neural networks in the brain, in order to convey sensations to the user. There are huge implications in medicine, with this wearable being considered as patches on prosthesis, and for use in persons with severe burn injuries. And that’s no science fiction either. Dr. Coclite says a group of scientists at Stanford has already managed to transmit signals on to the brain, working on a completely different prototype. The future is then in collaborations, bringing the best minds together to construct a better set of tools, all the better to help people live, ironically this time, being able to feel pain, also, the chill and heat, and a loved one’s touch.
The holy grail in medicine has for long been the human genome, decoding it, trying to fix the errors in the genetic code. Sridhar Sivasubbu and Vinod Scaria write this week on a revolution that will help in cancer care: From genomic medicine, a revolution rolls towards cancer care. Cancer is, essentially, a disease of the genome, the authors point out. It is caused by changes in genes that cause some cells to divide in an uncontrolled way. These changes can be inherited or acquired. Inherited genetic variants form the basis of many hereditary cancers, including breast and ovarian cancer. Advancements in genomic technologies in the last couple decades, including global initiatives like the Cancer Genome Atlas, have provided a shot in the arm to understand the molecular underpinnings of cancer, which in turn have yielded a new generation of therapies that target molecular defects.
As part of the U.K.’s ongoing ‘100,000 Genome Program’, a study of over 13,800 cancer patients, published last week, suggested cancer genomics could indeed transform cancer care. The programme reportedly demonstrated that genome sequencing integrated with routine clinical data could render cancer treatments more customisable. The implications of this study extend far beyond the boundaries of current practice of medicine, and mark a leap forward in the era of precision oncology. Of course, none of this would have been possible without our ability to do whole genome sequencing, a tool that can sequence a person’s DNA in its entirety – i.e. all 3.2 billion nucleotides – in a single comprehensive test.
If we are talk future, it is naturally impossible not to talk of artificial intelligence, which has moved out of the future and entered the present. Application of artificial intelligence in radiology will help in earlier detection of cancer, says an expert. Speaking on the sidelines of the national conference of Indian Radiologists and Imaging Association in Mangalagiri on January 25 (Thursday), Mukkamala Apparao, radiologist and clinical professor of radiology at the College of Human Medicine, Michigan State University, said: “AI will detect cancers present in the smallest parts of the body, which a human eye may not detect easily. Except blood cancer, it can detect cancers of the breast, lungs, cervical, prostate, brain in the early stage. Early detection of cancers will have 90% recovery rate.”
In a December 2023 paper in Nature, scientists reported that they had discovered a new class of antibiotics using a form of deep learning that has been gaining more attention. Sayantan Datta outlines the details of this path-breaking study, here. Unlike previous approaches that used deep learning to discover new drugs, the researchers said they were able to identify the chemical motifs. Their model was used to check whether a given compound could be an antibiotic.
From the future to an exciting present.
There is a great deal of excitement in the pharma sector. For starters, the Serum Institute of India (SII) has joined a global network to boost the production of affordable outbreak vaccines. SII has joined ranks with CEPI — Coalition for Epidemic Preparedness Innovations — an innovative global partnership working to accelerate the development of vaccines and other biologic countermeasures against epidemic and pandemic threats. The network will work towards getting vaccines ready for initial authorisation and manufacturing at scale within 100 days of recognition of a pandemic pathogen. The addition of SII to the CEPI manufacturing network will be a significant boost to vaccine production efforts in Global South regions.
The manufacturing network will focus on vaccine makers in the Global South, comprising broadly Africa, Latin America and the Caribbean, Asia, and Oceania, near areas with a high risk of outbreaks caused by deadly viral threats like Lassa Fever, Nipah, Disease X, and other pathogens with epidemic or pandemic potential prioritised by CEPI.
Bengaluru-based pharma major AstraZeneca Pharma India Ltd. said it had received approval from the Central Drugs Standard Control Organisation (CDSCO) for importing and marketing of Andexanet Alfa in India, a novel and life-saving antidote designed to reverse the effects of anticoagulant medications in emergency situations. It is well-tolerated and facilitates the early restart of anticoagulation following a bleeding event. The therapy is administered through an intravenous (IV) bolus over a duration of 15-30 minutes, followed by a two-hour infusion, as per a company statement.
Meanwhile, Bindu Shajan Perappadan reports the Health Ministry’s new treatment regimen for leprosy. The Ministry of Health and Family Welfare has decided to introduce a three-drug regimen for Pauci-Bacillary (PB) cases in place of a two-drug regimen for six months, following the “latest, globally accepted scientific research studies and evidence-based practices”. The World Health Organization (WHO) had agreed to supply the revised drug regimen from April 1, 2025. Thus, all States and Union Territories have now been asked to send their requisitions for anti-leprosy drugs 12 months beforehand.
This is more of a follow-up story, but important, nevertheless. On January 22, Cameroon in Africa became the first country in the world to launch the RTS, S malaria vaccine for children into its routine national immunisation services. The rollout follows a malaria vaccine pilot programme in Ghana, Kenya and Malawi, as efforts gather pace to scale up vaccination against the disease in high-risk areas. Twenty countries aim to roll out the programme this year, according to GAVI, the Vaccine Alliance, and other outfits which aim to provide equal access to new and underused vaccines for children living in the world’s poorest countries. Here’s an explainer: Can malaria vaccine rollout be scaled up?
Bringing you up to date on the COVID-19 situation, here: 2,083 cases of COVID-19 sub-variant JN.1, its lineages detected in India: INSACOG.
As we speak of genomic surveillance, here is another story that catches up with the latest development there: Labs unite to boost genomic surveillance globally. Two laboratories in Britain and South Africa, which were at the forefront of tracking new coronavirus variants during the pandemic, have teamed up to keep the focus on genomic surveillance globally as the COVID emergency recedes. The teams said they were worried governments and funders may pull back from such surveillance, despite its potential to better monitor many infectious diseases, from malaria to cholera. “One of the big benefits that came from the pandemic was this huge global investment in infrastructure,” said John Sillitoe, director of the Genomic Surveillance Unit (GSU) at the Wellcome Sanger Institute in Cambridge, one of the two partners. Hit on the link to read more.
Coming back to an old faithful theme in this space: lifestyle diseases. Serena Josephine M. writes that cervical cancer detection at an advanced stage remains a cause for concern, according to experts. Being the second most common cancer among women, oncologists raise a number of concerns: one of which is the stage at diagnosis of cervical cancer, as at least 50% of women are still diagnosed in the advanced stage of the disease. Most of the women present with the disease in the advanced stage in which it is not amenable for surgery, and the prognosis is bad. When detected early, there is a good prognosis but very few come at that stage. With January being observed as Cervical Cancer Awareness Month, oncologists say more needs to be done to improve awareness on screening and vaccination. The question is always about how to effectively run behaviour change communication, in a manner that will bring about the intended behaviour change. In this context, exploiting the power of street plays to sensitise the public on lifestyle diseases has been the chosen way for many organisations and the State itself. The above article is one such, well integrated with the health systems, offering entertainment and an opportunity to check one’s vitals too, in Kerala.
A shocking revelation comes from Dinesh Thakur and Prashant Reddy, as they outline one of India’s big problems in the pharma sector - different drugs, identical brand names. The use of identical trade names for drugs with different active ingredients is an old problem in India, and the medical community has been complaining about the issue for several decades. The more wide-ranging problem is the use of similar trade names which are phonetically and visually similar, used for something as common as a paracetamol, and a corticosteroid. The use of such identical or similar names is especially worrying in a country such as India for two reasons. First, the packaging of all drugs in India bears the name and prescription advice in the English language, a language spoken by less than 10% of the population. Second, Indian pharmacies are poorly regulated. Not only do many pharmacies in India routinely dispense drugs without prescriptions, but several also do not comply with the legal requirement to operate only with trained pharmacists who are registered with the Pharmacy Council of India.
There were quite a few stories on health care financing this week, in The Hindu. What comes as a boost to consumers is the ruling of the Consumer Commission, that insurance firms can’t reject a claim for reimbursement of medical costs on grounds that the claimant is diabetic, as Raghava M. reports. The Dakshin Kannada District Consumer Disputes Redressal Commission, referred to the 2022 decision of Delhi State Consumer Disputes Redressal Commission, which held that common lifestyle diseases like diabetes and hypertension cannot be treated as pre-existing diseases. And this cannot be grounds for insurance firms to reject the claim, it said.
It is only an efficient public health system providing quality patient care that can be a market regulator for healthcare in the country, said C.N. Manjunath, director of the State-run Sri Jayadeva Institute of Cardiovascular Sciences and Research. The rising healthcare costs in private hospitals can be checked only if public hospitals are able to provide quality and affordable care. He further urged the creation of a good work atmosphere: “We cannot deliver quality services with just buildings and equipment. We need to create an excellent working atmosphere, nurture talent and develop a culture of hard work and discipline among the workforce. The biggest challenge is to manage the manpower because each one has a different mindset.” For more insights, click on the link that will take you to the interview by Afshan Yasmeen.
The National Medical Commission has finally decided to do away with the seat-leaving bond policy for postgraduate medical students. And yes, there was a collective sigh from the students post that announcement. The move is reportedly aimed at creating a supportive and nurturing environment for medical students, and in turn, fostering their mental health and enhancing their overall well-being, leading to a positive transformation in the medical education system. The exorbitant amounts levied as bond-revoking fines not only exacerbate the financial strain on the students but also act as a deterrent for seeking necessary mental health support from the family. Instead, it will introduce a provision to consider debarring the students who opt to leave the course from taking admission in their State for the following one year.
And there’s another kind of level playing field that Manual Corpas advocates: A significant bias in medical studies towards men of European origin means genetic variants in understudied populations don’t get the focus they deserve, the author, a bioinformatician, says, advocating the urgent need for data to make personalised medicine equitable. The problem is that the majority of medical research, the author writes, including genetic research, is still done mainly on one subset of the world’s population: men of Northern European origin. This means that negative drug-gene interactions in other, less well-studied populations can fly beneath the radar. “We need to ramp up representation in genetic and medical studies to ensure fair treatment for all.”
Following up on an old, old story: Once again, the pause button has been hit on the National Exit Test as NMC invites comments from stakeholders. It is ideal, of course, that any decision on this front is well thought out and is cognisant of the points of view of various interested groups.
Here is something we will be watching over the weeks to come: The Centre seeks data from States to assess the functioning of the Surrogacy Act, 2021. The Union Health Ministry has asked all States and UTs about the total number of couples and single and unmarried women who have availed of surrogacy successfully since the Surrogacy Act, 2021, came into force to assess the functioning of the law. As a short backgrounder, the Surrogacy (Regulation) Act, 2021 was passed two years ago to regulate in vitro fertilisation (IVF) clinics and prohibit commercial surrogacy in India. Only married infertile couples and certain categories of women (single and unmarried) are allowed to avail of Artificial Reproduction Techniques and surrogacy. Surrogacy is only allowed for altruistic reasons under the Surrogacy (Regulation) Act, while commercial surrogacy has been prohibited in the country since 2015. We will come back on this, when the data becomes publicly available.
Tail piece
Karla Kaun’s piece on how alcohol/drug addiction rewires the brain by changing how genes work is our choice for the tailpiece this week. We, who are so quick to judge, must read this: addictive substances like alcohol and drugs of abuse can overwhelm the natural reward pathways in your brain, resulting in intolerable cravings and reduced impulse control. A popular misconception is that addiction is a result of low willpower, the author, a behavioural neurogeneticist reasons. But an explosion of knowledge and technology in the field of molecular genetics has changed our basic understanding of addiction drastically over the past decade. The general consensus among scientists and healthcare professionals is that there is a strong neurobiological and genetic basis for addiction.
From the Health page
While you are here, if you have a few moments extra to tarry, do click on the following links, or save them for later:
Vignesh Radhakrishnan and Rebecca Rose Varghese examine the data on antibiotic usage from the latest National Centre for Disease Control survey: Over half of antibiotics India uses belong to ‘watch’ group, highest globally | Data
The Hindu’s edit on the on the Anganwadi workers’ strike in Andhra Pradesh.
Outbreak of Western Equine Encephalitis Virus in Argentina.
Science sleuths are using technology to find fakery and plagiarism in published research.
U.N. urges reversal of funding pause for Palestinian agency, vows to punish staffers.
Should surgeries be broadcast live? NMC sets up committee to provide recommendation.
Here’s a smattering of regional content from our bureaus across the country:
Andhra Pradesh
Patients in remote areas being treated through smart ICU programme in Guntur.
Sambasiva Rao M. reports: Guntur-based surgeons perform complicated surgeries, save both legs of 70-year-old man.
Delhi
Delhi HC recalls order allowing widow to abort 29-week pregnancy.
Karnataka
Afshan Yasmeen reports on cannabis use: NIMHANS study finds risk perception low among college students.
Kerala
Kerala Governor’s policy address | Govt. to prioritise non-communicable diseases management, R&D in health sector.
Ladakh
Ladakh’s Muslims, Buddhists up in arms over naming health centres as Ayushman Arogya Mandir.
Odisha
AIIMS Bhubaneswar conducts successful drone trial for medical deliveries in Odisha.
Puducherry
Rajesh B. Nair reports: Medical fraternity in Puducherry appeals for recruitment of staff along with procurement of new equipment.
Tamil Nadu
R. Sujatha writes on SCARF, which completes 40 years in service of persons with mental illness.
Diabetes and endocrinology women’s initiative launched at VHS in Chennai.
As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.
