Pictures of the Future      Fall 2008

No Cause for Alarm

Dr. Fernandez has early-stage Alzheimer’s disease and prostate cancer. Cause for alarm? Not really. By 2020 extremely early detection technologies and a combination of lab tests and smart imaging may make it possible to treat both conditions rapidly, painlessly and effectively without surgery.

Things sure have changed since the old days when I was in med school. Of course, that shouldn’t surprise me since I’ve been a podiatrist (yes, I’ve seen a lot of feet!) for over 40 years. But things have a way of looking different when you become a patient yourself. About five years ago I had a biosensor installed in the lower lobe of my right ear. It was so small it was actually injected into the tissue. If you look carefully, you can see its combined computer-receiver-transmitter, which looks like an amethyst ear bead.

Doctor said it would detect biomarkers for a slew of diseases—cancers, atherosclerosis, Alzheimer’s, you name it! Early detection was the idea. All I had to do was use a mobile phone regularly. Phone sends a signal to the sensor, and the sensor downloads a mini report to a program in the phone: this is O.K., that’s O.K., you know. Well, anyway, couple of months ago, it said things were not O.K. "Contact your physician immediately," the message read.

So I did. Over at the local community hospital, Dr Pelzer downloaded a description of the findings from my phone. "Looks like you got a double whammy, Fred. System’s discovered early signs of Alzheimer’s and prostate cancer," he said. "Let’s find out what this is all about."

After a quick series of blood tests confirmed my sensor’s findings, I was given an injection of two compounds, one that combined a positron-emitting (PET) radioisotope with a molecule designed to latch onto Alzheimer’s plaque, and another that combined a PET isotope with a molecule that hooks up with thymidine—a building block of DNA. "If there are any malignant cells in your body," said Pelzer as I slid into position in a PET-MR scanner, "they’ll absorb the thymidine much faster than any normal cell and light up in the scan."

The next day I received an encrypted v-mail from Pelzer’s office that had been produced and sent by his hospital’s information system. "Dear Mr. Fernandez," it said, "As you know, the information from your biosensor was confirmed by blood tests. Our scan then localized early-stage Alzheimer’s-related plaque as well as an early-stage malignancy in your prostate. Your Alzheimer’s disease (AD) condition can be controlled using the following medication... which is now available at the following pharmacies... We suggest a follow-up imaging test in the next two weeks to ensure that the medication is working. With regard to your prostate condition, we recommend treatment at the following medical center... If you would like to have your electronic patient record brought to the attention of a specialist at that center, press ‘Agree,’ and you will be contacted for an appointment."

"Sure I agree," I muttered to myself as I pressed the virtual button on the screen. Within seconds, a return mail popped up. "Thank you for contacting our medical center. We have carefully reviewed your patient record and have made the following appointment for you..."

It was a blisteringly hot August afternoon when I arrived at the Medical Center. Thanks to the hospital’s advanced information management system, I already knew what to expect. Information downloaded to my PDA guided me along a maze of corridors to the Center’s Integrated Visualization and Treatment Section.

Minutes later, following administration of a mild tranquilizer and a local anesthetic, I was ensconced in a surgical device called a "Magnaviewer" that softly clamped around my lower torso. Dr. Pike, a specialist in genitourinary oncology, introduced himself. "I’ll be your master of ceremonies today," he said jokingly. "We’ll have you back in business in no time."

Since I had told him that, out of professional interest, I would like to follow the procedure as it took place, Pike explained every step. The Magnaviewer, he said, had access to the relevant 3D section of my PET-MR scan, which was superimposed on a real-time view of the surgical area. Using ultrasound to find its precise anatomical bearings in the context of the virtual MR image, the machine—guided by Dr Pike—inserted a needle-thin flexible endoscope through my lower abdomen. Outfitted with its own visible light nano-vision device, the needle followed a pre-calculated, optimized path to the cancerous area. After a few minutes I heard Pike saying, "We’re right in there now where the MR shows the cancer cells. But to find out more about those cells, I’m going to give those little guys a special infrared dye that only they can absorb." I heard him give the machine a voice command.

"There," he said a moment later. "They’re lighting up like a Christmas tree. You could spot ‘em a mile away!" He explained that the endoscope was capable of producing a spectrum of wavelengths and simultaneously reading the reflectance of cells that had absorbed the dye. "There’s a lot of information in that infrared light," he said. "Oxy- and deoxy-hemoglobin concentrations, water and lipid content. That kinda thing. It all goes into your file to help us zero in on the best treatment. But it also goes into a database that helps to fine tune our interpretation of what we see in MR images," he said.

The next step was supposed to be treatment—not an easy step since, according to the 3D MR scan, the cancerous cells had wrapped themselves around what might be a nerve, making even microsurgery risky. In spite of the feeling of invulnerability conferred by the tranquilizer, I felt a twinge of nervousness at this point. "Now don’t ‘ch worry" said Pike, reassuringly. "We’ve got a contrast substance here that homes in on nerve cells. "There," he said with satisfaction as he injected it, drawing out the sound. "Now we see it. Sure as heck is a nerve."

"Tell you what we’re going to do now," he said. And he explained that the wavelength analysis of the cancer cells had been matched to a database of therapeutic substances that could be combined with nanoparticles that..."

Somewhere along the way through Pike’s description, I must have drifted off into a light doze. By the time I woke up I had been given a shot of molecules designed to be absorbed specifically by my cancer cells—and put them out of business. "You’re all set," said Pike, slapping me on the shoulder as I headed for the door, still a little groggy. A week later I came back for a follow-up MR. The cancer cells were gone. All I could say to that was that things sure have changed since the old days when I was in med school.
                                                                                                              Arthur F. Pease