« If you have an amputated arm, will you be equipped with an artificial limb or will doctors succeed in recreating your own arm? I think it’s going to be a mix of both. (…) Robotics can not be deployed in the health sector by being disconnected from biology, especially regarding the functioning of the nervous system, » said to H&TI Sébastien Teissier, a French skin researcher and expert in bioethics, currently project manager at the Institute of Medical Biology (IMB) in Singapore.
The scientist delivered to H&TI his vision of the future of the industry, from the progressive development of 3D printing in the field of research to the arrival of revolutionary technologies, such as bionic eyes in the medical sector.
He also talked about the issues of the unsecured health data sharing from a bioethics perspective.
IMB create human skins in 3D
What kinds of high tech tools do you use within the IMB?
Sébastien Teissier: I use PCR machines [- a technique used in molecular biology to amplify a single copy or a few copies of a segment of DNA -] and various advanced search tools. More generally in the institute, we start to use 3D printing.
It’s very interesting. We create skins in 3D for example. They are not designed from the samples of our cell bank, they are artificial skins made from donor cells.
What does this technology bring you?
I’m not part of the teams who work on these 3D skins, but from what my colleagues have told me, the device seems very encouraging. This type of technology can ultimately help patients because it allows researchers to more closely examine the properties of the skin and the effects of treatments on the skin.
Which new technologies could help you to be more efficient regarding the management of the skin cell bank of IMB?
3D printing is by far the most promising technology.
The field of high tech is also a source of progress from a purely medical point of view. There are technologies used in hospitals that are really useful. There are, for example, skin suction machines that accelerates healing (scarring). These are pumps that doctors use especially for people burned. The process reduces infections, helps local circulation and accelerates regeneration. The device is already used at Singapore General Hospital.
In 2005, Isabelle Dinoire received a partial face transplant after having been attacked by her dog. It was a world first. Can new generation technologies facilitate the execution of this type of intervention?
It remains above all a medical prowess. Medicine is a bit of technology but in this case, success is really related to the talent of the surgeon. Before we can automate this type of operation, there is a long way to go. At this level, I am not afraid of words, it is art in my opinion.
Cyborg: from science fiction to reality?
You are a writer also, the author of X , a polar whose central character is a forensic officer. If we look at some of science fiction novels of the 70’s and 80’s, we realize that certain situations that were impossible at the time, especially in the field of health, do not seem so incredible today. This is the case, for example, of the bionic man, half man, half machine, which appears in particular in the Cyborg series of Martin Caidin (1972-1975).
When I was a student, we were wondering where we were going, towards more robotics or a better understanding of of embryogenesis aiming at recreating our cells? For example, if you have an amputated arm, will you be equipped with an artificial limb or will doctors succeed in recreating your own arm?
I think it’s going to be a mix of both, for several reasons. One of the problems here is autonomy. Having and controlling a robotic arm requires a lot energy. Robotics can not be deployed in the health sector by being disconnected from biology, especially regarding the functioning of the nervous system. For the moment, artificial limbs are very close to the natural limbs in terms of abilities, it is high technology but it is not symbiosis. It is necessary to create connections between the device and the body.
Not long ago, researchers have developed cameras that recreate vision for visually impaired people (see below). There, we can begin to talk about symbiosis. It is impossible to simply have a team of engineers in that case, a neurophysicist and other specialists are also indispensable. This requires an almost exhaustive understanding of physiology. And things are moving forward.
There are also nanotechnologies. Google Ventures, Google’s investment fund, recently invested US$10 million in the « Robot Pill » project developed by Rani Therapeutics, a pill capable of releasing a nanobot in the intestine that injects insulin into the body to treat diabetes.
Diabetes: « I think the most important thing is prevention »
Diabetes, one of the priorities of the Singaporean government.
Yes, Rates of diabetes have exploded in Singapore (Singapore has the second-highest proportion of diabetics among developed nations, according to a report published in 2015 by IDF)! The problem is that we try to find solutions to issues that could be solved by lifestyle changes. Type 2 diabetes, which begins to be called « the soda disease », is beginning to become truly critical.
Certainly, technologies can help to combat this scourge but I think that what is essential is prevention, by following a balanced diet of healthy food. The problem is that all WHO reports and information on the subject are available but are not highlighted. We have to find them. Something could be done about this in the area of eHealth.
Data sharing and bioethics: « There is no problem (…) if consent is informed »
You are specialized in bioethics. In the area of digital health, a common problem is the sharing of health data, particularly in Europe. Do you feel that opinions on this subject are different in Asia? Are Asian patients less suspicious when it comes to sharing their personal information?
It’s the case. The Data Protection Act was introduced in Singapore. It was supposed to strengthen personal data protection but, in my opinion, it was more a communication act because it slowed down a lot of medical procedures so that patients were more or less forced to sign the consents to share their data so, in the end, it did not change much.
Data sharing is always a problem because it means that we have to trust. Bioethics was created from the following question: « What if we were evolving in a malicious system? ». Nowadays, thinking that way means you are completely paranoid, you adhere to the theory of conspiracy.
Since the creation of bioethics at the Nuremberg trial (1946), we have realized that the authorities were not always benevolent.
Bioethics can be summed up as one principle, which can be found in different forms: this is safety, protecting the patient, the weakest. And then, the question is, what and who do we protect them from? It is from there that things are getting more complicated.
We have to protect them from using their data for commercial purposes, for example?
Yes, in particular. The big danger now is no longer the Nazis of course! Personal information has tremendous value. In terms of insurance, for example, it is a real concern. Fitbit watches and other connected devices are one of the problems. There are nice tools but the amount of information we provide for free is huge and all is recorded. How can I be sure that tomorrow my insurance company will not tell me « You have not walked enough compared to the average so you have to pay more! »?
What would be the solution?
Protecting. Informing. There is no problem in sharing personal data if consent is informed. When I say « informed », it doesn’t mean a disclaimer or a single click to say « I agree » and then I share my data.
This principle is not applied by all major groups, such as Google and Apple, which collect a lot of data. But if we participate in a study, whether it is for a questionnaire or to take pictures of your skin or whatever, I’ll spend a quarter of an hour or half an hour explaining to you all the principles, what we will do with the data, why, etc. And then, if you agree, you sign the consent, which is informed.
When you give all of your information without really reading the form, then we will say that it is always a lack of responsibility on the part of the one who does not read, but if I try to insist that you have to sign the document saying that it is just a formality, it will not be ethical.
