Bioengineering and World HealthLecture OneOverview of Lecture 1 Course Overview: Course organization Four questions we will answer Course project Technology assessment – The big picture World health: an introductionCourse Organization Syllabus Website: http://www.owlnet.rice.edu/~bioe301/kortum/class/ BIOE 301 RoadmapScience of Understanding DiseaseEmerging Health TechnologiesPreclinical TestingClinical TrialsAdoption & DiffusionAbandoned due to:• poor performance• safety concerns• ethical concerns• legal issues• social issues• economic issuesBioengineeringEthics of researchCost-EffectivenessFour Questions What are the problems in healthcare today? Who pays to solve problems in healthcare? How can we use science and technology to solve healthcare problems? Once developed, how do new healthcare technologies move from lab to bedside? Course Project BIOE 301: Develop and teach a global health education activity for local K-12 students BIOE 362: Design and implement a solution to a health challenge in a developing country Summer internship opportunities!Your Situation You have just been diagnosed with advanced cancer Your physician tells you that with standard treatment, there is only a 15% chance that you will survive 5 years. She informs you that she is testing a new therapy which may increase your chance of surviving 5 years by more than 40%. The new therapy has extremely painful side effects and there is limited scientific evidence that it works. The new therapy costs $150,000 and your insurance company refuses to pay for it. What do you do?Technology Assessment What is it? Why do we need it? Example Bone marrow transplants for breast cancerTechnology Assessment: Overview The disease: Breast Cancer The technology: High dose chemotherapy (HDCT) with autologous stem cell support (ASCS) $80,000-$150,000, high morbidity, initially high mortality The assessment: 1980s: Small clinical trials promising Many patients demanded treatment even though there was very little evidence that it worked What happened next?The Disease Breast Cancer 211,240 new cases of breast cancer will be diagnosed in the U.S. in 2005 Over 2.3 million women living in the U.S. who have been diagnosed with & treated for breast cancer 2ndleading cause of cancer death among women in the U.S. Incidence and mortality rates vs. timehttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH22/FG22_02a.jpghttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH24/FG24_22a.jpg Breast Cancer StagingStage Definition 5 yr survivalStage 0Cancer cells are located within a duct and have not invaded the surrounding fatty breast tissue 100%Stage IThe tumor is 2 cm or less in diameter and has not spread to lymph nodes or distant sites. 98%Stage IIThe cancer has spread to 1-3 lymph nodes close to the breast but not to distant sites76-88%Stage III(High risk)The cancer has spread to 4-9 lymph nodes close to the breast but not to distant sites49-56%Stage IV(Metastatic)Cancer has spread to distant organs such as bone, liver or lung or to lymph nodes far from the breast. 16%Treatments for Breast Cancer Surgery Lumpectomy Mastectomy Used to remove small tumors Chemotherapy May be used to shrink larger tumors so that they can be removed surgically May be used following surgery to reduce risk of recurrence May be used to treat stage IV breast cancer e.g. cyclophosphamide with doxorubicin or epirubicin Radiation Therapy May be used following surgery to reduce risk of recurrence Hormone Therapy May be used to shrink larger estrogen positive tumors so that they can be removed surgically May be used following surgery to reduce risk of recurrence e.g. Tamoxifen – an anti-estrogen drugThe Technology High dose chemotherapy (HDCT) with autologous stem cell support (ASCS) How does chemo work? How does high dose chemo work? Why do we need ASCS? Bone marrow transplants What are they? How were they developed?Chemotherapy How does it work? Chemotherapy drugs given IV or by mouth They travel through the bloodstream to reach cancer cells in most parts of the body Interfere with ability of cell to divide Cancer cells cannot repair damage caused by chemotherapy drugs so they die Rapidly dividing normal cells may also be affected by chemo drugs but they can repair this damage Possible Side effects Temporary: Nausea and vomiting, loss of appetite, hair loss, mouth sores, low blood cell count (infection, bleeding, fatigue) Permanent: Premature menopause and infertilityHigh Dose Chemotherapy Dose of chemotherapy Balance between goal of completely destroying all cancer cells & causing too much damage to normal cells Dose comparison studies of chemo in metastatic breast cancer show high dose is associated with high response rate High dose chemotherapy (HDCT) Wipe out cancer cells with extremely high doses of chemotherapy Such doses also destroy bone marrow, including stem cells that eventually mature into cells of the blood and immune system Patients receiving HDCT must undergo a transplant to restore the bone marrow cellsBone Marrow Transplants Components of blood Plasma Cells Red blood cells White blood cells Platelets Cells are produced in the bone marrow from pluripotent hematopoeitic stem cells Lab expts: a single stem cell can yield the half-trillion blood cells of an entire mousehttp://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medialib/Image_Bank/CH16/FG16_03.jpgHistory of Bone Marrow Transplants Conceived in a dog kennel in Cooperstown, NY during the 1950s RBCs could be successfully transfused from compatible donor to needy recipient Marrow cells could not: Body identified them as foreign invaders and destroyed them Hiroshima – one reason that radiation was so deadly because it destroyed the bone-marrow cells of its victims – hemorrhage, infection Need: ability to restore bone marrowHistory of Bone Marrow Transplants E. Donnal Thomas Grew up in Texas, attended Harvard Med School Treated leukemia patients with chemotherapy Believed that providing new, healthy bone marrow cells was essential to curing leukemia Tested various transplant techniques in dogs Tested them in patients with late stage
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