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Future of Bioengineering in World Health BIOE 301 MULTIDISCIPLINARY!!!!!!!! Lecture Twenty-Three http://www.unmillenniumproject.org/reports/index.htm http://www.unmillenniumproject.org/reports/index.htm Millenium Development Project Task

  1. Future of Bioengineering in World Health BIOE 301 MULTIDISCIPLINARY!!!!!!!! Lecture Twenty-Three http://www.unmillenniumproject.org/reports/index.htm http://www.unmillenniumproject.org/reports/index.htm Millenium Development Project • Task Force on Hunger • Task Force on HIV/AIDS, Malaria, TB, and Access to Halving hunger: it can be done Essential Medicines, Working Group on Access to Essential Medicines • Task Force on Education and Gender Equality Prescription for healthy development: increasing Toward universal primary education: investments, access to medicines incentives, and institutions • Task Force on Education and Gender Equality • Task Force on Environmental Sustainability Taking action: achieving gender equality and Environment and human well-being: a practical strategy empowering women • Task Force on Water and Sanitation • Task Force on Child Health and Maternal Health Health, dignity, and development: what will it take? Who’s got the power? Transforming health systems for women and children • Task Force on Improving the Lives of Slum Dwellers • Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on A home in the city HIV/AIDS Combating AIDS in the developing world • Task Force on Trade Trade for development • Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on Malaria • Task Force on Science, Technology, and Innovation Coming to grips with malaria in the new millennium Innovation: applying knowledge in development • Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines, Working Group on TB Investing in strategies to reverse the global incidence of TB http://www.unmillenniumproject.org/reports/index.htm http://www.unmillenniumproject.org/reports/index.htm 1

  2. Investment and Policy Clusters What Role is Bioengineering Playing? • Health systems: ensuring universal access to essential services • Biotechnology has emerged as one of the methods to address health and other – Best provided through an integrated district health system centered on primary care and first-level referral hospitals challenges in developing world – Practical investments and policies for a functioning health system include – Molecular diagnostics • training and retaining competent, motivated health workers • strengthening management systems – Recombinant vaccines • providing adequate supplies of essential drugs • building clinics and laboratory facilities – Vaccine and drug delivery – Bioremediation • Science, technology, and innovation: building national capacities – Bioinformatics – Creating science advisory bodies to the national government – Nutritionally enriched genetically modified – Expanding science and engineering faculties in universities and polytechnics – Strengthening development and entrepreneurial focus in science and crops technology curricula – Promoting business opportunities in science and technology – Promoting infrastructure development as a technology learning process http://www.unmillenniumproject.org/reports/index.htm Lancet 2005; 365: 1105-07. Need for Innovative Diagnostic Platforms for these Diseases • Initial funding by Bill and Melinda Gates Foundation • 4 common central laboratory techniques – Blood chemistry – Immunoassays – Nucleic-acid amplification – Flow cytometry • However, central laboratory model not applicable to the developing world! Nature 7101 (442), 27 July 2006 p 329-484 Nature 7101 (442), 27 July 2006 p 329-484 Benefits of POC Diagnostics Lateral Flow or Immunochromatographic Strip • Access to diagnostic tools previously unavailable • Faster and more accurate • Better epidemiological data for disease modeling • Define economics of a healthcare system • Better utilization of minimally trained personnel • Better use of existing therapeutics Nature 7101 (442), 27 July 2006 p 329-484 Clin. Vaccine Immunol. Biagini et al. 13 (5): 541 2

  3. Some ICS Available Tests Microfluidic Diagnostics • Diphtheria • P. Falciparum malaria • STI’s • HIV – Gonorrhea • Hepatitis B – Syphilis • Pregnancy – Chancroid • Fecal leukocytes – Chlamydia • Proteinuria • Vitamin A deficiency Nature 7101 (442), 27 July 2006 p 329-484 Nature 7101 (442), 27 July 2006 p 329-484 Discuss the article you read, Application of Microchip Assay DALYs Saved with New Diagnostics System for the Measurement of C-reactive Protein in Human Saliva , Lab Chip. 2005, 5, 261-269. • What is the biggest advantage of this platform for the developing world? • What was the most convincing piece of data presented for the ETC platform? Nature S1, 23 November 2006 Lastly, but Certainly not Least… Requirements of New Diagnostic Techniques • Don’t forget the larger issues – Social – Economic – Political – Ethical Nature S1, 23 November 2006 3

  4. For More Detailed Discussion • http://www.unmillenniumproject.org/reports/inde x.htm • Nature 7101 (442), 27 July 2006 p 329-484 • Nature S1, 23 November 2006 For the Developing world, order the following problems from the greatest to least cause of mortality in the age range 0-4 yrs. Exam Review - Malaria - Perinatal conditions - Diarrheal diseases - Lower respiratory infections What are the major health Leading causes of mortality: ages 0-4 problems worldwide? • Developing world 1. Perinatal conditions Back in January, you heard the story of a 2. Lower respiratory infections young woman from rural Haiti who died from AIDS-related opportunistic infections. 3. Diarrheal diseases 4. Malaria She was at-risk for dying from AIDS long before she met the man who gave her the • Developed world virus. In other words, she was a victim of 1. Perinatal conditions “structural violence.” 2. Congenital anomalies Define structural violence, and list its 3. Lower respiratory infections components. Geoff Preidis 4. Unintentional injuries MD/PhD candidate, BCM preidis@post.harvard.edu 4

  5. Structural Violence Lecture 5 & 6 Review • Non-physical violence imposed by the • In which health system does the market powerful upon the weak, which structures the victim’s living situation such that Welfare have the least influence? his/her choices in life are limited. – Poverty • Which health system is most associated – Gender with low income developing nations? – Education – Racism None- health systems reflect cultural, – And many others… political & economic values • Developed vs developing world: which has the highest % out of pocket expenses? Developing world � leads to poverty! Lecture 5 & 6 Review • Name 4 reasons for increasing health care costs in the US: List the steps in the engineering design method in 1. Aging population 2. Increased technology use the proper order. 3. Prescription drug costs 4. Administrative burden – Evaluate solutions • In what ways does technology actually DECREASE health care costs: – Communicate results 1. Increased outpatient procedures – Develop solutions 2. Longer productive life spans – Identify a need • Which of the following did NOT contribute to the Oregon plan: – Define the problem (goals, constraints) a. Increased use of managed care plans – Gather information b. Increased tax revenues c. Individual mandate to obtain health insurance d. Community value decisions c. Associated with the Massachusetts plan Engineering Design Method Review: Pathogens and the Immune System • Fashioning a product made for a practical goal in the presence of constraints • How does the innate immune system defend against bacteria on a rusty nail? • Six design steps: 1. Identify a need SPECS 2. Define the problem (goals, constraints) • How does the adaptive immune system 3. Gather information defend against the flu virus? 4. Develop solutions FMEA Refine Design 5. Evaluate solutions 6. Communicate results • Papers, patents, marketing 5

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