Overview of Lecture 1 � Course Overview: BIOE 301/362 � Course organization � Four questions we will answer � Course project Lecture One � Technology assessment – The big picture � World health: an introduction Course Organization � Syllabus � Project � Owlspace � BIOE 301 Roadmap Four Questions Course Project � BIOE 301: � What are the problems in healthcare today? � Design and implement a solution to a health challenge in a developing country � Who pays to solve problems in healthcare? � BIOE 362: � How can we use science and technology to � Design and implement a solution to a health solve healthcare problems? challenge in a developing country � Evaluate and prioritize health challenges � Once developed, how do new healthcare suggested for future design projects technologies move from lab to bedside? � Summer internship opportunities!
Your Situation Technology Assessment � You have just been diagnosed with advanced � What is it? cancer � Why do we need it? � Your physician tells you that with standard treatment, � Example there is only a 15% chance that you will survive 5 years. � She informs you that she is testing a new therapy which � Bone marrow transplants for breast cancer 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: Overview The Disease � The disease: � Breast Cancer � Breast Cancer � 211,240 new cases of breast cancer will be diagnosed in the U.S. in 2005 � The technology: � Over 2.3 million women living in the U.S. who have � High dose chemotherapy (HDCT) with been diagnosed with & treated for breast cancer autologous stem cell support (ASCS) � 2 nd leading cause of cancer death among women in � $80,000-$150,000, high morbidity, initially high the U.S. mortality � Incidence and mortality rates vs. time � The assessment: � 1980s: Small clinical trials promising � Many patients demanded treatment even though there was very little evidence that it worked � What happened next?
http://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/medi http://cwx.prenhall.com/bookbind/pubbooks/silverthorn2/m alib/Image_Bank/CH24/FG24_22a.jpg edialib/Image_Bank/CH22/FG22_02a.jpg Breast Cancer Staging Stage Definition 5 yr survival Cancer cells are located within a Stage 0 100% duct and have not invaded the surrounding fatty breast tissue Stage I The tumor is 2 cm or less in 98% diameter and has not spread to lymph nodes or distant sites. The cancer has spread to 1-3 lymph Stage II 76-88% nodes close to the breast but not to distant sites Stage III The cancer has spread to 4-9 lymph 49-56% nodes close to the breast but not to (High risk) distant sites Cancer has spread to distant organs Stage IV 16% such as bone, liver or lung or to (Metastatic) lymph nodes far from the breast. Treatments for Breast Cancer The Technology � Surgery � Lumpectomy � High dose chemotherapy (HDCT) with � Mastectomy autologous stem cell support (ASCS) � Used to remove small tumors � Chemotherapy � How does chemo work? � May be used to shrink larger tumors so that they can be removed surgically � How does high dose chemo work? � May be used following surgery to reduce risk of recurrence � Why do we need ASCS? � May be used to treat stage IV breast cancer � e.g. cyclophosphamide with doxorubicin or epirubicin � Bone marrow transplants � Radiation Therapy � May be used following surgery to reduce risk of recurrence � What are they? � Hormone Therapy � How were they developed? � 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 drug Chemotherapy High Dose Chemotherapy � Dose of chemotherapy � How does it work? � Balance between goal of completely destroying all � Chemotherapy drugs given IV or by mouth cancer cells & causing too much damage to normal � They travel through the bloodstream to reach cancer cells cells in most parts of the body � Dose comparison studies of chemo in metastatic � Interfere with ability of cell to divide breast cancer show high dose is associated with high response rate � Cancer cells cannot repair damage caused by chemotherapy drugs so they die � High dose chemotherapy (HDCT) � Rapidly dividing normal cells may also be affected by � Wipe out cancer cells with extremely high doses of chemotherapy chemo drugs but they can repair this damage � Such doses also destroy bone marrow, including stem � Possible Side effects cells that eventually mature into cells of the blood � Temporary: Nausea and vomiting, loss of appetite, and immune system hair loss, mouth sores, low blood cell count (infection, � Patients receiving HDCT must undergo a transplant to bleeding, fatigue) restore the bone marrow cells � Permanent: Premature menopause and infertility
http://cwx.prenhall.com/bookbind/pu bbooks/silverthorn2/medialib/Image_ Bank/CH16/FG16_03.jpg Bone 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 mouse History of Bone Marrow Transplants History of Bone Marrow Transplants � E. Donnal Thomas � Conceived in a dog kennel in � Grew up in Texas, attended Harvard Med School Cooperstown, NY during the 1950s � Treated leukemia patients with chemotherapy � Believed that providing new, healthy bone � RBCs could be successfully transfused from marrow cells was essential to curing leukemia compatible donor to needy recipient � Tested various transplant techniques in dogs � Marrow cells could not: Body identified them � Tested them in patients with late stage leukemia as foreign invaders and destroyed them � Every patient who underwent transplantation died � Hiroshima – one reason that radiation was so during the procedure of shortly thereafter. After deadly because it destroyed the bone-marrow 4 years stopped human trials. cells of its victims – hemorrhage, infection � “Things were pretty grim.” � Need: ability to restore bone marrow History of Bone Marrow Transplants Bone Marrow Transplants: Leukemia � Courtney Stevens � E. Donnal Thomas � High school sophomore with leukemia � Treated with a bone marrow transplant � 8 years later, identified genetic markers on WBCs of “It was a complete nightmare. For days, I’d be on histocompatibility all fours and just retch and retch.” � Enabled close matching of donor and recipient “I looked like a lobster, and thought I had bugs � Led to successful results in dogs crawling on me. I’d hit myself and scream.” � Resumed human trials “ I was in that sterile bubble, and forgot what skin � Led to successful treatment for leukemia against skin felt like. That was lost. I just wanted to hold on to my mom or dad, like a � Received the Nobel Prize in 1990 two-year-old, and I couldn’t” “I had terrible diarrhea, a blistering rash all over my body, and jaundice. I was the color of an egg yolk.” http://research.medne t.ucla.edu/images/nob http://www.jeromegroopman.com/bmt.html el_med.gif
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