- Aster DM Healthcare

The giant strides made in today’s medical field is at the tiniest
levels and hence surely ‘Small is Big’
By: Dr. Harish Pillai
T
he issue of
miniaturisation of
physical matter has
been dreamt about since
long. In the 19th Century,
Otto Klement and Jerome
Bixby wrote a story that was
adapted into a screen play
by Harry Kleiner in 1966 for
the sci-fi movie ‘Fantastic
Voyage’, wherein a crew of
humans and their submarine
were miniaturised and injected
using normal saline (intravenous) fluid into the blood
stream of a patient who was
a renowned scientist afflicted
with a stroke in his brain.
The mission of the crew was
to navigate the blood vessels
and reach the site of the clot
and use lasers to remove
the clot and resume blood
supply. In the course of the
movie, in typical Hollywood
style, the crew had a very
www.healthbizindia.in
Small is Big!
long anatomical detour and
a dangerous adventure due
to an arterio-venous anomaly
(hole) in the heart; an element
of cold war tension was also
injected into the plot with
characters representing both
Soviet and American interests!
This screenplay was taken
by the celebrated sci-fi writer
Issac Assimov and made into
a novel that was published 6
months prior to the release
of the movie. The other two
Health Biz India January 2016 37
main stream motion pictures
based on the same theme
were ‘Innerspace’ in 1987
and ‘Antibody’ in 2002. Hard
science buffs like Assimov
had doctrinal issues with the
breaking of fundamental laws
of Physics, but still went with
the flow of thoughts in the
quest to increase the mass
appeal for science and nano
technology.
The first postulation
There exists a plan
to use carbon
based diamondoid
nanometer structures
using positional
assembly almost
atom by atom
From the era of pop culture to
real science, the first scientist
to postulate the medical
application of nano or very
small devices was the late
Nobel Laureate physicist
Richard P Feynman. In his
land mark lecture in 1959
‘There’s plenty of room at
the bottom’, he postulated
employing machine tools
to make still smaller tools
and so on all the way down
to the atomic level. He, in
fact, offered the first known
medical application of nano
robotic surgery by stating the
wild possibility of ‘swallowing
the surgeon’ into the blood
vessels who will look around
and find out the problem area
and take a little knife and slice
it out! Thus, when we describe
nano technology today we
refer to microscopically small
tools, which are molecular
devices and nano medicine is
the application of this nano
technology to medicine.
Micro bots & more
The current exploits in
research labs world over
use an array of tools
ranging from dendrimers,
buckyballs and nano shells
to target specific tissues and
organs. These devices can
serve both diagnostics and
therapeutic functions. The
38 Health Biz India January 2016
several attempts to build
micro bots have resulted in
fascinating products. In 2002
at the Tokyo University a
research group created tiny
magnetically driven spinning
screws that will swim through
the blood vessels to deliver
drugs to infected tissues or
even drill at tumour sites with
the intent of killing them.
In 2003, the ‘MR Sub’
of Ecole Polytechnique in
Montreal tested a micro
bot that had ferrous
elements embedded within
and facilitated controlled
navigation using the variable
electro magnetic fields
generated by an MRI. By
2005, the original idea
proposed by the sci-fi movie
‘Fantastic Voyage’ became
a reality in a sense when
Brad Nelson’s team at the
Swiss Federal Institute of
Technology fabricated a
microscopic robot small
enough to be injected into the
body using a syringe.
Visualising nano
Nano engineering is a
dynamic and fast growing
field and the manufacturing
techniques being postulated
will surely revolutionise the
assembly line manufacturing
of nano devices by 2020. One
needs to visualise the entire
process at a sub atomic level
or at least atomic level. There
exists a plan to use carbon
based diamondoid nanometer
Experimental
applications have
already tried using
‘nano scissors’ to cut
a dendrite from a
single neuron without
damaging the cell
structures using positional
assembly almost atom by
atom to design and build a
wide range of nano machine
parts such as onboard sensors,
motors, power supplies,
molecular computers, gears
etc.
These structures have
already been created virtually
using super computers and
the theoretical models called
Diamond mechano synthesis
– DMS and is being fine tuned
for rapid application.
Nano drones
About the author
Dr. Harish Pillai is the CEO
of Aster Medcity, a USD 300
million greenfield medical
township project in Kochi
and Cluster Head - Kerala
Aster DM Health Care.
Apart from his management
skills, Dr. Pillai is a sci-fi
enthusiast, which gives him
an extraordinary insight into
the future of healthcare. In
this exclusive column, he
will present his thoughts
on where the healthcare
industry is heading and how
technology will play an even
greater role in the same.
40 Health Biz India January 2016
The range of clinical
possibilities and impact
is immeasurable and will
revolutionise the future
of medicine and surgery.
One can visualise nano
scavenger drones hovering
within the blood stream
constantly on the look out
for pathogenic and tumour
cells and swallowing them
almost like the great whale
habit of ingesting Krill (a
very small marine organism)
using a technique called
‘filter feeding’ by swimming
towards large schools of krill
and keeping it’s mouth open.
These nano robots will act
as artificial phagocytes and
will only produce as effluents
harmless sugars, amino acids
after completely digesting the
harmful cells.
The immediate impact of
such a drone is to fight one
of the commonest cause of
ICU deaths world wide –
anti biotic resistant Sepsis
or systemic infection due to
a bacteria or other infective
agents. The usual prolonged
length of ICU stay can be
dramatically cut short using
such nano drones in the fight
against infection. The other
most popular conceptual use
of nano drones is the precision
delivery of drugs at the target
cells, thus helping to prevent
damage to healthy cells.
This has wide application in
the treatment of cancers by
delivering chemo therapeutic
agents, the impact could
be the advent of aggressive
therapy and cutting short
systemic side effects in
addition to cutting short the
length of stay.
The surgical nanobots
introduced into the blood
stream can be a ‘slave master
robot’ like the current Da
Vinci Surgical system or it can
be an intelligent autonomous
surgeon with vast quantum of
anatomical and pathological
knowledge embedded in its
onboard nano computer.
Such a device could
perform both diagnostic
and therapeutic function.
Experimental applications
have already tried using
‘nano scissors’ to cut a
dendrite from a single
neuron without damaging
the cell. Even nano surgery
of individual chromosomes
is possible without damaging
cell viability. The future
nanobot will be able to find
and eliminate cancerous
cells; remove micro vascular
obstructions and recondition
the endothelial lining and
making the vessel more
youthful.
The days of modern day
surgeons and interventionalists
are surely numbered with
the rapid growth of nano
technology. The giant strides
made in today’s medical field
is at the tiniest levels and
hence surely ‘Small is Big’.