With globalization and technology leveling the playing field in the apparel industry, Third World garment workers have much to fear from a new scanner that may enable custom-tailored clothing to be made in the US as cheaply as ready-made clothes are churned out in China. There will likely come a day when a scanner like this and a personal clothing printer like the loom described in last month’s issue will be home gadgets.

Such a notion cannot be far-fetched, considering many of our homes are now well-equipped bakeries with fancy ovens and bread-making machines; print shops with glossy brochure production capabilities; garage-based builders, carpentry and machine shops; half-acre farms with tractors and tillers; and even clinics – some US homes have medical devices and drugs that would be the envy of many a professional clinic in the developing world.

* * *

That some of today’s biggest companies are both very young and very innovative should remind established healthcare institutions they risk not only being upstaged by innovative startups (ambulatory surgical centers, for example) but also losing opportunities by not being innovative themselves. The question healthcare leaders should be asking themselves is “What technologies might turn our world upside down tomorrow?”

Some world-turning technologies are evident in the preponderance of winning healthcare-related entries to this year’s Wharton Business Plan Competition, in the possibility of longer life spans following confirmation of the role of mitochondria in aging, in Francis Crick and colleagues’ nascent molecular neuroscience (which, if it succeeds, could have as big an impact as genetics), and in the convergence of biology and robotics, as illustrated by the growing interest in systems biology of top roboticists as systems biology reveals itself to function on robotic engineering principles.

Health technology opportunities do not diminish our challenge (last month) to the mantra that the US has the best healthcare system in the world. Even if that belief is based only on excellence in medical science and technology, the US seems to be losing that lead, as well, courtesy of the globalization it champions. (And it’s not just healthcare: Eying a trillion-Euro market, Europe is making strategic plans to be number one in nanotechnology.)

Perhaps US healthcare needs the equivalent of NASA’s Institute for Advanced Concepts, where concepts feasible within ten to 40 years are incubated. (An economist adds weight to that notion, with a theory that continual technological innovations of Internet magnitude will be needed to maintain economic growth.) Such an incubator, applied earlier to retailing, might have shown what is now clear: that Internet grocery shopping never quite died, and that hype can be confused with bad timing or poor execution.

Other signs of acceleration:

• Outsourcing of US white collar jobs to overseas is accelerating faster than was thought only two years ago. It goes to show how acceleration can catch everyone by surprise.
• Japan has successfully created the clone of a cloneof a prize bull.

Automation vs. Globalization

A body scanner developed by a company funded by the US textile and apparel industries and the US Department of Commerce generates patterns for custom-made clothing that is “faster and cheaper to make than any that could be turned out by a Hong Kong tailor,” writes Jay Cohen for the Associated Press. Clearly, this will be wonderful for a US industry “devastated” by globalization.

An older, larger, and less accurate version of the scanner in use at a men’s clothing store in New York for over two years left that company “pleased overall.” Another clothing chain has already bought one of the new scanners and has 11 more on order. The machines are expected to enable a custom-tailored suit to be sold for the same price as a ready-made suit.

“We’re looking at more information systems, technologies and things like that rather than trying to save the jobs here,” said an executive of the company that makes the scanner. There go those jobs, again.

Reference: Cohen, Jay (2004). “Super-Scanner Sizes Up Clothes Horses.” Associated Press via InformationWeek, May 13.

Innovation Rules

Three of the top five companies in this year’s Wired 40, Wired magazine’s annual list of enterprises leading in technology, innovation, globalism, networked communication, and strategic vision, were founded in the past decade.

Google, Amazon.com, Apple Computer (for its iPod and iTunes), and eBay take four of the top five, for reasons that will be obvious to even a moderately IT literate person. But one of the five was a biotech company, Genentech, whose vision and innovation have brought FDA-approved Avastin (colon cancer), Xolair (asthma), and Raptiva (psoriasis), and could bring ten new treatments for lung, prostate, and ovarian cancers, as well as arthritis, by 2010.

Gen-Probe made the Top 40 for automating the labor-intensive task of testing blood for viral genetic markers for hepatitis and HIV. Its FDA-approved Tigris system allows one person to run 1,000 tests a day, 10 times more than any other diagnostic device. The company is currently developing a screen for prostate cancer that promises to be three times more effective than the competition.

One regular pharma, Pfizer, made the top 40 on the basis of having a pipeline of 130 drugs in development, as well as 95 new uses for old ones.

There were also some dropouts — firms that were in last year’s list but not this year’s — including Affymetrix, whose microarrays, according to Wired, “didn’t deliver,” and Millennium Pharmaceuticals, which has reverted to traditional drug discovery after failing to deliver with a genomics approach.

Reference: Kelleher, Kevin (2004). “The Wired 40.” Wired, Issue 12.06, June.

Surprise

We have written an article for an upcoming (August) edition of Hospital and Health Networks Online concerning the surprise of the Pentagon and the media about the use and global impacts of consumer technology on the war in Iraq, the recent Spanish national elections, and on a precipitous decline in newspaper readership. The references below provide examples.

These impacts were predictable and probably predicted by someone, yet the predictions (if they were made at all) were either not heard or not heeded, and we are left to wonder whether healthcare institutions will one day wake up to a surprise as unwelcome as the digital pictures of Abu Ghraib were to the Pentagon.

Reference: Jardin, Xeni (2004). “Wartime Wireless Worries Pentagon.” Wired News, May 26.

Reference: Simon, Ellen (204). “Digital Cameras Change Perception of War.” Associated Press via Yahoo, May 7.

Reference: Unknown (2004). “Text Messages Killing Radio Star.” Associated Press via Wired News, May 7.

Reference: Unknown (2004). “Telemedicine on Rise in U.S. Military.” Associated Press via the New York Times, May 9.

Health is the Business of the Future

The top three winners of the 2003-2004 Wharton Business Plan Competition at the University of Pennsylvania were plans for healthcare-related companies that:

• Test disease-related proteins against large libraries of chemical compounds faster than current methods;
• Develop manipulated autologous stem cell therapy (MAST), in which cells are removed from a patient’s body, cultured, loaded with drugs, then put them back in the patient. The method has shown promise in the lab as a therapy for neurological problems;
• Market a new, patented handheld device called a HematoScope to detect brain bleeding in patients presenting with head injuries, reducing the need for CT or MRI where no bleeding is found while improving access to CT and MRI for patients who really need it.

The HematoScope business plan won first prize.

Reference: Wharton Center (2004). “This Year’s ‘Eight Great’ Business Plans: You Pick the Winner.” Website article available as of May 6, 2004.

Mitochondrial Cause of Aging

Swedish researchers have confirmed in animal experiments the theory that mitochondrial mutations are one of the causes of age-related illnesses. The finding “will provide a completely new angle to treat aging-related problems,” said one. The new angle might include drugs or procedures to prevent the mitochondrial mutations, and several companies are already working on compounds, potentially related to mitochondria, to tackle the diseases of old age.

The new study adds to a growing list of successes in understanding aging processes, including the identification of several age-related genes in animals, the link between telomeres and cell death,* and the damage to cells caused by free radicals. (Mitochondria, as it happens, also generate free radicals.)

However, a Harvard scientist said the Swedish experiment only ”suggests – but doesn’t prove — that mitochondria might really play an integral part in the aging process,” reports Alice Dembner in the Boston Globe.

* See also “Making Cancer Mortal Through RNAi” in the Therapeutics section of this issue.

Reference: Dembner, Alice (2004). “Researchers zero in on a cause of aging: Experiment points to defect in cells.” Boston Globe, May 27.

Science of Consciousness

Since co-discovering the double helix, Francis Crick has re-focused his attention mainly on the mind and consciousness, in the firm belief that mind and consciousness are essentially material and therefore explicable. “You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules,” he wrote in a book in 1994. His goal, and that of his Caltech collaborator Dr. Christoff Koch, is to find the “neural correlates of consciousness,” and their efforts are taken sufficiently seriously that the acronym “NCC” is bandied about freely by supporters and critics alike. Some critics are coming to accept that NCCs may exist, but continue to insist that material correlations are not sufficient to explain the phenomenon of consciousness.

The explanation of biological development through molecular genetics, provided by the double helix discovery, has had a revolutionary impact on biology and healthcare. The explanation of consciousness, if it is ever achieved, would be equally revolutionary. It could lead to the invention of a “consciousometer” for determining if a patient was fully anesthetized; or how conscious, if at all, are retarded children, demented seniors, and newborn babies.

Reference: Wertheim, Margaret (2004). “After the Double Helix: Unraveling the Mysteries of the State of Being.” New York Times, April 13.

Synthetic Biology

DNA was discovered to be the code for a computerized robot — a cell — that operates protein machines that produce living organisms all the way up to and including homo sapiens. DNA made homo’s own attempts to produce computerized robots pale in comparison. “But in a forthcoming denouement,” writes MIT roboticist Rodney Brooks in Technology Review, “engineering is poised for a triumphant comeback in molecular biology. . . . Now, we are on the brink of an engineering revolution that will transform our ability to manipulate the biological world. The results could be everything from cell-based computers to custom-made microbes that neutralize toxic waste or manufacture chemicals. It’s a leap as large as that from ancient alchemy to today’s materials science.”

As an example of progress, he cites the successful genetic manipulation of E. coli to act as NOT gates for binary computing, which could lead in “the next few years” to cells genetically altered to deliver drugs within a person’s body; for example, a cell programmed to “sense blood sugar levels and produce just the right levels of insulin in response.” As another example, he cites Craig Venter’s work re-engineering simple bacteria to identify the genes needed to sustain life and their specific functions, then mixing and matching genes from different organisms to create a unique living system.

“Where does this lead?” he asks, and answers: “Whereas now we grow a tree, cut it down, and build a table, in fifty years we might simply grow a table.”

We need more an deeper answers to that all-important question.

Reference: Brooks, Rodney (2004). “The Cell Hijackers.” Technology Review, June.

Globalization Bites Back

“The United States has started to lose its worldwide dominance in critical areas of science and innovation,” wrote William Broad in the New York Times, and US senator Tom Daschle warned a meeting of the American Association for the Advancement of Science of “disturbing signs that America’s dominant position in the scientific world is being shaken.”

Broad cites the following evidence:

• The US share of its own industrial patents has fallen steadily over the decades and now stands at 52 percent. Japan, Taiwan, and South Korea now account for more than a quarter of all United States industrial patents awarded each year — more than double their share in 1983 — and these are “good patents that have a high impact,” as measured by how often subsequent patents cite them;
• American papers published in the journal Physical Review have fallen steadily from 61 percent in 1983 to 29 percent in 2003;
• Americans once won the great majority of Nobel Prizes, now they are down to 51 percent;
• The considerable scientific successes of recent European Mars missions were largely ignored by a US media more interested in showing the American Mars Rovers — an enormous achievement, but by no means the only one;
• Europe is building the world’s most powerful atom smasher, set for its debut in 2007;
• The European Commission reported last year that Europe surpassed the United States in the mid-1990′s as the world’s largest producer of scientific literature;
• New doctorates in the sciences peaked in 1998 and then fell 5 percent the next year, a loss of more than 1,300 new scientists; and
• Applications from foreign graduate students to research universities are down by a quarter.

In a report last month, the American Association for the Advancement of Science said the Bush administration, to live up to its pledge to halve the nation’s budget deficit in the next five years, would cut funds to 21 of 24 federal agencies that do or finance science, except those involved in space and national and domestic security.

Reference: Broad, William J. (2004). “U.S. Is Losing Its Dominance in the Sciences.” New York Times, May 3.

Europe Aims to Lead in Nanotech

The European Commission intends for Europe to lead the world in nanotechnology. It proposes to boost R&D investment and infrastructure, improve training for research personnel, enhance technology transfer in Europe and its financing, study the impact of nanotechnology on society, and seek international co-operation towards a responsible approach to nanotechnology.

A commissioner noted that “The market for [nanotech-based] products and processes is estimated to be around 2.5 billion today worldwide. However, analysts predict it could be worth hundreds of billions of Euros by 2010, later exceeding €1 trillion. Examples of nanotechnology-based products already on the market include new computer displays, scratch-free paints, surfaces with specific functions, creams and medical products such as heart valves. These products, however, represent only the tip of the iceberg and nanotechnology research is expected to have an impact upon virtually all technological sectors in the coming years and lead to new developments, in particular, in healthcare, information technologies, energy production and storage, new materials, manufacturing, and environmental research.”

The EU was the source of 32 percent of international nanotechnology publications in 1997-1999, compared to 24 percent for the US and 12 percent for Japan, but has since fallen behind both the US and Japan in terms of per-capita investment in nanotech.

Reference: Unknown (2004). “Europe leads the way in nano-robots.” In-Sourced.com, undated.

Inventing the Future

The NASA Institute for Advanced Concepts, or NIAC, is a small agency where “the wildest of ideas” — from shape-shifting space suits to antimatter-powered spaceships to asteroid-killer robotic armadas to engineering the weather on Earth to a space elevator — are not only tolerated, but welcome, writes Noah Shachtman in Wired. It is an incubator for concepts ten to 40 years out.

Reference: Shachtman, Noah (2004). “NASA Funds Sci-Fi Technology.” Wired News, May 7.

Technology and Economic Progress

Economist Michael Mandel asks* whether we should be “optimistic or pessimistic about our economic destiny.” His answer is that it “is inextricably linked to our ability to come up with more technological breakthroughs that equal the Internet in magnitude,” on the grounds that economic progress has historically depended mainly on technological advances, and that periods of innovation drought — such as the 1970s — have coincided with lower growth.

“Without cost-saving breakthroughs in medical science, it won’t be possible to supply health care to a generation of aging Americans without bankrupting the young. Without new industries created by innovative companies, it won’t be possible to generate enough good new jobs to replace the ones going abroad. Without breakthroughs in energy production and distribution it won’t be possible to provide inexpensive power for industrialized countries in the developing world. And without rapid growth, it won’t be possible to simultaneously pay for national defense and the retirement of the baby boomers.”

* In his book Rational Exuberance: Silencing the Enemies of Growth and Why the Future Is Better Than You Think.

Reference: Gehl, John & Suzanne Douglas (2004). “Worth Thinking About: Rational Exuberance.” NewsScan, May 25.

Hype vs. Bad Timing

Shopping for groceries over the Internet flopped as a business in the US in the late 1990s, but like many innovations it did not die — it merely lay dormant for a while, and there are signs that the business is picking up again. Safeway’s online grocery business has “doubled the last two years and we expect it to double again this year,” said Safeway.com’s CEO. Peapod reports 150,000 active customers in Chicago and the East Coast. Freshdirect.com serves 100,000 active customers in New York — “a fourfold increase from a year ago.”

A benefit to the consumer is that shopping lists can be stored online for easy purchasing next time. Delivery can generally be arranged within a two-hour window to keep people from having to wait at home all day. Most charge less than $10 for delivery.

Online groceries in the US will make US$2.4 billion in sales in 2004, 0.4 percent of the total grocery market of $570 billion, says Jupiter Research. By 2008, sales will rise to $6.5 billion, or 1 percent — an annual growth rate of 42 percent.

Kroger and Wal-Mart are avoiding the business, for now. Some that have tried and failed may have failed because they were poorly run rather than because the business is inherently unsound.

Reference: Straziuso, Jason (2004). “Internet Groceries Continue to Expand.” Associated Press via Excite News, May 17.

Job Outsourcing

Forrester Research says the offshore outsourcing of US white-collar jobs is happening faster than it estimated in 2002. The annual projected loss is only a tiny fraction — a fifth of a percent — of the overall job market; but still, Forrester says 830,000 white-collar jobs will go overseas by 2005. By 2015 the number is expected to rise to 3.4 million.

Reference: Hilsenrath, Jon E. (2004). “Forrester Revises Loss Estimates To Overseas Jobs.” Wall Street Journal, May 17.

Cloning the Clones

Japanese scientists have successfully “serially cloned” a clone of a clone of a large mammal, a bull. It took several hundred tries to get two calves, one of which died shortly after birth, but the other is now 4 years old and appears to be healthy and fertile.

The cloned clone may benefit by having been cloned from a young animal, whereas its “parent” was cloned from an old animal. Old cells don’t grow as well in culture as young cells, because their telomeres — the chromosomal tips that shorten with each cell division and end in cell death when the telomeres are gone — are longer, therefore young cells have longer to live. However, while Dolly the sheep was found to have shorter than normal telomeres, she died of an infection, not of old age, and most cloned animals have telomeres of normal length and in fact telomeres get longer in each generation of clones.

Reference: Philipkoski, Kristen (2004). “Bullish Hopes for Serial Cloning.” Wired News, May 24