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James C Walters

Dr. Rand

Rhetoric 102

2 May 2008

Medicine of the Future

Modern medicine has changed our life expectancies greatly and, in effect, the

course of history. As programs like Barbara Walters “Live to 150: Can . . . Can You Do

It?” begin to enter the mainstream, we begin to wonder: “How long can we really walk

this planet?” No longer is the question “Would I really want to live past 100 years old?”

just an entertaining quandary; modern medical breakthroughs—eking eerily close to

science fiction’s wildest fantasies—allow us to be part of a world we never thought

possible. Mechanical limbs, cryogenic freezing, and chemicals that mimic the fountain of

youth are a few of the more quixotic developments that are currently being undertaken. If

medicine progresses at the rate it is going now, you may no longer ask “How long can I

live?” but— “How long do I want to live?”—which has Frankensteinian overtones and

questions the ethical boundaries of science. Of course, this is just speculation, but our

technological capabilities have expanded exponentially and are seemingly endless in

theory and application. Furthermore, breakthroughs in medicine are taking place

constantly. Implantation of mechanical organs, revolutionary cellular biology, organ

farming, and even regrowing organs are the more realistic aims for projects that are

currently under development. Regenerative medicine, in accordance with modern

stem cell experimentation, is one of the new fascinating methods for increasing the

human life span, but at the moment it may hold the most promise. It is exciting to be

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alive in this era, not only because of the abundance of technology, but also because this

technology directly affects our own time on this planet.

Understanding Regeneration

“Individual survival in the face of environmental insults and entropic processes

requires a mechanism that can maintain the functional integrity of tissues. That

mechanism is regeneration” (Stocum 1). Without the ability to regenerate certain parts in

our bodies, we would not survive for very long. As one of the “great masters of

regenerative biology,” Richard J. Goss asserts: “If there were no regeneration there could

be no life” (qtd. in Stocum 1). Evidently, our bodies go through regeneration constantly

—regenerating cells and even various types of tissues—what David L. Stocum denotes as

“homeostatic regeneration,” or maintenance. Stocum also mentions that we lose (in terms

of survival) as individuals, but win as a species (through reproduction) (1). Sherwin

Nuland, writer of the book How We Die, would argue that death is a necessary and

inevitable aspect of human life. Best put by the blind poet, Homer, in his epic poem, The

Iliad: “As the generation of leaves, so is that of humanity. The wind scatters the leaves on

the ground, but the live timber burgeons with leaves again in the season of spring

returning. So one generation of men will grow while another dies” (6.146-50). Thus,

death should not be feared because it is a necessary part of human life. David L. Stocum,

however, makes the distinction that nature provides us with fibrosis, which “patches a

wound with scar tissue whose structure is quite different from the original tissue

structure” (1). In order to discover what this difference was, I interviewed Dr. Ed Devlin,

Professor of Biology at Hampden-Sydney College, who explained: “[Scar tissue] doesn’t

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have as much flexibility or as much elastic fiber [as normal skin]. . . . So even though

they’re [the scar tissue cells] made up of the same material that you see in the rest of the

body, their orientation and organization can make them a little bit less flexible.” Thus, the

integrity of scar tissue is not quite as strong as regular tissue and, therefore, less effective.

On the one hand, we may not be able to regenerate another organ or limb, like some

amphibians, but on the other hand, Mother Nature has not left us defenseless. As Stocum

explains: “Repair by fibrosis maintains the overall integrity of the tissue or organ, but at

the expense of reducing its functional capacity” (1). In short, it’s like fixing a hole in a

metal pipe with duct tape (probably more effective than duct tape).

According to Stocum, regeneration takes place at three levels: molecular, cellular,

and the tissue level (4). This explains why we can regenerate necessary bodily fluids, like

blood, but why we can not regenerate whole organs. An example of the molecular level

would be adjustment of molecules after protein synthesis (4). In terms of cellular

regeneration, Stocum adds: “a single carrot cell can regenerate a whole carrot” (4).

Unfortunately, tissue regeneration is not as simple, requiring three prerequisites:

mitotically competent cells (“cells that have the receptors and signal transduction

pathways to respond to a regeneration-permissive environment”), the “[injured]

environment of the tissue must contain the necessary signals to promote the proliferation

and differentiation of these cells in an organized way,” and last, circumstances that

inhibit cell regeneration must not be present (4). Put simply, tissues must have cells that

can communicate well with other cells, enough of the injured area must remain intact,

and there can be no extenuating circumstances that would otherwise inhibit regeneration.

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The salamander is a master at the art of limb regeneration; it can regrow a limb as

many times as is needed; therefore, it is our paradigm for regeneration techniques:

When the tiny salamander limb is amputated, blood vessels in the remaining stump

contract quickly, so bleeding is limited, and a layer of skin cells rapidly covers the

surface of the amputation site. During the first few days after injury, this so-called

wound epidermis transforms into a layer of signaling cells called the apical

epithelial cap (AEC), which is indispensable for successful regeneration. In the

meantime, fibroblasts break free from the connective tissue meshwork and migrate

across the amputation surface to meet at the center of the wound. There they

proliferate to form a blastema—an aggregation of stem like cells that will serve as

progenitors for the new limb. (Muneoka, Han, and Gardiner 57)

According to Muneoka, Han, and Gardiner, writers for Scientific American: “A loose

arrangement of cells called fibroblasts holds all these internal tissues [skeleton, muscles,

ligaments, tendons, nerves, and blood vessels] together and gives the limb its shape” (57).

But when a limb or other large part of our body is amputated, fibroblasts do not migrate

to the affected site like they do in salamanders. The biggest question, in regards to

salamanders, that plagues our mind is “How do their regenerating parts know where to

go?” According to Dr. Devlin, when the salamander limb is severed, the cells in the

affected area dedifferentiate, becoming more like stem cells. Dr. Devlin mentions that the

salamander’s body pumps ions to the “stump,” which “generates a small electric current

that helps orient the cells for regeneration. Moreover, Dr. Devlin adds that scientists have

conducted experiments by hooking small batteries and sending a current to the limb,

which helps speed up the process of regeneration.

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Certain organs and tissues regenerate constantly in the body. Dr. Devlin explains:

There’s quite a few parts of the body that regenerate. The body has a number of

stem cell populations . . . about every two weeks you replace all of the epidermis

[skin]. . . . The liver’s a great organ of regeneration. Every time a student partakes

in drinking, and takes in various types of toxic substances, the liver works very

hard to detoxify that stuff, and a lot of cells are killed off; but they have the ability

to regenerate themselves. The lining of the gut . . . regenerates itself; in about two

weeks, it will form a whole new gut. In addition to that, things you wouldn’t think

of as being regenerative tissues . . . bones . . . even though the cells don’t

regenerate, a lot of the tissue regenerates.

Indeed, many types of organs are constantly regenerating. I think it’s more intriguing that

the bones, even though the cells don’t regenerate, regenerate over time.

Interestingly enough, one part of the human body is known to hold regenerative

capabilities: the fingertip. Evidently, regenerating the fingertip only requires the person to

“clean the wound” and cover it with a “simple dressing.” According to Muneoka, Han,

and Gardiner: “If allowed to heal naturally, the fingertip restores its contour, fingerprint

and sensation and undergoes a varying degree of lengthening” (61). The same

phenomenon is recorded in mice. Further, Lee Spievak, a man who accidentally cut off

an inch of his middle finger with a model airplane propeller, regenerated his entire finger

back; incidentally, Spievak used a protein powder that may have helped his finger

regenerate (Muneoka, Han, and Gardiner 60).

Recent Breakthroughs in Regenerative Medicine

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The potential for this new form of medicine is seemingly boundless in its

application regarding wound treatment as well as slowing the overall aging process. In a

more lucrative approach, the market for this new medical technology is ubiquitous;

everyone wants to remain youthful—and in years to come—no one will (have to) live

without body parts, ranging from the spinal cord to the kidney—as long as they can

afford it. These kinds of developments are daunting in their complexity, yet much simpler

than most surgical procedures in their physical applications. In fact, Dr. Stephen

Richardson, University of Manchester, England, regarding spinal trouble, asserts: “What

we envision is a one-stop shop for treatment. You’d come in, get these cells implanted

into your spine, and end up with regenerated new tissue. And that would be it, for life. . . .

The patient could go home the same day as the procedure” (qtd. in Weiss n. pag.).

Furthermore, regenerative medicine would put a less dismal overtone on organ

transplantation. Dr. Anthony Atala, chairman of the urology department at Wake Forest

and president of the North American Tissue Engineering and Regenerative Medicine

International Society, explains that patients wouldn’t have to wait “for someone to die so

they can live” (qtd. in Parson F5). “A more immediate goal is to improve upon a

multitude of smaller therapies: transplantable valves for ailing hearts, cell-and-gel

preparations for crushed nerves, injections of skeletal muscle cells for urinary

continence . . .” (Parson F5). Interestingly enough, these aforementioned projects are

already being tested and applied: “That same year [1999] he [Atala] inserted his bladder

scaffolds into the first of seven children with spina bifida. . . . ‘All seven continue to do

well. . . . The oldest of the new bladders has functioned for more than six years’” (qtd. in

Parson F5).

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According to the U.S. Department of Health and Human Services, the number of

American adults suffering with disabilities or “limitation(s) in usual activities due to

chronic conditions” is 34.4 million; that’s 11.8 percent of America, not including

children. The Disability Insurance Trust Fund Expenditures for 2007 was 95,865 million.

The number of Americans who have been diagnosed with heart disease is 24.1 million;

that’s 11 percent of America. Heart disease is ranked as the number one cause of death in

the United States; it caused 652,486 deaths by April 1st 2008. The number of people on

the waiting list for organ transplants is 98,796. Americans with disabilities may become a

thing of the past; imagine 34.4 million more people not only being able to work, but not

drawing welfare. Moreover, if regenerative medicine reaches its full potential, heart

disease will no longer be an issue because you would be able to either regrow clogged

arteries or even an entire heart! Unfortunately, I can already hear what the lethargic,

obese portion of America will be saying: “I don’t need to exercise honey: I’ll just get a

new heart. I’ve already been through two already.” When regenerative medicine comes

into full-swing, all these statistics will change dramatically; incidentally, Dr. Devlin

believes that this kind of technology (at least for a while) will be accessible mainly to

people who can afford it.

Many burn victims suffer the loss of their family, home, and skin. Victims of

third-degree burns are branded by fire; in many cases they lose their dignity because of

their physical appearance and suffer from constant physical torment. Luckily, tissue-

engineered skin is a reality for regenerative medicine, which could provide a gleam of

hope for third-degree burn victims. Tissue engineered skin has been developed because

autographs (removing skin from another part of the victim’s body) cause much “pain,

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infection, and scarring” (Priya, Jungvid, and Kumar 105). Interestingly enough, as S.

Geetha Priya, Hans Jungvid, and Ashok Kumar, biological engineers, write: “The

application of tissue engineering progress in medicine is discussed according to the origin

of germinal layers during embryonic development. Thus engineered tissues could reduce

the need for organ replacements” (105). That might reduce a hefty chunk of the 98

thousand people on the organ transplant waiting list. Another problem with human

autographs is that they are costly and “limited and therefore cannot be used in case of

extensive third-degree burns” (105). Unfortunately, as of now, there are problematic

issues with tissue-engineered skin: “Tissue-engineered skin is one of the most advanced

tissue constructs, yet it lacks several important functions; hair follicles, sebaceous glands,

sweat glands, and dendritic cells” (Priya, Jungvid, and Kumar n. pag.). Dr. Devlin argues

that you could probably get by without hair follicles and sebaceous glands. As for sweat

glands, Devlin asserts that if the skin is going to an area of the body that does not regulate

body temperature, such as the armpit, sweat glands would probably not be necessary.

Regarding dendritic cells, Dr. Devlin reveals that those are the cells associated with

pressure and nerve cells, so you do not necessarily need those, depending, once again, on

what part of the body is being addressed. Evidently, the tissue-engineered skin of modern

medicine (2008) has some problems to work out until it is reliable. Nonetheless, it does

have the advantage of being less painful than normal skin grafts, potentially more

effective and faster, and it does not require a donor. As Priya, Jungvid, and Kumar

remind us, skin: “protects against toxins and microorganisms in the environment and

serves to prevent dehydration of all non-aquatic animals” (119). So it goes without saying

—skin is very important to humankind. Furthermore, there exists no current engineered

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skin that “completely replicates normal uninjured skin,” but “As engineered skin

substitutes improve in quality, they will become more similar to native skin autographs”

(119).

Moreover, the exciting research for regenerative medicine is expanding and

economizing; since businesses are racing for the finish, it will not be long until this

technology reaches the mainstream. Dr. Devlin notes that private companies do a lot to

further the research in biomedicine, as well as the non-profit organizations and the federal

government. In a 2007 issue of Drug Week, Geoff MacKay, CEO of Organogenesis, Inc.,

remarks: “Our field has now transitioned from visionary science fiction, into exciting,

proven science. In order to ensure the technology reaches patients, regenerative medicine

companies need to evolve into successful commercial entities” (“Gene Therapy” 295). Ya

gotta love capitalism.

There are, nonetheless, some moral concerns regarding this research because a

great deal of the experimentation is done with embryonic stem cells. “The era of human

embryonic stem cells dawned in 1998 in James Thomson’s lab at the University of

Wisconsin” (Cookson 4). Since the discovery of embryonic stem cells in Thomson’s lab,

regenerative medicine was born and with it the new, highly-controversial era of wasting

stem cells to save lives; however, organizations like The Coalition for the Advancement

of Medical Research (CAMR) are working to sidestep these ethical landmines. CAMR’s

website explains that the organization is “dedicated to being a national, collective voice

on Capitol Hill and in the media for those who believe that regenerative medicine,

including embryonic stem cell research, holds the key to providing American families

with hope for the future” (n. pag.). Personally, I believe that, as long as no one is being

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hurt—since the fetus is already dead—there is no moral-conflict in the use of aborted

fetuses (especially fetuses that are aborted during the first trimester) as a means of

progressing scientifically and potentially saving millions of lives. Dr. Devlin explains:

“Mostly they don’t use the later aborted fetuses though because if your wanting to get a

stem cell population, you don’t want a population that has started to go down the

developmental pathways . . .” Fortunately, science may not even have to meddle with this

particular ethical dilemma.

Science is sidestepping these ethical landmines at an unstoppable speed.

Advanced Cell Technology, Inc. has discovered an interesting way to deal with the stem

cell controversy: cloning embryonic stem cell derivatives (“Regenerative Medicine”

303). But much more fascinating, as Joseph K. Vetter writes, in an section entitled

“Medical Breakthroughs ’08,” with the equally fitting title “Stem Cell Stunner”: “[A]

Japanese team led by Shinya Yamanaka, demonstrated that with a little coaxing, the iPS

cells [induced pluripotent stem cells], could transform themselves into different types of

human tissue” (145). This explains why Reader’s Digest properly dubs this finding

“Breakthrough of the Year.” The significance of this experiment is tremendous in terms

of regenerative medicine because these cells were created using skin cells rather than

embryonic stem cells; therefore, these cells could be used for regenerating all sorts of

tissue, and, theoretically, scientists could produce an “unlimited supply” (Vetter 145).

This breakthrough brings with it endless possibilities for healthcare. Regarding the

locating of adult stem cells, Dr. Atala chuckles: “The irony of the whole field was that

people were looking for cells according to the properties of the tissues they resided in . . .

but they were overlooking the tissue’s regenerative cells, the cells that grew best, because

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they were immature and didn’t yet have those properties” (qtd. in Parson F5). According

to Vetter: “The iPS cells even have an advantage over embryonic: Since they’re derived

form the patient’s own cells, there’s no risk of rejection” (145). Put best by Dr. Alan

Retik, chief of urology at Children’s Hospital Boston: “Using a patient’s own tissue in

this fashion for self-repair is ‘inevitable. . . . It has so many advantages over conventional

surgical methods that ultimately it will be the preferred method’” (Parson F5). Even more

exciting: “[The Japanese team tried to manipulate] heart cells. Just 12 days after mixing a

sample of iPS cells with a cocktail of proteins in a petri dish, the scientists watched as

clumps of newly formed cardiac cells started beating like a human heart” (145). This is

perhaps the most interesting and exhilarating news of the year; if scientists can create

heart cells, and the heart is the most important organ, second to the brain, in terms of

survival, then that only leaves the brain, and we could, theoretically, live—forever. Once

again, this brings up the ethical ruminations left by Mary Shelly after reading her novel,

Frankenstein.

Conclusion

Regenerative medicine and other modern medical breakthroughs may provide a—

once unfathomable—extension to the human life span. While regenerative medicine is

certainly the most feasible and hopeful type of futuristic medicine, others exist.

Resveratrol, a phytoalexin found in substances such as red wine, has recently been

studied because of its beneficial effects on heart disease, immunity, cancer, and other

medical uses (Shazib n. pag.).

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Creeping even more toward science-fiction based ideology, the age of the cyborg

looms ever nearer. In fact, a new development, an artificial lung, is now under

development, thus further reducing the need for organ transplantation. Robert Bartlett,

professor emeritus of surgery at the University of Michigan, claims that his “BioLung”

relies on the heart to pump oxygen and blood flow throughout the body (DiCesare 147).

Unfortunately for Dr. Bartlett and his team, it might appeal more to people to grow a new

lung than to insert a mechanical one inside their body. On the other hand, “The device

can even remain in place following a transplant, until the donor lungs are fully

operational,” (DiCesare 147) which would mean that there would still be use for this

technology in surgery.

Biologist J. Craig Venter, PhD and founder of the Institute for Genomic Research,

has recently decoded his own genome (Tyranski 148). This is an interesting development

because it can mean a quantum leap forward in preventative medicine. Dr. Venter found

he was predisposed to Alzheimer’s, diabetes, blindness, and heart disease. When asked if

he was worried, Dr. Venter replied: “Not really. I’ve tried to change my diet and get more

exercise. And I started taking a statin to lower my cholesterol” (qtd. in Tyranski 148). Dr.

Venter is an excellent example of what identification of the various genomic

predispositions can help us do; even if we can not change our susceptibility to a particular

ailment, we can do our best to prepare for it and possibly prevent it entirely.

As Dr. David Stocum argues: “Regenerative medicine is on the cusp of becoming

a millennial revolution. . . . Twenty-five years ago, patients paralyzed as a result of spinal

cord injuries were told . . . that there was no hope. Like other dogmas, this one, too, has

crumbled under the weight of scientific advance” (Stocum 425-426). Regenerative

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medicine may very well be the answer to all our modern medical problems, at least until

the next millennia when people are concerned with living to 1000 years. Dr. Devlin

believes both cybernetic limbs/organs and regenerative technology will play a major role

in the next phase of medicine—as well as preventive medicine. I can see it already:

Tonight on ABC, Barbara Walters “Live to 1500 . . . Can You Do It?” However, Dr.

Devlin dispels these myths: “Every time [the cells of our body] divide, a little end of the

chromosome, called the telomere, is chopped off. As the cells divide, that telomere gets

shorter and shorter and that cuts into genes that are useful to the organ. . . . Also, DNA is

damaged over time . . . those damage sites accumulate over time . . . eventually those

damage sites go into parts of the DNA that code for the cell cycle.” As we all know,

when the cell cycle gets out of control, cancer develops. But Dr. Devlin also mentioned

that, in evolutionary terms, we are only supposed to live to about 30-40 years, so who

knows what technology holds in store for us.

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CAMR. Coalition for the Advancement of Medical Research. CAMR: The Coalition for

the Advancement of Medical Research. 2001. 14 Apr. 2008

<http://www.camradvocacy.org>.

Cookson, Clive. "Era of 'regenerative medicine'.(WORLD NEWS)." The Financial

Times (Nov 21, 2007): 4. Academic OneFile. Gale. Hampden-Sydney College. 15

Apr. 2008 <http://find.galegroup.com>.

Devlin, Ed. Personal Interview. 17 Apr. 2008.

DiCesare, Ann. “An Artificial Lung.” Reader’s Digest. Mar. 2008: 147.

“Gene Therapy; CEO of World’s First Profitable Regenerative Medicine Company,

ORGANOGENESIS, Details Path to Profitability for the Regenerative Medicine

Field.” Drug Week. 25 May 2007: 290. LexisNexis Academic. LexisNexis.

Hampden-Sydney College. 14 Apr. 2008 <http://www.lexisnexis.com>.

Homer. The Iliad. Chicago: Chicago, 1951.

Muneoka, Ken, Manjong Han, and David M. Gardiner. “Regrowing Human Limbs.”

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Parson, Ann. "With Special Scaffold, a Tissue Engineer Sows Cells and Grows

Organs." The New York Times (July 11, 2006): F5(L). Academic

OneFile. Gale. Hampden-Sydney College. 15 Apr. 2008 

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Priya, S. Geetha, Hans Jungvid, and Ashok Kumar. "Skin tissue engineering for tissue

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Shazib Pervaiz, "Resveratrol", in AccessScience@McGraw-Hill,

<http://www.accessscience.com>.

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