Risky enough business?

I?m an obvious beneficiary of medical technology. Without the computer surgically embedded in my skull, I?d be totally deaf. The device, called a ?cochlear implant,? routes past my damaged inner ear by triggering my auditory nerves with sixteen tiny electrodes coiled up inside my cochlea. It?s not a cure, though, any more than glasses cure vision loss. It?s a prosthesis, a workaround. Compared to the extraordinary delicacy and precision of naturally evolved organs, it?s clumsy. It?s like

By | February 8, 2006

I?m an obvious beneficiary of medical technology. Without the computer surgically embedded in my skull, I?d be totally deaf. The device, called a ?cochlear implant,? routes past my damaged inner ear by triggering my auditory nerves with sixteen tiny electrodes coiled up inside my cochlea. It?s not a cure, though, any more than glasses cure vision loss. It?s a prosthesis, a workaround. Compared to the extraordinary delicacy and precision of naturally evolved organs, it?s clumsy. It?s like fixing a spider web with yarn. But someday scientists may learn to coax the body into repairing its own damaged parts instead of creating technological fixes that require a constant supply of batteries. That?s what makes stem-cell research so exciting. Forget prostheses. How about a cure? When I was offered the chance to attend this symposium I jumped at it, the way Moses would if offered a quick tour of the Promised Land. What makes stem cells exciting is that they are pluripotent: with the appropriate chemical triggers and physical nudges and pushes, they?ll turn into any kind of cell there is. Several panelists noted that with the help of stem cells, the body is constantly remaking itself -- skin, intestines, red blood cells. In many cases, the body degenerates and ages not because it has lost the ability to create stem cells, but because it has lost the ability to trigger the stem cells it has. Find those triggers, learn how to activate them, et voila. The conference was kicked off by San Francisco mayor Gavin Newsom, who looks exactly the same in real life as he does on TV and speaks so fluidly that I started wondering where the teleprompter was hidden. He was clearly delighted that linkurl:California?s Proposition 71;https://www.the-scientist.com/news/display/23097/ would pump $3 billion into funding for stem-cell research. He also clearly hoped some of that money would end up here in San Francisco instead of in, say, L.A. or San Diego. Newsom touched on what would prove to be a recurring theme of the day: risk. He spoke approvingly of the virtues of ?having a risk orientation.? Several other speakers after him said much the same thing. Risk is a good thing. Risk pays off. Risk is part of the American Way. Which worried me. Risk is like sex: if you talk about it a lot, odds are you aren?t doing it. In fact, at least three of the conference speakers had left the U.S. to pursue their research. Is the Bush administration?s medieval attitude toward science to blame? Perhaps it?s too obvious to mention anymore, but I heard no one making that claim in detail. One panelist commented that pressure from the religious right had ?cast a pall? over other states? efforts to emulate California?s Proposition 71. Another disapprovingly quoted one of Bush?s speeches on stem cells, saying that a real culture of life would not pass up opportunities to alleviate suffering. Apart from that, the day?s politics were muted. But there were plenty of professional risk-takers in the room. Anula Jayasuriya (M.D., Ph.D., M.B.A.) of Draper Fisher Jurvetson cogently outlined what linkurl:venture capitalists;https://www.the-scientist.com/article/display/15805/ look for when investing in stem-cell companies: 1. A disruptive technology. 2. Proof of concept. 3. Reasonable time-to-market and costs. 4. Potential for financial return. 5. A business model. 6. An exit strategy ? that is, how the VC ultimately cashes in. Curiously, Jayasuriya argued that venture capitalists are not, in fact, risk takers. The word ?risk? is probably relative here. Nonetheless, Antoun Nabhan of Sagamore Bioventures told the audience more about how VCs evaluate companies. The bar has been set much higher than it was during the dot-com boom days, he said. These days, a biotech company can?t just have a good idea and a business plan; it has to have gotten as far as Phase II or even Phase III clinical trials. Antoun went so far as to emphasize that venture capitalists look for ?a highly probable outcome.? Fair enough, when you?re putting up your own money. However, I can?t help thinking that by Jayasuriya?s criteria, the cochlear implant pioneers of the early 80s would never have gotten VC funding. In his memoir of designing the first commercial cochlear implant, Graeme Clark of Australia lists five obstacles that most of his peers had considered insuperable. He quite literally stood on street corners shaking tins for change to raise money. When he was performing his first cochlear implant surgery, he knew that he was putting his career on the line. Compared to that historical record, the rhetoric of the VC people struck me as being, well, risk-averse. But we also heard from someone who takes, you might say, risks squared: Peter Diamandis, president of the X Prize Foundation. What was he doing here? I was dying to know. I?m enough of a space buff to know off the top of my head that the $10 million Ansari X Prize was offered to whomever could launch a manned rocket 62 miles high ? and do it twice with the same spacecraft within two weeks (thus proving reusability.) Burt Rutan?s company, Scaled Composites, won the prize in October 2004. But what were the X Prize people doing here, at a stem cell conference? Diamandis told us that Lindbergh didn?t just fly solo across the Atlantic because he could. He was chasing prize money ? in this case, a $25,000 purse. Prizes motivate competition. Competition fosters innovation. What had been done for space, Diamandis hoped, could be done for medicine. He was an M.D., Diamandis reminded us. He had a personal interest in stem cell research. During a break I sought out Keith Adam Powers, the X Prize Foundation?s VP of strategy and business development, to learn more. He told me that the X Prize people ultimately hope to support 10 to 15 prizes in fields such as energy, medicine, education, and the environment. They?d be like the Nobel Prizes, except they?d drive innovation instead of rewarding it after the fact. I mulled that over. ?The Ansari X Prize had an easily verifiable goal,? I said to Keith. ?You either get 62 miles high or you don?t. But biology research doesn?t usually offer you clear-cut outcomes like that. What kind of goal are you proposing?? Good question, Keith said. In fact, they were at the conference to get input from people on just that. They were in a discovery process, where they were soliciting advice and putting together an advisory panel. They had to frame a goal that was scientifically valid and would capture the public imagination. They had to figure out a way of measuring whether it had been met. And they had to make sure that the measurement process would stand up to challenges from disgruntled losers. Keith shared one other tidbit of info with me. The X Prize Foundation was not done with space. It was just beginning. There would be more prize goals. The next one wasn?t decided yet, but it might consist of landing an unmanned spacecraft on the moon. I thanked Keith and headed off. At the coffee stand I ran into Alan Colman of ES Cell International in Singapore. At his panel, Colman had mentioned stem cell treatments for diabetes ? regrowing the islet cells in the pancreas. I asked him if he knew anything about regrowing hair cells, that is, the tiny cells in the cochlea that convert sound energy into electricity. He didn?t, but I ended up telling him about how electrical stimulation may someday be used to help cochlear nerve fibers connect up to regrown hair cells. Curing deafness might require a cochlear implant whose electrode array also delivers nerve growth factors to the cochlea through tiny holes. He told me that the same thing might be true for spinal cord injuries ? that electrical stimulation might help there too. I told him that the company that made my implant, Advanced Bionics, was also working on spinal cord implants to control pain. He perked up on hearing that, and we exchanged cards. Scientifically, the best part of the day was at the end, when the final panel presented new directions in research. Brian Cummings of UC-Irvine presented an elegant set of experiments on injecting human stem cells into mice to restore missing cellular components. He showed us a strain of mice born without the gene that makes myelin, the insulating sheath around nerve fibers. When such mice?s spines are damaged, they?re still able to partially recover; they can regain some hind leg function. But when they?re injected with human cells that make myelin, they recover to a much greater extent. The proof that it?s the human cells that are doing the job? Inject the mice with diptheria, a toxin that kills human cells but has very little effect on mice. The mice lose the extra progress they?ve made. Afterward I asked Dr. Cummings about auditory stem cell research, and he didn?t have much to tell me either. I?m not quite sure why auditory research wasn?t on the radar screen at this conference. Dr. Cummings suggested it might be harder to model in animal studies. Perhaps it?s an inherently harder problem; I know that one of the big problems is not so much getting hair cells to grow, it?s getting the nerve endings to hook up to them. But Dr. Cummings suggested that progress in other areas was likely to apply to ears eventually. But what can be done for deafness right now is extraordinary. Whenever I?m at conferences I feel a gleeful delight at being able to swim through noisy crowds conversing and trading business cards even though I?m biologically completely deaf. I do remarkably well in hypernoisy environments. The babble of voices melds into a featureless roar and the person I am talking with stands out like a sine wave, as easy to decode as newsprint. People often ask me if I am reading lips. I?m not aware of doing so. I?m getting a great deal of auditory information. Perhaps it?s supplemented by telepathy. But however I do it, I?m profoundly grateful. Without a cochlear implant, the life I live would be quite impossible. Had I lost the rest of my hearing in 1981 instead of 2001, my life as I had known it would have been over. The trait I like most about myself ? a springy, peripatetic curiosity ? would have withered under the weight of deafness. Today and every day I feel as I?ve come back from the dead, and the thrill of that has not faded. May the work that is done here grant other people new lives the way neurotechnology has for me.

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