Notes > NoEH

Notes on Engineering Health, December 2023: ICYMI 2023 Edition

Jonathan Friedlander, PhD
Geoffrey W. Smith

Jonathan Friedlander, PhD & Geoffrey W. Smith

December 27, 2023

As is now a tradition, our last missive of the year is an opportunity for us to reflect on the topics we covered earlier in the year in our Notes on Engineering Health and see if any updates are in order.

In January, we wrote about the ongoing talk of the town—the rise of generative AI capabilities and their influence on science and medicine. ChatGPT, released a little over a year ago, has already passed medical licensing exams, delivered improved diagnostic abilities, and led the way to a furious race for preeminence among various tech firms’ chatbots. The increasing prevalence of generative AI has worried some researchers that ill-informed use of these models is driving a deluge of papers with claims that cannot be replicated, or that are wrong or useless in practical terms. The scientific and medical communities have yet to fully adapt to the way to use these newly developed capabilities, but the apparent rush to adoption remains somewhat frenzied.

In February and August, we dove into the genealogies of two technologies: fermentation and the light microscope. Through interrogating their storied past and technical advancements, we explored how serendipity, ingenuity, and perseverance expanded human knowledge and improved the lives of millions. Beyond the direct benefits of these technologies, the products they made possible (from liqueurs to vaccines) and the images they produced inspired scientists and citizens to seek more.

To better understand our healthcare system, we spent some time reading about the health insurance industry. In March and October, we looked at two different facets of health insurance in the US. First, we tried to understand how our current system, where employers buy health insurance for their employees, came to be. A post-Second World War historical accident set the framework place, and a set of strong incentives solidified it into the system we know today. In the following post, we took a closer look at the payer structure in the US and abroad, highlighting the pros and cons of a universal payer system (with one or more payers) versus a hybrid model. And we noted some of the strategies payers put in place to tackle the ballooning administrative cost of delivering care to patients.

In April, we wrote about xenotransplantation, the ever-lasting dream to transplant an organ from one species to another. Since we wrote, the understanding of the mechanisms by which the body recognizes something as self has kept expanding and translated into new genetically modified animals better suited to serve as organ donors to humans. The latest experiment was performed in August by a team from NYU Langone Transplant Institute and showed the pig kidney performing optimally after 32 days in a man declared dead by neurologic criteria. This was the longest period that a gene-edited pig kidney has functioned in a human, and the latest step toward the advent of an alternate, sustainable supply of organs for transplant. These encouraging results make the proponents of xenografts hope for a first clinical trial in the near future.

In June, a year after the Supreme Court of the US overturned Roe vs. Wade and abortion became illegal in a number of states, we wrote about Women’s Health and the need to increase focus and funding in order to better understand the biological, physiological, and socio-cultural differences between men and women, and to reduce the vast gender gap in medical research. Recent efforts at the federal level have moved in the right direction.

In July, in the midst of a scorching hot summer, we explored the effects of heat on the human body. As the year ends, it has become clear that 2023 has been the hottest year on record. It also means that the excess deaths due to heat will beat another record. These grim achievements compel us to make every effort to better understand how to adapt the practice of medicine, the technologies we develop, and the decisions we make as a society to the unmistakable truth of climate change.

Finally, 2023 has been a year of growth for Digitalis Ventures. We added incredibly bright talents to the team who have contributed to our group’s practices—venture investment, technology development, and company creation. They also contributed to the content creation we have been engaged in with passion and enthusiasm.

A newsletter dedicated to animal health, Notes on Animal Health, led by Cindy Cole, DVM, PhD, released its inaugural edition arguing for a broad definition of health that includes humans and animals, producing better outcomes for everyone. And in its second edition explored the battle between pets and pests and its impact on our health.

Jacob Oppenheim, PhD, an entrepreneur-in-residence at the firm, has contributed by merging his blog into our own efforts as our Engineering Biology series. Starting from the question "Are we learning from data?”,  he wrote about what we actually mean by this question; the informatics tools, cloud systems, and ways of working we need to leverage data effectively; how a data science team fits into a biotech company, how to grow into using machine learning, and where to apply it; the two types of machine learning and how they map onto problems in industry as well as where they lead to nowhere. Going forward, he's interested in writing about how our ability to engineer biological systems implies new ways of working through software + digitization and full integration with data + ML. He closed the year with a series on the false promises of big data and a conceptual reframing to protect privacy and important uses. Engineering Biology will return monthly in 2024 beginning in the first week of the year.

The whole team at Digitalis Ventures wishes you a happy, healthy, and peaceful New Year.

– Jonathan Friedlander, PhD & Geoffrey W. Smith

January 2023 — This Text Was NOT Written by AI
February 2023 — Some Notes on Fermentation
March 2023 — Notes on Employer-Sponsored Health Insurance
April 2023 — Notes on Xenotransplantation
May 2023 — Notes from Jacob Oppenheim & Travis Hughes
June 2023 — Notes on Women’s Health
July 2023 — Notes on Heat and Humidity
August 2023 — Notes on Seeing Biology
September 2023 — Notes on Frailty
October 2023 — Notes on Payers
November 2023 — Notes on How We Drug The Brain

First Five
First Five is our curated list of articles, studies, and publications for the month.

1/ The Stripes of the Tiger
The question of how organisms develop complex patterns and shapes is never more powerful than looking at a tiger’s, a leopard’s, or a zebra’s fur. A team of researchers published an explanation using simple physical and chemical mechanisms to tackle this complicated biological phenomenon in Science Advances. They show that genetics alone do not explain where exactly the spots will develop on a leopard. The team used computer simulation to prove their theory, suggesting that when chemical agents diffuse through tissue, they also drag pigment-producing cells with them through diffusiophoresis. The sharp patterns are due to differences in concentrations in different parts of the tissues.

2/ Breathing Memories
While the importance of sleep in consolidating memories had been established, the role of breathing in this process during sleep was unclear. A team of neuroscientists recently published in Nature Communications that respiration modulates the emergence of sleep oscillations and thus memory formation. This study highlights the role of brain-body interactions during sleep and points the way to better sleep and learning.

3/ Debunking the Myth of the Hunting Man and the Gathering Woman
The theory by which men evolved to be hunters and women to be gatherers is getting some heavy pushback. Promulgated in the late 1960s, this theory doesn’t withstand a fresh look at the evidence. There is both physiological and archeological evidence that women were fierce hunters. Scientists going over physical attributes and hormonal differences between men and women give a fresh narrative on the division of labor in early humans!

4/ Writing History Using Archeology and Genetics
Rewriting the history of populations using Ancient DNA has become more popular. When combined with rigorous archeological findings, it is able to create powerful new narratives. This time a team has focused its research on the Balkan Peninsula to write a new history of the influence of the Roman Empire on the region. By presenting genome-wide data from 136 Balkan individuals dated to the 1st millennium CE, they showed in a Cell paper that despite the Roman Empire's extensive military and cultural influence on the Balkan peninsula, there was no genetic evidence of Iron Age Italian ancestry. Instead, there seemed to have been successive waves of migrations from Western Anatolia, central and northern Europe, and the Pontic-Kazakh Steppe during the Empire's reign.

5/ Daydreaming the End of the Year
Daydreaming, or having the brain tune out the world and wander to an old memory, is a common yet poorly understood phenomenon. A team of scientists set up an experimental way to better understand it. By imaging the calcium activity of thousands of excitatory neurons in the mouse lateral visual cortex in a quiet waking state, they described in a Nature paper that occasionally, these neurons fired in a pattern similar to one that occurred when a mouse looked at an actual image, suggesting that the mouse was thinking—or daydreaming—about the image. Whether these “daydreams” occurred largely influenced the future reaction to the image. This preliminary research may help shape our understanding of cognition and ways to alter it!

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