Essay Coverstory Interview

What Does Breast Cancer Innovation The Healthcare

Technology Bring? Replaces Doctor Ambassador
P. 8 P. 14 P. 26

1
 88
Foreword
For this first edition of the U-Tech magazine, we dare
to take a glimpse into the future: Over the past couple of
years, medical technologies have been booming more
than ever, and they allow us to imagine what the doctor’s
offices of tomorrow might look like. To make this imagi-
nation a bit less blurry, we chose several very promising
medical innovations, and present to you their working
principles and their potential to change the medical sector.

Our cover story, which shows such a medical innovation, has

a particularly special meaning to us – with October, the inter-
national breast cancer awareness month, just having passed,
we want to take a moment to think about it. What happens
when you get diagnosed with such a disease? How does it feel?
But also, what does technology offer to help fight the disease?
The innovation we are focusing on in this issue could poten-
tially improve the lives of thousands of women and men wor-
4
ldwide, and definitely deserves some additional attention.
But the innovation market contains promising technologies
in a multitude of other fields as well. Cancer screening pills,
so small that they are not visible for the naked eye, or blood
measurement by means of light, are only two of many as-
tounding technologies that this magazine sheds a light on.

Above the impressiveness of all these new developments,

however, stands the task to innovate ethically and res-
ponsibly. With interesting and philosophical approaches
to the topic, we aim to leave you enthusiastic, but realistic
about medical innovation. So let’s dive into the doctor’s
offices of tomorrow, and see what the future holds for us!

Leonie Albrecht
Miriam Hinternesch
Monique Docter
Romee Lammers
Valentina Bartali

2
 Content

4 Needless Needles

8 What Does Technology Bring:

Better Life or Doom Scenarios?

14 Breast Cancer Innovation

Replaces Doctor

19 Human Positivity in a
Destructive Illness

20 Stem Cells: a Lifesaving Tool

23 Extremely Small Particles with

Extremely Large Potential

14 26 The Health Care Ambassador

28 How Organs-on-Chips can

Decrease Animal Testing and
Increase Drug Testing Efficiency

3
 Needless Needles
To test if preterm babies have jaundice, the painful heel stick method is
used. But why doing it with needles, if you can also do it with light?
Imagine a little baby, born 15 weeks too early. A
body so small, it fits in only one hand of the doctor.
During the day, his skin turns yellow, indicating that
he might have jaundice. To test whether this is the
case, the nurses have to make a cut in his little heel to
extract a drop of blood. They leave him with his pa-
rents, full of pain and with bruised heels. After three
hours of waiting, finally the results come in. But af-
ter five hours, the whole process has to start again.
This happens every day to preterm babies, ap-
proximately 8% of all the babies born in the
Netherlands. Since their organs do not function
optimally, they often suffer from jaundice, a di-
sease by which the skin turns yellow. This happens
when the amount of bilirubin, a yellow pigment
made during the normal breakdown of red blood
cells, is too high. For adults, jaundice is harm-
less, but for those preterm babies, it can cause
damage in their brains and it can even be deadly.
‘‘A preterm baby has only as
much blood as fits in an
espresso cup’’
To test whether a baby has jaundice or not, blood
is taken by means of the making a small cut, from
which the blood is extracted, which is call the heel
stick method. And not one-time, for some preterm
babies this has to be done three times a day. This
method is causes a lot of discomfort for the baby
in the form of pain and bruised heels, and it can
affect the neural system, which can lead to pain
syndromes later in life. Thereby, it also causes a
serious lack of blood. Envision an espresso cup.
A preterm baby has only as much blood as fits in
that cup. This means that when blood is subtracted
multiple times a day, there is not much blood left.
On top of that, it takes a few hours before the re-
sults are available, as it also needs to be analysed in
the laboratory. What if all of this could be solved?
4
Measuring light
Dr. Nienke Bosschaart, assistant professor Biome-
dical Photonic Imaging of the University of Twente,
came with an alternative. She developed a device
which can, by means of light, look through the skin
into the blood vessel of the baby and determine
how much bilirubin there is. This device makes use
of spectroscopy or, to be specific, Low Coherence
Spectroscopy (LCS). The device sends out whi-
te light, since white light contains all the colours.
When there is a lot of bilirubin in the blood, only
the yellow light will be reflected, since this pig-
ment is yellow. It works the same as when you see
a red wall: only the red light is reflected. Because
the bilirubin has a particular colour, the device can
determine the concentration by measuring how
much and how strong the yellow light comes back.
The bright side
“The medical motivation to develop this techno-
logy is the most important for me”, said Nienke
Bosschaart, Assistant Professor in Biomedical
Photonic Imaging of the University of Twente and
researcher of the innovation. This medical motiva-
tion consists of the reduction of risks in the me-
thod when compared to the current method, sin-
ce the method causes no pain to the babies, which
eliminates the risk of affecting the neural system
or causing a lack of blood. But also for the hos-
pital the new method can have several benefits.
First of all, the method can be cost-efficient. The
method of the heel stick costs €64,70 each time,
which among other things consists of the costs
of sending the blood to the lab in order to ana-
lyse it. The LCS method contains of less steps,
which results in less employees being involved,
and this makes the technology cost-efficient. Se-
cond, the results of LCS are given immediately,
which reduces the waiting time up to three hours.
Challenges
However, the method of LCS does not only have
benefits. In this stage of development, it is not yet
accurate enough to test it on the little babies. The
coming three years will be about developing a pro-
be in order to do the measurements directly on the
patients. Nevertheless, Bosschaart is optimistic
that in a few years, the technique will be accurate
enough to be applied in real life and will replace the
heel stick method. Consequently, once the techno-
logy is developed sufficiently, the next step is im-
plementing it in the hospital. This will be a long,
complex process with many costs on the short-
term, of which the exact number is still unknown.
“If the method would be performed more often
than necessary because it’s so easily performed, it
might not be cost-efficient after all”, said Monique
van Uum, Clinical Laboratory Technologist from
Rijnstate Arnhem. This quote illustrates a concern
of the new technology of analysts working with the
current technology regarding the new technology.
Replacing technology
Once this innovation can be implemented, it will
replace the method of the heel stick. But when is
an innovation worth the replacement of an older
technology? Regarding healthcare, and therefore
this case, the reason for replacement of an exis-
ting technology is often because it’s more cost-ef-
ficient, less harmful or safer for the patients. For
example, the replacement of the method of an
open-heart operation to placing a stent in the heart
via blood vessels. This innovation is cost-efficient,
because patients are allowed to go home after five
hours, and it’s a safer procedure. With regard to
‘‘This type of innovation
can become a game changer’’

SPECTROSCOPY
A painless measure device for premature babies

Heel stick method LCS method

Causes discomfort for Babies will have less pain
babies

Their blood (as little Their blood will not

as an espresso cup) be taken.
will be taken.

Results take 2 to 3 Immediate results

hours

Costs 64,70 per baby Cheaper method

The risk of jaundice is higher

for a premature baby, so
more tests are needed.

24

5
 the innovation of LCS, the same could be said. Sin-
ce the innovation is less harmful for the patients
and, in all probability, cost-efficient, there could
be said that the innovation can replace the older
method. In all, it is important to consider whether
an innovation is worthwhile to be implemented.
For decays, Kodak was the leading company in
film-based photography, for instance. They in-
vented the first digital camera but neglected the
potential of this innovation which finally resul-
ted in disrupter of their business. Nowadays, in-
novation is much recognized in the development
of smart devices. Let’s go back to our innovation.
This type of innovation can become a game chan-
ger, since this type of technology gives the possi-
bility to check the medical condition of a patient
from a distance. Measures on the skin instead of
the use of needles would be a revolutionary inno-
vation, and therefore worth the implementation.

Promising future
Even though the method is still in development,
the future of the technology is believed to be pro-
mising by the researchers. Because the new me-
thod is harmless and easier to perform, the tech-
nology could lead to new findings, for example
to recognize a certain pattern in development or
course of a certain disease. Also, the researchers
expect the technology to be used for adults as
well in the future. As Bosschaart mentioned: “If
we can measure bilirubin in newborns, I expect
that we can eventually also use it for adults who
need regular blood sampling.” She explains that
‘‘The future of the technology
looks very promising’’
in the USA, there is a research group who is doing
a similar research, but instead of babies, they ap-
ply the method of spectroscopy on adults. “They
are applying it to the retina, where they measure
oxygen in the vessels. So it is a little different, but
they have already applied it on humans, but not as
a clinical tool. It serves more as a research tool”.
By means of LCS, the first days of the little lives
of a lot of babies could be much easier. However,
for now the main challenge for scientists is to make
the device accurate enough to actually use it in
hospitals. Thereby the debate is whether the new
technology is worth implementation considering
the pros and cons along with the current method.
And as Bosschaart states, “Doesn’t everyone relate
to wanting a painless method for preterm babies?”.

6
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7
 What Does Technology Bring:
Better Life or Doom Scenarios?
Looking into the past can oftentimes
reveal notions which remain surpri-
singly relevant for our society today. In
medical technology, developments are
going faster and faster into the futu-
re. But in order to make sure that the-
se developments don’t harm, but help
us, seeking advice from yesterday’s phi-
losophers may possibly be much more of
a step forwards than it initially sounds…
Already since the old Egyptians, medicine has exi-
sted. Since then, more and more medical techno-
logies have been implemented which have saved a
lot of lives. The health sector is a mean to let people
live longer in a better way by curing the diseases
that would otherwise kill them, by replacing a hip
if theirs does not work anymore or even by pre-
venting that people get ill in the first place. Nowa-
days we are already quite far in extending the life
of humans and in improving the way of living. But
how far do we want to go? How old do we want
to become? These are questions a lot of people are
asking when it comes to innovative medical tech-
nologies. Take for example the Nanopill, a pill that
goes through your body in order to find cancer
cells. But do we really want something unnatural to
swim through our body to look for something, that
some of us maybe do not even want to know about?
With these new technologies being implemen-
ted into society, ethical and philosophical ques-
tions arise. Many philosophers in the past dealt
with the significance of implementing technology
into society. The ideas of philosophers could help
us understand better why we create technologies
and why we need them now and in the future. By
comparing the philosophies of Ernst Kapp and
Arnold Gehlen, a clear thought on why techno-
logy should be implemented in the future health
care or not can be formed. Ernst Kapp is conside-
red as one of the founders of philosophy of tech-
nology with his work “Principles of a philosophy
of technology” from 1877. Another thought on
8
the subject came from Arnold Gehlen, a German
scientist who describes the connection between
technology and humans in his work “Man, his na-
ture and place in the world’’, published in 1940.
These philosophers emphasize how humans have
tried to improve their lives by using technologies,
which is also visible in the healthcare sector. In
this sector humans are cured and treated for di-
seases in hospitals everyday. Technological deve-
lopments are crucial for this process and in labo-
ratories worldwide, scientists and researchers are
working on innovative ideas that may heavily in-
fluence our future healthcare and the quality of life.
‘‘Human bodies are adapted to
technology and that we cannot
live without it’’
 
A better life through new technologies
All technological innovations that have been imple-
mented in the healthcare industry over time have
made the treatment procedures for patients a lot
easier. According to Ernst Kapp, these technolo-
gies are understood as something organic. Techni-
cal inventions are continuations of human organs
and functions of human organs are extended onto
tools to improve the functioning of them. A ham-
mer can therefore be used as a stronger fist or a saw
as better teeth. The theory of Arnold Gehlen went a
bit further than Kapp’s - he said that technology is
part of the human. This means that the human bo-
dies are adapted to technology and that we cannot
live without it. The human is not able to survive
solely based on instinct, and therefore technology
is needed. Humans do not have claws or denture
to attack, they do not have protection against all
weather conditions. So they make weapons and
manufacture clothes to solve these shortcomings.
In Gehlen’s anthropology, technologies are simply
the exact reflections of our weaknesses. To take
a closer look at this anthropology we will analyze
the concept of robotic innovations in health care.
There are specific robots in developing and some
are already implemented in the healthcare sector.
For instance, the robot arm which works in com-
bination with the Raman microscope. This robot
removes a tumor with a needle, which results in
a smaller wound for the patient. It reduces the
chance of damaged nerves or blood vessels. This
is impossible to do for a surgeon and therefore
a reflection of one of the surgeons’ weaknesses.
Furthermore, there are technologies in develop-
ment that has helped us live longer by improving
health facilities. In this case you can think about
the Nanopill. This pill can detect colorectal can-
cer cells within the body. As a result, cancer can
be detected much earlier, more effective and it
is less complicated than with all previous me-
thods. In the philosophy of Ernst Kapp, the Nano-
pill can be seen as something organic. Organs
perform specific vital functions in behalf of the
human body. Moreover, there are many possi-
bilities in stem cell research to improve human
health in the future. Different kinds of stem cells
with different functions can be retrieved from the
human body. By working with them, researchers
are able to understand in which way humans de-
velop and the human body recovers and thus they
are on the verge of finding cures for many diseases.
Even though they are widely used in medical re-
search, they offer greater prospects for the future.
Taking all these developments in technology into
account we can say that technology influence the
society in a positive way. Nevertheless, no matter
how fascinating and fruitful technological deve-
lopments are today, they do pose the question of
whether the future they establish is ethically ac-
ceptable, let alone desirable for us as humans.
‘‘To which extent do we want
to allow technology to impact
our lives and enter our
daily rhythms?’’
9
 Conspiracies and doom scenarios
As we continue to expand our technological hori-
zons, an opposition starts to form. The ‘what if we
go too far’ scenario, as rather extremely depicted
in movies such as The Matrix and 2001: A Space
Odyssey, sketched the image that there is a sense of
fright amongst the population on the development
of technology. Of course, these doom scenarios are
more love children of fictional writers than sheer re-
ality, but the success of these movies sparked a criti-
cal discussion on how technology should progress.
‘‘Can an innovation that does
not serve as an organ be
considered as necessary?’’
Although medical technologies seem like positive
developments, the question that arises to the mind
is to which extent do we want to allow technology
to impact our lives and enter our daily rhythms?
10
From the viewpoint of Kapp, technology served as
an expansion to the human body. However, it is
unclear whether the Nano-pill could ever take on
the position of an organ in the philosophy of Kapp.
It cannot be specifically used to perform another
action and it opens up another dimension on the
field of beneficence. Can an innovation that does
not serve as an organ be considered as necessary?
Technologies that actually do serve as an ‘organ’
for the human being could be used by someone
else to exert influence from the outside, which
could hence be seen as a downside. For instan-
ce, chips implanted into brains or pills with na-
notechnology and a lot of conspiracy materials in
them seem prone to unethical activities in terms
of privacy. Based on different studies, it can defini-
tely be assumed that people will not be okay with
having robots or other technology in their body,
afraid of possibly being tracked down by govern-
mental organizations, for instance. Therefore we
should wonder to which extent technology can be
seen as a vital organ in the universe of Kapp, and
to which extent it is superficial or even dangerous.
As Gehlen puts it himself, humans are lacking in
specialized organs and are deficient. This is an
acceptable assumption, a human being could,
for instance, not survive without fire to keep him
warm or to support him cooking food. However,
with technologies that significantly change hu-
man DNA or implement robotic substances in
the human body, the idea that technology might
overtake the deficiencies Gehlen mentioned is not
far-fetched. Based on Gehlen’s theory, it seems
ethically wrong towards the nature of the human
being to enhance technology that significantly.
When comparing the two philosophers, we can
draw a picture that technology is a simple tool
that can be used to help a human to perform cer-
tain actions. However, it seems to be that the
technological advances are taking it too far and
have therefore overtaken the purpose of ‘hel-
ping’. It appears that technology has outgrown
the role of tool and has become a pivotal part of
our daily lives. A continuation of this trend could
see new standards developing in which techno-
logy could threaten the concept of a human being.
Harmful versus enhancement
When it comes to making a final judgement on
whether medical technology improve or harms our
future society, the complexity of the topic makes
a one-sided conclusion nearly impossible. What
is certainly clear is that all technological innova-
tions will hold some challenges for society once
they are implemented. New technological inven-
tions in the medical field are designed to help to
increase health. The theories of Kapp and Gehlen
provide an image on if the medical technology
being developed today are needed or even ethical.
Kapp would argue that these inventions are reflec-
tions of human organs. While technologically crea-
‘‘New technological
inventions in the medical
field are designed to help to
increase health’’
ted artificial organs and organs-on-chips might very
well fit this description, this does not necessarily
go for all of the technologies. The Nanopill helps to
detect cancer cells, which makes a defect of an or-
gan visible, which in turn can be improved. Thus,
the pill does indirectly belong into Kapp’s propo-
sed category. The theory of Gehlen suits these in-
ventions because they are made to improve human
health. 50 million Europeans died in the middle
ages due to the plague. Today, infectious diseases
are contained much faster. Ebola virus disease with
its big outbreak in 2014 in West Africa was decla-
red no longer an emergency in 2016. As those two
examples are bold comparisons, they clearly show
that the demographic change in society due to large
improvement in healthcare is inevitable. The im-
provement of medical technology could be a path
to creating perfect, immortal humans, even human
enhancement instead of just ensuring survival.
‘‘The improvement of medical
technology could be a path
to creating perfect, immortal
humans’’
Technological impacts of society cannot only be
justified by the use and functioning of the techno-
logy on society but also hold significant challen-
ges which society must overcome. These inven-
tions have similarities in possible ethical issues
and pressures in society and on the government.
Especially with the use of stem cell technology in
the organs-on-chip and artificial organs the de-
bate on when and if life should be created artifi-
cially and what life is needs to be taken into con-
sideration. This is specifically due to the use of
stem cells that are retrieved from embryos. The
question on if life begins as early as an embryo
and the ethicality of using an embryo and there-
fore destroying a life is risen. This issue is mainly
discussed between certain groups of people, espe-
cially religious groups, which are against the use.
However, in the larger society using stem cells in
the medical field to improve health and create the
greater possibility of life for individuals is seen as
ethically correct. The discussion of when life starts
and when it should end connects to the idea of an
immortal human. Today’s research is far from
curing all life-threatening diseases and preven-
ting senility. Human enhancement may be seen as
unethical but overcoming all physical and mental
limitations cannot be realized in the near future.
11

The innovations require medical personnel that
uses them, therefore the innovation can only be as
good as the medical personnel applying the tech-
nology to the patient. Due to the technology and
the research of the innovations being new and
‘‘The information will be more
sensitive than ever before’’
early in the development, the costs once they are
accessible on the market will be very high. This can
cause societal inequality since the technology will
most likely be only available for the higher classes.
Another aspect is the privacy of the patient, with
new technology in the health sector not only me-
12
dical personnel is able to derive information out of
the technology or access it. With the use of stem
cell technology especially in laboratories the DNA
of individuals is exposed to personnel who are not
used to handling patient data. Moreover, the in-
formation will be more sensitive than ever before,
enabling to detect how prone an individual is to
having a disease. With the increase of technology
many of the data is stored online and on compu-
ters which introduces the risk of data being ille-
gally obtained through hacking. Patient data must
be protected with requirements of confidentiality
and through laws and regulations on every level,
in order to protect the privacy. Therefore, person-
nel has to be trained to treat patient data safely.
To prevent further inequality in society es-
pecially between the wealthy and lower in-
come classes the government must subsi-
dize the implementation of the technology.
Otherwise the innovations could not reflect and
improve organs or adjust the defects of any person. Conclusion
The benefits for society of new technologies are
Many questions arise, ethical as well as philosop-
clear: the society strives to be healthier and pre-
hical, when it comes to acceptance of technology
vent diseases. Humans are naturally disrupted
in the healthcare sector. At the same time, it has
by the thought of someone close dying and stri-
been wondered whether we can even live without
ve to create more possibilities in the medical
technology. The question is whether the tech-
field to cure and prevent this from happening.
nologies would actually function as an organic
In general, individuals should answer for them-
extensions, as Kapp suggests, or as a means to
selves the ethicality on which medical technology
survive, like Gehlen puts it. It might be that the-
should be implemented into their medical care. It is
re are innovations not functioning with the pur-
a personal decision how much technology should be
pose to help, but to be one step ahead of humans.
incorporated within the body to improve health and
People might wonder how much we would want
prevent diseases. The individual benefits and risks
to accept this and to let these innovations influen-
should be addressed individually as well as by the
ce our lives, whether the positive aspects would
medical staff using the technology on the patient.
weigh out the negative aspects. Would a Nano-
pill detecting cancer cells or stem cell technology
as organic extensions improve our life’s quali-
ty? Or would it be ethically wrong to implement
such a measure as it would change lives radically?
All in all, the medical benefits have to be compa-
red to the ethical and philosophical consequences
on whether it is worth and right to implement it
into society. Every innovation influences work
areas, the costs of the hospital and the position
of society regarding certain medical fields. People
might fear diseases less as they expect the soluti-
ons to be there to solve their problems, but peo-
ple might also fear the fact of finding out every
single thing that is wrong in their body and the
consequence of exposure of their personal data.
So every single step, aspect and consequence has
to be taken into account before implementation
of a new technology can take place responsibly.

13
 Breast Cancer Innovation
Replaces Doctor
Promising technology gives a good deal of confidence to future
breast cancer patients

14
A lot of people would recognize a situation
like this: one day, a woman, take for exam-
ple your mother, feels a hump in her bre-
ast. Concerns are immediately rising and
people are starting to worry. Is it cancer?

In the worst case, your mother will hear the

words nobody wants to hear. “We found a
tumor in your breast”. This would be the
start of a back-breaking process of healing.

15
 The diagnosis of breast cancer is often based
on the results of a mammography. The method
where the breast is squashed between two parts
of the machine is often referred to as very pain-
ful. When the diagnosis is made and the tumor is
found, the tumor must be removed from the bre-
ast. This happens in surgical operation. The goal
is to remove the tumor completely, to make sure
the patient leaves the surgery room without tumor
tissue in her body. Of course the doctors are train-
ed to make the surgery succeed, but that does not
always guarantee the desired result. Sometimes,
patients need a second surgery because the tumor
was not completely removed in the first surgery.
Current method
In a normal breast tumor removal surgery, the
surgeon cuts out the tumor of the breast and
sends the tumor to a laboratory. When the tu-
mor arrives at the laboratory, a pathologist exa-
mines the tumor and checks whether the tumor
is encapsulated by healthy breast tissue. Only
when this is the case, it is safe to say that the com-
plete tumor is removed. This checking process
normally takes three days. When the results in-
dicate that the tumor was not removed comple-
tely, a new removal surgery needs to be planned,
and the breast needs to be cut open once again.
‘‘The Raman microscope is
used to examine the tumor
in a few minutes’’
Raman microscopy
The newly developed technology that includes
Raman microscopy changes this process. The Ra-
man microscopy machine will be implemented in
the surgery room where it replaces the laboratory
in the process of examining tumors. A breast tu-
mor removal surgery with the Raman microscope
will start off just like a normal one, the surgeon
cuts out the tumor. “But instead of sending the
tumor to the laboratory and receiving the results
after three days, the Raman microscope is used to
examine the tumor in a few minutes” says dr. ir.
Herman Offerhaus, a researcher at the University
of Twente. In case the conclusion is that there is
still a part of the tumor in the breast, the surgeon
can remove the remaining part of the tumor right
16
away. Because of the velocity of the examining
process, no second surgeries will ever be required.
Normal microscopes use normal light to magnifys-
mall samples. When observing something with a
normal microscope, a doctor can distinguish the
different tissues because they will appear in dif-
ferent colors. The tissues that appear lighter re-
flect more light and tissues that appear darker
absorb more light. Even though this information
can be collected using a normal microscope, it is
not possible to see which exact tissue is observed.
This is something a Raman microscope can do.
The lasers in a Raman microscope enable the tech-
nology to observe the tissue on a very deep level.
The microscope can see the atom bindings in a
molecule of a cell, which make it possible to tell of
what ‘fabric’ the tissue is made of. In other words,
the Raman microscope scans the atom bindings
in a cell and can tell from that whether normal,
healthy breast tissue or tumor tissue is observed.
The Future
A possibility for this innovation in the future is that
it will be applied with the use of robotic surgery. The
robot will insert a needle, and with the help of the
microscope; the tumor will be located completely.
The needle will then ‘suck out’ the tumor precisely.
With the use of this specific robot, only a small hole
needs to be made in the breast to conduct surgery,
instead of a big incision that is needed right now.
The robot arm will also be more precise with the
removal of tumor tissue than a surgeon would be.
Implementation
Offerhaus expects both innovations to work in
five years. “It works in a laboratory environ-
ment, but it needs to work in hospitals and cli-
nics. This whole process of investigation, impro-
ving and implementation will take some time.”
Concerns
Even though the use of both innovations have big ad-
vantages, a focus group research from the Universi-
ty of Twente has shown that are also a few concerns
regarding the microscope and the robotarm. Wo-
men from the breast cancer risk group (women ol-
der than 50) mention that they are concerned about
the lack of human contact when the innovation will
be applied with the use of a robot arm. They don’t
want to get treated by robots, as they believe that
sick people are vulnerable people that need human
attention. This concern can be relieved by having a
doctor by their side at all times during the surgery.
 to be more relaxed within and after the surgery.”
Besides, participants emphasized the fact that
a second surgery isn’t needed as very posi-
‘‘Can you imagine? You are in a tive. “This helps also in the stress relieve, being
hospital, there is a robot nervous for a second surgery is not neces-
coming your way, press one sary, because there won’t be a second surgery.”
Because both technologies help the curing
for your results, that would be process, they give better results, are peop-
strange’’ le quite positive about the new technologies.

Other options?
There are so many possibilities in the curing and
investigation process of breast cancer. A few of
Regarding the microscope, the breast cancer risk these options are the named before mammo-
group, even as the future breast cancer risk group graphy, radiation curing and scan. But all the-
(women around the age of 20), emphasize the fact se options don’t do anything within the surgery.
that this innovation always should be used, when The microscope and robot arm are purely focused
results prove to better than the current results, on removing and investigating tumors. The only
when the tumor is investigated by a pathologist. other option is the current method, manpower.
Moreover, especially the breast
cancer risk group emphasized the
need of second opinions. Even if
the microscope has better results,
patients should be able to ask for a
Raman Microscopy
second opinion from a pathologist.
The breast cancer risk group finds
it also very important to have
human contact before and af-
ter technological intervention in
surgery. According to them, the 1 in 8 women will Raman microscopy is
appointments with doctors before receive a breast used in breast cancer
cancer diagnosis tumor removel
and after surgery, as it is done now,
during their life. surgery.
should stay. A participant from
the breast cancer risk group said:
“That’s really important, human
contact before and after surgery.
Can you imagine? You are in a
hospital, there is a robot coming
your way, press one for your re-
sults, that would be strange.”

Advantages
From the focus group done by the
University of Twente also beca-
me clear that people find it very
convenient that the new techno-
logies (especially the microscope) How it works Breast cancer Pros Cons
make sure that waiting for re-
sults won’t be necessary anymo- • 17.178 Dutch
1. Surgeon cuts • Much quicker Ethical concerns:
re. One participant said: “waiting out tumor women had results
for results gives so much stress, breast cancer in • No second Would you lay your
2016 surgeries surgery in the
with this technology there is no • 20% of all breast • The microscope is hands of a robot?
2. Raman microscope
waiting included, which helps examines tumour
cancer patiens more accurate
are younger than than the human
50 eye.

3. Results within
minutes 17
 The microscope and robot arm will not be able to
get rid of the “awful mammography” as said by
Offerhaus. It will also not get rid of the troubled
times that breast cancer will bring to the patients.
The stress, sadness and emotionality of the situ-
ation won’t be resolved by technology. But it will
change the waiting process after surgery, as there
will be none. This will help reduce the experienced
stress a bit. Besides that, a second surgery won’t
be necessary. There are concerns and advantages
as with all technologies. But in the future, the ad-
vantages will grow and grow as results are getting
better according to Offerhaus. “Results are getting
better, a lot of research is needed to get the micro-
scope and robot arm to fully work, but when it will
be running and implemented in approximately
five years, the results of these technologies will be
better than the current results from a pathologist.”
Even though the microscope and robot arm can-
not change the harshness of cancer, every little bit
helps to make the road to recovery an easier one.

‘‘The results of these

technologies will be better than
the current results from a
pathologist’’

18
 Human Positivity In A Destructive Illness
Brigitta Pots-Knol, age 56, was diagnosed with breast cancer
10 years ago. Fortunately, she has been cured and everything
goes well nowadays. October, which is the international breast
cancer month, made Brigitta look back on what happened to
her and how she has experienced certain aspects of the curing
process, such as the use of the technologies. This is her story.

“I started my curing process with a surgery where the tumor was taken
out of my breast. After that I did a chemo cure for a year, followed by
radiation.” Following these interventions, Brigitta had a breast recon-
struction to make her breasts look as normal and beautiful as possible.
“With regard to the chemo, a lot of people think it is very sad, and it
is. But we, me and the other patients, always had a lot of fun when ha-
ving chemo. I even still have contact with one woman, we always stayed
friends!” Staying positive has always been very important in Brigitta’s
journey. “One can always get positive things out of such a journey.”

Technology
“One can always get Technology played an essential part in the curing process. “Radiati-
on curing was done by a machine which worked millimetre by milli-
positive things out metre, so it took a long time. It had to be done, although it was quite
of such a journey’’ scary, as the only other person was sitting behind a screen and hand-
ling the machine. That also made it more frightening.” Although
Brigitta was not in favor of the procedures, it became easier with every
treatment. “The first few times were very emotional, however after a few
appointments that feeling went away.” Still, Brigitta remained very positive. “It is so special and
important what they can do with such a machine, and because I realised this, my fear declined.”
“I experienced MRI scans too, I still have to do that once a year. I find this harder as I general-
ly become very emotional and sad, because I’m all alone in a tube. Sometimes, my experiences
from my sickness come back to me while undergoing this treatment. That’s quite hard.” A disease
like cancer can follow the participants even years after being cured. Additionally, the precisi-
on of nowadays technology can improve the patient’s feeling of safety throughout the therapy.

The people factor

In Brigitta’s personal opinion, having human interaction is a important element of the curing process.
“There always needs to be human supervision, even when machines can do specific medical jobs on
their own. It helps a lot when people know that technology can be quite intimidating. They can help
you handling your fear.” Brigitta continues: “At the times where I had to undergo the technological
examinations, I made very positive experiences with other people. The doctors and nurses know when
you are feeling uncomfortable. They handle it in a great way by comforting you and just being nice.”
Even though years have passed since her treatment, her statements are still relevant. By conducting
the curing process in a more personal way, it made her feel more human and more than only a patient.

The future
Brigitta has no concerns regarding the upcoming technology in breast cancer investigation and
surgery. “I heard a lot about robot arm surgery, they have great results.” She sees a bright future
for this innovation, as it already is implemented in a lot of cancer surgeries where it does good
work. According to her personal experience, it should be more widely supported to have human
interaction within the process of curing. By including personal conversations or time spent with
other people inside and outside of the hospital, the therapy is more bearable for the patients.

19
 Stem Cells: A Lifesaving Tool
Stem cell research offers new treatment options for organ transplants and various
diseases and can save the life of many people.

After being on the liver waiting list for 4 and a
half years, Amelia finally received the call that
a donor liver was available to her. The news of
this possible transplant was the best in years.
Throughout high school, Amelia knew that so-
mething was not right; most of the time she was
tired and felt sick. However, she did not want to
worry her family and kept moving forward. She
just wanted to be a normal teenager. Consequent-
ly, she did not tell anyone about her symptoms.
rise to the field of stem cell technology. In Europe
alone, 56.000 patients are on the waiting list for
a donor organ and only one third of those peop-
le can get an organ the same year. In the past 5
years, only one fourth of the needed organs were
donated. On average, people have to wait about
one and a half year for an organ. All around the
world, scientists are developing new ways to cre-
ate organs and tissues for transplants with higher
chances of compatibility. These methods based
on stem cell technology can solve these problems.

As she mentions: “At graduation I thought it

was a miracle I was still alive.”

The weeks before leaving for college her symptoms

increased. She could no longer hide her pain from
her family. The symptoms turned out to be those of
Cirrhosis*. A few months later her disease progres-
sed so far that she had to be put on the waiting list for
a new liver. She already felt hopeless when, after 4
and a half years, she was able to receive a new organ.

There are a lot of people with problems

like Amelia. Whilst waiting for the right or-
gan donors, they get frustrated and depres-
sed. They wonder if it they will make it or not.
Some of them die because of lack of donors.
The lack of effective therapies for curing organ re-
lated diseases and the need for new organs gave

The process of artificial organs and tissue

*Cirrhosis is a liver disease. In teeenagers and
young adults could be caused by immune hepati-
tis. In this case, the immune system attacks liver
cells causing liver inflammation. The human ha-
bits that may cause this disease are still uncertain.
Even people with an healthy lifestyle could get it.
The first symptoms encountered may be weakness
and loss of weight. Afterwards, liver size may chan-
ge, urines may look darker and the skin may get
yellow. Recent studies showed that patients with
cirrhosis may be live less than the general popula-
tion. In severe cases, a liver transplant is needed.
engineering
Stem cells are the basic component to create or-
gans and tissues. In general, stem cells have the
capacity to repair damaged parts in our body. Ho-
wever, our body does not contain enough of them
to be able to totally repair itself and protect itself
from diseases. It is like having a jacket that can
protect you from the cold and rain, but that it is
not permeable enough for a big rain storm. The-
se cells have the capacity to change their func-
tion related to the organ or tissue to which they
belong. They can become liver cells, muscle cells,
blood cells, intestinal cells, nerve cells and so on.

20
“Because of their differentiation, scientists dis-
tinguished three main kinds of stem cells: em-
bryonic stem cells, induced pluripotent stem cells
(IPS) and adult stem cells.” Jeroen Leijten, rese-
archer at the University of Twente specialised on
tissue engineering, describes. The first ones are
retrieved from dead embryos, the placenta and
umbilical cord. These are the most useful because
they are still undifferentiated and can be used to
create every kind of tissue and organ. Adult stem
cells can be retrieved from within different parts
of the human body. Induced pluripotent stem cells
are cells created in laboratory by washing adult
stem cells and transforming them into cells with
the same characteristics of embryonic stem cells.

“The most preferred stem cell option is the in-

duced pluripotent stem cell, which is the most
flexible type of stem cell and it does not in-
volve the use of embryos”. Leijten explains.

The newest method of creating organs consists out
of growing human organs in animals that have the
same body structure as humans, such as pigs. All
kinds of organ can be grown like hearts, livers, or
lungs. As described by Leijten the process of ar-
tificial organs consists of five main steps. First, a
few stem cells are retrieved from the patient. Se-
cond, the development of a pig’s organ is shut
down by removing the cells in the pig’s embryo.
Thirdly, the human stem cells are retrieved from
humans and in the fourth phase scientists im-
plant them in the pig embryo and the organ starts
developing. Finally, after the pig is full grown,
the organ is transplanted in the patient. Parts
of organs can be created in the same manner.
animals. Therefore, the animal needs to grow up
in a sterile environment to prevent such danger.
During the process of harvesting embryonic stem
cells, the embryos are destroyed. This raises ethi-
cal concerns mainly among religious groups who
believe that an embryo is a human life. This means
that through this research, a human life is ended
and therefore, it is morally wrong. Moreover, stem
cell could be used to create clones. Because of the
different concerns, some Governments still did not
create the right regulations to let stem cell research
proceed. But as Leijten says “Limits need to be cre-
ated. If there is no legislation, nothing is approved”.

The process of tissue engineering is relatively shor- “Limits need to be created. If

ter. Because there is no need of creating the tissue
inside the animal, tissues are also less complicated
to create. After having retrieved the desired stem
cells from the patient, the new tissue is created in
a laboratory. Afterwards, the tissue is ready to be
immediately transplanted on the damaged part.
Concerns zed companies is also a concern. They could set pri-
Nevertheless, every technology in health care co-
mes with certain risks. Treatments with stem
cells have a 20% risk of placed cells dividing in-
correctly and causing cancerous tumors. Leijten
also explained this. “Once stem cells enter the
human body, it is hard to control them. Therefo-
re, stem cells could develop into cancer cells and
cause tumours”. Another risk regarding growing
organs with stem cells in animals, is that the pa-
tient may get infections and viruses from the
there is no legislation, nothing
is approved”
Exploitation on the sales of organs by commerciali-
ces that are too high for the average civilian, which
would make the technology only available for the
entitled. Furthermore, general treatments with
stem cells are still quite expensive. According to
Leijten, the price for a treatment is around €60.000.
However, Leijten says: ‘There will always be peop-
le that disagree, but there will also be people that
want to be cured. People are not forced to under-
go the treatments. It is their choice to choose’.
21
 Benefits
On average, 20 people die everyday waiting for
a transplant and this number gets bigger eve-
ry year. Moreover, with ageing and different
kind of diseases, human organs deteriorate cau-
sing unhappiness among the general population.

Artificial organs and tissue engineering could be

the solution to these problems. Because the stem
cells needed to create the organs are retrieved from
the patients, chances of incompatibility are mini-
mal. Moreover, people would not need to wait on a
donor list. For example, patients with a kidney di-
sease will not need to use dialysis, a long and pain-
ful treatment. They could get a kidney grown right
away. Tissues and organs, damaged by ageing and
diseases, could be replaced with new ones, opening
the possibility to live a longer and healthier life.

Future applications
The technology will not be on the market soon.
According to Leijten, “Right now, the techno-
logy is not classified or regulated yet. Moreover,
the treatment costs too much to be easily im-
plemented in the healthcare sector. Less ex-
pensive treatments needs to be conceived.”
For now it is the job of the researchers and the
governments to reduce the disadvantages to a mi-
nimum, so that stem cell technology can create
a lot of organs and save more lives in the future.
In some years, stem cells and their different uses
could be the cure for many diseases: to regene-
rate burned skin, to recreate corneas to improve
sights, to treat people with leukaemia and to de-
feat diabetes type 1. Moreover, it could cure car-
diovascular diseases, generate cures for degene-
rative diseases, and create joint replacement for
those who need it. Therefore, stem cells could
be seen as a lifesaving tool. Or as Leijten said
“who would not like to be 70 years old and still
be healthy and be able to fully enjoy his life?”.

22
Extremely Small Particles With
Extremely Large Potential

Researchers at the University of Twente are up not actually having the disease. The specificity
developing an innovation with the capac- is way too low”, states Dr. Loes Segerink, research-
ity to revolutionize the medical sector: A er at the University of Twente in Enschede. This
pill full of technology, which could flip the means that those 50% have to undergo an invasive
script in the battle against colorectal cancer. and complicated colonoscopy, which searches for
colorectal tumors, unnecessarily. Dr. Otis Braw-
“I wasn’t worried at all, thought it was colitis. ley from the American Cancer Society adds: “To-
When I woke up from the procedure — I’ll nev- day’s colonoscopies seem to be lacking in high tech
er forget the look on the doctor’s face — she said to discover smaller tumors in the human body.”
I’m 99 percent sure it’s colon cancer.” This is the
story of Joan, a 35-year old woman from New Jer- In order to tackle this problem, institutes such
sey. She is one of the 95.000 Americans that are as GoogleX are creating pills filled with tiny high
diagnosed with colorectal cancer every year, ac- tech particles, so-called Nanopills. The most no-
cording to Medical News Today. Numbers from table version, however, is being developed by
the other side of the globe, the Netherlands to Segerink and her team of researchers at the Uni-
be precise, indicate that over 9.000 Dutch citi- versity of Twente (UT) in Enschede. With their
zens are suffering from the disease as of 2013. In Nanopill, colorectal cancer could be detected
fact, approximately one in twenty persons will earlier and much simpler than with the current
struggle with colorectal cancer in their lifetime. procedure. “The idea was to use the Nanopill as
How can this life changing problem be solved? a digital screening method” explains Segerink.
“But instead of using an indirect sign, such as
having blood in one’s stool, our pill can directly
‘‘The current screening process identify whether there are cancerous cells or not.”
is far from ideal’’ The Nanopill
Although it looks like a regular pain killer, the Na-
nopill is filled with the newest technology. Nano-
Since colorectal cancer oftentimes affects the el- technology operates on an extremely small scale; in
derly generation, people are advised to undergo a fact, the size difference between one nanoparticle
screening procedure from the age 50 and onwards. and a basketball is equal to the ratio between the
However, the current screening process is far from same basketball and our earth. The particles are not
ideal: “In 50% of cases, people are put into a risk visible for the human eye, unless viewed through
group due to having blood in their stool, but end a special microscope. Only skilled scientists, such
23
 as Segerink and her team, are able to manipulate
the particles to utilize them for medical purposes.
For the patient, the process of using the Nanopill
is as simple as can be - it has to be swallowed nor-
mally like any other tablet. What happens when
the pill arrives in the intestines after travelling
through the digestive system, however, is far from
24
usual: By analyzing the liquid surrounding it, the
pill can detect specific parts of DNA that are abnor-
mal, and thereby, cancerous cells can be detected
long before any tumor would become visible for a
normal screening. As soon as such an indication
is found, an alert is sent to a separate device, such
as a smartphone or smartwatch. “You just swal-
low it and then you will get a message whether the
biomarker is there or not”, summarizes Segerink.
Meanwhile, the Nanopill passes through the body
in the normal process and is discharged completely.
According to the researcher, the Nanopill comes
“without any risks, but with other methods you
can harm your body a lot, even if you don’t have
cancer”. The Nanopill thus seems to be a better
solution than current screening methods. Even
if the procedure sounds like science-fiction ini-
tially, it might soon be a reality. The University
of Twente researchers aim to make the Nano-
pill market-ready within the next 5 to 12 years.
Time counts
The Nanopill’s implementation onto the mar-
ket would improve the current medical system in
a number of ways. Ensuring an early diagnosis is
surely one of the main benefits: Early treatment
is crucial for colorectal cancer, which can develop
a lot faster than other types of cancer. However,
detecting the disease timely is difficult, especial-
ly because early stages do not typically cause any
symptoms. Segerink explains: “Once you have
symptoms, it’s often too late”. Detecting colorec-
tal cancer early is therefore crucial to decrease the
number of fatal cases. According to the Ameri-
can Cancer Society, nine out of ten people survive
five years and longer, when colorectal cancer is
found in an early stage. In contrast, only one out
of ten survives five years when diagnosed in an ad-
vanced stage, which illustrates the necessity of a
screening that reliably detects the disease in time.
With the Nanopill, this would finally be possible.
It is also striking how much simpler the Nano-
pill would make the whole procedure. The pill is
not only faster in its diagnostic process and deliv-
ers immediate results, it also offers a much more
precise approach. As Segerink illustrates, the pill
uses a direct and therefore clear biological mark-
er, while the current screening depends on indirect
clues. A more effective diagnosis is highly benefi-
cial for both patients and doctors, who consequent-
ly wouldn’t have to conduct as many unnecessary
colonoscopies. “The rates of false positives would
be less, so the people that are getting a colonos-
copy will be less”, confirms Segerink. This change
also holds economic implications: By decreas-
ing the number of patients who need expensive
treatment for late-stage colorectal cancer, a lot of
money can be saved, which means that health care
insurances are likely to support the innovation,
since it entails financial benefits for them as well.
Upsides and downsides
Its prospective efficiency, effectiveness and accura-
cy sets the Nanopill apart from all previous meth-
ods. Nevertheless, there are certainly some points
of concern that have to be taken into account when
weighing the invention’s impacts. First of which
is, logically, that there cannot be a positive im-
pact if the pill is not on the market - right now,
the Nanopill is amidst development and its tech-
nology has to be fine-tuned in order to provide the
degree of accuracy that the researchers promise.
This also means that there may be risks that can’t
be fully determined yet. One of which, especially
when talking about the connection of the pill and
a smartphone, is data security, or the lack thereof.
Generally, smartphones are hackable, and keeping
important medical information on it makes it even
more risky. Criminals can potentially hack the de-
vice and can steal and sell medical information of
the users. Furthermore, in the hands of healthcare
insurance companies, the data delivered by the
pill can have negative implications for the insured
people. For example, patients could be pressured
into taking the pill, by having to pay higher month-
ly fees if they reject it. Dr. Segerink agrees: “Un-
fortunately, that is how the market is right now”.
‘‘It could be an immense break-
through for colorectal cancer
detection and treatment’’
Bright future
Although there might be risks concerning the
confidentiality of medical data, or more spe-
cifically, third parties’ misuse of this data,
this does not lessen the pill’s inherent worth.
As a matter of fact, the Nanopill’s and its tiny high
tech particles could, if developed successfully,
be an immense breakthrough for colorectal can-
cer detection and treatment. With a completely
new approach, that puts patient-friendliness as
a top priority, Segerink and her team are bring-
ing society a step closer to helping Joan and oth-
ers in her situation. And for the future, the re-
searchers have even more promising plans: “Right
now, we are focusing on the intestines, but in
the future, the Nanopill could possibly improve
screening procedures for many types of cancer”.
25
 The Healthcare Ambassador
Interview with Lucien Engelen
© Lucien Engelen

Lucien Engelen is the first dutch health 2.0 ambassador, founder of the Radboud
REshape Centre and Head of the emergency healthcare network and advisory
to the Executive Board at the Radboud University Medical Centre in Nijmegen.
In his work within the changing health care system and its increasing technological
impacts, Engelen firmly believes that enhancing the participation of the patients and
their informal care in their own disease is essential. His mission is to understand which
technologies and changes will occur in the following years in order to determine which
implementations are needed regarding patient empowerment, research and education.

What experience or stage in your life has
shaped the way you think?
The first thing that influenced my way of thinking
was that both my parents got caught with cancer
and other diseases at a relatively young age.
The second thing is that I like to think I am a
technical optimist. I believe there are a lot of
opportunities in technology, as I can see that the
technologies can help and find evidence for this.
Moreover I worked in the ambulance services
for 25 years. Regarding the time we are living
in and all the technological innovations, these
factors caused me to be doing this: I love it.
“We tend to think we know
what patients need, when in
reality, we don’t have a clue”
What are important steps when
implementing technology into the
medical health system?
We should include what matters most, first of all
patients themselves. The number of projects done
and changed without consulting the patients
is insane! We tend to think that we know what
patients need, while in reality we don’t have a clue.
To solve this, we created a patients including chart
in 2011, which states that patients and family will
be included in all projects, conferences and for
every step we take. Including patients and their
families leads to a very different dynamic within
projects: sometimes professionals come up with
an expensive innovation, while the patients do not
think they need it. Better communication is needed.

26

Why do the implementations of
technologies often fail?
A lot of the times, technologies are created as a so-
lution while there is no problem. And we need to
look at the patients: a majority of the innovations
are developed while it doesn’t take into account
that a patient isn’t a machine. While a new techno-
logy is useful when you have diabetes, it might be
useless when you have diabetes and heart failure.
So, is the overall idea to first have a
demand for a specific technology and then
create it?
Yes, nowadays too many technologies are created
first, which results in looking for a demand. Inno-
vations are sometimes developed based on a few
statements, the research has not been done well.
This concludes in the technology not being wan-
ted. To avoid this, the research has to be done
well and the right people have to be consulted.
What are the chances and challenges of
technology in the healthcare sector?
The challenges are that our organization has twi-
ce the amount of health care dynamic. A lot of
people in the health care escort don't see that
coming. And they don't reflect what it means
for their own job. The challenge is also to create
awareness: a lot of people know that they have
to innovate but they think someone else is going
to do it. This leads into a chance that we have:
You have to show people what is coming up.
Are patients confident to accept technology?
The answer will surprise you. Being in that area
for 7 years right now, I am absolutely sure that pa-
tients adopt and trust technology way more than
even the professionals do. If you would create a
solution again with the patient themselves, that
would help the patients, and they would love it.
‘‘People will trust technology
way more than professionals
think’’
Can you give a specific example of an
innovation that was implemented into the
healthcare sector which was surprising?
From the patient’s perspective this is very hard, as
there is not a lot of surprise anymore due to pa-
tients being able to use almost everything. From
my professional perspective, what surprises me
on a daily basis is that people use technology
every day to listen music online, book flights on-
line, run their bank account online, but then are
against bringing their patient documents onli-
ne. They expect everything in their daily life to
be online, everything but their professional life.
Is there something that the patient can actively do to
support the implementation of new technologies?
They can ask for it. For example, the next time
you visit your physician you can ask your doc-
tor whether the visit can also be done online.
So, every patient that suffers from a
disease and is searching for a solution
should ask for new technologies?
Yes, research done in the Netherlands showed
that patients said, for the fourth year in a row,
that they wanted to use a certain technology, ho-
wever it was not offered by their professional.
When the professionals were asked why the tech-
nology wasn’t offered, they said that the patients
didn’t ask for it. In this situation, both were just
waiting until the other person made a move.
Do you believe that patients should be
included into that process?
No, absolutely not. The technology now is helping
and everyone knows that it is possible. Because now
you can see something that has been introduced
in India this afternoon and you see it in the news
tonight. Which is different from 20 years ago. You
now see an adaptation from patients as well. We are
definitely getting there, but it just takes more time.
Where do you see technology in the
healthcare system in the future?
The line between medical technology and consu-
mer technology is going to blur. Our smartpho-
nes are already becoming medical devices. We are
going to delocalize healthcare with technology.
Things that were just possible to do in the hospital
are now possible to do in your home and in your car.
How can fear be reduced for patients?
I think there is no fear among patients. It is the
same as it was with electronic banking, you see
90 percent of people in the Netherlands use
it, they gained the trust of technology. But be-
fore that, there was the same discussion and
same debate we have in healthcare right now.
Last message?
Patients are also experts, and they are needed
with regard to the implementation of new tech-
nologies. Technology is creating possibilities and
gives us opportunities to do better, so let’s try!
27
 How Organs-on-Chips
Can Decrease Animal
Testing and Increase
Drug Testing Efficiency

An estimated number of over 100 million

animals are victims of drug testing pro-
cedures every year in the U.S.. Mice, rats,
rabbits, and cats are, amongst others,
kept in scientific laboratories and used
for testing procedures for medicine and
cosmetics, infected with deadly disea-
ses and thrown away after their death.

Researchers worldwide are currently working

on a nanotechnology tool which not only pro-
mises to be a real alternative for animal testing
procedures for drug testing, but also a better and
more reliable method with higher validity. Head-
lines such as “Biochips instead of animal expe-
riments” and “mini-organs are supposed to re-
place animal experiments”, promise the so called
‘organs-on-chips’ as the solution for solving the
ethical problem of experimenting on animals.
The development at the University of Twente
Andries van der Meer, who has a background in
cell biology and heads his own research group
at the University of Twente, in which he focuses
on developing organs-on-chips, explains: ‘’The
term ‘organs-on-chips’ didn’t exist yet when I
started my research in 2005’’. ‘’We had the tech-
nology to create small microdevices and ma-
nipulate small amounts of liquid in them, and
then there came the realisation that this would
actually be suitable as a tool to subject cells to
different mechanical stresses and fluid flows.’’
At the same time as he was doing his project, at
multiple places in the world researchers started
to build in more and more complexity in these de-
vices, such as placing multiple cell types and tis-
sue types in the same device. Then, around 2010,
people started seeing it as one integrated techno-
logy. Van der Meer: ‘’if you think of it as an inte-
gral piece of technology, then what we were actu-
ally doing is to mimic part of the human body.’’
28
‘‘If you think of it as an integral
piece of technology, then what
we were actually doing is to
mimic part of the human body’’
Soon researchers started to specialise in diffe-
rent aspects of the human body, for example at
the University of Twente the focus lies mostly in
the cardiovascular field. They make for instan-
ce a heart on a chip, blood vessel on a chip and
retina on a chip, which also has a very strong
vascular component. There is even a brain on
chip, that mimics especially the blood vessel
that run through the brain, which can be used
to study brain disorders such as meningitis.
The typical organ-on-chip is very small, only the
size of a USB-stick, since only a few layers of cells
are needed to mimic an organ’s function. The chip
looks glassy; however, it’s made of silicon rubber,
which is slightly flexible. There are metal wires co-
ming out of it, which are electrodes that, for example
in the case of a heart-on-a-chip, are used to stimu-
late the heart tissue to contract, and can be used as
a sensor. Inside the rubber a synthetic membrane is
placed with a number of channels running through
it, which can be filled with blood or other fluids.

Marinke van der Helm, Paul ter Braak
The ongoing presence of animal testing
Both models, organ-on-chip and animal testing
procedures, react in a certain way to drug tes-
ting experiments, though with different results.
For the chips, the reaction to certain medici-
ne is captured in detail, and these reactions are
gathered by the researcher as data which can be
used for the development of the drug. Van der
Meer argues “Comparing data out of an animal
model one on one with data of a chip will ne-
ver fully overlap. It is not as simple as taking an
animal and replacing it entirely with a chip.”
With the use of human stem cells however, the
complexity and diversity of the human tissue can
be captured, and more reliable results are obtained.
Several cases have proven that animal testing pro-
cedures do not offer reliable results when it comes to
the effects of drugs. Due to the differing organic com-
position and functioning of the human body com-
pared to the ones of animals, scientists discovered
that drugs have different effects on animals than
on humans.
The most preceding and extreme case, known as
the Elephant Man trial, shows exactly which fatal
consequences can occur. In this certain case, six
men were given medicine which was previously te-
sted on animals. The high doses of the medicine
however, had perilous effects on the probands in-
cluding the danger of organ failure and a high risk
of cancer. In another case Ritalin was found to be
toxic to male mice but is very effective as a medi-
cation for ADHD treatment for humans. Although
these represent extreme examples, they clarify the
dissimilarity of animal bodies and human ones.
On the other hand, animal experiments today are
superior in detecting side effects, as the effect of a
drug can be seen in the whole body of the animal.
The organ-on-chip, in contrast, can only capture
the effects on the specific organ which it is con-
structed to mimic. In animal testing the effects of
a drug for a heart treatment can also be seen on
the liver and on other organs of the animal, while
the ‘organ on a chip’ would only show the effects
on the heart. Moreover, the experiments in animal
laboratories are done longer and can be multiplied
on a larger scale. Organs-on-chips are currently
very labor intensive, because they are in early de-
velopment, which is hindering long term experi-
ments and multiplication of the experiments today.
Possibilities with organs-on-chips
One of the main possibilities of this innovation is
making the path of bringing a new drug to the mar-
ket shorter, cheaper, and overall more efficient. The
efficiency of the drug development process has de-
clined alarmingly over the past decades. Less and
less drugs make it to market. More than half of all
new drug candidates fail when they are first tested
on humans, either because they cause toxic side-ef-
fects that were previously undetected, or simply
because they don’t work like they’re supposed to.
Another positive impact of the technology is that
it offers the possibility to test drugs not only for
humans in general, but on a specific person with
which the researchers use an individual person’s
stem cells. Stem cells of any human can be used in
the chip to make a personal organ-on-chip. Indivi-
dual medicine treatments can be tested on the chip
for its effects and efficiency, so the patient gets the
medication that is most effective for his or her body.
Thus, it would also be possible to test drugs for peo-
ple with certain health risks or chronic diseases.
29
 However, a downside of the technology is that Differences In Drug Testing Of
at this moment the chips are still limited in their
full functioning and extent to which they can mi-
mic the organs, the innovation is still being deve-
ORGAN-ON-CHIP
VERSUS
loped is far from having reached it’s full potential.
They also have a limited lifespan, “it is not like you ANIMAL
can mimic a disease process that has been going on
for years”, stated Van der Meer. The ‘organs on a chip’
can currently be used in an average time span of a few
MODEL
weeks. The consequential problem is that one cannot
mimic a disease process which has been going on for Cell Type
years, such as Alzheimer or cardiovascular diseases, on
such a chip. However, there is the possibility to instant- Are seeded with Mice which have
human cells, but cells animal cells cannot
ly put the cells on the chip in the diseased state, by for are naturally in early capture the complexity
example placing inflammatory tissue in the microchip. stage of the human
Despite its positive effects and advantages for the
human health, it is doubtful if everyone will be Side Effects
able to have access to the technology. Currently Side effects only of Can detect side
the costs of construction are expensive in an ex- organ and parts in the effects of other
organ can be captured
tent, that ordinary people would not be able to af- organs in the body
ford such treatment, but only wealthier people.
Another critical issue that arises with the techno- Long Term Effects
logy is the uncertainty about data protection. As Experiments are Experiments can be
scientists use an individual’s stem cells to emula- short term due to done longer to
te the functioning of organs, they also possess the organ not being kept capture long term
alive for long effects
DNA of that specific person. Additionally, the risk
of computer hacking presents a potential danger for Promises
data protection of the patients results, which could Cells from people of
then be spread to third parties. Hence, the techno- different ages, gender The animal model
logy’s impact on data protection needs to be con- or genetic can be studied as a
background can be living organism
sidered in the further development, not only by the used
researchers but also by governments and NGOs.

The need of a faster development of medicine and

drugs is evident. With the innovation of organs-
on-chips this problem may be of the past. With the
use of stem cell technology the tiny organs create a
replica of the human organ which captures the high
complexity of human tissue. This enables more relia-
ble results in laboratories than with animal models.
However, animal models cannot be fully replaced by
organs-on-chips. Stem cells are naturally in an early
stage of development and are not able to apprehend
long term diseases which develop over multiple years.
Both methods have benefits and limitations with
which they are able to test different scenarios. The-
refore, animal experiments will perhaps not be enti-
rely replaced by organs-on-chips in the near future,
but they have great prospects to reduce animal testing
and are a great addition in drug testing procedures.
With more research being conducted on stem cells,
organs-on-chips will improve and might have even
bigger potential. With researchers and companies that
scale up the producing of organs-on-chips the new
technology improves very quickly these days, and it is
hard to predict in what way and how fast organs-on-
chips will develop in the future. Today’s research sets
the prospect of multiple organs-on-chips connected to
each other, or even a ‘human-on-a- chip’ which would
come even closer to fully substitute animal testing.

30
 U-Tech
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