How far can we go in the battle against illness? Earlier this year, Austrian researchers came up with the startling suggestion that life should be regarded as beginning at sixty five.
Researchers at the International Institute for Applied Systems Analysis examined predicted ageing rates up until 2050 and concluded that we should no longer view someone reaching retirement age as ‘old’.
World Population Program Deputy Director Sergei Scherbov, who led the study, said: “What we think of as old has changed over time, and it will need to continue changing in the future as people live longer, healthier lives. Someone who is 60 years old today, I would argue is middle aged. Two hundred years ago, a 60-year-old would be a very old person.”
All very encouraging. Or is it? Living longer would be terrific were it not for the long shadow cast by illness, a shadow that persists despite the breakthroughs being made by medical science.
Every day, diagnostics are improved, drugs developed, lives saved, cures found and some illnesses like smallpox even recede into memory yet people still become sick and millions die before their time.
All of which begs the question – how far can we go in eradicating illness? In this special feature we look at the way that scientists from different disciplines are waging war on ill-health.
Battlefront 1 – waging war on infection
Twenty five per cent of deaths worldwide are caused by infectious diseases and scientists readily acknowledge that, although they can make advances in the fight against bacteria, it is one that they can probably never win.
Among reasons for such a conclusion is the remarkably adaptable nature of the bacteria. This is an enemy that keeps rewriting the rules.
Professor Simi Ali, Professor of Immunobiology at the Institute of Cellular Medicine, part of Newcastle University in North East England, said: “We can probably never fully eradicate infectious diseases and one of the reasons I say that is the emergence of new forms of old diseases as bacteria become resistant to drug treatments.
“Bacteria can multiply at a rapid rate which means that they can mutate quickly and become drug-resistant, which reduces the effect of the antibiotics that we use to treat them.”
Another challenge, according to Prof Ali, is changes in human behaviour over recent decades, including deforestation and unprecedented travel, which are increasingly bringing people into contact with bacteria that previously they would have avoided.
Prof Ali said: “A big challenge in the work to combat communicable diseases is the emergence in humans of ‘new diseases’. These tend not to really be new but actually old diseases to which humans become exposed.
“Take ebola as an example. It had occurred sporadically in humans before the recent big outbreak in West Africa but, because humans lived away from animals such as primates and bats which carried it, the outbreaks were isolated.
“Many of the Ebola outbreaks have occurred in forest fringe areas, where expansion of human populations is bringing them into contact with pathogens which they were not exposed to earlier.
“That change in population behaviour carries the risk of more transmissions from animals to humans of illnesses such as Avian Flu and SARS in the years to come.”
However, Prof Ali believes that advances are being made, saying: “There are reasons to be optimistic, not least because of our increasing understanding of the genome of bacteria. For the first time, we really have a handle on the genomics involved.
“One of the things that we need to do is use that information to better target the way we use drugs, targeting specific drugs at specific strains of bacteria, and genome sequencing technologies will improve the diagnosis and control of infectious diseases.
“I still think we will always be fighting the battle against bacteria but medical science could, in time, allow us to be one step ahead.” – Professor Simi Ali – Professor of Immunobiology at the Institute of Cellular Medicine
Latest chapter in an old story offers hope
The idea that each generation of medical researchers moves closer to victory is illustrated in the story of an illness that has killed millions down the centuries and continues to do so.
Throughout history, people have died long and lingering deaths from the effects of infection, everyone from victims of the Black Death in the late Medieval period to 20th Century soldiers in two world wars as they succumbed to battle wounds.
Although treatment of sepsis, the illness caused by the body’s overreaction to infection, is continually improving, many millions of people still die from it. Now, a team including scientists from Teesside University has come up with a way of dramatically improving early diagnosis.
The project is being seen as a classic illustration of the way that different scientific disciplines, including bioscience, can work together.
Sepsis, which can be triggered by infection or may occur after medical treatment or surgery, has been recognised since the fifth Century BC and its story is an excellent example of how scientific advancement works.
For example, Ignaz Semmelweis, a 19th Century obstetrician at the Vienna General Hospital, noted that the death from fever of women waiting to give birth was a common complication. Semmelweis discovered that it was common for medical students to examine pregnant women directly after pathology lessons. By introducing hand-washing and surgical gloves, he reduced the mortality rate from 18% to 2.5% per cent.
Further adding to the knowledge were 19th Century French chemist Louis Pasteur, who discovered that tiny single cell organisms caused putrefaction, followed by Joseph Lister, who noted when he became chairman of a surgery department that about 50 per cent of patients with amputations died of sepsis. Lister pulled together work done by Semmelweis and Pasteur to develop skin and instrument disinfection with carbolic acid, known as the antiseptic method, drastically reducing post-amputation mortality.
The mass introduction of antibiotics in the 20th Century continued to bring the death rate down and now the next step could have been taken by the team behind the £1.3 million CE-microArray project, which is coordinated by Teesside University and includes eight other European academic and SME partners.
Current methods of diagnosing sepsis involve analysing blood culture and can take up to 72 hours. In cases of severe sepsis, a diagnosis which brings forward the start of antibiotic treatment by just one hour could lead to a 6-10 per cent reduction in mortality rates.
The CE-microArray technique improves the sensitivity of blood tests. Taken in conjunction with the development of a more reliable biomarker for the diagnosis of risk, which will be undertaken by the Universities of Freiburg and Ulm in Germany, this could lead to a test which could be up to 100 times more sensitive than conventional ones.
The project, carried out under the EU Seventh Framework programme, is being coordinated by Dr Meez Islam, a Reader in Physical Chemistry in the School of Science & Engineering at Teesside University and one of the SME partners in the project is Anasyst, a company specialising in analytical systems which was spun out of Teesside University research.
Following completion of the project, the development of the sepsis test will also involve clinical trials. Dr Islam said: “Anything that can speed up the diagnosis times and start treatment earlier, even by a small amount, could potentially save thousands of lives each year.
“In the United States alone, the cost of treatment as a result of hospitalisation for sepsis is thought to be about $17 billion annually so it could have a huge benefit for healthcare budgets as well.. At the end of this project, we hope to have novel ways of testing for sepsis which could have a massive impact across the world.
“It came about because we had developed the technology but did not really have an application for it. However, through the consortium it became clear that it could be used for more sensitive diagnosis for sepsis.
“I did not know much about sepsis at that time but this is how science will develop in the future, with scientists from different disciplines working together. It is all about choosing the right partners.
“I know colleagues in the physical sciences working on exciting ideas for which there is no application that they know of but take it to someone else and they can find the right application.
“In this case, we knew how to develop the technology but it needed someone else to identify an application. We could not have done it on our own, but working with the bioscientists and the engineers we came up with something that can save lives.
“Every scientist dreams of their work making a difference and we have. This kind of approach is the way science must go as we seek to reduce illness.”
Battlefront 2 – ageing populations brings severe health challenges
While there is hope in the fight against infectious diseases, that is only part of the picture because seventy per cent of deaths worldwide are caused by non-communicable diseases, a quarter from cardiovascular conditions, 11` per cent from cancer, eight per cent from respiratory conditions and five per cent from diabetes.
One of the big challenges for medical science is the increasing life expectancy for many people, particularly in the western world, which brings with it increased exposure to everything from dementia to cancer.
Ruth Plummer, Clinical Professor of Experimental Cancer Medicine at the UK-based Northern Institute for Cancer Research, said: “Predictions suggest that we will move from one in four people developing cancer in their life time to one in two due to the fact that we are living longer.
“We do see younger people with cancer, of course, but the rates go up with people in their seventies. We are living longer than ever before and as we get older we contract more health conditions. That presents a major challenge for medical science.”
Prof Plummer, who is based at the Sir Bobby Robson Unit at the Freeman Hospital in Newcastle, named after the former England, Newcastle United and Barcelona football manager who died of cancer, supports calls for experts from different disciplines to work together to tackle the problem.
The professor, who was Sir Bobby’s physician, said: “We can never make the promise of a cure to a patient with advanced disease but we are making progress.
“Survival rates are improving due to scientific advances and that is because our methods of treatment are improving and because more people realise that they have to live healthier lives, eat better, not drink too much and not smoke.
“I think that it is a good idea for scientists in different fields to work together. For instance, Newcastle University has expertise in the study of the ageing process so we are working with those in that area to understood more about the increased frailty seen with age and the way it can impact on health and the ability to give cancer treatments.
“That kind of approach makes sense given that people are at risk of more health conditions the older they get. For scientists, being exposed to new ideas and new ways of thinking is exciting.”
Battlefront 3 – could genetics hold the key to eradicating ill-health?
Talk to bioscientists about the chances of eradicating health conditions and the talk very rapidly makes its way to the potential offered by genetics.
Cancer is one of the areas in which the involvement of geneticists is offering real hope for the future.
Dr Emma Smith, senior science communications officer for Cancer Research UK, said: “We’ve made incredible progress over the past 40 years. Survival rates have doubled, and half of all people now diagnosed with cancer survive.
“Without a doubt, the genetic revolution has been central to our understanding of and progress against cancer. From the early realisation that cancer was a result of mutations in our own genes, we’re now at a point where a person’s entire genome can be sequenced relatively cheaply and easily.
“But far from being a simple case of identifying a few broken genes and ‘fixing’ them, the wealth of genetic information has only made the realisation of the challenge we face starker. What’s emerging now is a bigger picture of just how complex an enemy we’re facing.”
For Dr Smith, the answer lies in a large-scale response. She said: “Understanding the genetic causes of cancer has led to the development of some very effective treatments but, in order to get a bigger picture of cancer, genetic sequencing is needed on a much grander scale.
“For people with a family history of cancer who have an increased risk of developing the disease, genetic screening could offer more ways to manage the risk better.
“There’s still a way to go before we fully understand the complexity of how genes interact with each other to affect our risk, and how best to factor in environmental and lifestyle factors too, but the technology is being developed.”