Top Doctors 2008

Future Perfect

Seattle’s cutting-edge biogadgets and novel treatments—think lab-grown heart muscles and robotic limbs—are about to redefine health care. It’s guaranteed to take your breath away.

With Jessica Voelker and Kelly Huffman By Stefan Durham and Lee Fehrenbacher December 27, 2008 Published in the August 2008 issue of Seattle Met

Seattle’s cutting-edge biogadgets and novel treatments—think lab-grown heart muscles and robotic limbs—are about to redefine health care. It’s guaranteed to take your breath away.

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Just Add Blood

Are skin cells the new stem cells?

BRISKLY TRAVERSING a white-walled lab on the fourth floor of UW’s Brotman Building, developmental biologist Dr. Lil Pabon snaps on a pair of green latex gloves and powers up a microscope. A soft blue light flickers to life as Pabon reaches into a refrigerator full of incubating petri dishes. She surveys the contents, grabs one, and sets it beneath the scope. Instantly, a glob of mucous jumps into view on an adjacent computer screen. Then—out of nowhere—it beats. Ba-dum. Like a heart beating. Like a muscle contracting. The screen blurs as the microscope refocuses. Did that slime just move?

ISCRM, the University of Washington’s Institute for Stem Cell and Regenerative Medicine (“Ice Cream” to insiders), is just one of two labs in the country growing heart muscle out of embryonic stem cells. The South Lake Union center’s beating boogers represent the initial stages of a discovery that—for the million Americans who suffer heart attacks each year—may hold the key to life itself.

“Myocardial infarction [heart attack] is the number-one cause of death in the United States,” explains ISCRM’s codirector Dr. Chuck Murry, a bioengineer and pathologist by training. After years of struggling to promote heart attack response awareness (basically: yes, you are having the big one; for God’s sake get to a hospital), Murry decided to focus instead on mending the organ by halting the gradual decay of tissue that leads to fatal heart failure. After an attack—in effect, a clog in the blood flow of an artery that suffocates blood-pumping muscle tissue—the heart scars and turns into dead muscle. If a person is not treated, this leads to new attacks, killing more muscle tissue and ultimately causing organ failure and death. But if you could regrow heart tissue and inject it into the heart, reasoned Murry’s team, you could stop further attacks from occurring. They set about reprogramming stem cells into heart-muscle cells by injecting them with a cocktail of four specific genes, then grew them into muscle tissue.

"I have not yet found the person who is offended by the use of skin cells."

There was just one problem. Embryonic stem cells are drawn from human embryos, fertilized eggs that carry the capacity for life as well as the ability to save it. But many believe embryonic research is unethical, George W. Bush among them. In 2001, amid a fiery debate surrounding the origins of life, Bush drew a line in the sand, approving 60 existent human embryonic stem cell lines for research purposes, but forbidding government-funded scientists from creating new ones. Of the approved stems, just 21 turned out to be useful in the lab, and it’s those 21 lines that ISCRM uses to grow hearts. As the years go by, however, the lines are aging, making the cells more difficult to program and grow into tissue.

A few months ago the team conducted a study on rats. They induced myocardial infarction in the rodents, then implanted lab-grown tissue into their hearts. Initial results show that the transplanted tissue prevented additional heart failures. They would like to try it on humans, but unless new stem lines become available they may never have enough tissue to heal a human heart.

In the meantime some ISCRMers have begun focusing on the business potential of organ engineering. Dr. Buddy Ratner, director of the UW Engineered Biomaterials Center and an ISCRM researcher, has had a hand in five of the 100 medical device companies that have spun out of the UW in the past 10 years (and into an industry estimated at $100 billion). Redmond-based Healionics currently markets a Ratner biomaterial that may one day be used as fully implantable glucose sensors for diabetics, putting an end to all that finger pricking. He’s also collaborating with an orthopedic surgeon at Harborview Medical Center to create a bio-degradable scaffold that will help humans regrow fingers in the same way a salamander regrows its body parts. As tissue grows around the scaffold, the scaffold biodegrades, leaving only the new finger in its place.

Late last year, an ISCRM discovery sent Murry over the moon: Collaborators in Japan have used his team’s genetic cocktail to grow heart tissue using skin cells instead of stems. “I have not yet found the person who is offended by the use of skin cells,” says Murry, beaming from behind his desk. On top of that, skin cells are about as abundant as the air we breathe. “Imagine we took a skin biopsy from you,” he says, pinching my arm, “grew up some of your cells that we’d reprogrammed with these four genes. Look what they can do.” He spins around a computer monitor displaying a blob of slime that is slowly, steadily, throbbing its way into existence.

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Stroke Signals

It’s the year 2018, and amazing, Seattle-born medical technologies are
 about to save your life. by Stefan Durham


Wake Up to the Future
“Ouch!” You scream, jolted out of bed by a hammering pain in your skull. Maybe it’s the unpredictable August weather (a snowstorm last week froze up the light rail system just a month after it opened) or the dizzying altitude of your latest condo upgrade—an 80th-floor flat in trendy SeaTac—but for most of 2018, you’ve felt like a headache magnet. You dress and head out the door, never dreaming that within hours, your life will be on the line.


A Busy Commute
Pedaling toward your office in downtown Delridge along Mayor Dave Matthews’s new bicycle superhighway, you use your voice-controlled, earbud smartphone to log on to Healthvault—a global online medical network developed at Microsoft’s Redmond HQ—and check your latest blood test results. Ten years ago you could only store and organize your health records and personal device data (from portable dialysis machines or heart monitors, for example) on the system, but now that it’s connected to your doctor’s computer and your credit card company, the program draws from a continually updated database of your diet habits, personal medical info, and family health history. In seconds, the system reports that your lab work has indicated signs of atherosclerosis—inflamed 
artery walls—and elevated levels of artery-
clogging cholesterols.


Predisposition Noted
Alarmed by the news, you dictate a phone message to your doctor detailing recent dizzy spells, the off-and-on weakness in your left leg, and those head-splitting pains. Healthvault automatically transcribes your voice memo and sends it in a text email using Microsoft’s tried-and-true Unified Communications software (which first broke down the barriers between phones and computers back in 2007) and then scans your medical background for related keywords. Discovering that your grandfather suffered a minor stroke when he was around your age, the network sends a priority email to your doctor urging her to examine your migraines ASAP.


Bad News, Good News
After reading your email, your doc sends a reply saying she’d like to start monitoring your headaches and do a scan for blockages in your cranial arteries. By the time the office security robot grants you access to your building, your doctor has ordered courier delivery of a new PhysioSonics portable ultrasonic head lab, in development by University of Washington doctors since 2000.


Life-Saving Head Gear
You sign off on the delivery, slip on the baseball-cap-shaped head lab, and pour yourself a cup of Starbucks green-tea-fortified soy smoothie from the office dispenser. Before you’ve begun sipping your drink, the head lab starts using an array of ultrasound emitters and sensors to determine how much blood is flowing through your brain’s arteries, and to detect any hazardous free-floating bits—like blood clots—that could mean your headaches are due to more than President Schwarzenegger’s vexing domestic policies.


Automatic Ambulance
After lunch you notice some distortion at the edges of your vision—not good. The head lab picks up something else: A small clot in a main artery on the right side of your brain is cutting off blood flow. It wirelessly transmits the information to your hospital’s internal Amalga system, where staffers can make patients’ MRI results, blood work data, and other medical info instantly available to emergency response teams or special care clinics that may need it. Amalga was first created by a team at the Washington Hospital Center in 1996, later developed by Micro-soft for use on hospital intranets in 2006, and recently connected with the Healthvault network to create an always-alert online health system, which automatically notifies your doctor and contacts a local emergency response network before you know you need it. Just as you’re starting to feel a tingling sensation in your left hand, the Amalga-Healthvault central computer summons an ambulance from the closest hospital to your office building.


Instant Message
A message instantly sent to your phone and email address warns that you’re suffering a mild stroke and notifies you that medics are on their way to treat you. You alert coworkers that there is an emergency; they help you out of the office building and meet the ambulance at the exact moment it pulls up to the entrance. (“Excuse me, sir, are you the one having the stroke?”)


Rapid Response
As soon as you are inside the vehicle, a full-fledged blockage, a thromboembolism, triggers a serious attack. With the right side of your face going numb and your arm limp at your side, the medics flip on a TeleStroke monitor that wirelessly connects them to a 24-hour on-call team of stroke specialists at Swedish Medical Center, Seattle’s top cardiovascular clinic—six miles away in Cherry Hill.


Dial-Up Diagnosis
The doctors at Swedish remotely diagnose your stroke and direct the medics to give you an IV mix of tissue plasminogen activator to stop the clotting.


Miracle Meds
By the time the ambulance arrives at the intensive care unit, the drugs have taken effect. Your doctors decide to fortify your IV cocktail with an infusion of Neu2000KL, a drug first developed—and tested—by Sammamish-based Amkor Pharmaceuticals in 2008. The neuroprotectant reduces damage to brain tissue caused by stroke and encourages the repair of affected brain cell structures.


Under control
Family members show up and you chat with them. Thanks to the rapid treatment, the stroke seems to have caused minimal damage, though lingering weakness in your left arm and leg means that you’ll have to undergo rehabilitative therapy.

Day 2

On the mend
You sit down to the first sessions of your robot-guided regimen of arm and leg rehabilitation exercises at UW’s Harborview Stroke Center. Next week, you’ll return to work, though you’ll need to wear that head lab for the next few months—try to ignore your snickering colleagues.

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Natural Selection

Alternative medicine and the genome pave the way to über-personalized health care.

by Jessica Voelker with Kelly Huffman

INSIDE THE SOUTH LAKE UNION office of Dr. Astrid Pujari, patients begin their visits with an offer of herbal tea and a leisurely chat about how their lives are going, how they’re feeling physically, and what’s been on their minds. Next, Pujari—who worked as a primary care physician at Virginia Mason before setting up her private practice—might guide them through a meditation or refer them to an expert masseuse. If this is the future of medicine, sign us up.

“Behavioral change is what 99 percent of medicine is about,” says Pujari. “It comes from inspiring people and helping them get reinspired about their lives. In order to really change things, you have to have somebody who is looking at a patient like more than just a physical machine.” A slim woman with large, expressive eyes and a few wiry, white hairs topping her -tangle of black curls, Pujari is at once a plain-talking scientist (“Are you familiar with E = mc2?” she asks seriously, ready to lay it out for you if necessary) and a free-spirited, tie-dyed-in-the-wool hippie (“I love plants; when I go camping it’s like I’m visiting my friends”). She’s the daughter of a French woman and an Indian man, with an MD from Tufts University and expertise in medical herbology earned at the College of Phytotherapy in London. If integrative medicine needs a poster child, Astrid Pujari will do.

Complimentary and alternative medicine (CAM) often conjures images of herbal potions and needle-wielding old women administering acupuncture. That’s not inaccurate: The umbrella term encompasses everything from chiropractic therapy to Chinese herbal medicines to yoga. But what unites most CAM practitioners—and what has made them so popular (one in three American adults now uses them)—are two things: They avoid recommending symptom-suppressing meds whenever possible, opting to root out the cause of illness instead, and they consider their patients holistically, rather than focusing only on the physical body. While most of us would be happy to take antibiotics for our more serious bacterial infections, we also want help avoid illness in the first place. And when are sick, we want a provider who will guide us through it, help us not only survive illness but learn from it, and live better afterward. More and more, Americans are demanding a personalized health plan, one that allows them to cherry pick treatments, seeing a conventional doc for an irregular heartbeat, say, but asking a naturopath to help them find drug-free ways to conquer insomnia. With states, including ours, now forcing insurance companies to cover alternative therapies, and with med schools—University of Washington among them—adding CAM to the curriculum, the mainstream medical world has started to catch on.

More and more, Americans are demanding a personalized health plan that allows them to cherry pick treatments, seeing a conventional doc for an irregular heartbeat, say, but asking a naturopath for drug-free ways to conquer insomnia.

“Personalized health care” became a buzz phrase back in 2003, when researchers finished mapping the human genome. Armed with their patients’ DNA, experts figured, future docs would be able to customize every treatment plan. So if a woman’s genetic code indicated she was prone to breast cancer, for instance, her doc could prescribe a mammogram at age 20 instead of 40. No longer would patients be lab rats, testing out prescriptions to see what works. Our docs could now precisely prescribe our drugs based on how they’d interact with our DNA. The implications for insurance plans were enormous, and enormously terrifying—who would cover a patient whose genetic makeup made them 99 percent likely to come down with some deadly disease? Genetics have not had quite this effect yet: DNA analyzers are on the market, but they’re too expensive to be a doctor’s office mainstay. Still, it’s not far-fetched to believe they’ll be affordable within the next few years, and when that happens things are going to get very personal.

In a way, then, the genome map has paved the way for integrative practitioners like Pujari, who specialize in helping people avoid illnesses. A genetic predisposition usually only means a person could get a disease, after all. Lifestyle choices—nutrition, stress reduction, exercise—go a long way in warding off illness, and CAM providers are all about inspiring patients to make healthy choices, whereas allopathic doctors aren’t often trained to teach deep breathing or counsel patients on their diet. But before MDs start referring patients to herbalists and Ayurvedic physicians, they want proof that their approaches actually work. And although the National Institutes of Health has funded millions of dollars’ worth of CAM research, there’s almost nothing conclusive on the books.

Seattle naturopath Joe Pizzorno wants to change that. The founding president of Bastyr University and a former appointee under Presidents Bill Clinton and George W. Bush, Pizzorno’s passion is bringing rigorous evidence-based study to the holistic world. He says the problem is that the lion’s share of CAM studies measure one single factor rather than the entire approach. So a study may offer subjects St. John’s wort to see if it helps their depression, he says, rather than assessing whether a complete naturopathic treatment—including nutrition plans and health-related lifestyle changes—makes patients happier.

In his own research Pizzorno focuses on supplementary therapies, a hallmark of naturopathic medicine. Right now he’s measuring vitamin D deficiencies in denizens of sun-deprived climates (Attention Seattleites: Pizzorno says he’s never seen a local who had normal levels of D). He believes that once people learn the most effective way to get vitamin D—seek more sun exposure (but not enough to burn), take a carefully prescribed supplement—we’ll see a dramatic reduction in a host of illnesses, from breast cancer to autoimmune disease. Pizzorno is also building an artificial intelligence system called SaluGenecists, which docs and patients will use to investigate holistic treatments. “I believe we’ll develop a health-care system which is collaborative between conventional medicine and natural medicine,” he says, “where we use the strengths of each medicine where they are most effective and work collaboratively towards the patient’s best interest.” If that means more sunbathing and massages, our health-care future could be very bright indeed.

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