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Voiceover:

Welcome to UNSW’s Engineering the Future podcast – a series where we’ll speak to academics and industry leaders who are embracing cutting-edge ideas and pushing the boundaries of what is truly possible.

In this episode, we’ll take a deep dive into exciting developments in biomedical engineering and discuss what impacts we can expect on society as a whole over the next two decades.

We’ll hear from leading experts in the field, Associate Professor Mohit Shivdasani and Claire Bridges, as they explain how the science-fiction of bionic humans is now rapidly becoming a reality.

They’ll also give their verdict on whether the speed of progress will continue and lead to things such as artificial lab-grown organs, nanorobots inside the body, or computers hardwired to the brain becoming common in the next 20 years.

So join us as we discover how world-changing action starts with fearless thinking in…. “Engineering the Future of Biomedical Engineering”.

Neil Martin:

Hello, and welcome to Engineering the Future of Biomedical Engineering. My name is Neil Martin and I'm a journalist and STEM communicator working in the Faculty of Engineering at UNSW. Joining me today to discuss the exciting biomedical developments that could revolutionise healthcare over the next 20 years is Associate Professor Mohit Shivdasani from UNSW Sydney. Mohit leads several research programs including the development of bioelectronic devices for the blind, as well as for those suffering chronic pain, and for people with inflammatory bowel disease. Mohit was also previously named ‘Young Biomedical Engineer of the Year’ by Engineers Australia. Welcome to you, Mohit.

Mohit Shivdasani:

Thanks, Neil. Very glad to be here.

Neil Martin:

Also with us is Claire Bridges, a PhD candidate at UNSW who is conducting research on blood vessels to help prevent and treat cardiovascular disease in people with diabetes. In addition, Claire has a clinical background as an authorised nurse immuniser and perioperative registered nurse at several hospitals in Sydney. Hello, Claire.

Claire Bridges:

Hi, Neil.

Neil Martin:

So I'd like to get straight into this discussion I think because there seems to be so many exciting developments in biomedical engineering, whether artificial organs or nanomedicine or brain computer interfaces, and maybe those things sound like something out of a science fiction movie to a lot of people. I'm keen to know just how likely it is that such amazing technologies will be commonplace in 20 years’ time and what that might mean in terms of quality of human life. Claire, I might start with you. How transformative do you think biomedical engineering will really be in the next 20 years?

Claire Bridges:

Within the next 20 years we're definitely going to see some things happen that right now seem impossible or exactly like you said, science fiction futurey. We've come a long way with medicine, but there's still a lot of pretty significant challenges to overcome. So we're on a good path to make progress on a lot of those and then I'm sure find new ones.

Neil Martin:

And, Mohit, do you think people would believe what might well be possible 20 years down the line?

Mohit Shivdasani:

Oh absolutely, Neil. Science fiction and biomedical engineering have always gone hand in hand for many, many decades. I mean, everyone relates to a lot of different science fiction shows and movies. The '70s, who could forget The Six Million Dollar Man, for example, that was a fascinating show and just basically showed or imagined possibilities. So I think, yes, 20 years in the future, whatever we can imagine today, it might become reality.

Neil Martin:

How likely do you think it will be that we'll have a bionic man in 2050?

Mohit Shivdasani:

Oh, I think we already do. Bionic devices basically which is fancy term for combining biology and electronics are essentially devices that try to treat and give back quality of living to someone who might have lost some function due to disease or trauma. And those kind of devices already exist. I mean, we already know the well-famous cochlear implant for example, that is built and manufactured right here in Sydney and that was developed in the '70s and became commercially available in the '80s. So bionic devices are here. They're already here and they're only going to get better because technology is going to get better. So these devices are going to become smarter and more capable of giving back even more functions.

Neil Martin:

Claire, do you think more and more people will be taking advantage of these new technologies 20 years in the future? It won't be just a rare thing. Maybe it might be quite common to have a bionic implant or an artificial organ.

Claire Bridges:

Yeah, absolutely. In fact, actually we are starting to see even more of an uptick now. So the cochlear implant is a great example of a bionic device and researchers across the world are working on other devices to restore function or help improve quality of life, which is really overarchingly what our goal typically is in biomedical engineering. But for example, there's a company based out of Boston, Massachusetts called Beta Bionics and they just had their bionic pancreas cleared with the FDA for use.

So that essentially works in conjunction with a Dexcom which is a glucose monitor that person wears and it monitors their glucose in real time and that talks to this new bionic pancreas which then automates all of their insulin doses so people don't have to count their carbs and put in how much insulin to get and things like that.

But things like that really take a lot of the day-to-day burden off of people. And so I think as we get more and more devices to help restore some of those functions that are easy to take for granted. If you don't have any problems with them, I think we'll see more and more of that. And as we get to improve those more, I think we'll also be able to improve that access equity as well. Because it is true - a lot of these devices can be quite expensive. But we keep researching to see if we can't make them with a more affordable price point or generally something that more people could get their hands on. So I think that'll be pretty common.

Neil Martin:

You mentioned there improving function. Mohit, I believe that one of the things that you work on is potential bionic eye to assist blind people, which is obviously a major function of the body. That would be amazing for people who have little or no sight to be able to see. Again, that must be very exciting to potentially be able to deliver that.

Mohit Shivdasani:

Oh, absolutely. And just to first add to Claire's point earlier, I mean in terms of uptick. In the last 10 years, we've seen everyone become tech savvy, everyone wants smart stuff carried around with them. Everyone wants to be part of the artificial intelligence world. Everyone is embracing technology more and more. So I think as these devices are going to get smarter and more capable, there will be more appetite for uptick with these, particularly if they're doing remarkable jobs in restoring functionality.

And absolutely with the bionic eye, it is all about giving back visual function. I mean there are lots of assistive devices already that exist for blind people and a realm of technology that already exists. The bionic eye was conceived as it was initially thought that it could surpass all of the existing assistive devices because the idea was to essentially give back the perception of vision in itself.

And then we realised, "Oh boy, the eye is quite complicated. Sight is not an easy thing to give back." We started out primitive and yes, we did some amazing work in Melbourne and we had clinical trials going in Australia itself. I was fortunate enough to be part of them and fortunate enough to actually see people 20 years after they've gone blind that they get back some function. And that made us realise that yes, it's possible, but we have a long way to go before we can call this actual restoration of sight. So I think we're quite a way off but it has motivated us even more because we are always seeing room for improvement.

Neil Martin:

I think all of these things, people would understand that they're very complicated - they're not easy things for you biomedical engineers to develop. I might just go through some of the things that I've seen that have been proposed and maybe get your comments on whether you think they're feasible, how likely they are to be in place if we are looking 20 years in the future. One of the first things that I read about was artificial organs. I wonder if you could, Claire, maybe explain what they are, how they work and what the impact on people would be?

Claire Bridges:

Yeah, absolutely. So one of the biggest challenges that we have in medicine is a lack of donor organs for transplants. The fact that we transplant organs at all, I still get a little bit awestruck by because somebody at some point said, "Let's engineer the body and that one doesn't work. Okay, we'll swap it out with a new part and it works," which is crazy, but unfortunately those organs have to come from somewhere and there is always a supply shortage.

So one of the goals of biomedical engineering is to come up with some type of solution for that. The two that I have seen the most discussed are basically a continuation of what we were discussing with a bionic-something and implant-something that could be surgically usually put into the body in order to either assist or replace the function of an organ that's failing or has failed. Or there's the tissue engineered, basically grow a new organ from ideally the patient's own stem cells so that we also get rid of some of the rejection risks and things like that. Both of those things have quite the challenges associated with them, but both have a really, really significant impact that could absolutely change the lives of, I would say millions of people for sure.

Neil Martin:

I think we all have heard stories of people who are on waiting lists for an implant and unfortunately sometimes that wouldn't be possible. So I guess this would solve that problem. What you were saying, Claire, there as well to me sounds, and I've heard people mention this, that you can grow your own new liver or your own new kidney and have your own spare parts as you mentioned, which does sound very sci-fi to me.

Claire Bridges:

Yeah, absolutely. We do some sort of self-donor treatments already in medicine. So even things like if you have a bypass graft done, a surgery done on your heart to bypass a blocked coronary artery, the graft is usually a vein that's taken from somewhere else in the patient's body. So we are familiar with and like to use patient's own things. It would be really nice if we could, exactly, as you put it, have some spare parts or at least have the ability to generate some spare parts in the future.

Neil Martin:

Of those two options, Mohit, do you have a view of which you think is going to be the most prevalent or do you think that they will work in tandem. They’ll be these kind of artificial, I guess more mechanical, I guess what you might call a lab grown organ.

Mohit Shivdasani:

I think they're going to be complimentary, and Claire mentioned an example where you take apart from the patient's own body and replace it in another area. I think that the reason why that's so amazing is because that is the patient's own cells and the artificial stuff that you can make in a lab or make out of known material. So one of the issue with making anything or engineering something artificial, not from cells but from other materials, is you're limited by the choice of materials because the human body as complex as is it is, is known for rejecting anything foreign that's inserted into it. Any implant that's made out of a foreign material will cause a reaction in the body. And the idea is that that must not cause too much of an adverse reaction. So it's always about the risk of putting something artificial into the body versus the benefits that it's actually going to provide. So it's always going to be this risk benefit ratio of whether to go with something that's artificially made or engineered versus some something that's artificially grown out of cells versus something that's the patient's own part that's reused in a certain way.

And so I think, yes, they're going to be complimentary in some cases. It's not going to be feasible to use natural stuff. In some cases we are going to rely on artificial implants. But what's amazing is that the choices are there and that we can help people today and not wait for something 20 years into the future that might help them later on. But there are things that we can do today is, I think, is what is important.

Neil Martin:

And this might be a tricky question if it's a very futuristic thing, but do we have any timeframes for how long we might expect these lab grown cell-based organs to be grown? I mean, do you think it might be the case, "I need a new liver, or we can grow you one from your own cells within a week or two weeks?" Or would it be a much longer process or might you have to be doing that in advance?

Claire Bridges:

I think there's sort of a couple of things that go into that. And one is that one of the main challenges we have right now with creating a new organ, basically growing a new organ, is getting the actual structure right. Which is also a challenge that they look at in the less medical, but lab grown meat industry as well. Because we can culture cells and grow them in a dish or on a scaffold, but our organs are made up of a whole bunch of different tissues, and each of those tissues is made up of a whole bunch of different types of cells.

So getting all of the right cells in the right place is a challenge as well as the fact that the structure of our organs is both very complex but also in some places very, very small - so much smaller than we can currently actually like 3D print. So a capillary, which is the very smallest blood vessel essentially in our body where we do that nutrient exchange, we can't really 3D print a capillary at the moment. It's just too small and that kind of complex and very small-scale morphology or geometry presents its own challenge.

If I was going to wildly speculate, I would say it would certainly take probably at least, I want to say an absolute minimum six weeks.

Neil Martin:

It's very hard to say I guess because this is very new stuff that hasn't actually been done yet. And as you said, very, very complex as all of these technologies are. One of the other new developments that I see talked about falls into that category as well, I think, which is brain computer interfaces. The ability to have something that talks to your own brain and affects your body sounds very crazy to me, but these things are happening, Mohit.

Mohit Shivdasani:

Yeah, absolutely. You’ve brought up brain computer interface. Just saying a human brain talking to a computer directly without you using your hands. Well, even to think of something like this. Let's put it this way, even The Six Million Dollar Man did not envisage.

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Neil Martin:

We're moving into Star Trek there, I think.

Mohit Shivdasani:

Yeah, that's right. So just we have computers all around us. They're in our pockets. They're travelling with us everywhere we go. But just then to think that, "Oh, I can integrate this with my brain and I can once again use the technology." So imagine someone with multiple sclerosis, so ALS for example who are paralysed and they cannot integrate as much with this technology and then trying to give them back this function of being able to integrate with a computer - it's pretty amazing.

We actually saw evidence of a brain computer interface way back in 2006 in the US at Brown University where they implanted electrodes in a person's motor cortex, which is the part of the brain that is responsible for encoding thoughts and actions of movement. And they showed pretty amazingly that one particular person was able to control a robotic arm just by thinking about it and have her morning coffee while another person was able to move a cursor on a computer screen and read his email.

There is no commercial brain machine interface that a person can use outside of a laboratory setting, but we're very close because biomedical engineering does depend on a lot of other streams and other disciplines to get us to that point.

And as technology moves chips get better and smarter, they will be incorporated into medical devices. So we're not far off from seeing someone walking around with a brain machine interface outside of a lab.

Neil Martin:

Do you see that in 20 years time that would be that main focus of that technology to, again, restore function to people that have lost either I think walking or reading, writing, that kind of thing?

Mohit Shivdasani:

Absolutely.

Neil Martin:

Because their brain isn't sending the right signals. Is that what that solution is providing?

Mohit Shivdasani:

Well, their brain can send the signals, but those signals can't get to or either they cannot get to their limbs to be able to then walk themselves or essentially they're disrupted. So what a brain machine interface would do is read those thoughts and try to convert those thoughts to an action. So either drive an exoskeleton for example, or let a patient drive their own wheelchair, for example.

The latest brain machine interface that I read about, which is actually being developed in Melbourne, it's a very fascinating device by a company called Synchron and they're developing a very interesting technology to put the electrodes of the brain machine interface into the blood vessel into the brain rather than directly into brain tissue.

But then one of the news articles that I read said that this patient was able to tweet using their brain machine interface and I went, "Wow, that's very interesting that rather than drive a wheelchair, they were just elated that they were able to tweet again."

I mean I've had a lot of chats with blind patients, for example. When you ask them what do they want to do, what do they want from a bionic eye for example, they'll say things, "I want to see my family." I remember one talking to a lady, she said, "I would love to be able to see the Target sign again," because when I go into the shopping centre, I want to be able to find Target really easily.” As an engineer, I would never have thought about that, that that could be so important.

Neil Martin:

But it is, as you said before, it's so transformative for people and that brain computer interface to be able to help people to walk again for example, it's such a big, massive impact on their life. It must be amazing for biomedical engineers to work in this field and to be able to potentially provide that to people.

Mohit Shivdasani:

Yeah.

Claire Bridges:

Yeah, absolutely. One of the reasons that I like the combination of both doing some clinical work with theatre, surgical nursing and also doing this biomedical engineering world is essentially that you have the opportunity to change the way that somebody lives - usually a significant portion of their life. There's a part of the National Preventative Health Strategy in Australia is essentially focusing on decreasing disease burdened or years of somebody's life where they are unwell.

On average, Australians spend about 11 years of their life in poor health and with the advances in our biomedical technology, both in terms of physical, actual hands-on implanted treatment or drug delivery or things like that, but also with the way that we provide and improve access to healthcare, we have a lot of opportunity to improve those things. And it doesn't always seem like a lot for somebody who doesn't have specific health issues or struggles, but it's just like Mohit said, I mean, somebody wants to just be able to go to Target and it's easy to take that for granted.

Neil Martin:

You mentioned diseases which is maybe a more prevalent thing across society, and I wonder whether one of the other new technologies that I've been reading about seems to be a bit of a buzzword, nanomedicine and nanorobots. Is that something that's more targeted towards disease prevention and disease cure and what is it when we talk about nanomedicine?

Mohit Shivdasani:

I think one thing that we haven't really touched about, we've been talking about treatments and cures for example, but one of the other purposes of biomedical engineering is also to improve diagnosis and actually help medicine have early diagnosis, have better prediction, have better prognosis so that the right treatments can be delivered at the right time, the appropriate right treatments. So, I think nanomedicine plays a huge role in that. I've heard of smart nanoparticles for example that could be injected into someone.

Neil Martin:

What is a nanoparticle?

Mohit Shivdasani:

Well, the word nano means in engineering terms is 10 to the power of negative nine. So, it's really, really small.

Neil Martin:

Very small.

Mohit Shivdasani:

Very small. Something that you cannot see with the naked eye and it needs to be small because then it can be less invasive. So a nanoparticle is essentially a particle, an engineered particle that would be very small. It could either carry some drugs, so it could be loaded with drugs that then need to get delivered into a difficult location, for example, that you may not be able to deliver it through the bloodstream. If you want to directly deliver it to a certain location, you could inject those nanoparticles and into that location for example.

There's research going on using nanoparticles for treating hearing loss, and that competes with cochlear implants technology. The other area is cancer. So there are certain cancers that are very clever at hiding, but you can use nanoparticles loaded with some kind of smart dye that would then go and hunt and find the cancer and attach to it. Lo and behold, suddenly now you can image it whereas previously you couldn't. So I think that will improve diagnosis and prognosis, which will then improve treatment. But I think there's great power in using engineering to also improve diagnosis. With that, I want to mention artificial intelligence and its role in improving diagnosis. I mean, I know that in the eye disease for example, there's already AI that can be used to scan images of the patient's eye and actually scan them longitudinally over time and be able to predict how the disease is progressing within a given person. And that gives a tremendous amount of information to the physician who's responsible for treating that person.

Neil Martin:

I think it's a very valid point. We have a separate episode on artificial intelligence, and we touched on artificial intelligence in medicine before and it seems that there is so much data that can be gleaned from the body but there's so much data that it would be impossible for any single person to be able to analyse all that. So I guess this is where artificial intelligence comes in, Claire, to be able to assess all that and to also look at trends, I guess, across populations as well.

Claire Bridges:

Yeah, absolutely. The use of AI in that type of world is really, really beneficial because as you said there is so much data in the human body that we can measure. I have a professor who describes the human body as just a big bag of chemical reactions and molecular interactions. So it's always interesting to think about just how many things are going on at one time.

One of the most beneficial ways I think that we'll see some of that come into play more and more over the next 20 years are in areas as, Mohit mentioned, like diagnosis and then also moving into this idea of connected health. So with COVID we saw a huge increase in the expansion of telehealth because we needed to and that's been incredibly beneficial. And to further expand that and further improve on our ability to provide healthcare to people who might not be able to physically stand in front of me and have a certain test done, we can use wearables. So your smartwatch or your ring or even things like your blood glucose monitor or something else that's then perhaps implanted. So if we get into that brain machine interface world, things that could then collect data and use most likely some type of AI to do a lot of the analysis and processing, and then send the relevant information directly to the treating physician or doctor or NP or whoever that gives us a much better real time opportunity to intervene when people are acutely unwell or to pick up on risk factors or indicators that something could progress or get worse with time.

Mohit Shivdasani:

I'll take an example from the bionics world which is my favourite world that there's a company in Australia called Epi-Minder that is developing a device for epilepsy and that is meant to be a device that records seizure activity in the brain and beam it to a cloud. And then you have this AI trolling through all the data and how amazing that a neurologist can have then that information coming to them so that they can tailor appropriate treatments. Claire mentioned this area of connected health where we're going to have sensors for everything and that's going to be beamed to a cloud and physicians are going to be able to access it.

Neil Martin:

I was going to ask when Claire was talking about that monitoring and the AI, the thing that sprung immediately to my mind was maybe to do with heart attacks. Can you perceive a situation where you are walking down the street and your phone beeps telling you, you are at high risk?

Claire Bridges:

Yeah, absolutely. We see that even a little bit now with some of those things like the continuous blood glucose monitors, which we'll send a phone alert or a buzz to somebody if their blood sugar is dangerously low or dangerously high, or even trending that way - we'll only be able to expand on that. With improvements in our technology, we'll be able to expand from just this sort of one parameter monitoring to measuring a whole lot of different parameters. So whether it's inflammatory markers in the blood or hormone secretion or neurotransmitter issues, depending on what sensor we're talking about and where we're looking, ��so that we could catch things earlier and get that early diagnosis thing happening so that we can have more effective preventative health and really intervene ideally before we lose some of those functions or abilities that we're also trying to restore with some of the other work.

Mohit Shivdasani:

We mustn't forget that it may not just be the person who might be experiencing the heart attack to want to know that they're about to experience a heart attack, but it might be their carer who would be very important. Once again, thinking about the epilepsy world and a seizure prediction system. So there's a whole lot of research going on into can you predict using data from brainwaves. Can you actually predict the onset of a seizure? And then, yes, predict the likelihood and the severity. And that would be very beneficial in then reporting back to either the person or the carer so that something can be immediately done about it.

Neil Martin:

How worried, do you think people should be with regards to their medical information being up in the cloud? I guess there is an obvious benefit that they will get improved health outcomes, but there is a downside to having all that information potentially available to people who you might not want it to be available to.

Mohit Shivdasani:

We need the cybersecurity discipline to help us. Biomedical engineering is not just one discipline, it's an amalgamation of every discipline that wants to make a difference to health. We need computer scientists to be helping us develop better cybersecurity algorithms that will protect that data and we need to convince patients and users and carers that data is being protected and that it is being regulated, and it is only accessible by their physician.

Neil Martin:

Can you understand why some people would be worried, Claire?

Claire Bridges:

Oh, absolutely, yes. It's something that I think we all worry about generally anyway. And there is legislation that governs this. In the US it's called HIPAA, which everybody is usually quite familiar with, but in Australia, it's the Privacy Act of 1988 that basically governs who can and who cannot access your health information and why they can or cannot access it. As our technology and our abilities expand, we'll need to expand that legislation and we'll need to expand the awareness of that so that users feel comfortable using it.

Neil Martin:

I wanted to ask, what are some of the main challenges or problems that you think need to be solved? People talk about power being one of the bigger issues.

Mohit Shivdasani:

Power is a huge problem that needs to be solved. Power is king, as they say in a lot of medical devices, but there has to be not just power optimization. We need better hardware, better software, better algorithms, better wireless streaming capabilities and better cybersecurity, better storage. So all of it needs to come together. Once again taking the example of a brain computer interface that part of the reason that it hasn't really gone outside of the laboratory environment is because we're waiting for technology to come up to that point where we can actually then incorporate it into the medical device. Not only do you need your device to consume less power, but you need the actual power source to be small if you want to implant that power source. Battery technology is also something we are waiting for to make medical implants more power efficient.

Neil Martin:

So, Claire, we've heard there from Mohit about the potential problems that need to be solved with regards to power. Are there any other barriers that you see that need to be solved for these things to be widely implemented 20 years from now?

Claire Bridges:

Yeah. I think one of the main barriers that's common across all healthcare, not just sort of the technology development part is going to be basically cost and then accessibility. So one of the things that we do, even once we have a device designed and working is then we try and keep improving that classic engineering iterative design where you make something and then you go back and see how you can improve it. Ideally, we want to make things at a more cost-effective price point and also at a scalable level. So that way, 4 million people can have these $10 devices or whatever the equivalent is.

Neil Martin:

Just to finish off, I mean this has been a fascinating discussion and so many exciting things in the world of biomedical engineering. I might just ask you, if you were a 16 or 17-year-old thinking at the moment of going into a career in biomedical engineering, what would you be most excited about?

Mohit Shivdasani:

Okay, sure. I would tell them that if you have a passion for health and you have an interest in engineering, it doesn't really matter which particular discipline of engineering that you choose to take up. Whether it be mechanical engineering, electronic engineering, chemical, material science, telecommunications, ultimately, if you have a passion for problem solving in health, even computer science, you will become part of biomedical engineering and you will be able to make a difference.

Because what we saw 20 years ago where things were just a possibility - are now a reality. And things that we're imagining now are only going to become realities of the future. And just to be part of the journey to be able to ride that train, I think it would be amazing. Whether or not you choose to go into cybersecurity, whether or not you choose to become an electronics engineer that works on better Wi-Fi and better internet of things and better sensors. You will have the opportunity to be part of this amazing journey. So it's an absolute awesome time to be an engineer in this field.

Neil Martin:

And, Claire, same question.

Claire Bridges:

I think one of the most exciting things about biomedical engineering is the opportunity to make a positive change or a positive impact on a huge population with whatever your contribution is to science. There's a lot of variety in career in terms of biomedical engineering. We have a nice opportunity to really take some of that hard science as it's often described and put it deliberately towards good use for the benefit of people in positive ways.

Neil Martin:

I think any young person listening would've learned so much from you both today. It's been absolutely fascinating speaking to you. Unfortunately, that's all we've got time for. Associate professor Mohit Shivdasani, many thanks for joining me.

Mohit Shivdasani:

Yeah, thank you. Thank you for this opportunity. It's been fantastic.

Neil Martin:

And, Claire Bridges, it was also great to speak to you.

Claire Bridges:

Thanks so much, Neil.

Neil Martin:

I think it's clear the next two decades hold immense promise for biomedical engineering offering breakthroughs that will transform healthcare, prolong lives, and enhance human wellbeing in profound ways. It's interesting for me to think about the number of people listening right now who might one day massively benefit from such new technologies that currently simply don't exist.

Maybe they'll even remember hearing about them first on this podcast. I've been Neil Martin, thanks for listening and I hope you'll join me again soon for the next episode of Engineering the Future.

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