From bench to bedside

18 March 2015
By Sarion Bowers

Stem cell technology has the potential to deliver new treatments.  Credit: Genome Research Limited

Stem cell technology has the potential to deliver new treatments. Credit: Genome Research Limited

The transition from science to technology is not straightforward – great science is not enough to ensure success.

Some technologies, such as the internet, are so novel that they require new infrastructure to make them succeed. Other technologies take us to places we could never foresee: no-one predicted the invention of the selfie-stick when Martin Cooper at Motorola made the first ever mobile phone call.

So how does a new technology go from an experiment in the lab to becoming a life-changing innovation?

It is tempting to think that the steps to making a new technology are easy. Do some interesting science, fiddle around with it to make it useful, market it and lo and behold you have a successful innovative product. Alternatively, that societal need is all that’s required to drive innovation – as the saying goes necessity is the mother of all invention.

However, innovation is not always so simple. Brilliant ideas fail to make workable products or new products cannot overcome incumbent technologies. Sometimes people get so used to using a technology that they cannot or will not change the way they work; that’s when technology gets locked-in.

As I type this on my qwerty keyboard I’m living an example of that very technological lock-in. Despite the fact that I’m creating an entirely electronic document that will possibly never see a piece of paper I’m doing it on a typewriter keyboard. The neat analysis of which letters commonly go together when writing and then ensuring they were placed apart on the keyboard to avoid clashes was so brilliant that the solution has stuck even when the problem is long since gone away. The vast effort that would be required to move on from qwerty is so costly that we are locked-in with this historical relic.

Being the perfect solution to a problem is not the only way to become a successful technology. The Pap smear has long persisted despite being not particularly well suited to the task. Interpreting Pap smear test results is highly subjective and the knowledge required to do this interpretation is hard to transfer from one person to another. It is not easy to describe the changes in a cell that mean it may be cancerous and therefore it is not easy to write down and pass on. Worse still, it is not even clear which changes lead to cancer and which do not.

Learning to interpret Pap smears is time-consuming, difficult and requires experience. However, the relative ease of collecting the sample and the fact that the repetitive task of interpreting results can be done by technicians rather than doctors, who at the time the technology was first introduced were typically women and therefore paid less than men which reduced the cost, means the technology has stuck around for 60-odd years.

Only in the last five years or so has a workable alternative to the Pap smear begun to be introduced. The development of a new test has required the coming together of DNA amplification technologies developed in the 1980s, with the finding that cervical cancer is caused by the Human Papilloma Virus (HPV) and collaboration between industry hospitals, universities and government bodies. The test has to be cheaper, more effective and easier to use than the Pap smear and patients and doctors must be convinced of the validity of testing for HPV rather than looking at cellular changes. The battle between Pap and HPV is far from over and any woman reading this will testify that the speculum is still very much a part of screening for cervical cancer.

These examples show us that the relationship between science and technology is complex. The cost of abandoning an obsolete technology can be too high and the simplicity of a technology can overcome its inadequate nature.

Turning science into technology requires planning, careful thought and consideration and often a serious commitment from governments and other major institutions to push a technology through. This is a problem the Wellcome Trust Sanger Institute is familiar with.

Nearly 15 years on from the completion of the Human Genome Project, we can see how the science of genomics could become a transformative technology for healthcare, but in order to for the idea to become a reality the NHS must be able to take it on, the public must support its use and we must understand the ethical, legal and societal issues surrounding it. It also requires the government to understand the value of these technologies and the challenges faced when trying to introduce a radically different approach to the established organisational structures of the NHS.

The Sanger Institute has been working on these areas for a number of years, through projects such as DDD, research by Anna Middleton into ethics and genomics and through the creation of spin-out companies such as 14M Genomics and Congenica who are developing new technologies for the healthcare market.

Now the Sanger Institute has joined a prospective new cross-Parliamentary group that will focus on implementation and the importance of effective delivery of health innovations for patients as a partner organisation. We believe that by working with politicians across all parties we can help ensure that exciting new sciences become societally valuable technologies for healthcare which can benefit all.

Sarion Bowers is the Research Policy Advisor at the Wellcome Trust Sanger Institute. She has a PhD in Biochemistry. Before joining the Institute she did postdoctoral fellowships in Leeds and Connecticut. She recently completed an MSc in Science and Technology Policy, in which she researched the adoption of genomics into the NHS.

References

  • Casper MJ and Clarke AE. (1998). Making the Pap Smear into the `Right Tool’ for the Job: Cervical Cancer Screening in the USA, circa 1940-95 Social Studies of ScienceDOI:10.1177/030631298028002003

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