Episode 7 Bang Goes the Theory

Welcome to Bang Goes The Theory, bringing you the science behind the headlines

and tackling the issues that have a real impact on all our lives.

Tonight, it's about a revolution in healthcare,

because medicine is getting personal.

With the power of the internet

and a wealth of new technologies at our disposal,

we're all turning ourselves into our own doctors.

It's not just that we're raiding the pharmacy.

We're testing, diagnosing and even treating ourselves at home.

At the same time, medicine itself

is becoming more individual than ever before,

with pioneering treatments now tailored to our very own genes.

So, tonight on Bang, personal medicine.

'Coming up, it doesn't get any more personal than our own DNA.

'I find out how cutting edge gene therapy

'is helping to save this man's eyesight.'

I think the most important thing is that there is real hope.

'Over five million people suffer from asthma,

'but for many of them, the drugs don't work.

'Maggie discovers how personalised medication is helping.'

Within a few days, the symptoms were just completely gone,

all the coughing was gone, no tightness of chest, nothing.

'Plus, is prevention better than cure?

'We meet a family using technology to track their health 24-7.'

In some cases, it's a little bit frightening.

I know that, sort of 5,000-odd steps a day really isn't cutting it.

That's tonight on Bang.

'Our first port of call in personal medicine is internet self-diagnosis.

'Online health searches are the third most popular web activity.'

Is going online something you would do if you didn't feel too good?

Initially, yes.

Yes, because they give you an awareness that

when you do go to see a professional doctor,

you've got some idea of what he might be talking to you about.

Would you go on the internet first,

or would you go and see the doctor first?

I would probably check the internet first.

Internet's brilliant, but it's limited because all you can do

is read and read and read, but you've got to do something about it.

The first thing I do if I'm not feeling too good

and I don't know why, is to go online and check out the symptoms.

So do 70% of us.

But only 25% of us ever check the source of that information.

So, how reliable is it?

We're putting online diagnosis to the test.

In one corner, we have Dr Ayan Panja

the product of six years of medical training,

a further 14 years treating patients

and countless hours spent keeping up with the latest research.

In the other corner, we have two kilos of plastic and metal,

a Wi-Fi connection and the Great British public.

If they're anything like me,

their entire medical training consists

of a one-day first aid course and an episode of Holby City.

It doesn't really seem like a fair match.

I mean, even with the weight of the web,

what chance do our intrepid volunteers have

against a true medical professional?

Each patient gets five minutes

to look up their symptoms on the laptop.

I get, like a real shooting pain in my right buttock.

Give me your self-diagnosis.

I've fractured one of the small bones in the wrist.

What have you discovered? What's the worst case scenario for your symptoms?

Deep vein thrombosis, which is a blood clot.

But will their online diagnosis

match what the doctor finds from a physical examination?

191 over 106 now. That is...

high blood pressure.

We ought to get that X-rayed.

This is most likely to be a long term sprain of the wrist.

That's lovely. Now, what I'm going to do...

-I can feel a little twitch there.

-This is a very common problem

and it's something called sciatica.

The itchy patches where I've scratched them.

But they're also on my hands.

It looks like a type of infestation, it's a type of parasite.

So, how did the two consultations compare?

Well, it was really interesting. I think the internet

on about half of the occasions,

correlated quite well with what I diagnosed.

Occasionally it was completely wrong.

Um... So, for example, the lady that we saw with sciatica,

she'd been looking online and it came up with DVT,

deep vein thrombosis, which is a very serious condition.

And it really made her worry, so there are pros and cons.

I think when it comes to things like rashes for example,

that's going to be pretty hard to diagnose.

Whereas I think things like back pain,

you can get generic pieces of advice that are fairly useful.

I think the really key point

is knowing where to look for this advice,

and I would always go to a trusted site, for example, the NHS website.

Do you think that the way patients do have access to the internet

and being able to look things up, it's empowering, isn't it?

It is empowering, the internet is useful.

It's just knowing how to take this massive beast and tame it

and use it to our advantage, without making people anxious

and without being unsafe.

While internet self-diagnosis

can't replace a flesh and blood doctor yet,

online health searches aren't just feeding our cyberchondria.

They're also helping researchers

track outbreaks of diseases like flu around the world,

which could have benefits for all of us.

But there is another way of making a self-diagnosis,

which has been around for some time.

Cholesterol has become something of a buzzword.

There are small kits like these, which you can buy over the counter

to test the level of cholesterol in your blood at home.

Now, that clip is over 20 years old,

but home testing kits are still as popular as ever.

And people are taking self-monitoring to new levels,

as Jem finds out.

There are some impressive gadgets on the market,

that record everything, from blood pressure, to stress levels.

But can self-monitoring 24/7 actually help our health?

To try and find out, I'm setting up my own life-logging experiment.

This is the Hutt family.

Dad Steve, mum Kate, kids Emily and Oliver and grandad Tom.

They're going to be the first people in the UK

to trial the Metria sensor,

a brand new device promising to be the ultimate accessory

for any serious self-tracker.

Oh, the guinea pigs, right. Good.

You guys are in for a surprising week.

-Yes.

-What you're going to be using is a prototype

unavailable to anybody else.

Nobody in this country has done this experiment yet.

-Wow.

-OK?

Now what happens is an incredibly high-tech sensor

gets stuck on your left hand side, just below your ribs, right?

This little device will be detecting your heart rate,

your respiration, your breathing rate

and the G forces you're being subjected to.

And then all of that gets blue toothed to these tablets.

-Oh no.

-Right, competition begins here.

I was worried somebody might say that.

Because the other thing is, I'm going to have one too.

-What do you reckon, Oliver?

-Hmm. Good.

Your job is to oversee this.

Make sure they don't take their sensor off and shake it

to make out they're incredible athletes or anything like that.

-OK, now you each get a tablet. Tom.

-Thank you.

We'll wear these sensors 24 hours a day for an entire week.

-Any signs of life?

-Says he's asleep!

THEY LAUGH

They'll monitor our activity at work, rest and play.

Good, right.

I'm really intrigued to discover, how my life in numbers shapes up

to how I imagine it being.

I think it might be a bit of a wake-up call in some ways.

I think you're probably right.

So that's it.

We're now all patched up and connected to computers.

I guess we just lead our everyday lives and see what we learn

in the next seven days.

In the meantime,

to find out about the benefits of self monitoring,

I'm meeting with GP and medical gadget expert, Dr Jack Kreindler.

They all look suitably shiny.

What do these various gadgets and devices do?

Well, we've got a whole range here, ranging from medical devices

through things that can help you monitor your lifestyle.

The thing that's particularly striking about what's here

is the size of it all.

Well, interesting you say that.

Maybe a few years ago, if you were measuring something

like your ECG, your heart tracing, you'd have to go to a hospital.

You'd have to have an expert wire you up to a machine like this.

But now, I have one of these, which is just a simple

smart phone cover but in fact it has a clinical grade ECG monitor on it.

So if you've got an arrhythmia of normal rhythm of your heart,

you can now check that and you have something that a doctor would

understand instantly that you can send to him

that would normally have to be printed out from here.

What strikes me is, you could almost put a roof over this table

and that's a hospital.

We've got an incredible opportunity with this kind of technology

becoming ever smaller, ever more powerful, ever more accurate

and ever more useful to the profession, that we can transform

the way we practise medicine by collecting the data, understanding it

and acting earlier, making better decisions before we get ill.

So how about our own trial with high-tech gadgetry?

For the past seven days, our breathing, movement,

and every heartbeat has been captured and logged by the sensors,

while we got on with our everyday lives.

Your temperature, your blocked nose, it's all yourself,

trying to get yourself better.

And cut, great.

Now the Hutt family and I are back to see Dr Jack

to analyse our results.

With our daily lifestyles laid bare, will there be any surprises?

We've got a whole load of really interesting things

that your devices have picked up.

You can see some amongst us

have been doing a little bit more running around than others.

So, Jem, you training for a marathon that day?

No, that's Saturday. I'm looking after the kids on a Saturday.

Oh, I see. Excellent.

Nearly 16,000 steps equivalent, so a pretty active day.

So here are the averages. We've got Tom.

Nearly 6000 steps a day.

That's good for me. Probably on the walk down the pub.

And Kate there, is nearly doing double that amount,

which is really quite extraordinary.

I work in a big hospital

so when I'm actually at work, there's lots of walking around.

A lot of running around.

Shall we also have a look at something

that I found very interesting, which was your sleep?

Tom, on average over the week, you got about 6.8, nearly 7 hours.

-Steve, 7.3.

-I'll take that.

Emily had a grand 9.5 hours of sleep, which doesn't surprise me at all

because you do most of your growing as a child, when you're asleep.

Now Kate, how many hours of sleep are we meant to get a day?

About eight, I think.

Now obviously you're managing a busy job and a big family.

You're still doing OK. 6.6 hours. You had this thing for a week.

Did it surprise you, inform you of anything you hadn't known before?

I never knew that my mum would actually get 10,000.

I was quite surprised on just a normal day that

I got that many steps and I thought that I probably

got the least sleep as well so I kind of feel vindicated.

All my moaning, "I'm so tired!"

I think the interesting thing as well with that is, it's factual.

It's data.

It's data and in some cases, it's a little bit frightening.

Now we've been chatting about this I know that sort of 5,000 odd steps

-a day really isn't cutting it.

-Because it's all being recorded,

did you sort of try to become more active?

-Yeah, we did.

-We tried to be more active.

Because it was a bit like a competition.

We thought, instead of Steve getting in the car and going down the shops,

we'd all walk down the shops.

It's only a five-minute journey but it's that extra little bit.

It's like having a sort of a personal coach, you become your own coach.

It's called bio-feedback. It's the ability for you to see the results

of what you're doing and then feel what it's like to be more active.

And you can imagine that those things might become smaller in future.

More and more invisible.

Last for a month before you need to recharge the batteries.

All of these things. I think that they'll become part of life.

I don't know if I'm ready to become a full time life-logger quite yet,

but it was fascinating to see an entire week of my life

reduced to a page full of numbers.

It was also wonderful to see just how much the Hutt family enjoyed

the experiment and how,

it seems the very act of being monitored makes everyone more

interested and indeed competitive with regard to their health.

This natural competitiveness we all have can be taken advantage of.

Across the world, we spend 3 billion people-hours a week on gaming.

And now medical experts are using that to turn some

elements of healthcare into games.

David and Ben have type 1 diabetes

and need to check their glucose levels up to five times a day.

How much of a chore is it to constantly monitor your blood sugar?

It's quite a big one, but you have to do it.

It's your life, you can't mess it up.

Although Ben and David know they have to keep a close eye

on their blood sugar, being kids, they still need a bit

of motivation sometimes and now there's a game that could help.

So this is it, Monster Manor. How does it work?

Basically, you put in your blood sugar after you've just tested

and you get coins from it.

And you get prizes.

And do you find having a game like this that's kind of

linked in to monitoring your blood sugar, does it make it

kind of easier, I guess, to remember or to want to do it?

If you want to play Monster Manor you'll think,

"I don't have enough coins so, test my blood."

And now I've get more coins.

The makers of Monster Manor have found that using

games as motivation can have very positive results.

What we've definitely found is the relationship between doing

a blood glucose check and then having some fun for a short amount

of time afterwards is very effective at creating the habit

that you're looking for.

That small behaviour change, that small amount of fun,

starts to create the habit.

And what I find particularly fascinating about that is that

with type 1 diabetes the real life stakes are incredibly high

and yet the kind of fun of the game is actually

more of a draw than that.

And that's really the whole thing about gamification

because you do respond.

The applications of this technology could be far reaching.

By motivating people and giving them more control over their own health,

it could be used to tackle a whole range of lifestyle-related illness.

Biological data of an even more personal nature could allow doctors

to make treatments more effective than they are at present.

Despite all of the advances we've made in medicine,

one of the hard truths that remains

is that a lot of the time, the drugs just don't work.

In fact, the vast majority of medications

are thought to be effective in only 40% of people.

But all that could be about to change,

and the key lies in our genes.

Ten years ago, scientists finished mapping the entire human genome

and now medicine is on the brink of a genetic revolution.

Coming up - I find out how cutting-edge gene therapy

is helping patients to preserve their sight.

It is genuinely a life-changing event that has happened.

And Maggie investigates how genetic testing

can help asthma sufferers like Ewan.

I could do anything I wanted

without having this fear of having an attack at any moment.

But first, how cutting-edge science is tackling ageing.

Inside this pharmacy, they're going to take a sample of my DNA,

because they say it can give me a better chance

of fighting the ageing process.

We all age differently depending on our genes.

If we can work out what those genes are,

can we tailor our skincare accordingly?

Professor Chris Toumazou from Imperial College

has invented a portable device that does genetic tests while you wait.

So what we've done is we've taken your saliva

and now we're going through a process of what we call DNA extraction,

it's a very simple process.

We've taken what would normally happen

in a very sophisticated laboratory

and brought it to the counter, effectively.

So what's going to happen to my DNA now?

Yes, so your DNA now has been placed onto this microchip.

And on this chip,

we basically have the signature DNA of the anti-ageing mutation,

which is collagen degradation.

And so we're comparing now the DNA we extracted from you

to the signature DNA on that chip.

'My profile is wirelessly pinged to a database in Hong Kong

'and 30 minutes later my anti-ageing results are in.'

-So you've got the results now.

-Yes.

Well, what's the story? What are they telling you?

You've got a sea of ingredients there,

so that doesn't mean anything to me. What's it telling you?

What it means to me, by looking at those ingredients,

is that you are a very fast degrader of collagen.

No! I refuse to believe this.

And I refuse to believe it as well! But you are, unfortunately.

Gosh, I'm ageing before your eyes!

Based upon your genetic information,

the database is recommending

some of the very strong, collagen-boosting actives.

So what do you think the implications of this technology are?

Well, I think, if anything,

it's going to give consumer awareness of this sort of genetic technology.

Yes, OK, trying to make beautiful people more beautiful,

but really my major motivation is to make sick people better.

And if we can drive this forward,

particularly into the healthcare system,

then it would mean that you'd see the future GP

being able to take a saliva sample in his surgery

and recommend the right drug for that individual.

In fact, one clinical trial in Dundee

is already using personalised medicine to change people's lives.

'Ewan Macintosh is just one of the one million sufferers

'of childhood asthma in the UK.

'He's now 18, but has suffered from this debilitating disease

'since he was born.'

Sometimes I would wake up coughing in the night,

giving me really broken sleep,

so I'd get really tired during the day.

And while I always had a very good group of friends,

I would sometimes feel I couldn't join in with their sports things.

Hearing your child coughing through the night

and knowing that he's not getting a good night's sleep,

it's never a good thing for a parent to hear.

The normal treatment that everyone else who has asthma has -

a lot of people do - was not working.

We thought, why was it not working for him and it works for others?

The standard medication given to children with severe asthma

is a drug called Salmeterol, but for Ewan, it just didn't seem to work.

And he's not alone.

It's thought that one in seven children with asthma

don't respond to Salmeterol.

The problem is working out who those children are.

But a clinical trial run by Professor Somnath Mukhopadhyay

from Brighton and Sussex Medical School

may hold the answer.

One of the main difficulties that we face right now

is that we do not have a simple test

to identify which children will not respond to the Salmeterol.

What you've been doing is,

you've been using genetics to help you with this.

That's absolutely right.

In many of these children there is a faulty gene,

which means they will not respond as well to the Salmeterol.

And we've picked up the children

who have this particular "faulty gene"

and we've given them Montelukast instead of Salmeterol.

The results of the trial confirmed

that a DNA test can easily identify those children

who will respond better to the alternative drug.

The asthma trial is one of the UK's first examples

of personalised medicine,

something we've been talking about for years

and researchers have been working towards

since first mapping the human genome ten years ago.

And the impact on patients in the trial

has been nothing short of remarkable.

Ewan's genetic make-up

suggested that he could be one of the one in seven

who would respond better to the substitute drug.

Within a few days the symptoms were just completely gone,

all the coughing was gone,

no tightness of chest, nothing.

I could do anything I wanted

without having this fear of having an attack at any moment.

It was just a complete change.

The leap at the beginning was quite amazing.

I thought, "Oh, what?

"It's gone quiet, there's no coughing."

Coughing in the night-time had gone.

-It gave you your freedom back.

-Yeah, I could go out.

I could go and join in with sports at school.

I joined the Air Cadets,

so I could go and do all these sporty things,

which wasn't available to me before.

Personalised medicine is still at a trial stage,

but it's hoped that eventually a simple saliva test

could determine the correct drugs for many diseases.

Changing your medication to suit your DNA is one thing,

but what if you could change some of your genes

so that you didn't need treatment in the first place?

Genetically modifying people may sound a little Frankenstein,

but it's real and it's called gene therapy.

And there could well be a future where the doctor,

instead of prescribing drugs,

is prescribing a slight alteration to your DNA.

I'm meeting a man who suffers from a genetic condition

called choroideremia, which leads to complete blindness.

With only tunnel vision remaining,

his hope lies in a new gene therapy treatment

being trialled on a handful of people.

Stanford, how are you feeling today?

Slightly nervous, slightly apprehensive,

but obviously looking forward to what the future holds.

So when did you first know that you had choroideremia?

I first knew I had choroideremia when I was 27 and I'm now 43,

so it's been quite a few years.

I used to be quite active, I was a diver, worked as a carpenter.

I found over the last few years,

it's really started to affect my life and what I can do, my mobility,

my work, it's becoming more difficult.

If it's left unchecked,

I have about ten years' vision left in my left eye.

So for me to be on this trial is an absolutely amazing feeling.

Stanford is going to be in the expert hands of Professor MacLaren,

who's leading a groundbreaking new gene therapy trial

here at the John Radcliffe Hospital in Oxford.

So, when a patient has choroideremia,

what exactly is wrong with their eyes?

These patients have got a faulty gene,

which encodes a protein known as REP-1,

and without this gene, the photoreceptor cells,

the light-sensing cells at the back of the eye undergo degeneration.

And it begins in childhood and it affects men,

because the missing gene is on the X chromosome

and that degeneration starts on the peripheral part of vision

and gradually comes into the centre

until finally the last bit of vision disappears.

So tell me about this trial.

Tell me how you go about targeting a tiny gene in so much DNA?

What we do is we commonly use a virus,

which has evolved to be very effective at going into cells

and delivering its own DNA,

only we're putting our DNA into the virus so it does the job for us

and it does it very, very efficiently.

So once the correct version of the gene is inserted

using this virus vehicle, what happens to those cells?

What we hope to do is, by replacing the missing gene,

those cells, those light-sensing cells, are then going to survive,

whereas previously they would have died,

and that hopefully will preserve the patient's vision for much longer

than if they have the disease.

How on earth do you go about

inserting the virus carrying the correct gene

into a patient's eye?

Well, we need to separate the retina from the back of the eye

so that we can put the virus underneath it.

Professor MacLaren uses a specialised flexible needle,

just one tenth of a millimetre in diameter.

It leaves such a small hole in the retina

that it prevents the injected viral particles from escaping.

So that's it - 10 billion viruses have just been injected

onto the back of Stanford's eye.

And it sounds like a lot, and it has to be,

because each virus is carrying a working copy of the REP-1 gene

and the more viruses you inject,

the better the chances

of the photoreceptor cells on the back of the eye

taking in the DNA when the virus infects them.

After only 90 minutes, the operation is over

and the healthy genes have hopefully been delivered

to the cells in the back of Stanford's eye.

That was incredible.

Now Professor MacLaren and his team

have already operated on six other patients.

And one of them was operated on over a year ago now,

so I'm going to meet him

to see how the gene therapy has impacted on his life.

So, Toby, tell me about how quickly did you begin to notice a difference?

When I went for the first sight test,

which was a month after the op,

and that's when I saw that I could see more with the left eye,

which was the eye they operated on, on the sight chart.

And how did you feel? I mean, it's a silly question, really.

It was fantastic, it really was,

because what they had always said to me

is that the trial is to try and slow down or stop the degeneration,

and here we have a situation where it seems, in fact,

that it has slightly reversed the process

and so I can see that much more.

So how has your quality of life improved so far, Toby?

I think the most important thing is that there is real hope.

I've always said that

as long as I can read and play tennis I'll be happy.

And what this has done

is to enable me to have very real hope that I will be able to do that.

Forgive the cliche,

but it is genuinely a life-changing event that has happened,

purely as a result of the gene therapy,

Professor MacLaren and his team.

This gene therapy has huge potential

for preventing blindness in various eye conditions

and it's a great example of how modern medicine

is becoming more and more tailored to the individual.

And with trials being carried out for more complex diseases,

like cancer and heart disease and immune disorders,

it's predicted that gene therapy is going to become

a much more important part of our healthcare in the future.

When out in crowds I'm often struck

by how we're all so unmistakably human, but utterly individual.

And now medically, it seems,

we're engineering ways of capturing that and working with it.

I think there are some very interesting times ahead

as we learn to manage our health with more and more precision.

That's it for this programme.

There's another special film from Jem at our website -

bbc.co.uk/bang

And you can follow the links to the Open University

for information about alternative and complementary medicine.

Subtitles by Red Bee Media Ltd