What do we know?

Instead of the traditional futuristic archetypes of humanoid robots collecting physiological information from us while using their free time to take care of household chores, technological trends are pointing in the direction of much more complex scenarios on which thousands of interconnected gadgets provide ubiquitous services (6). We are already seeing this through a plethora of projects that promote Ambient Assisted Living (AAL), an area that is receiving considerable attention in those regions of the world that register the longest life expectancy, such as Japan and the European Union (7, 8). Instead of the traditional futuristic archetypes of humanoid robots collecting physiological

The following is a summary of what is happening in relation to each of the components of the GRIN movement.

The G factor

Today it is already relatively straightforward to change the structure of a section of DNA in a laboratory, use a virus to introduce it into a cell and see if it performs a particular function. This technological feat, however, has not been translated into the spectacular breakthroughs in the management of disease that were expected when the human genome was decoded. Although it would seem that this is just a question of time (9), it is possible that given the myriad elements that explain most of the chronic ailments affecting humans, regenerative medicine and gene therapy will only be successful at curing a handful of minor diseases, failing to produce the expected «silver bullets» that would correct the main sources of morbidity and mortality for single major diseases.

The picture is even more dismal in relation to potential gene therapies for multiple chronic diseases.

The R factor

There have also been impressive developments in robotic therapy (10). Nonetheless, the results are still falling short of the expectations of a few decades ago.

 In Metropolis, the famous film of the 1920s directed by Fritz Lang, a futuristic society was divided into two castes, the thinkers and owners who lived on the surface, and the workers of the underground, laboring ceaselessly to maintain the pace of life of their masters.

 They ultimately come into conflict. Maria, the leader of the oppressed, is kidnapped by the masters and replaced by an android replica, with the aim of sowing chaos among the rebels. The humanoid image of this robot then became the popular archetype that has ever since inspired hundreds of researchers into artificial intelligence, viewing the replication of the human form as the logical path to the future. However, this descendant vision championed by many has been challenged with compelling arguments.

 Many leading experts believe that we should promote the basic conditions required to allow artificial intelligent systems to evolve spontaneously, learning in a self-organized form, in the belief that once they have surpassed a certain threshold of information processing, intelligent behavior would emerge. The aim, then, would be an attempt to emulate what happens, for example, in colonies of termites, which are capable of manifesting the emergent intelligent behavior that allows them to construct sophisticated ventilation and storage systems, in a way that could not be explained by the arithmetic sum of their individual intelligences. In this case, the transfer of simple short-range chemical messages can generate highly precise coordinated reactions similar to that of neurons interacting through neurotransmission in their synapses.

As these two currently opposing strands evolve, an intermediate pathway represented by advances in so-called «human-machine interfaces» is evolving; the very same approach that has guided the development of tools capable of overcoming our limitations (e.g., pulleys, cars, planes, computers). Today, the boundary between biological and artificial is becoming blurred. Advanced surgical techniques are now beginning to be used to incorporate cybernetic creations as extensions to our own biological structures, bordering in many cases on what some still view as science fiction. Chronic conditions associated with the loss of limbs following accidents, in particular in traffic incidents and the workplace, are being managed with highly sophisticated controllable myoelectric prosthetics and re-nervation techniques (11) which may soon incorporate haptic interfaces capable of providing a sense of touch. Cognitive robotic innovations are also being spurred on by advances in functional magnetic resonance imaging, which allows careful observation of neurological activity in areas affected by neurodegenerative conditions or by strokes.

The I factor

Information and communications technologies represent more than simply another piece in the jigsaw being outlined here. They are essentially the glue that binds together the GRIN complex and underpins its potential.

The power of online social networks has been expressed clearly during natural disasters (12). As official information management systems were rendered ineffective by Hurricane Katrina, members of the public were able to generate, in a matter of hours, an online repository of resources and database of victims, allowing thousands of people to locate their relatives swiftly (13).

Similarly, many patients who were previously left to endure in solitude the daily consequences associated with chronic diseases are now beginning to join forces, supporting each other as «prosumers» (14, 15) or as e-patients (16).

In addition to the growing level of patient emancipation afforded by social networks, another powerful shift in the way in which humans create and manage knowledge is being brought about by hybrid webs or «mash-ups» (17). In essence, this involves something like «a pinch of this and a dash of that» in order to extract and blend different functional elements of disparate applications into a new set. As a result, it is now possible to blend electronic health records, large databases of demographic data, online maps and  powerful statistical tools to create dynamic spatial representations of the distribution of diseases in a population, and their associated risk factors (18).

Another wave of change is being nurtured by the unprecedented wave of technological convergence that is ushering in the age of mHealth (mobile health), heralded by mobile telecommunication devices connected to the Web. This is leading to the emergence of powerful telehealth solutions designed to improve the quality of life of people living with chronic diseases and to optimize the use of limited resources (19).

Unfortunately, little is known about the value of this veritable renaissance in reducing suffering for people living with multiple chronic diseases.

The N factor

Nanotechnologies, which allow the manipulation of matter at its smallest scale, are giving birth to an area already known as «Nanomedicine», a hybrid of the physical and biological sciences that promotes the interaction between the human body and different materials, structures or devices which operate on a nanometric scale.

The most important aspect of nanotechnologies lies not only in the manipulation of matter itself, but the potential derived from the radical change undergone by the physical and chemical properties of matter when working at such a scale (20): electrical conductivity, color, resistance or elasticity (21).

At present, the application of nanomedicine focuses on three major transversal strands, irrespective of the pathology being targeted (22):

- Nanodiagnosis, comprising the development of analysis and imaging systems designed to detect illnesses at the earliest possible moment, both in vivo and in vitro. A promising area of work focuses on nanobiosensors (21), minute tools that combine biological receptors (a cell, a fragment of DNA or protein) capable of detecting the presence of a substance, with sensors or transducers capable of measuring any related reactions.

- Nanotherapy, the controlled release of drugs, through systems able to deliver drugs exclusively to the affected areas or cells in the body, in the hope of achieving maximum therapeutic effects with minimal or no adverse events. Exciting work is being conducted on innocuous biodegradable nanoparticles (23) which can carry drugs and then be effectively eliminated by the kidneys once they have performed their task (24).

- Nanoregeneration, the purpose of which is to repair or replace damaged organs or

tissues. Carbon nanotubes (25), for instance, are being created to build replacement limbs with levels of performance that exceed those of their natural counterparts.

Unfortunately, the knowledge available on the role that nanotechnologies play in the management of multiple chronic diseases is scant.