The best medicine

IN THESE dark days of financial constraint, rising unemployment and a contraction of the economy, it is especially pleasant to…

IN THESE dark days of financial constraint, rising unemployment and a contraction of the economy, it is especially pleasant to hear Ireland being endorsed as the ideal location for the development of next-generation medicines delivery technology.

Dr Stephen Oesterle, senior vice president for medicine and technology with Medtronic, the leading US medical technology company, says Ireland is sitting on an extraordinary opportunity to lead the world in convergent technology.

Widely seen as the "next big thing" in medicine, the new technology brings together the latest biological treatments with devices that deliver those treatments to the exact place in the body where they are needed.

"You have a unique opportunity in Ireland to converge these things . . . If I had to pick one country in the world that has the best chance of catalysing this convergence of technologies, it is here - because of the scale of the country, the homogeneity, the culture," says Oesterle, a trained cardiologist.

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Oesterle is speaking in Galway, from where Medtronic supplies the world with Endeavor, a cardiac stent (ie, a drug-releasing metal tube used to prop open diseased arteries).

He believes the confluence of medical technology companies, life-science resources and information technology means Ireland is uniquely placed to bring all three together to produce convergent technology.

"You have this little crucible here where you can cook all this up [biotech and medical devices], and the interesting layer you put on this is you also have one of the greatest collections of IT and communications technology start-ups in the world."

Oesterle's vision for Ireland is built around the next generation of treatments. At present, most patients with chronic conditions such as heart or joint disease take medication that has been designed on a "one-size-fits-all" premise. Drugs are tested on large populations and, once approved by regulatory authorities, are prescribed in similar dosage for a broad group of patients.

But in the future, through genomic engineering, a more personalised approach will be developed. Part of this new dawn will involve delivering drugs and biological treatments to the exact part of the body where they are needed.

Oesterle has an interesting take on chronic disease. He says the entire body can be reduced to a series of proteins, and all chronic diseases are secondary to either too much or too little of a specific protein. So, for example, type one diabetes is the result of a deficiency in the protein insulin, while someone with heart failure has insufficient contractile protein in their heart muscle.

But most disease is related to having too much protein, Oesterle believes. In the case of osteoarthritis, for example, there is too much inflammatory protein, with cancer the result of faulty regulatory proteins. "Biotechnology works by suppressing the proteins that people have too much of, or by replacing the proteins we are missing," he says.

Oesterle says the discovery of a new form of cellular messenger (small interfering ribonucleic acid or RNA) by the winners of the 2006 Nobel Prize means nature's way of suppressing protein has been identified.

It is in the delivery of protein suppression that Medtronic will play a key role. RNA or genes cannot be swallowed like conventional medicines. Instead, there is a need for infusion technology to target a treatment directly at organs such as the brain or heart.

But what does Ireland need to do to become the centre of this new industry? Oesterle again emphasises the presence of key pieces of the jigsaw: an island with a population of five million that already plays host to a large medical devices and pharmaceutical industry. "The one thing Ireland needs badly is risk capital," he adds, however.

"What I don't see in Ireland - but where the US does have a leg-up - is the amount of risk capital available to entrepreneurs. This kind of development is entrepreneurial and is generally done well by start-up companies at a small level. You cannot expect the Government, the IDA or Ibec to fund it."

Oesterle believes Ireland needs to bring back expatriates who have established successful careers, rather than those who have just finished training, and "to let them see that the opportunities here are better than America".

With Medtronic in Galway already employing 2,000 in the production of cardiac stents, as well as in research and development, does it have a role to play in the future of convergent technology?

Oesterle pauses before answering: "We think most biological treatments will be delivered by flexible plastic catheters, tracked by navigation devices. Where do we plan to make these? On the west coast of Ireland."