MRSA, The Metaverse & Medical Milestones

As 2022 begins, our technology for gadgets & gaming progresses with it. Chris Smith talks with BBC's Zoe Kleinman & Naked Gaming's Chris Berrow about these latest developments and trends...

Chris Smith - First though let's talk tech and find out what were the top tech trends in 2021 and what is on the way in 2022. Zoe Kleinman is the BBC's technology editor. Zoe, what has tickled your tech fancy in 2021?

Zoe - I asked a few people about this, 'what has been their top gadget of 2021?' The answer that kept coming back was Apple. It's no surprise is it that they've just been named a $3 trillion company? We had the iPhone 13 that lots of people were waiting for, we've had the air tags that have been a big hit. Apple really does still have the golden touch when it comes to launching products. That said, let's not forget that we've had this crazy backdrop of a global shortage of computer chips. It's causing big supply problems. I suspect a lot more people would've got their hands and a lot more gadgets if there'd been more chips to have made them within the first place.

Chris Smith - I was a victim of that as well because I tried to go and buy a Raspberry Pi. I wanted to build a project, and I was shocked to see it sold out across the board. Further investigation shows that they're also a victim of the global chip shortage.

Zoe - It's in all sorts of things. What really struck me is how many chips these devices need, especially cars. There's a big problem with the car industry at the moment. Turns out cars are more computer than vehicle these days, they have dozens and dozens of these chips and they're just not anywhere to be found. The other problem is you can't just set up a chip making factory overnight; It takes two years. While all over the world countries are scrambling to get production up to speed, it's taking ages. They're saying that possibly even towards the end of 2022 we'll still be playing catch up here.

Chris Smith - One other big story, which came in the latter part of the year was Facebook. This rebranding of the entity as 'Meta' and Mark Zuckerberg setting out his vision for what he dubs the "metaverse". What actually has he got in mind for Facebook?

Zoe - 'The metaverse' is one of these things that you're gonna hear loads about in 2022, but it doesn't yet exist. It's not going to exist in 2022. It's going to take years to build. It's going to be one of those things we're going to talk about a lot and you're going to sit there and go, 'Okay, well when can I actually see it?'. And the answer is possibly 5 to 10 years time. Think about it as a really extreme virtual reality where you are living inside the web. You're navigating various worlds using an avatar, you're not looking at a screen, you're actually part of the action. It's what some of the tech giants are seeing as the next evolution of the web. The first one was kind of us looking at very static information. The second one has been us using platforms to share our content. The third one is instead of looking at our content, we're actually being in it. It sounds crazy. It sounds very ambitious. Facebook is very influential, it has thrown a lot of money at this and has rebranded itself accordingly. Zuckerberg obviously thinks this is the future. Will consumers go and vote with their feet? Well, I think it'll be interesting to watch VR. Is this finally the big year of VR? We've seen virtual reality grow in popularity over the years, but it's never been the sort of ubiquitous big thing that we thought it was going to be. Could this be the year? I hate to bring up Apple again, but they are rumoured to be bringing out a VR headset in 2022. Apple just tends to do things well. Could it be that that product becomes the breakthrough product that gets a lot more people on board?

Chris Smith - I was watching, over new year, a rerun of 'Johnny English Strikes Again' when he dons a virtual reality headset and accidentally ends up in the street, and then beats up a café owner, pushes the lady out into the street and another bloke off a bus. Do we really want this? I'm not sure the idea of sticking a modified ski mask over my face and pretending I'm in a meeting with my colleagues is going to be any nicer than just going and meeting my colleagues. Why do we want this?

Zoe - Yeah, I agree with you. I think the hardware, the actual headset, has really held it back. It's clunky, it's uncomfortable. Lots of people get nausea, get sickness. I get sickness in VR after a while. I can't do it for that long before I start to feel quite queasy, which is embarrassing. I think in a way you are right, I don't think it will replace meeting people face to face. But if we've learned anything in the last two years it's that actually, we sometimes have to meet online. It's easier to meet online and it's better for the planet to meet online than to be jetting all over the world. It's not long before you get that zoom fatigue, and you start thinking, 'You know what? I like you Chris. Do you play golf? Why don't we go for a virtual round of golf while we're having this chat?' Would that be more interesting? Would that be more fun? Would it help us to connect better? Yes, possibly it would.

Chris Smith - We've moved the conversation onto the question of gaming. There was a new game demo called 'The Matrix Awakened' to show off the 'Unreal Engine 5' that came out. It's basically the original matrix film remade, but all CGI - absolutely amazing to some people's minds. Someone we got to play it said this about the demo.

Alex Rhodes - Unreal. It's supposed to be unreal. Oh, here come the agents. Bit of slow-mo going on. It does look very good.

Chris Smith - Bottom line is that they were creating all of the footage in a computer. It's not a film anymore. It's basically computer generated, but good enough to fool Alex Rhodes, who is the correspondent asked to review that for Chris Berrow from 'The Naked Gaming' podcast who is with us. He obviously liked it.

Chris Berrow - It's one of those tech demos which gives you a flavour of what the future of gaming could be. What was amazing about this particular demo is that it was like you were watching 'The Matrix' film with the classic Matrix footage, and then you'd press a button and you'd see all the underlying graphics that go into building all the models of the characters and the buildings and things like that. You realise that this video game simulation of the film, it's like another kind of matrix. Then the game demo drops you into the game and you can walk around the city which you've come to know and love from the film. It's unbelievable. The scope and the scale of what they can do. Obviously it's only a tech demo. It's not a proper game, but it gives you an idea that actually, let's say you've watched a new Marvel film, the new Spiderman film, or maybe they could just scan that into the Unreal Engine 5, and you could be running around as Spiderman using those buildings to swing around. It's an amazing tech demo and Alex was quite impressed, as I think you heard there.

Chris Smith - The thing is that the games industry is actually a value prospect and value proposition is actually much bigger than Hollywood in terms of its turnover, the amount of money that flows through it. Games have gone from very, very basic 20-30 years ago, to things - as you are hinting at - that could rival Hollywood. Are we at risk of losing the message in the medium, because you're employing armies of artists, you're employing a huge, great computing power to make something that looks all glittery and sparkly. Are we actually losing something the essence of why people wanted to play games?

Chris Berrow - Yeah and I think that that's a very good point that there are certain genres and styles of game. And some people like Leigh Milner, who co-presents the podcast, she hates games that are like films because she thinks that it is losing the essence of what gaming is, which is to have control to jump around, to lose yourself & to collect coins. She loves those old school games, whereas like this Matrix game demo, and like some of the huge releases from 2021 'Ratchet and Clank Rift Apart' - it feels like you are playing a Pixar film. It feels that you're running around in that incredible world, but for some people it's just too much. I dread to think what it's like to be a games developer starting up in this day and age, because how on earth can you have the budget to create the sort of games, the AAA games that are running on the PlayStation 5, the Xbox One and PCs now that are so incredible. You just can't do it, so you see start-up companies are going back to creating old school games. 2D side scrolling platforming games. Once they've done that, they then reinvest their money into their next big release. I totally agree; there is certainly a danger of losing what gaming is compared to watching a film, but some people love that. And you know what, if someone really wants to essentially watch a film, but press a couple of buttons here and there, there's a market for that as well and it can be very relaxing to do that.

Chris Smith - Zoe, is the huge demand that this is putting on computing power from gaming, driving the industry or is the industry and what we can do enabling gaming. Do we know? Or is it both?

Zoe - I suspect it's a bit of both. I think there's nothing more frustrating for a gamer than their kit not being up to scratch, whether that's your broadband connection being too slow to download the game you want, or Microsoft has an amazing game where, where you are basically a pilot and you are flying around the world. The graphics are beautiful, it's stunning. But your average computer won't be able to manage it, so you need a sort of proper kit to be able to do it and I think that does cause some frustration. The Unreal Engine is just a phenomenal tool that's been developed by Epic Games who are probably best known for the game 'Fortnite'. But the Unreal Engine is a really interesting part of their business. This idea of being able to virtually create an entire world so realistically is incredible.

Chris Smith - To finish, what would you be playing in 2022 Chris? Your eagerly awaited release?

Chris Berrow - You've talked about the semiconductor chip shortage. I was trying to buy a VR headset, but I can't get hold of one yet, because they're just not in stock anywhere. I'm looking forward to 'The Legend of Zelda -  Breath of the Wild 2'. I think that's probably a lot of people's most anticipated game. If you really like the 'Zelda' series, you're gonna be really looking forward to that on the Nintendo Switch. The first one was just incredible. There's a new console coming actually, which is super interesting just to quickly mention, called the 'Steam Deck'. If you've always wanted to play computer games, but you can't afford a hugely expensive computer like myself, if you just don't have space, this Steam Deck console will actually play all of those Steam games, which are traditionally based on a computer. We're looking forward to the release of that early on this year to just give it a go because it's super interesting how powerful handheld consoles can now be.

Chris Smith - What are you talking about - can't afford it, Chris? it's all on The Naked Gaming budget. Thank you for joining us. Tech journalist, Zoe Kleinman, and also 'Naked Gaming's Chris Berrow.

Chris invites history of science expert Kersten Hall to discuss the first insulin treatment in 1922 before welcoming Charlotte Boughton, a Cambridge University endocrinologist, to tell us what future medical interventions for the condition could be...

Chris - For people who live with type 1 diabetes insulin is a lifeline because, as we know, people with the condition can't make any of the crucial hormone themselves. Insulin tells our cells to pick up the sugar glucose in the bloodstream. Now, if this doesn't happen, our cells run out of energy and levels of sugar in the bloodstream climb dangerously. Long term, this can damage blood vessels, nerves, our kidneys, and also our eyes. Historically, type 1 diabetes was a fatal condition until this week a century ago doctors began injecting the hormone and saving lives. The story of diabetes can actually be traced back much further than a century ago, though. In fact, to 1776 and a certain doctor, Matthew Dobson, who boiled the urine from someone with diabetes and noticed something peculiar:

"There remained, after the evaporation, a white cake, and this cake was granulated; broke easily between the fingers. It smelled like brown sugar. Neither could it, by taste, be distinguished from sugar except that the sweetness left a slight sense of coolness on the palate."

Chris - Luckily not something that we do in medical school these days. With us now is Kersten Hall who's written the book called 'Insulin - The Crooked Timber', which documents the history of diabetes. Bit of an unconventional technique these days, Kersten. Take us back to a hundred years or so ago and tell us a bit more about how diabetes was actually discovered and what insulin's role was found to be.

Kersten - Happy new year, Chris. Thanks very much for having me on the program. Actually, the oldest reference to diabetes is on an ancient Egyptian scroll from about 3000 years ago. I think the Ebers Papyrus talks about a medicine to drive away the making of too much urine, and that's a reference to what I think is probably the most common symptom of the onset of diabetes: frequent passing of water as the kidneys go into overdrive to clear all this excess sugar that's in the blood. By the 19th century, it was known that the pancreas was central to diabetes. Two researchers, Minkowski and Meren, noticed that when you surgically removed the pancreas from a dog the poor animal became diabetic. Researchers began to speculate that maybe the pancreas produces some hormone that controls blood sugar levels and so the hunt was on to find that hormone. The person who is credited with having found it was Canadian scientist Fred Banting. In the summer of 1921, Banting and a younger colleague, Charles Best, who was a final year honour student, had been removing the pancreas from a dog to make the animal diabetic. Then, they'd been making pancreatic extracts and injecting those into the diabetic dogs to see whether that would bring down their blood sugar levels. And then, of course, the time came to test this on a human patient. So, January the 11th, 1922, young Leonard Thompson had been brought into Toronto general hospital. He was 14 years old. He'd been diagnosed with type one diabetes a few years earlier, and when his father brought him into Toronto general hospital he was pretty much at death's door from diabetes because, prior to the discovery of insulin, a diagnosis of type 1 diabetes was pretty much a death sentence. There was nothing really that could be done for the patient other than to put them on a starvation diet to basically delay the inevitable. So, January the 11th, 1922, Leonard was injected with some of Banting and Best's extract.

Chris - Is that from a dog, Kersten?

Kirsten - No. By that time they were making the preparations from bovine pancreas.

Chris - They realised that you could go to another animal and the analogous organ would work? So it was a reasonable step to then say, "well, let's take this because it's a bigger animal, big pancreas, lots available", and try injecting that?

Kersten - That first injection on January the 11th was actually not considered to be a clinical success. The reason was, yes, sure, Leonard Thompson's blood sugar levels fell, but he was still producing ketones in his urine. These are toxic compounds that are produced in diabetic patients. But the most serious result of all was that Leonard had suffered an adverse reaction. Two weeks later, January the 23rd, 1922, Leonard was injected for a second time. This time it was a success. His blood sugars dropped and there was no toxic adverse reaction.

Chris - And how did they achieve the improvement? Did they filter it or clean it up in some way?

Kirsten - Well, what had changed was that second batch of preparation hadn't actually been made by Banting and Best: it had been made by their colleague, James Collin. What he'd been able to do was work out exactly how you could use alcohol to clean up the pancreatic preparation to remove those impurities that were causing the toxic reactions.

Chris - Did he continue to receive these things? Because there've been these sad stories in the history of science and medicine where people invent amazing remedies - and I'm thinking, of course, of Fleming and Florey's penicillin - where people's lives were initially saved but they couldn't sustain the production and people then died because they couldn't keep treating them. What happened here? Was the story a happy ending?

Kersten - Well, Leonard, I think, continues to be treated. He died very young. In folklore, he died in a motorbike accident: that's not actually true - I think he died from a pneumonic infection in the end. But what happened with insulin was, very quickly, word got out about this discovery. The thing is Banting and Best and the Canadian researchers had the media on this. They had two key factors: They had the media on their side, the newspapers, and they also had industrial clout because, of course, it's one thing to make a discovery like this at the lab bench, but to get it scaled up, to get it purified, to get it into patients, you need industrial backing and they had that in the form of Eli Lilly. Insulin is an interesting example in the history of medicine because, by early 1922, this stuff was being put into patients in clinical trials. The problem was production was the rate limiting step and there were stories about patients coming and camping out in order to try and get hold of this stuff. The issue really was how: "How do we make enough of this stuff and how do we make it fast enough to start getting it into patients?" The other issue, as well, was I think the clinicians at the time were concerned about the media trumpeting this as a miracle cure for diabetes because the clinicians at the time knew it was nothing of the sort. What it does is it transforms what would be an otherwise fatal condition into a long term chronic one that can be managed. There was a very eminent American diabetes specialist at the time, Dr. Elliot Joslin. He was concerned about patients suffering depression if their expectations were ramped up beyond what could realistically be expected.

Chris - This is the perfect opportunity to introduce the other person we have here today, Charlotte Boughton, and she's a diabetes and endocrinology researcher at the University of Cambridge. She's been part of a team who in the past have come up with the organ that you've been referring to, the pancreas, in an artificial form so that we can try to treat diabetes better. Charlotte, you better tell us what was in your mind. I mean, how does this work?

Charlotte - Thank you. An artificial pancreas is actually three bits of hardware: unlike the pancreas, which sits in the body, all the bits of hardware are on the body or nearby. It's all external and it comprises a glucose sensor which measures the glucose levels in the fluids surrounding the cells in real time, an insulin pump which delivers insulin just under the skin, and both of these components are commonly used by people with type one diabetes. The clever part of an artificial pancreas, or a closed loop system, is an algorithm which in the system that's been developed at the University of Cambridge is hosted as an app on a mobile phone. That receives information from the glucose sensor and calculates the right amount of insulin to be delivered by the pump. It does this automatically adjusting the levels every sort of 10 to 12 minutes and allows the person with diabetes to continue without having to do those adjustments manually.

Chris - Apart from superior convenience - not having to prick your finger, test your blood and so on - is it better to have a system continuously taking these measurements and topping up insulin? Is that because it's more similar to what your body would do itself? Does that translate into better health?

Charlotte - Yeah, exactly. It allows you to get more what we call physiological replacement of insulin and we've shown, and other groups internationally as well, that close loop systems allow people to get better glucose control than with a pump on its own or injections, and also can reduce the risk of dangerous hypoglycemia as well. So there's both biological benefits, but also psychological and burden benefits for somebody living with type 1 diabetes.

Chris - Is this the only show in town or are you working on version 2.0 which doesn't have any external features? How are you going to take this forward?

Charlotte - At the moment, the systems that are commercially available to people with type one diabetes still require people to count their carbohydrates and manually tell the insulin pump how much they're eating and therefore how much insulin to deliver. With the newer ultra rapid insulins that have been developed we are seeing at the moment whether those are quick enough to get rid of the need for people to interact with it. So, actually, people could literally just wear the devices and forget about it until the devices need changing. That would truly reduce the burden of type 1 diabetes management. There are also lots of other areas of research within this including smart insulins, which are designed to turn on when they're needed (when glucose levels are high) and turn off when they're not. I think these are quite far behind where we are with diabetes technologies such as closed loop. But I think these are certainly something to look out for in the future.

Chris - I wonder what Leonard would've made of this a hundred years ago, Kersten.

Kersten - I think, well, I think he would've been delighted. I just wanted to say to Charlotte, I actually have type 1 diabetes myself. In fact, as you've been speaking there I've just been doing a quick blood glucose check. I'm fitted with one of these cyborg devices. That's how the kids like to think of it as Dad being a cyborg - one of these implants. I just swipe my phone on it. I thought your work there on the artificial pancreas is so exciting. As somebody with type 1 diabetes, I'm really gonna be watching this with eager anticipation, and as somebody who's just written a book about the history of insulin I'm thinking, "oh my goodness, I better get in touch with my publishers and beg them to publish a second edition", so I can write another chapter to cover the research you've been doing! I just wanted to say thanks very much for all you're doing there and I look forward to it. Got big hopes. Fingers crossed.

Chris - Thank you very much Kersten and thanks also Charlotte. That's Charlotte Boughton and Kersten Hall. And you can get Kersten's book that's out from the 13th of January, appropriately enough for the anniversary; the centenary. It's called 'Insulin - The Crooked Timber: A History From Thick Brown Muck to Wall Street Gold.'