Tiresias: Precise medicine for the 21st Century

"Be precise. A lack of precision is dangerous when the margin of error is small.”

Donald Rumsfeld

My friends,

Tiresias has addressed the capital raising and the current share price in the last several posts so today he's going to leave this issue until the raising is completed. Once complete, Tiresias anticipates, the air will clear, and the upside movement of the share price will begin. Today Tiresias would like to address an issue, something he has touched on previously, but not really in detail and not how it relates to Optiscan’s Confocal Digital Laser Endomicroscopy which enables 3-dimensional cellular and sub-cellular microscopic visualization and histopathological diagnosis real time in the operating room, enabling real tailored individualised cancer treatment.

You see, my friends, Tiresias believes that we are now entering a new third stage of medicine. Let Him explain. Tiresias sees that we are exiting the second historical period of medicine now, really as we entered the twenty first century. Tiresias see the previous stages as;

Prescientific - which lasted, and is still widely practiced, having been around for 30,000 to 50,000 from the paleolithic period to the end of the 19th and beginning of the 20th century.

Scientific -With anatomy starting in the renaissance, the development of microscopy in the 17th century, the germ theory and cell theory in the 19th century are the beginnings of scientific medicine with exuberant flowering and the dramatic advances in the 20th century.

We are now however entering stage three. A new era is dawning. You see, my friends, current scientific medicine is actually, genericmedicine. What does Tiresias mean by this? What this means is that all patients have a generic diagnosis and are given “one same treatment fits all” generic treatment, regardless of their individual genetic variability and vulnerability, regardless of the precise details of the disease process, and regardless of the microanatomy and precise microscopic pathology. This is a very shotgun, a blunderbuss approach to something that should be and must be done with the highest precision, accuracy, and care. The time is here and the limits of this generic blunderbuss approach to cancer treatment has reached its limits. To go beyond this to individualised approach precise instant diagnosis, in vivo, is essential to enable and precise individualised treatment, in the operating room. This will not only exactly guide the surgeon in terms of excision of malignant cells and preservation of normal viable tissue but also guide use of local highly focussed brachyradiotherapy and locally applied chemotherapeutic and biologic agents, to the visualised cellular environment. As an example, of what is underway right now in this field, Tiresias will take what Zeiss is trying to do with Optican’s CONVIVO microscope. As Tiresias has previously said, the treatment of glioblastoma multiforme, malignant brain tumour, despite all the scientific advances in neuroimaging and neurosurgery there has been no improvement in outcomes in survival in the last 60 years. The generic cancer treatment has remained the same; “cut, slash, burn and poison”, through surgery, radiotherapy and chemotherapy and every patient and every patient get the same trinity of treatment. The New Paradigm is individualised medicine beckons, no, has arrived. This really starts with the human genome project and the sequence of the entire genome and now development of quick individual genome sequencing. This has shown us just how variable and how much variability there is in the genetics of each individual and how their responsiveness to drugs, diseases and treatments is so variable. Understanding this is propelling medicine to tailoring individual treatments to each patient and their very specific very individual pathologically precisely differentiated cancer to achieve much better results with much less harm to the patient.

And this is where Optiscan comes in. To take an example from the history of cancer treatment; specifically breast cancer. The modern era of breast cancer treatment starts with famous surgeon, William Halsted, who introduced the super-radical mastectomy which involved cutting of not only the breast, but all underlying muscle, dissection, and excision of the lymph nodes in the armpit and even the ribs. This mutilating surgery was de rigueur from about 1900 right into the 1970s and 80s. Fortunately, this has gradually been reduced, initially a mastectomy with the axillary clearance, then partial mastectomy, and now lumpectomy, increasing preceded by generic toxic chemotherapy, followed by radiotherapy. But this to is still of course generic blunderbuss flamethrower applied to and delicate highly complex organ. The current surgical part of this process, once a lump is discovered, after percutaneous biopsy which are often indeterminate, and only serve to heighten anxiety, the surgeon proceeds to perform a lumpectomy. Once the breast is cut open, the surgeon cannot see the tumour as there is no demarcation between the tumour and normal beast. He does it by feel! He or she feels for the lump between his fingers cuts it out, and hopes, “has got it all out’. A week or two later, after the excised tissue is processed and histopathologically examined, and patient undergoes post operative scans one in three patients are called back for further surgery, and of course with the same limitations.

This is where Optiscan in vivo real time microscopy, which currently being used in Melbourne Hospitals, and on which we wait, comes in. With Optiscan’ s microscopy and with the developing AI now also well underway, surgeon will scan the surgical bed, see every malignant cell, modify the operation to deal, either surgically, application of local brachyradiotherapy, which would be much, more effective and less toxic, or apply topical chemotherapy, immunotherapeutic biologics or other possible treatment yet to come, facilitated by this new technology. And this will be applicable to all cancers and then some.