Opinion - First person

Andrei Issakov from the World Health Organisation and E&T's electronics editor, offer their views on current issues.

If you ask me

Healthcare's poisoned chalice

The maxim "never look a gift horse in the mouth" doesn't constitute a wise stance for developing countries if they want donations of healthcare equipment.

Many developing countries are increasingly dependent on donations to meet objectives. In some countries, nearly 80 per cent of healthcare physical assets are either directly donated or funded through international donors or foreign governments.

When donations play such a large part, the process is widely influenced, if not dictated, by donor policies and preferences, or short-term political imperatives. In most cases, donations circumvent the proper planning, selection and procurement systems, where they exist. Little consideration is given to actual local needs and requirements, capacity to manage donated assets, or technical expertise of user and service personnel. The donation can become a liability.

Sometimes equipment is new, but more often it is surplus, no longer manufactured, due for replacement or has been removed for other reasons. Donations may be quality items that can be put to good use, but unfortunately many don't meet basic requirements and standards, and are not supported by any adequate after-sale arrangements such as training, maintenance, spare parts and service manuals. As a result, they seldom work for any significant length of time, and quickly end up in a junk pile, or are often unusable from the start due to missing critical parts, manuals, or wrong electrical current. Even when they do work, they often become a burden to the recipient who becomes responsible for heavy costs.

There are a wide range of systemic policy, organisational and technical problems behind the current widespread suboptimal donation practice. The donation process is complex, as are the relationships between various players in the donation chain, where donors and recipients do not usually communicate on equal terms.

To ensure that donations benefit the recipient's healthcare delivery system, clear policies, guidelines, regulations, standards and procedures are needed as a crucial component of a national healthcare infrastructure and technology policy. Donating healthcare technology in a policy vacuum is not a viable option; it is even dangerous as it can freeze development rather than advance it.

Recipients need to make clear to prospective donors what kind of assistance they require. The onus is on recipients to establish clearly defined needs for the benefit of well meaning donors who are often not aware of specific local conditions. Information on donations in the pipeline or expected from other sources is also crucial to avoid donor overlaps in some areas leaving gaps in coverage.

A concerted effort is required by all parties with a dedicated global support from WHO and its international and national partners. Strong advocacy, policy and technical advice and guidance supported by decision-making and management tools, and international communication and networking mechanisms are vital if good donation practices are to be established, commonly accepted and routinely followed by both donors and recipients. Only with these in place can we enure smart donations and eliminate the frequently observed effect of the most useful part of a donation being its container.

Andrei Issakov, coordinator of health technology and facilities planning at the WHO and keynote speaker at the IET seminar on appropriate healthcare technologies for developing countries in London, 21-22 May (http://conferences.theiet.org [new window])

CAD for the genome

When synthetic biologists talk about what they are doing, they often make analogies between their work and what happens in engineering, particularly electronics engineering. You can point to some processes in living cells and describe them in the same terms as digital logic or oscillators - the kind of functions you find in a lot of electronic circuits.

From this, it sounds as though science is well along the road to being able to design biosystems. The relationship between parts of the bacterial genome seem so well understood that people have started to build tools to assemble the designer sequences: CAD for the genome.

A group at the Virginia Bioinformatics Institute has come up with Genocad: a tool that checks artificial gene sequences to see if they obey the 'grammar' of bacterial genetics. You would define switches, oscillators, and AND and or OR gates. A compiler would then take all those statements and compile them into a DNA sequence that would, when inserted into a cell, start to perform all the functions you defined.

However, this is the point where the analogies between electronics and IT begin to break down. If you look at a circuit diagram, you have lots of things like AND gates scattered around. In biology, as it stands today, you only get to use one of each. If you want to have two AND gates in the same biosystem, you need to find another gene that performs the same function but in a different way.

The advantage that electronics has over biology is the ability to define connections between parts. In bacterial cells, at least, you don't get that. Everything happens in what is effectively a little bag of soup in which proteins and molecules only get together by bumping into each other.

As you add more genes into a system, you start to introduce odd little dependencies which means, in most cases, the thing doesn't work. There seem to be ways around this. One is to simplify the bacterial DNA chassis to the bare minimum. Another is to focus on doing more design downstream of the gene - it seems that nature makes a lot of use of what are called protein scaffolds. With these, you bring a bunch of functions together in one protein or design the proteins in such a way that only when certain proteins stick together does something happen.

The problem that faces the synthetic biology community is working out just how concepts such as modularity fit into the discipline. It may be that engineers can only design these systems with a lot of computer support - with statistical tools working out what the potential interactions are between genes and other parts of the cell.

It will be very different to what most people think of engineering. But the concentration on statistics might have other spinoff benefits - the inability to deal with random, infrequent events is so often what brings IT to its knees. Maybe biology has some clues.

Chris Edwards, electronics editor

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