Category: Health

Smart Phones Bring Power to the Patient

(p. A11) We instinctively reach for our smartphones when we need to take pictures, get directions, deposit checks or reserve a table. Eric Topol, a cardiologist and digital pioneer, thinks that they are ready to perform at least one more task: revolutionize health care. In “The Patient Will See You Now,” he argues that smartphones will democratize medicine by bringing data and control directly to the people.
The power of doctors, says Dr. Topol, “can be likened to that of religious leaders and nobility” in centuries past, when knowledge and authority belonged to a small elite. He notes that we’ve never seen “a discrete challenge to the medical profession” akin to Luther ‘s challenge to the Roman Catholic Church or democracy’s challenge to monarchy and despotism. “But we’ve not had the platform or landscape for that to be accomplished. Until now.” Smartphones, he says, enable a range of medical applications to move from the hospital to the home, and they shift medicine’s locus of control from doctor to patient.

For the full review, see:
DAVID A. SHAYWITZ. “BOOKSHELF; Doctor Android; In the same way that Luther challenged the Catholic Church, smartphones are poised to upend the medical profession.” The Wall Street Journal (Tues., Jan. 13, 2015): A11.
(Note: the online version of the review has the date Jan. 12, 2015.)

The book under review is:
Topol, Eric. The Patient Will See You Now: The Future of Medicine Is in Your Hands. New York: Basic Books, 2015.

Double-Blind Clinical Trials Are NOT the Only Source of Good Evidence

(p. 16) Back in her office, . . . [rheumatologist Jennifer Frankovich] found that the scientific literature had no studies on patients like this to guide her. So she did something unusual: She searched a database of all the lupus patients the hospital had seen over the previous five years, singling out those whose symptoms matched her patient’s, and ran an analysis to see whether they had developed blood clots. “I did some very simple statistics and brought the data to everybody that I had met with that morning,” she says. The change in attitude was striking. “It was very clear, based on the database, that she could be at an increased risk for a clot.”
The girl was given the drug, and she did not develop a clot. “At the end of the day, we don’t know whether it was the right decision,” says Chris Longhurst, a pediatrician and the chief medical information officer at Stanford Children’s Health, who is a colleague of Frankovich’s. But they felt that it was the best they could do with the limited information they had.
A large, costly and time-consuming clinical trial with proper controls might someday prove Frankovich’s hypothesis correct. But large, costly and time-consuming clinical trials are rarely carried out for uncommon complications of this sort. In the absence of such focused research, doctors and scientists are increasingly dipping into enormous troves of data that already exist — namely the aggregated medical records of thousands or even millions of patients to uncover patterns that might help steer care.
. . .
(p. 17) . . . , developing a “learning health system” — one that can incorporate lessons from its own activities in real time — remains tantalizing to researchers. Stefan Thurner, a professor of complexity studies at the Medical University of Vienna, and his researcher, Peter Klimek, are working with a database of millions of people’s health-insurance claims, building networks of relationships among diseases. As they fill in the network with known connections and new ones mined from the data, Thurner and Klimek hope to be able to predict the health of individuals or of a population over time. On the clinical side, Longhurst has been advocating for a button in electronic medical-record software that would allow doctors to run automated searches for patients like theirs when no other sources of information are available.
With time, and with some crucial refinements, this kind of medicine may eventually become mainstream. Frankovich recalls a conversation with an older colleague. “She told me, ‘Research this decade benefits the next decade,’ ” Frankovich says. “That was how it was. But I feel like it doesn’t have to be that way anymore.”

For the full story, see:
VERONIQUE GREENWOOD. “Eureka; Dr. DATA; Can Statistical Analysis Tell Us What Clinical Trials Cannot?” The New York Times Magazine (Sun., OCT. 5, 2014): 16-17.
(Note: ellipses, and bracketed name, added.)
(Note: the online version of the story has the date OCT. 3, 2014, and has the title “Eureka; Can Big Data Tell Us What Clinical Trials Don’t?”)

26 Different Drugs Lengthen Healthy Life Span in Mice

(p. F5) For thousands of years, people have sought to escape or outrun their mortality with potions, pills and elixirs, often blended with heavy doses of hope and will.
In the “Epic of Gilgamesh,” a Mesopotamian king searched for the secret of immortality after the death of his best friend. At least three Chinese emperors in the Tang dynasty died after consuming treatments containing lead and mercury that they hoped would make them immortal. In the late 19th century, a French-American physiologist seemed to have found the elixir of life by injecting the elderly and himself with extracts from animal testicles.
. . .
“By targeting fundamental aging processes, we might be able to delay the major age-related chronic diseases instead of picking them off one at time,” said Dr. James Kirkland, a professor of aging research and head of the Robert and Arlene Kogod Center on Aging at the Mayo Clinic. “For example, we don’t want to have situation where we, say, cure cancer and then people die six months later of Alzheimer’s disease or a stroke. It would be better to delay all of these things together.”
This is where the field known as the biology of aging is moving — to develop drugs that will increase life span and what researchers refer to as health span, the period of life when people are able to live independently and free from disease.
Dr. Kirkland said that at least six drugs had been written up in peer-reviewed journals and that he knew of about 20 others that appear to affect life span or health span in mice. The goal is to see if those benefits can be translated into humans to increase their longevity, “to find interventions that we can use in people that might, say, make a person who’s 90 feel like they’re 60 or a person who’s 70 feel like they’re 40 or 50.”
Other researchers are studying centenarians, seeking to understand whether certain genes have carried them past 100 years old and kept them in good health.

For the full story, see:
TRACEY SAMUELSON. “Science (and Quacks) vs. the Aging Process.” The New York Times (Weds., Nov. 19, 2014): F5.
(Note: ellipsis added.)
(Note: the online version of the story has the date NOV. 18, 2014.)

Obamacare Advisor Says Obscure Law Passed Due to “Stupidity of the American Voter”

(p. A4) Jonathan Gruber, the economist at the heart of a fresh debate about the Affordable Care Act, has had more than a dozen appointments to visit the White House since Democrats began drafting the health law in 2009, records show.
The visits included at least one group meeting with President Barack Obama , as well as appointments with senior administration officials who helped shape the 2010 law that expanded health insurance to millions of Americans.
The White House in recent days has tried to distance itself from Mr. Gruber, a 49-year-old Massachusetts Institute of Technology economist, since a 2013 video surfaced last week in which he said the law passed because of the “huge political advantage” of the legislation’s lacking transparency. He also referred to the “stupidity of the American voter.”
Republicans have seized on the comments as evidence that supporters of the law purposely misled the public about its costs.
“It is amusing to watch Washington liberals discount Mr. Gruber’s truth-telling as a gaffe and disown” his involvement in the law, said Sen. Orrin Hatch (R., Utah).

For the full story, see:
STEPHANIE ARMOUR and COLLEEN MCCAIN NELSON. “Health Adviser Gruber Logged Regular White House Visits.” The Wall Street Journal (Tues., Nov. 18, 2014): A4.
(Note: the online version of the story has the date Nov. 17, 2014.)

Outsiders Persevere to Pursue Breakthroughs

(p. 315) Despite all the examples given, mainstream medical research stubbornly continues to assume that new drugs and other advances will follow exclusively from a predetermined research path. Many, in fact, will. Others, if history is any indication, will not. They will come not from a committee or a research team but from an individual, a maverick who views a problem with fresh eyes. Serendipity will strike and be seized upon by a well-trained scientist or clinician who also dares to rely upon intuition, imagination, and creativity. Unbound by traditional theory, willing to suspend the usual set of beliefs, unconstrained by the requirement to obtain approval or funding for his or her pursuits, this outsider will persevere and lead the way to a dazzling breakthrough. Eventually, once the breakthrough becomes part of accepted medical wisdom, the insiders will pretend that the outsider was one of them all along.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

While Looking for Spotted Fever, He Found the Cause of Lyme Disease

(p. A25) Willy Burgdorfer, a medical entomologist who in 1982 identified the cause of what had been a mysterious affliction, Lyme disease, died on Monday [November 17, 2014] at a hospital in Hamilton, Mont. He was 89.
. . .
In the early 1980s, Dr. Burgdorfer was analyzing deer ticks from Long Island that were suspected to have caused spotted fever when he stumbled on something unexpected under his microscope: spirochetes, disease-causing bacteria shaped like corkscrews. They were located in only one section of the ticks, the so-called midguts. He had studied spirochetes in graduate school.
“Once my eyes focused on these long, snakelike organisms, I recognized what I had seen a million times before: spirochetes,” he said in a 2001 oral history for the National Institutes of Health, which include the National Institute of Allergy and Infectious Diseases.
He had not been working on Lyme disease, but he had spoken with the doctor who helped discover it, Dr. Allen Steere of Yale. After he saw the spirochetes in the Long Island ticks, he quickly realized that the bacteria might also be in the deer ticks believed to be playing a role in Lyme disease in Connecticut and elsewhere, including Long Island.

For the full obituary, see:
WILLIAM YARDLEY. “Willy Burgdorfer, Who Found Bacteria That Cause Lyme Disease, Is Dead at 89.” The New York Times (Thurs., NOV. 20, 2014): A25.
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the obituary has the date NOV. 19, 2014.)

“Bad Ideas Die Hard, Especially Those that Flatter Our Vanity”

(p. C5) Mütter was one of the first plastic surgeons in America.
. . .
Mütter was also a pioneer of burn surgery.
. . .
Every hero needs a good antagonist and Mütter had a great one, a professor and blowhard named Charles D. Meigs who was as contrary as a Missouri mule. Meigs was a highly regarded obstetrician and one of Mütter’s colleagues at Jefferson. He rejected Mütter’s namby-pamby notions by reflex. Anesthesia? Pshaw! Men and women are put on earth to suffer. Handwashing? Humbug! The very idea that physicians could spread disease was preposterous. As Meigs wrote, “a gentleman’s hands are clean.” Unfortunately, bad ideas die hard, especially those that flatter our vanity. The fight to make medicine as humane as possible continues long after Mütter’s premature death from tuberculosis in 1859.

For the full review, see:
JOHN ROSS. “The Doctor Will See You Now.” The Wall Street Journal (Sat., Aug. 30, 2014): C5.
(Note: ellipses added.)
(Note: the online version of the review has the date Aug. 29, 2014, and has the title “Book Review: ‘Dr. Mütter’s Marvels’ by Cristin O’Keefe Aptowicz.”)

The book under review is:
Aptowicz, Cristin O’Keefe. Dr. Müt­ters Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine. New York: Gotham Books, 2014.

Embryo Stem-Cells Improve Sight in Severe Vision Loss Patients

(p. A7) Researchers have used stem cells from human embryos to treat patients suffering from severe vision loss, the first time the technique has been shown to be both safe and potentially effective in a sustained way.
. . .
. . . , Dr. Lanza and his colleagues first obtained an eight-cell embryo from a fertility clinic. (The embryo was left over from fertility treatments and was destined for destruction.)
. . .
Vision tests suggested that 10 of the 18 treated eyes had improved sight, with eight patients reading more than 15 additional letters on a reading chart in the first year after transplant. Visual acuity remained the same or improved in seven patients, though it decreased by more than ten letters in one patient.

For the full story, see:
GAUTAM NAIK. “Vision Improves in Stem-Cell Trial.” The Wall Street Journal (Weds., OCT. 15, 2014): A7.
(Note: ellipses added.)
(Note: the online version of the story has the date OCT. 14, 2014, and has the title “Stem Cells Show Potential Benefits for Eye Diseases.”)

Forssmann’s Courage Rewarded with “Professional Criticism and Scorn”

(p. 197) Forssmann’s report in the leading German medical journal garnered him not hosannas but instead fierce professional criticism and scorn. In response to a senior physician who claimed undocumented priority for the procedure, the twenty-five-year-old Forssmann was forced to provide an addendum to his publication one month later. Rigid dogmatism and an authoritarian hierarchy characterized the German medicine of that day. The human heart, as the center of life, was considered inviolable by instrumentation and surgery.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

Denied Approval to Catheterize Hearts, Forssmann Catheterized His Own

(p. 195) Forssmann received his medical degree from the University of Berlin in 1929. That year, he interned at a small hospital northwest of Berlin, the Auguste-Viktoria-Heim in Eberswalde. He pleaded with his superiors for approval to try a new procedure–to inject drugs directly into the heart–but was unable to persuade them of his new concept’s validity. Undaunted, Forssmann proceeded on his own. His goal was to improve upon the administration of drugs into the central circulation during emergency operations.
The circumstances of the incident on November 5, 1929, revealed by Forssmann in his autobiography, could hardly have been (p. 196) more dramatic. The account reflects Forssmann’s dogged determination, willpower, and extraordinary courage. He gained the trust of the surgical nurse who provided access to the necessary instruments. So carried away by Forssmann’s vision, she volunteered herself to undergo the experiment. Pretending to go along with her, Forssmann strapped her down to the table in a small operating room while his colleagues took their afternoon naps. When she wasn’t looking, he anesthetized his own left elbow crease. Once the local anesthetic took effect, Forssmann quickly performed a surgical cutdown to expose his vein and boldly manipulated a flexible ureteral catheter 30 cm toward his heart. This thin sterile rubber tubing used by urologists to drain urine from the kidney was 65 cm long (about 26 inches). He then released the angry nurse.
They walked down two flights of stairs to the X-ray department, where he fearlessly advanced the catheter into the upper chamber (atrium) on the right side of his heart, following its course on a fluoroscopic screen with the aid of a mirror held by the nurse. (Fluoroscopy is an X-ray technique whereby movement of a body organ, an introduced dye, or a catheter within the body can be followed in real time.) He documented his experiment with an X-ray film. Forssmann was oblivious to the danger of abnormal, potentially fatal heart rhythms that can be provoked when anything touches the sensitive endocardium, the inside lining of the heart chambers.

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.

Major Cancer Drugs Have Come from Unexpected Sources

(p. 182) Starting in the last decades of the twentieth century, last decades of the twentieth century, sophisticated genetics and molecular biology have been aimed toward a more precise understanding of the cell’s mechanisms. Yet, even here, chance has continued to be a big factor. Surprising discoveries led to uncovering cancer-inducing genes (oncogenes) and tumor-suppressing genes, both of which are normal cellular genes that, when mutated, can induce a biological effect that predisposes the cell to cancer development. A search for blood substitutes led to anti-angiogenesis drugs. Veterinary medicine led to oncogenes and vaccine preparations to tumor-suppressor genes. In one of the greatest serendipitous discoveries of (p. 183) modern medicine, stem cells were stumbled upon during research on radiation effects on the blood.
Experience has clearly shown that major cancer drugs have been discovered by independent, thoughtful, and self-motivated researchers–the cancer war’s “guerrillas,” to use the reigning metaphor–from unexpected sources: from chemical warfare (nitrogen mustard), nutritional research (methotrexate), medicinal folklore (the vinca alkaloids), bacteriologic research (cisplatin), biochemistry research (sex hormones), blood storage research (angiogenic inhibitors), clinical observations (COX-2 inhibitors), and embryology (thalidomide).

Source:
Meyers, Morton A. Happy Accidents: Serendipity in Modern Medical Breakthroughs. New York: Arcade Publishing, 2007.