The story of your health in a black box

Yikes! That hurts!

For years I thought that one answer to our broken healthcare system was electronic health records. I still think so, but with a lot of caveats.

The federal government is pushing hard for their adoption. Physicians, driven by the promise of better care, cost savings and nearly $23 billion in new federal incentive payments, are racing to turn their scribbled medical records into digital files, Smart Money reports.

Thirty-five percent of hospitals now use such systems, more than double the share two years ago, according to U.S. government figures. But for all the hype about electronic records, little attention has been paid to what some say is a serious weak spot: When those sensitive bits and bytes fall into the wrong hands, it's often patients who feel the pain.

Here's the trouble.

Since 2009, there have been more than 420 security breaches involving the records of some 19 million patients, according to the U.S. Department of Health and Human Services' Office for Civil Rights. And such breaches are on the rise. A December 2011 report by the Ponemon Institute, a security-research firm, found that the frequency of data losses and thefts among health care organizations increased 32 percent over the previous year.

This is one reason I'm a skeptic about a national healthcare system. Already too many computer systems are familiar with my body.

A doctor in your hand

Is there a doctor in the House?

Health-related apps for smart phones are coming of age. Here are some of the latest.

• One of the latest device-and-app creations to pass muster with the federal Food and Drug Administration is iBGStar, a blood glucose meter that attaches to iPhones or iPads for diabetes monitoring. It's a product of Bridgewater, N.J.-based Sanofi, and sells at Apple retail stores and Walgreens drugstores for about $100 and $75, respectively.

• Heart-EKG uses the iPhone's microphone or camera flash to calculate users' average number of heartbeats per minute or to take their pulse, after placing the phone over an artery, and activating the app. Dallas-based Surich Technologies says the app is handy for aerobic workouts, but isn't intended as a lifesaving monitoring device. It's downloadable from iTunes, for $2.99.

• The iHealth Wireless Blood Pressure Wrist Monitor, expected on the market in September, measures users' blood pressure directly from their iPhone, iPad or iPod Touch. Its app records systolic/diastolic numbers, heart rate and pulse wave, and can chart blood pressure readings, says Karyn Anderson, spokeswoman for Mountain View, Calif.-based iHealth Lab.

• AliveCor Heart Monitor has developed an electrode-studded cellphone case that turns the iPhone 4 into an electrocardiogram device that users hold in their hands or place on their chests to detect irregular heart rhythms. Combined with the app, the monitor can analyze, transmit and store an ECG reading for diagnosis. The heart monitor has been through several clinical trials, said physician David Albert, the device's inventor and co-founder of San Francisco-based AliveCor. He hopes to introduce it for veterinarians' use for dogs, cats and horses later this summer. The device doesn't yet have FDA approval.

• A cellphone-based E. coli sensor for water and other fluids is under development by a University of California-Los Angeles research team. Commercial manufacture of the system, which uses a lightweight attachment to the phone's camera, could be only two years away, said team leader Aydogan Ozcan, a UCLA associate professor for electrical engineering.

• San Francisco-based CellScope's otoscope attaches to the phone's camera lens and will enable parents to photograph their child's eardrum, and e-mail the images to medical professionals checking for an ear infection. CEO Erik Douglas says he hopes to get this to market in about a year.

You'll wanna stay awake for this

Good advice.

"If I told you that I had a neurological disease which meant that for eight or more hours a day I lost control of my faculties, bade farewell to the outside world, and was subject to complex hallucinations and delusions – such as being chased by a grizzly bear at Stockport Railway Station – you would think I was in a pretty bad way. If I also claimed that the condition was infectious, you would wish me luck in coping with such a terrible disease, and bid me a hasty farewell.

"The fact that we accept without surprise the need for a prolonged black-out as part of our daily life highlights our tendency to take for granted anything about our condition that is universal. We don’t see how strange sleep is because (nearly) everyone sleeps.

"Since all animals sleep, we assume it has a biological purpose. The trouble is, we don’t know what that purpose is. There are many theories – energy conservation, growth promotion, immobilisation during hours of darkness when it might be dangerous to be out and about, consolidation of memories – but they are all open to serious objections. William Dement, one of the leading researchers of the last century and co-discoverer of Rapid Eye Movement sleep, concluded from his fifty years in the forefront of the field that 'the only reason we need to sleep that is really, really solid, is that we get sleepy.'"

-- Raymond Tallis

Miracles and wonders: a new hand, zapping cancer

Tickling the ivories, digitally.

The real news in healthcare is coming out of the laboratories, not bureaucracies in Washington.

A research team from Georgia Tech has been working on a rehab glove that is already showing effectiveness for people with limited hand motor skills and proprioception due to spinal injury. The electronic Mobile Music Touch (MMT) glove works with a piano and vibrates individual fingers to point to which keys should be pressed. Using the MMT, people in the study practiced playing the piano for thirty minutes three times a week, and followed up with the glove but without the piano (air piano?), and saw considerable improvement at a time when traditional therapy is usually no longer effective.

Damaged and aged heart tissue of older heart failure patients was rejuvenated by stem cells modified by scientists. "Since patients with heart failure are normally elderly, their cardiac stem cells aren't very healthy," said Sadia Mohsin, Ph.D., one of the study authors and a post-doctoral research scholar at San Diego State University's Heart Institute in San Diego, Cal. "We modified these biopsied stem cells and made them healthier. It is like turning back the clock so these cells can thrive again."

Devising effective drugs is only half the battle faced by pharmaceutical companies. The other half is delivering them to the place in the body they are needed. Some researchers, therefore, are exploring an alternative: building tiny factories that make and release a drug precisely where it is needed. Among these investigators is Daniel Anderson, a chemical engineer at the Massachusetts Institute of Technology. And as he reports in Nano Letters, he and his colleagues have built a device which might do just that. Dr Anderson’s drugmaking machine is a simplified, artificial version of a living cell.

A new method of mapping people's DNA promises to make the procedure more accessible to patients and to help doctors zero in on gene mutations that may cause disease, according to a report Wednesday in the journal Nature. The latest advance in whole-genome sequencing requires only a small amount of DNA to produce a more complete picture of someone's genome, and to immediately determine whether a faulty gene is inherited from the mother, the father or both. That finding could be critical to interpreting results.

In a significant step forward for the development of a potential new cancer treatment, scientists have found how a common cold virus can kill tumors and trigger an immune response, like a vaccine, when injected into the blood stream. Researchers said that by hitching a ride on blood cells, the virus was protected from antibodies in the blood stream that might otherwise neutralize its cancer-fighting abilities. The findings suggest viral therapies like this, called reovirus, could be injected into the blood stream at routine outpatient appointments -- like standard chemotherapy -- making them potentially suitable for treating a range of cancers.

Miracles and wonders: fake jellyfish, perfect teeth

Ersatz jellyfish.

Teenagers today will see extraordinary things in their lifetimes.

Researchers have designed a bioengineered jellyfish that can swim, an early step in scientists' quest for a way to make fresh tissue for patients with damaged hearts. The lab-made jellyfish is created with a mix of silicone and rat-heart cells. Although it isn't a living organism, the robot's muscular structure closely resembles that of a real jellyfish, enabling it to swim freely through water. Scientists hope that such techniques will make it possible to harvest cells from one organism and then reorganize them in sophisticated ways to make a bioengineered system for human use, such as a heart pacemaker that wouldn't require battery power.

Thanks to tiny microneedles, eye doctors may soon have a better way to treat diseases such as macular degeneration that affect tissues in the back of the eye. That could be important as the population ages and develops more eye-related illnesses – and as pharmaceutical companies develop new drugs that otherwise could only be administered by injecting into the eye with a hypodermic needle.

A nationwide team of scientists successfully used stem cells to further the goal of creating personalized medical treatments for Parkinson's disease. Because scientists were able to isolate the disease outside the body with the help of stem cells, they could control for certain variables which allowed them to test treatments in a more systematic way. "This study points the way to screening patients with Parkinson’s for their particular variation of the disease, and then treating them with drugs shown effective to work on that variation, rather than trying to treat all patients with the same drugs, as is generally done now." 

Johns Hopkins tissue engineers have used tiny, artificial fiber scaffolds thousands of times smaller than a human hair to help coax stem cells into developing into cartilage, the shock-absorbing lining of elbows and knees that often wears thin from injury or age. Investigators produced an important component of cartilage in both laboratory and animal models. While the findings are still years away from use in people, the researchers say the results hold promise for devising new techniques to help the millions who endure joint pain.

Happy, happy, happy.

A new chemical could make human teeth 'cavity proof' -- and do away with the need for visits to the dentists forever. The molecule has been called 'Keep 32' - after the 32 teeth in a human mouth. The chemical wipes out all the bacteria that cause cavities in just 60 seconds in tests. The chemical could be added to any current dental care product, turning toothpaste, mouthwash and chewing gum into 'super cleansers' that could get rid of the underlying cause of tooth decay.

Research: prostate surgery not so helpful

Here's another data point for men worried about prostate cancer: surgery was no better in saving lives than observation over a 10-year period, according to one of the first rigorous studies to compare the two approaches in American men with early-stage disease.

The U.S.-funded study assigned 731 men across the country with early prostate cancer to have the gland surgically removed or be observed without any attempt at curative treatment. Ten years later, 47 percent of men in the surgery group had died, mostly from other diseases, versus 49.9 percent who were just watched, results published in the New England Journal of Medicine found. The difference wasn’t statistically meaningful.

“There is no question in my mind that what we have been doing in the United States for the last 20 years has hurt a lot of men needlessly,” said Otis Brawley, chief medical officer for the American Cancer Society. “We need to be telling men that there is tremendous evidence that a large number of men with prostate cancer could be watched and don’t need to be treated.”

In May, the U.S. Preventive Services Task Force recommended against using the prostate-specific antigen (PSA) blood test to spot the disease, saying the screening leads to overtreatment and unnecessary side effects.

Currently, only 10 percent of American men with prostate cancer who are eligible for observation choose observation, according to a National Institutes of Health report last year.

The vast majority elect surgery or various forms of radiation in an attempt to cure their cancer. Both forms of treatment have side effects, including impotence. “When men hear cancer they want something done,” said Durado Brooks, director of prostate and colorectal cancers for the cancer society. The idea that some prostate cancers aren’t life-threatening is “very difficult for people to accept because they are accustomed to thinking of cancer as this ravaging, always-lethal condition.”

After a median of 10 years, 171 of 364 men assigned surgery had died, while 183 of 367 assigned to observation died. In the surgery group, 5.8 percent of the men died from prostate cancer compared with 8.4 percent of the men in the observation group. Neither difference was statistically significant.

More than 1 in 5 patients in the surgery group had complications within 30 days of the operation. Urinary incontinence and erectile dysfunction were much more common in men who got the surgery, while men who got observation had a higher rate of developing bone metastases.

“The results are consistent with emerging science suggesting that for the vast majority of men observation can be a wise and preferred treatment choice” if they have localized prostate cancer, said Timothy Wilt, a researcher at the Center for Chronic Disease Outcomes Research at the Minneapolis Veterans Affairs Health Care System, and the study’s lead author.

Follow the link to the full article, print it out, and take it to your doctor to discuss.

The power of suggestion

We're all familiar with the placebo effect, in which a sugar pill makes people feel better. Researchers have now identified a nocebo effect, in which suggesting side effects of a fake drug cause people to experience those effects.

If you tell a group of trial volunteers that they’re testing a new drug that may relieve the pain of migraines, a significant number of volunteers will experience pain relief after taking the drug — even if they’ve been randomly assigned to the placebo group and are receiving nothing but sugar pills. The placebo effect in action. 

But here’s where it gets interesting. If you tell the volunteers that the side effects of this new medicine may include dry mouth, tingling in the hands and feet, and slight dizziness, some volunteers will experience precisely these side effects — inboth groups. In fact, some volunteers who are taking nothing but sugar pills will be made so uncomfortable by these symptoms that they will choose to drop out of the trial early.

The relevance of the nocebo effect is not limited to clinical trials.

A particularly nasty demonstration of its power can be provided by patients who are being treated for Parkinson’s disease with small doses of electrical current delivered to certain structures in the brain. This technique, known as Deep Brain Stimulation (DBS), has been shown to be effective in controlling tremor and other motor issues in patients who are resistant to drugs. But if you tell a DBS patient that the current has been switched off — even though it remains on — their coordination and other motor functions will abruptly decline until you tell them that the juice has been switched on again. Classic nocebo.

Someone suggested that I look tired and will probably need a nap this afternoon. Wow, they're right!