Archive for the 'Measuring/Monitoring' Category

01
Jan
11

Here we come, ready or not!

Compare the population pyramid of the USA whic...
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On this date 65 years ago the first kids of what would become the “Baby Boom Generation” started to build perhaps the most influential demographic in US history. Today the first ones turn a symbolic and practical corner by entering the traditional 65-year-olds bracket. It’s like the first play of the fourth quarter of a football game. There’s more game ahead, but the end is palpably approaching.

I got a three-week jump on the gang. I was born in December 1945, but I still count myself in that social bracket. It took awhile for a social perception of the big population bulge to emerge and longer to find out what the consequences would be. As the “pig in the python” moved through the decades the sheer size of the population affected everything from education to social norms to defense practices.

Now here we are at another key point. We’ve gotten better at understanding that such a large population pool has social, political, and economic consequences, but in the US we still don’t do much to actually prepare for things. Ken Dyctwald has been talking about the “Age Wave” since I was in public health grad-school 40 years ago. He’s made a career and an industry out of spelling out what’s coming…but knowing that the hurricane is swirling around and heading to shore hasn’t produced great preparation. The Age Wave may result in something Katrina-like because, in the US, we have ideological prejudice against planning. No, we prefer to wait until the calamity is upon us and then scramble to survive. After it’s over we proclaim: “We made some mistakes but we learned from this disaster and it’ll never happen again.” Famous last words, over and over.

I’ve gotta say, already having my Medicare card in my pocket and Social Security checks being deposited in the bank is comforting. It’s the people at the back of the Boomer cohort that have more reason to sweat it. The denouement of the Baby Boom generation is one of the huge dynamic factors that, along with others, suggest to me that the future will be like a vortex–hence the name of this blog–of swirling forces that’ll send us all spinning. For what it’s worth, here we come.

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26
Dec
10

Auguring the future

I can’t help being fascinated by prognostications about the future. My last post was about online jobs for 2011, and the end of the year provokes a lot of crystal ball gazing. Even heavyweights like IBM indulge in exercising their forecasting skills. You’ve gotta pay at least  some attention to what an outfit with such a solid track record has to say. These are things to happen between now and 2015.

  1. Batteries for your gadgets will last up to ten times longer. The batteries will “breathe” or take in oxygen from the air and react with energy-dense metals to generate energy.
  2. In some devices batteries could be replaced entirely by scavenging energy from our surroundings. Watches that maintain a charge by taking energy from the motion of your wrist, as some do today, is an example. There’s a lot of unused energy around; the problem is transducing it.
  3. IBM plans to recycle much of the energy used in data centers to heat buildings and drive air conditioning. Up to half of the energy of data centers today is just to keep the servers cool, and it goes out to the air again through cooling towers. Hey, I might be able to heat my shower water with my home computers?
  4. They’re expecting 3D communication person to person by hologram like Princes Leia in the first Stars Wars movie.
  5. IBM’s looking at “adaptive traffic systems” that’ll personalize your commute,  predict traffic jams and adjust the flow. (It’s kinda discouraging to think that people will still be grinding away their lives on commutes to awful offices. Let’s go with the holograms and Google’s self-driving vehicles.)
  6. Finally, Big Blue predicts that we ordinary citizens will be “walking sensors” equipped with enough environmental sensors in our phones to keep a running data stream to analysts who can use it to do scientific ecological research.

I’m disappointed that IBM didn’t mention health applications of being walking sensors, so I’ll add another prediction of my own: By 2015 we’ll be wired with sensors alright, but many of them will be plastered on us so continuous data can be collected about how our body is doing 24/7. With that I think we’ll be able to get a lot closer to the idea of personalized medicine and personalized health behavior. There are a lot of companies already working on a range of data collection devices and another five years ought to bring much of it into common use.

11
May
10

another volley in the healthcare revolution

The Washington Post is reporting today that a company called Pathway Genomics on is going to start selling through Walgreen’s 6,000 drugstores an over-the-counter kit for testing certain genetic traits.

Beginning Friday, shoppers in search of toothpaste, deodorant and laxatives at more than 6,000 drugstores across the nation will be able to pick up something new: a test to scan their genes for a propensity for Alzheimer’s disease, breast cancer, diabetes and other ailments

The test also claims to offer a window into the chances of becoming obese, developing psoriasis and going blind. For those thinking of starting a family, it could alert them to their risk of having a baby with cystic fibrosis, Tay-Sachs and other genetic disorders. The test also promises users insights into how caffeine, cholesterol-lowering drugs and blood thinners might affect them.

Yeow, that’s going to set off a firestorm! A couple of years ago when companies like 23andMe began to offer tests to consumers the California and New York public health departments and the FDA tried to shut them down. They issued “cease and desist” orders and threatened to charge them with violating various violations of business practice laws. In fact the kerfuffle has already started.

The Food and Drug Administration questioned Monday whether the test will be sold legally because it does not have the agency’s approval. Critics have said that results will be too vague to provide much useful guidance because so little is known about how to interpret genetic markers.

The medical profession is conservative with good reason: lives are at stake. But in all this, in my opinion, is also a component protection of professional prerogatives. Professions in any field don’t give ground to the ordinary person easily.

I’ve had some experience with this. When I started in the cancer field 36 years ago we had two sets of printed literature: one set for the lay public and another for doctors and nurses. You were risking getting fired if you let a cancer patient get hold of the professional literature! The reasons then were the same ones physicians express now about internet information: “they (the public) won’t understand what it means; they will misinterpret it; they’ll suffer anxiety; they might make bad decisions about treatment.” But the internet irreversibly smashed the barrier to access to professional medical information. Doctors are still fighting a rear-guard action and complaining mightily about how it was better in the old days when they were the exclusive source of medical information. I’ve commented on that before.

I’m not dismissing the concerns. No doubt there will unfortunate incidents around these new tests. But what gets me is how unwilling the medical profession is to see the revolution of information that is underway and to rethink the medical paradigm. My pleas is for physicians to start — as a profession — to work on a more equitable and flexible basis with the citizens who want a greater and more equal role in their medical life. We’ll always have a doctor/patient relationship, but I think its going to be much different in the not far distant future.

The internet isn’t going away; instead it’s going to go much, much deeper into our health lives. And genetic tests are not going away either. Like it or not, deep personal knowledge about what lurks in our genes is on the way. Why isn’t the medical profession working with entrepreneurs, patients, futurists, and internet gurus to anticipate what’s coming and do something positive that works for everyone? There’s much, much work to be done, and soon. Without a collaborative movement of innovation and adaptation we’re going to suffer through repeated, time-wasting bouts of friction.

27
Mar
10

do patients need doctor navigators to use the internet?

In the March 25 New England Journal of Medicine Drs. Pamela Hartzband and Jerome Groopman of published an opinion piece titled “Untangling the Web — Patients, Doctors, and the Internet” in which they expressed a lot of concerns about how the internet is putting patients in touch with a lot of questionable information about disease and about how it is changing the doctor-patient relationship in an adverse way.

Since, overall, my views are about 180 degrees in the opposite direction, I’d like to quote some of their remarks and comment on them. (I recommend reading the full article so the context isn’t neglected.)

Information traditionally flowed from doctor to patient; the physician described the genesis and course of a disease and the options available for treating it. Often, pamphlets were provided to reinforce the doctor’s explanation and advice. The patient might then receive additional input from family and friends, usually in the form of anecdotes about people who faced similar clinical situations.

I can only say from my experience that the first sentence about information flowing from doctor to patient is pretty ideal. When I started working at the community level for a large national cancer organization in the ’70s there were doctors who not only didn’t explain the disease well but there were some who chose, on the basis of their judgement about the emotional frailty of the patient, not to tell some patients they had cancer. They’d tell a spouse or adult child perhaps. Fortunately, things have improved and, hopefully, the “don’t tell” practice has been replaced by informed consent. Still, I think for many situations the amount of information going to patients is limited by the short time allocated to face-to-face interaction with doctors. I am a Kaiser Permanente client. They have implemented email to doctors, online lab results, and an online information resource. The docs don’t give full explanations unless you press them on it.

Other patients whose diseases have no ready cure are drawn to chat rooms and Web sites that may make unsubstantiated claims — assertions that macrobiotic diets cure aggressive lymphoma, that AIDS can be treated with hyperbaric oxygen, that milk thistle remedies chronic hepatitis, and myriad other fallacious claims. Falsehoods are easily and rapidly propagated on the Internet: once you land on a site that asserts a false rumor as truth, hyperlinks direct you to further sites that reinforce the falsehood. Material is perceived as factual merely because it is on a computer screen. We sometimes find ourselves in the uncomfortable position of trying to dissuade desperate and vulnerable patients from believing false testimonials. Doctors may be perceived as closed-minded, dismissive, or ignorant of “novel therapies” when they challenge such Internet rumors.

Firstly, there is absolutely nothing new about charlatans and doctors who have been peddling snake oil and gimmick cures for generations. Again, when I went to work in cancer control my organization had a major effort to combat “quackery.” Many, many cancer patients were getting all kinds of bad advice and misinformation from naturalistic health magazines and other sources. (For a thorough tour of the quackery hall of infamy, see Dr. Steven Barnett’s site Quackwatch.) People by the thousands were going to clinics in Mexico for cancer treatments no responsible doctor would perform. This was rampant decades before the internet. There was an epic, nationwide legislative battle over Laetrile, the marketing name for amygdalin from apricot pits. Despite the best efforts of medical and public health organizations, especially in California, Laetrile production was legalized in 27 states . The arguments about “freedom of choice” from the ’70s seem to have echoed down the decades and have turned up again in the rhetoric against health reform, especially in the condemnation of  comparative effectiveness determination.

Secondly, even highly authoritative institutions have to change their tune once in a while. When I joined cancer public health in the ’70s the medical community almost universally rejected the idea that food and nutrition had anything to do with the prevention of cancer. People who talked about a relation between nutrition and cancer were sneered at and called the “fruits and nuts” crowd. Thirty-five years later as I approached retirement I had to chuckle inwardly many times about the current enthusiasm for the view that diet and nutrition are key to the prevention of much cancer. These days ya gotta eat your greens and grains!

Thirdly, doctors themselves are not always reliable sources of informaiton. That’s why we have second and sometimes third opinions. Drs. Hartzband and Groopman cite anecdotes about people who believe unsubstantiated information from the internet and suffer anxiety or waste doctors’ time. But I think most of us who have been around a few decades have our own fist full of stories from our own experiences or those of friends and acquaintances where doctors have failed to diagnose something or misdiagnosed situations, where lab tests have been wrong or complex treatments have been bolixed up in a hospital. I think the public knows all too well from well-publicized reports about medical errors by the Insyitutes of Medicine that the medical system itself is far from fault free. With regard to health it’s a risky world, even in the bosom of the medical establishment.

The article concludes:

As physicians, we are struggling to figure out how best to use this technology in the interests of our patients and ourselves. Although the Internet is reshaping the content of the conversation between doctor and patient, we believe the core relationship should not change. A relative recently asked us, “What can you possibly learn from your doctor that is not available on the Internet?” We suspect we’ll hear such radical sentiments increasingly in the future. Knowledge is said to be power, and some of the past imbalance of power between patient and doctor may be equalized. But information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the Internet will make such expertise and experience more essential. The doctor, in our view, will never be optional.

Uh, count me among the radicals. Let me say that the doctors are not totally negative about the internet, but their overall conclusion is that every patient should vet all their information through their physician. It sounds like they’re saying — like other professionsals who’ve had their domain disrupted by the internet — we’d all be better off if the internet went away and we could return to the status quo ante.

I’m just here to assert that that’s just not going to happen. The genie has been out of the jug for years and it’s not going back in. The Pew Internet and American Life Project has been documenting for years now the growing reliance of the public on the internet in health matters. Doctors just don’t seem to get it that there are needs that they’re just not satisfying. The use of digital media for health information and support is only going to increase, and rapidly.

My position is not that doctors are somehow unnecessary. However, I do believe that ordinary citizens are capable of knowing much more and doing much more about their own personal health and digital systems are an evolving platform for that. And after the so-called “health reform” slugfest we’ve been through I’m even more convinced that we all need to be more autonomous. We can’t continue to depend on a cabal of politicians, doctors, hospitals, insurance and pharmaceutical companies for our health. It’s just too important.

My suggestion to physicians is, instead of promoting a somewhat idealized notion of the doctor-patient relationship unsullied by the internet, why not work with citizens, professionals, and organizations to make the internet a better platform for the public and for doctors and patients to work together around their health issues? There are many support measures that can be undertaken. If docotors are worried about accurate information then why not build a comprehensive, evidence-based, easily accessible, user-friendly information resource? Medpedia, a project started by a consortium of medical and public health schools, is an interesting and constructive exercise along this line. Only thing is, the site is not public-friendly and so far the effort appears not to have attracted much involvement from anyone but professionals.

The concern about people not being able to critically evaluate health information is certainly legitimate. In fact, evaluating ALL internet information is an issue. But where is the support system for helping people learn how to do that? Why don’t doctors and organizations get busy spelling out some guidelines for evaluation and get them disseminated through many channels? That would be constructive and doable.

There already is a kind of parallel world of information and tools starting to envelope the health sector. (Tip: If you think the internet is something, check out the apps in the iPhone App Store supposedly intended for medical professionals but perfectly downloadable by anybody.) It’s like the way the blog-o-sphere enveloped journalism. After a lot of pining for their old, defunct newspapers, more far-thinking journalists have learned how to work with digital media and to reclaim their futures. Something similar is happening in medicine and, hopefully, perceptive medical professionals will learn how to work with it rather than try to will it away.

29
Jan
10

My self-tracking: the prequel

I mentioned a few weeks ago that I’m doing my thing with adopting a permanent exercise and diet regimen. (Who isn’t?) This program has evolved. Starting back in July 2009 I wanted to get on a self-improvement track. At the same time I was getting interested in what I think is a very significant trend: health 2.0, participatory medicine, e-medicine or whatever else people are calling it.

I started by setting up accounts in both Google Health and HealthVault. Neither is very suitable for what I wanted to do: keep track of my exercise and diet. Both are designed to enable people to set up computer accessible versions of the records their doctor or health provider has. Fortunately I’ve been in good health most of my life, and I don’t have any complicated records of disease episodes or conditions to put in there — even if I wanted to. I say “if I wanted to” because it became apparent that getting records into these PHR (personal health record) systems either requires hooking-up with a limited number of providers, using go-betweens, or just getting your paper records and manually transferring everything in. It didn’t seem worth it in my case.

However, I discovered that HealthVault offers the option of linking your medical records account up to the MSN Health & Fitness site. Health & Fitness is specifically for recording exercise and food consumption. The data and graphs are then accessible in HealthVault.

Good idea, I thought, so I started recording what I was doing in the fitness form. The Health & Fitness recording system calls for you to make a daily exercise and diet plan. Then you keep track of what you actually eat and do for exercise that day and enter it at day’s end. The program then compares your goals with what you really did. That was a problem for me because I never know what I’m going to eat, and I wasn’t embarking on such a controlled diet routine that I was going to control it by, say, preparing and packing my lunch to the office. So, for me, the food consumption planning was useless.

Also, the interface for diet planning and recording is poor. You can search for a food or drink and select from alphabetical drop-down menus. But no matter how many times you have the same thing there’s no way to get a shortcut to your commonly consumed items. Finally, the exercise planning and recording is set up around running or gym workouts. All I wanted to focus on was walking. Believe me, I’m way beyond the six-pack-abs stage.

After about three or four days I realized this wasn’t going to be something I wanted to do for weeks much less years. There was way too much “paperwork” involved through an interface that wasn’t very helpful. Indeed, I ran smack into what I think is a very common obstacle for getting people engaged with health routines: doing the manual labor of keeping track of your progress. There are notorious hurdles in the way of people keeping up sustained health routines, and this is a big one.

I realized pretty quickly that I needed a better way of gathering my data. Coincidentally my cell phone contract was up for renewal, and I latched on to what I hoped (or rationalized) would be a big step forward in convenience of recordkeeping: the iPhone. That was the next phase on my self-tracking saga, and I’ll go into using a smartphone in more detail in the next installment.

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06
Dec
09

Single atom transistor. Whee!!

Researchers in Finland and Australia have submitted a research paper about their demonstration of a single-atom transistor. The report on Physorg.com says: “Researchers…have succeeded in building a working transistor, whose active region composes only of a single phosphorus atom in silicon.”

Why get excited about a geeky development like this?

I’ve made a big deal about how complex real world systems are such as a bacterium and the genetics of cancer and other bad diseases. The only way we’ll master them eventually is having more and more computing power for elaborate computer models and sensitive devices for looking deep within living things. To my mind these research reports are the early signals of progress forthcoming in development of electronic components, sensors, information storage and communication. These things are going to emerge in the not-too-distant-future.

The rapid development of computers, which created the present information society, has been mainly based on the reduction of the size of transistors. We have known for a long time that this development has to slow down critically during the future decades when the even tighter inexpensive packing of transistors would require them to shrink down to the atomic length scales.

These are not going to be transistors like we have in our laptops and mobiles; they’re going to be transistors for the next generation of computing: quantum computers. To be sure, there are enormous engineering challenges to getting to the next level, but there are frequent reports of developments like this one. It’ll happen and the impact will be great.

Unraveling the complexities of life processes and applying them to our day-to-day concerns is daunting. But developments like the single-atom transistor say to me that the forces of technology are converging to keep us moving ahead. We just need to persist.

29
Sep
09

Nanosensing Transistors Powered by Stress

From Technology Review:

ACS/Nano Letters

ACS/Nano Letters

…new sensors consist of freestanding nanowires made of zinc oxide. When placed under stress, the nanowires generate an electrical potential, functioning as transistors.

Zhong Lin Wang, professor of materials science at Georgia Tech, has previously used piezoelectric nanowires to make nanogenerators that can harvest biomechanical energy, which he hopes will eventually be used to power portable electronics. Now Wang’s group is taking advantage of the semiconducting properties of zinc oxide nanowires–the electrical potential generated when the new nanowires are bent, allowing them to act as transistors.

Gee, maybe the global energy problem is solved! There’s plenty of stress out there.




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