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Test Timeline

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the path to a new health paradigm takes one big step

Two or three years ago as the first direct-to-consumer DNA kits were being offered by companies like 23andMe and Navigenecs a big kerfuffle erupted when the California and New York departments of public health threatened to shut them down. The authorities claimed it was their duty to block the tests because the tests were offered online rather than through a licensed physician and because they were worried to death that the test results might be misinterpreted and cause unnecessary anxiety among recipients.

I was working with CA State Health Department people back at the time through my job in cancer public health. Nevertheless, I always suspected that the legal moves by the states were more to protect their statutory prerogatives and the medical profession than to protect the public. After all, I had been running into similar excuses to control cancer information among physicians for 30 years. Back in the ’70s some doctors would not tell their patients that they had been diagnosed with cancer for the ostensible reason that it would cause a lot of anxiety, and, besides, often there wasn’t much physicians could do about many cancers at the time. The situation improved after informed consent laws were passed forcing medical practitioners to explain diagnoses to patients before treating them. Also the organization I worked for would not give cancer patients professional-level pamphlets or journal reprints for fear of “confusing” patients and for fear of the docs who’d clobber us.

A lot of debate about the hypothesized impact of genetic information has been similar to the argument about the advisability of cancer information in years past. Fortunately some studies have been conducted to try to measure the emotional impact of genetic test information, especially genetic indicators for diseases like Alzheimer’s for which there is no treatment. The NY Times reported a couple of days ago about a study published recently in the News England Journal of Medicine that found essentially that news from the genetic tests didn’t cause a lot of anxiety in a study group of 2000. Many people didn’t take advantage of free genetic counseling offered or even discuss it with their doctors. Nor did the test affect behavior much in a positive way, such as changing lifestyle toward better eating habits. The surprising finding was how little impact the information had on people.

An author of one of the study stated:

“The medical field has been paternalistic about these tests,” says Peter J. Neumann, the lead author of the study, who is director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. “We’ve been saying that we shouldn’t give people this information because it might be wrong or we might worry them or we can’t do anything about it. But people tell us they want the information enough to pay for it.”

The author of the article, John Tierney, offers:

The traditional structure of American medicine gives control to doctors and to centralized regulators who make treatment decisions for everyone. These genetic tests represent a different philosophy, and point toward a possible future with people taking more charge of their own care and seeking treatments customized to their bodies. “What we have today is population medicine at the 30,000-foot level,” says Dr. Topol. “These tests are the beginning of a new way to individualize medicine. One of the most immediate benefits is being able to use the genetic knowledge to tweak the kind of drugs people take, like choosing among statins and beta blockers to minimize side effects.”

I agree with Tierney. This is a step toward a new way of medicine. As I write this the conflict over health care reform is on again. The health care model in the US is a mess and isn’t financially sustainable with about 8,000 baby boomers being added to Medicare each day. I think we need to shift a great deal of health responsibility to people, but it must be real, empowered responsibility with knowledge tools, decision making, and a support infrusturcture that’s available to all citizens. Conservatives use the term “responsibility” as a code word for blame. You know, “You’re  responsible (i.e., to blame) if you’re sick, not me. Don’t ask me for taxes to fix you up.”

If people are to take meaninful responsibility they need a system that provides them with meaninful information about their genetics, real time data about how they’re doing through, perhaps, mobile health monitoring, and a worldwide communication system that makes the latest scientific evidence about disease freely available in comprehensible, personalizable form. Putting up barriers to information like the results of DNA test through spurious fears of damaging effects is not the way to go about it. In the last century and a half we’ve created a huge, expensive scientific and medical system that restricts information and authority to an elite few gatekeepers. That’s got to change.


Ya gotta take the long view to put today in perspective

A press release from Ohio State today drew attention to te findings by a couple of researchers (Julie Ditkof and Michael Barton) that led them to conclude that underneath the Hawaiian Island chain is one massive magma chamber that is only 1.9 to 2.5 miles down. That’s pretty thin skin!

It reminded my why I like geology: it puts today’s seemingly urgent events in perspective by showing that, in geologic time, today is less that a blink of an eye. There is a very, very long past and there will be and equally long future. As my mother used to say: “This too shall pass.”

Last year about this time my wife and I vacationed on our favorite island, Kauai. Since the island is at the northern end of the chain I googled the history of the islands and learned that Kauai is about 6.1 million years old. Actually, the whole chain has been burping up islands for over 65 million years as the Earth’s crust moves over a hot-spot at a few centimeters per year. Many of the earlier islands have subsided back under the Pacific and are just called seamounts.

At the southern end of the chain is the Big Island (a.k.a., Hawaii) that still has active volcanoes like Kiluea. Off the southern shore is yet another volcano, Loihi, that hasn’t even broken the surface yet. I hear that there is some sort of gimmick where somebody is already selling land on the island that will eventually reach the surface. Yeah, get your beach-front property now; it’ll be ready for condos in about a half-million years.

Be that as it may, I find it reassuring that no matter what I’m fretting about today (e.g., the economy, politics, climate change, etc., etc.) there will be another beautiful piece of paradise out there in the Pacific long, long after whatever we do today– or fail to do–fades into time.


Rub two sticks together? Nah, matter and anti-matter.

There’s nothing, I mean NOTHING, like matter/anti-matter annihilation for pure energy. So says “Starts With a Bang” blog.


Single molecule computer chip

Mr. McGuire: I want to say one word to you. Just one word.
Benjamin: Yes, sir.
Mr. McGuire: Are you listening?
Benjamin: Yes, I am.
Mr. McGuire: Plastics.
Benjamin: Just how do you mean that, sir?

In the 1967 movie, The Graduate, a family friend, Mr. McGuire, offers Benjamin (Dustin Hoffman) just one word of advice to set him on a path to future success: “plastics.” That was more than 40 years ago. If I were to adopt a one-word recommendation for the emerging generation it would be: “nanotech.” I’ve mentioned this before.

I was reminded again last week about how dramatic the development in the science and technology of billionth-of-a-meter devices is. Singapore’s Agency for Science, Technology and Research (A*STAR) Institute of Materials Research and Engineering announced a partnership with 10 European Union organizations for the ATMOL project–an effort to build a single molecule computer processor.

A*STAR’s IMRE and 10 EU research organisations are working together to build what is essentially a single molecule processor chip. As a comparison, a thousand of such molecular chips could fit into one of today’s microchips, the core device that determines computational speed. The ambitious project, termed Atomic Scale and Single Molecule Logic Gate Technologies (ATMOL), will establish a new process for making a complete molecular chip. This means that computing power can be increased significantly but take up only a small fraction of the space that is required by today’s standards.

The R&D will work on some cutting-edge techniques for creating molecular components: “The fabrication process involves the use of three unique ultra high vacuum (UHV) atomic scale interconnection machines which build the chip atom-by-atom. These machines physically move atoms into place one at a time at cryogenic temperatures.”

But here’s the thing about this path to success: How do you sustain a career in a field where your current knowledge is as evanescent as the morning dew? Riches will be made in nanotechnology, but knowledge obsolescence has been a problem for mid-career technicians in IT for decades. I don’t see how it’ll get any better.


T Friedman on needed boost in US education

Editorial by Thomas Friedman today is in line with concerns regarding education I’ve been talking about lately. Badly needed cultural fix but a long haul…if at all.


The Law of the Infinite Cornucopia


The late Polish philosopher Leszek Kolakowski, in what he called the law of the infinite cornucopia, stated that there was never a shortage of arguments to support any doctrine one wanted to believe in for whatever reasons. This law is well known, if not by name, in political spin rooms and on talk shows, and is likely to continue to get quite a workout. Of course, a strong argument could also be made that nothing like that will happen at all.

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