News from InHealth

Organizational Changes at EHTI

Sat, 28 Jan 2012 00:00:00 EST

As of January 15, 2012, Rosanna Tarricone has stepped down from her position as Executive Director of EHTI. Rosanna has been the main driver of EHTI since its creation. Thanks to her vision and dedication, EHTI has become a respected research institute within the healthcare arena. The EHTI Board would like to thank Rosanna for her work and the results she has achieved with EHTI and wishes her all the best in her future role as Director of CERGAS (Bocconi University). The Board is very pleased that Rosanna will remain involved in scientific activities of the Institute as EHTI Scientific Director. Rosanna will remain available at rosanna.tarricone@ehti.info

At the same time, the EHTI Board is pleased to announce that Yves Verboven has been appointed EHTI Executive Director. Yves has held previous positions at Alcon, where he was Assistant Director Health Economics Outcomes Research, at Medtronic and at Intermedics in clinical outcome research and clinical engineering. Having been part of the EHTI Executive Committee and active member of the Eucomed Economic Affairs Working Group, HTA Project Team and REG/HTA Task Force, Yves is by no means a stranger to EHTI nor Eucomed. Yves can be reached at yves.verboven@ehti.info

Next to the financial commitment, Eucomed is also dedicating human resources to support EHTI in 2012 with Sophie Koettlitz, sophie.koettlitz@ehti.info, continuing her duties as Economic Affairs Officer, EHTI and Thomas Lindemans providing communication support.

Furthermore, EHTI has been looking for a new industry representative to join the Executive Committee. The EHTI Board carefully reviewed all applications and in December 2011 elected Matteo Pinciroli, Director, Perceval Program and Global Health Economics & Reimbursement–Heart Valves BU from Sorin Group, the new industry representative. Matteo replaces Anastassia Anastassopoulou who took on a new career opportunity.

Also in December last year, EHTI welcomed four new expert reviewers: Rodamni Peppa (Boston Scientific Corporation), Hilbrand Bodewes (Biomet), Markus Ott (Covidien) and Eszter Kacskovics (SCA Hygiene Products Kft).

EHTI in 2012

The Institute will continue its close collaboration with external advisors and interest groups. EHTI is committed to bringing, timely data and evidence on the social and economic value of medical technology and its impact on the economy and welfare of European countries. For more information, visit ehti.info.

Charles Fleischman Named Acting Executive Director of InHealth

Sun, 1 Jan 2012 00:00:00 EST

Martyn Howgill retires from the Institute for Health Technology Studies, the organization that commissions independent research on the value of medical technology

Washington, D.C. — The board of directors of InHealth, the Institute for Health Technology Studies, announces that Martyn W. C. Howgill retired effective December 31, 2011. Mr. Howgill led the organization since its inception in 2004 and has agreed to assist InHealth in an emeritus capacity. The board is pleased that director Charles M. (Chuck) Fleischman has agreed to act as InHealth’s executive director as the board searches for Mr. Howgill’s successor.

“The board and supporters of InHealth greatly appreciate the service that Martyn has provided, especially his unique role in developing the organization from its beginnings. We wish him the very best in his retirement,” said InHealth Chairman John W. Brown, chairman emeritus of the Stryker Corporation. “We are also grateful that Chuck Fleischman has agreed to shepherd the organization in the coming months as we review candidates for the executive director position.”

Fleischman, an entrepreneur and venture capitalist, currently sits on the boards of InHealth and One Lambda, Inc., and serves on the national advisory council for the Johns Hopkins University School of Education, as well as the boards of the Potomac Conservancy and St. John's Hospital Foundation. He previously held multiple positions at Digene Corporation, including president, chief financial officer, chief operating officer, and director. He graduated from Harvard College and obtained his master’s degree in Business Administration from The Wharton School, University of Pennsylvania.

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About InHealth

Launched in 2004, the Institute for Health Technology Studies (InHealth) is a nonprofit research and educational organization supporting independent analyses of the social and economic effects of diagnostic and therapeutic medical devices. Follow InHealth on Twitter @inhealthdotorg.

Routine head hits in sports may injure brain, experts warn

Fri, 18 Nov 2011 00:00:00 EST

Routine head hits in sports may injure brain, experts warn

By Mary Elizabeth Dallas, HealthDay

Updated 2h 55m ago

Comments

Young athletes who routinely take hits to the head could experience brain injury — even if they do not suffer a concussion, according to the results of a new preliminary study.

KEVIN WOLF, AP

And, the researchers pointed out, the brains of the athletes who took routine hits to the head showed more similarities to the brain of the athlete with the concussion than the brains of the non-athletes.

KEVIN WOLF, AP

Researchers from the University of Rochester Medical Center (URMC) said their findings could be a red flag for the potentially serious consequences of seemingly mild head injuries among young people whose brains are still developing.

The study was published in the Nov. 12 online edition of the journal Magnetic Resonance Imaging.

“Although this was a very small study, if confirmed it could have broad implications for youth sports,” the study’s lead author, Dr. Jeffrey Bazarian, associate professor of emergency medicine at URMC with a special interest in sports concussions, said in a university news release. “The challenge is to determine whether a critical number of head hits exists above which this type of brain injury appears, and then to get players and coaches to agree to limit play when an athlete approached that number.”

Researchers followed nine athletes over the course of one year along with six non-athletes and compared their pre- and post-season brains using imaging based on quantitative data.

Although only one of the athletes suffered a sports-related concussion, six others sustained between 26 and 399 routine hits to the head, which resulted in abnormal brain scans. And, the researchers pointed out, the brains of the athletes who took routine hits to the head showed more similarities to the brain of the athlete with the concussion than the brains of the non-athletes. The authors added that the changes picked up on the brain scans were consistent with the athletes’ symptoms and number of head hits they took.

The research showed that the white matter brain changes among the six athletes who sustained many routine hits to the head were three times higher than the non-athletes. The study’s authors noted, however, more research is needed to understand implications of the findings for athletes.

“Our studies are taking important steps toward personalized medicine for traumatic brain injury,” concluded Bazarian. “In the future we’d like to be able to have a baseline image of a brain and clearly know the significance of changes that occur later.”

On the Web:

The American Association of Neurological Surgeons has more about sports-related head injury: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Sports-Related%20Head%20Injury.aspx

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The doctors behind the world’s first transplant of an artificial windpipe made from stem cells are to begin clinical trials next year on a stem cell ‘bandage’ for mending torn knee cartilages.

Fri, 18 Nov 2011 00:00:00 EST

The doctors behind the world’s first transplant of an artificialwindpipe made from stem cells are to begin clinical trials next yearon a stem cell ‘bandage’ for mending torn knee cartilages.

Professor Anthony Hollander of the University of Bristol, whohelped to save patient Claudia Castillio’s life with the transplantof a tissue-engineered windpipe or trachea, will lead a team thatwill carry out a pioneering stemcell treatment on patients with tornknee cartilage.

The doctors aim to transplant stem cells derived from a patient’sbone marrow on to a damaged knee joint. It is hoped the cells willact like a repairing bandage to mend the damaged tissue. It will bethe first clinical trial of stem cells aimed at repairing tornmeniscal cartilage, which protects and lubricates the joint.

Bristol University said clinical trials had been approved by theMedicines and Healthcare Products Regulatory Agency and that theuniversity’s spin-out company, Azellon Cell Therapeutics, had raisedPounds 2.25m for the trial to go ahead.

Every year, 1.7m people in the UK need knee operations to mendtorn cartilages, which can lead to early onset osteoarthritis, andeven knee replacement operations.

Early last month the European Court of Justice banned theissuing of patents for embryonic stem cell research. The judgementis designed to prevent the commercial exploitation of discoverieswhich involve the destruction of human embryos.

The Anisakis allergy debate: does an evolutionary approach help?

Tue, 15 Nov 2011 00:00:00 EST

Allergic phenomena share common pathways with the immune response against helminth parasites. The definitions regarding allergens and their related concepts have their roots in the area of allergy research. The experience with the fish parasite Anisakis simplex-associated allergic features still nurtures an open debate on the necessity of larvae being alive to induce allergic reactions such as urticaria or anaphylaxis. Conceptual definitions of allergen, major allergen, as well as putatively crossreacting antibodies, as are used in food allergy, depend on the clinical relevance of specific IgE and deserve careful interpretation in the various forms of A. simplex-associated allergic features. Conversely, an evolutionary based interpretation of the presence of specific IgE depends on the viability of A. simplex.

http://www.cell.com/trends/parasitology/fulltext/S1471-4922(11)00179-6

Neutron dose equivalent and neutron spectra in tissue for clinical linacs operating at 15, 18 and 20 MV

Tue, 15 Nov 2011 00:00:00 EST

In this work, the dose equivalent due to photoneutrons and the neutron spectra in tissue was calculated for various linacs (Varian Clinac 2100C, Elekta Inor, Elekta SL25 and Siemens Mevatron KDS) operating at energies between 15 and 20 MV, using the Monte Carlo code MCNPX (v. 2.5). The dose equivalent in an ICRU tissue phantom has been calculated for anteroposterior treatments with a detailed simulation of the geometry of the linac head and the coupled electron-photon-neutron transport. Neutron spectra at the phantom entrance and at 1-cm depth in the phantom, depth distribution of the neutron fluence in the beam axis and dose distributions outside the beam axis at various depths have also been calculated and compared with previously published results. The differences between the neutron production of the various linacs considered has been analysed. Varian linacs show a larger neutron production than the Elekta and Siemens linacs at the same operating energy. The dose equivalent due to neutrons produced by medical linacs operating at energies 15 MeV is relevant and should not be neglected because of the additional doses that patients can receive.

Neutron dose equivalent and neutron spectra in tissue for clinical linacs operating at 15, 18 and 20 MV

1. S. A. Martínez-Ovalle1,2,

2. R. Barquero3,4,

3. J. M. Gómez-Ros5 and

4. A. M. Lallena2,*

1. 1Departamento de Física, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia

2. 2Departamento de Física Atómica, Molecular y Nuclear, Universidad de Granada, E-18071 Granada, Spain

3. 3Servicio de Radiofísica y Protección Radiológica, Hospital Universitario ‘Río Hortega’, Calle Dulzaina, 2, E-47012 Valladolid, Spain

4. 4Departamento de Radiología, Universidad de Valladolid, E-47071 Valladolid, Spain

5. 5Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Avda. Complutense, 22, E-28040 Madrid, Spain

1. ?*Corresponding author: lallena{at}ugr.es

* Received September 21, 2010.

* Revision received November 20, 2010.

* Accepted November 25, 2010.

In this work, the dose equivalent due to photoneutrons and the neutron spectra in tissue was calculated for various linacs (Varian Clinac 2100C, Elekta Inor, Elekta SL25 and Siemens Mevatron KDS) operating at energies between 15 and 20 MV, using the Monte Carlo code MCNPX (v. 2.5). The dose equivalent in an ICRU tissue phantom has been calculated for anteroposterior treatments with a detailed simulation of the geometry of the linac head and the coupled electron–photon–neutron transport. Neutron spectra at the phantom entrance and at 1-cm depth in the phantom, depth distribution of the neutron fluence in the beam axis and dose distributions outside the beam axis at various depths have also been calculated and compared with previously published results. The differences between the neutron production of the various linacs considered has been analysed. Varian linacs show a larger neutron production than the Elekta and Siemens linacs at the same operating energy. The dose equivalent due to neutrons produced by medical linacs operating at energies >15 MeV is relevant and should not be neglected because of the additional doses that patients can receive.

http://rpd.oxfordjournals.org/cgi/content/short/147/4/498?rss=1

My self-destructing syringe could save millions of lives

Tue, 15 Nov 2011 00:00:00 EST

Unsafe injections kill 1.3 million people a year, says former “spoilt brat” Marc Koska, who is on a mission to stop syringe reuse

You are on a mission to stop the reuse of syringes. How big is the problem?

The World Health Organization (WHO) says 1.3 million people die every year because of the reuse of syringes. The burden of disease cost is over $100 billion a year from syringe reuse, which is just mind-blowingly horrific. Twenty-two million cases of hepatitis B are spread every year because of the reuse of syringes. The WHO says one in two injections given is unsafe.

You invented a simple non-reusable syringe, the K1. Where did it all begin?

I read a newspaper article in May 1984 which predicted that syringes would one day be a major cause of the transmission of HIV. It was what I had been waiting for, a project that had a lot of the things that I liked: problem-solving, product design, campaigning, and being a bit of a big mouth pain-in-the-bum.

I grew up in England, went to a nice public school, then didn’t want to go to university so I thought I would wander around. I did a season skiing, a bit of sailing, typical spoilt brat stuff. I ended up in the Caribbean. I was having a blast. I was really waiting for this bit of inspiration if you like, and it came in the form of syringes.

How did you go about designing a self-destructing syringe?

Syringes are made in their billions every month around the world, and I realised that until I could go to a manufacturer and say “this is going to add nothing to your manufacturing costs” then I didn’t have a hope. That dictated the design. There is a part of the existing moulding process that is easy to change. I designed a mechanical valve into the plunger. After one use the plunger passes a ring inside the barrel. If you try to retract the plunger past that ring it locks. If you use excessive force, the plunger snaps and it can’t be used.

Tanzania has just agreed to use only this kind of syringe. Tell me about that.

The Tanzanian government recognised there is a problem: that they don’t have enough sterile syringes, that they are being reused probably four or five times each, and that this reuse is a massive contributor to their burden of healthcare.

How did you persuade the Tanzanian officials to switch to non-reusable syringes?

I was anonymously sent a video of a healthcare worker reusing a syringe on three people: a 4-year-old, an adult with HIV and then a 1-year-old baby. I edited that into a short version and was able to show it to the minister, who was appalled.

What’s next for your safe syringe campaign?

In 2012 I want to concentrate on east Africa. I want to see Tanzania through, then I want to move on to Uganda, Kenya, Rwanda and Burundi. A country like Tanzania is going to go from using 40 million syringes to 200 million. That’s going to require them spending about $7 million extra, but is likely to save them $70 million in healthcare costs. But where do they get the $7 million in the first place? My role is also trying to help them find the money.

When this article was first posted, it incorrectly stated that Tanzania had agreed to use only the K1 syringe.

Profile

Marc Koska has worked for 27 years to stop the reuse of syringes. He designed the self-destructing K1 syringe, set up Star Syringe to manufacture it and runs the charity SafePoint, which campaigns against unsafe injections

Microscopic scales weigh up cancer therapies

Tue, 15 Nov 2011 00:00:00 EST

WHAT use would it be to weigh a single living cell? Microscopic scales that do just that may help doctors to predict how a person’s cancer will respond to anti-cancer drugs.

The scales are actually a tiny maze of fluid-filled channels, 10 to 15 micrometres wide, sitting on a chip attached to various sensors. Computer-controlled jets direct cells around the maze until one becomes trapped in a receptacle just big enough to hold it. The receptacle sits at the end of a springboard-like channel that vibrates at specific frequencies depending on the channel’s mass. When a cell is forced into this channel it displaces some of the fluid inside. This changes the frequency of vibration, which is monitored and used to weigh the cell.

Scott Manalis from the Massachusetts Institute of Technology and colleagues have shown that the scales are able to weigh yeast cells accurately to within a few trillionths of a gram.

Manalis’s team then used them to monitor changes in cell growth in response to drugs. First, the researchers trapped single white blood cells within the scales. They left the cells to grow for 10 minutes, then replaced the glucose fluid in the scales with one containing sodium azide – a toxic chemical that damages cell membranes – and left the cells to grow for a further 10 minutes. As the cells grew, fluid was displaced, changing the frequency of vibration of the channel, which was monitored throughout. Cells grew at a much slower rate after the sodium azide solution was added (Lab On A Chip, DOI: 10.1039/c1lc20736a).

Manalis says the scales could be used to help develop personalised cancer therapies that could be tested on an individual’s cells. “We plan to determine if the growth response of tumour cells can be predictive of how a patient will respond to a therapy, he says.

BRIEF: Franken to propose bill to speed approval for innovative devices

Mon, 14 Nov 2011 00:00:00 EST

By Wendy Lee, Star Tribune, Minneapolis

Nov. 14–U.S. Sen. Al Franken said on Monday he will introduce legislation that could speed up the time to get innovative medical devices approved for the market.

His bill calls for the U.S. Food and Drug Administration to ease its requirements on all devices for medical conditions that affect fewer than 4,000 people a year. The bill would allow medical device firms for the first time to make a profit on such products.

“It will help people with rare diseases,” Franken said, after speaking to 800 Medtronic employees in Mounds View on Monday morning.

The news comes as medical device companies have complained that the process for approving medical devices through the FDA takes too long and is too expensive. As a result, some investors have been reluctant to fund medical device start-ups. Meanwhile, consumer advocates have said more must be done to monitor the safety of medical devices.

Physicians attending the event at Medtronic applauded the proposal. Several said many medical device firms are testing their products abroad because it is easier to get approval there. In the long run, some physicians said that could hurt patients who want to access those products here.

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Visit the Star Tribune (Minneapolis) at www.startribune.com

Distributed by MCT Information Services

In hospitals, automated defibrillators may not work so well

Mon, 14 Nov 2011 00:00:00 EST

Lilly Fowler

Just over a decade ago, hospitals around the country began spending millions of dollars to buy automated defibrillators to save the lives of patients who go into sudden cardiac arrest. The purchases were spurred by a recommendation from an American Heart Association committee, which concluded that the equipment would bring patients speedier help.

But research done since the switch suggests that the more costly gear, which is now found in nearly all hospitals, saves fewer lives than old, lower-tech defibrillators. One recent study suggests that nearly 1,000 Americans die in hospitals every year because it can take longer to assess patients with the new devices and because nurses aren’t adequately trained on the equipment.

All told, some doctors now believe that the AHA recommendation came too soon, without investigating whether the new device is as effective in hospital settings as the old gear.

“I think they jumped the gun,” said Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic.

According to members of the AHA committee, concern about slow response times for treating hospital patients in cardiac arrest prompted the switch. The idea was that automated equipment would be so easy to use that almost any medical staffer nearby could operate them and quickly start helping a patient whose heart had stopped.

The new technology “was demonstrated to be effective in saving lives,” said Robert A. Berg, a committee member and the critical care division chief at Children’s Hospital of Philadelphia.

“We just assumed that we were going to make a difference,” added Roger D. White, who was on an AHA subcommittee that studied automated defibrillators and who currently is an anesthesiologist at the Mayo Clinic in Rochester, Minn. But, he said, “what we thought would work hasn’t worked so far.”

AHA officials said the new research is unlikely on its own to force reconsideration of the guidelines when they are eligible for a five-year review in 2015. “Guidelines are based on the entire body of evidence,” said a spokesman for the association.

AED sales soar

Defibrillators use an electrical current to shock hearts back into normal rhythm. Since the 1990s, automated equipment providing step-by-step audio instructions has been in widespread use at public buildings, including some hospitals. But the AHA panel’s 2000 guidelines pushed for far greater use by hospitals, saying this would reduce in-hospital preventable deaths.

Committee members said in interviews that studies had shown that the basic model of the new devices — often known as automated external defibrillators, or AEDs — saved lives in non-hospital settings such as airports.

“Data was accumulating that lay-rescuer AED programs could shorten time from collapse to shock delivery and result in very high rates of survival,” said Mary Fran Hazinski, an AHA science editor and nurse who was a member of the committee.

Among the 11 committee members, three have acknowledged receiving research funding from manufacturers of the devices. (In one case, that funding was disclosed in the committee’s report.) When contacted, they said this funding was not a factor in their decision to approve the guidelines; rather, they were convinced that the automated equipment would save lives.

Purchases of the devices zoomed after the 2000 guidelines were released. U.S. hospitals bought close to 100,000 of the basic automated models between 2000 and 2010, according to the consulting firm Frost & Sullivan. The firm projects that sales of the AEDs to hospitals will keep rising over the next few years.

The cost of switching hospitals to the newer equipment was modest, by hospital equipment standards. The widely used basic models, which walk someone through the process after pads are attached to a person’s chest, begin at around $1,600.

Yet even as their use was increasing in hospitals, an analysis published this summer raised concerns about the automated devices.

Flaws lead to recalls

Based on reports sent to the Food and Drug Administration from 1993 through 2008, researchers found that the equipment sometimes failed to work properly. For example, the devices failed to turn on, turned off unexpectedly or failed to deliver the recommended shock. The analysis associated more than 1,000 cardiac-arrest deaths with equipment failures in a variety of settings.

The FDA said manufacturers have recalled tens of thousands of the devices.

The Advanced Medical Technology Association, which represents the medical device industry, said that companies are working with the FDA to improve the devices. It added that the FDA “continues to advocate the use of external defibrillators and is not recommending any change to current use practices for these devices.”

A separate study raised broader questions about the value of AEDs for hospitalized patients.

Published last year in the Journal of the American Medical Association, the study tracked 11,695 patients in 204 hospitals who suffered cardiac arrest between 2000 and 2008.

“AED use was associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use,” the study found. The main reasons were that patients who suffer cardiac arrest tend to be sicker than the average victim and may have complex medical problems that make them more apt to suffer “non-shockable” cardiac arrest — episodes that can’t be fixed by a defibrillator.

The study indicated that the use of an automated defibrillator might interfere with other life-saving techniques in some cases.

In those cases, a defibrillator may be needed to provide readings on how a patient is responding to cardiopulmonary resuscitation, or CPR. Ordinarily, CPR is applied and then periodically interrupted so that the defibrillators can provide those crucial readings. A big drawback to the automated machines is that they require longer interruptions to make those readings, and the lost seconds of CPR can be fatal.

Adequacy of training

The study also suggested that the new defibrillators have failed to achieve one of the major goals behind the AHA recommendation: getting patients in cardiac arrest shocked more quickly. It suggested that was not happening because many nurses had not been adequately trained to use the new devices.

All told, the study calculated that cardiac arrest patients treated at hospitals with automated defibrillators survived only 16.3 percent of the time. By comparison, the survival rate was 19.3 percent at hospitals that used manual equipment to shock patients.

Based on estimates that AEDs are used in one in six of the approximately 200,000 annual cases of cardiac arrest in hospitals, the lower survival rate would translate into about “965 fewer patients potentially who may be alive” every year in the United States, according to the study’s lead author, Paul S. Chan, a cardiologist at Saint Luke’s Health System in Missouri.

Manufacturers and some doctors counter that research shows that patients at certain hospitals, particularly those with a shortage of staffers trained to use manual defibrillators, benefit from the automated devices.

Richard O. Cummins, an emergency medicine professor at the University of Washington and one of three members of the AHA committee who said he received some funding from AED makers, said he stands by the committee’s original reasoning, emphasizing that financial considerations were never a part of his thinking. “I still endorse the idea” of the AEDs, he said.

Dana Edelson, a board member of the nonprofit Sudden Cardiac Arrest Foundation and an assistant professor at University of Chicago Medical Center who was not on the committee, agreed that the devices are needed despite the problems found in the studies.

“I think it would be a mistake to throw out a blanket statement [that] hospitals shouldn’t be using an AED,” she said. “It depends who is there in the middle of the night.”

This article was produced by FairWarning, a nonprofit investigative news organization focused on public-health and safety issues. A longer version can be read at www.fairwarning.org .

Op-Ed Contributor: Our High-Tech Health-Care Future

Wed, 9 Nov 2011 00:00:00 EST

FRANK MOSS

WHY can’t Americans tap into the ingenuity that put men on the moon, created the Internet and sequenced the human genome to revitalize our economy?

I’m convinced we can. We are in the early phases of the next big technology-driven revolution, which I call “consumer health.” When fully unleashed, it could radically cut health care costs and become a huge global growth market.

Over the past few years, innovations like electronic health records and the use of mobile computing devices in hospitals have begun to improve medical care delivery. Consumer health information Web sites and online disease support groups have made millions of people active participants in their own health care.

But imagine a far more extreme transformation, in which advances in information technology, biology and engineering allow us to move much of health care out of hospitals, clinics and doctors’ offices, and into our everyday lives.

Here’s a picture — inspired by ideas and innovations emerging from university research labs, clinical innovation centers, start-ups and large companies — of how it could work.

It would begin with a “digital nervous system”: inconspicuous wireless sensors worn on your body and placed in your home would continuously monitor your vital signs and track the daily activities that affect your health, counting the number of steps you take and the quantity and quality of food you eat. Wristbands would measure your levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. Your bathroom mirror would calculate your heart rate, blood pressure and oxygen level.

Then you’d get automated advice. Software that could analyze and visually represent this data would enable you to truly understand the impact of your behavior on your health and suggest changes to help prevent illness — by far the most effective way to cut health care costs.

Many situations would still call for professional medical attention, of course, but in most cases you wouldn’t need to make a costly trip to the doctor’s office. If you were not feeling well, a lifelike avatar on your smart phone would use natural-language processing to listen as you described your symptoms and then would translate them into medical jargon. After consulting a diagnostic supercomputer, the avatar would ask you to run a few quick medical tests at home.

You might slip a low-cost plastic attachment over your phone display, look into its eyepiece and conduct a cataract exam. The avatar would transmit the results to your human doctor, who would send you a video message explaining the diagnosis and prescribing treatment.

When you did need an office visit, you and your doctor would sit side by side in front of a large touch screen that would display a conceptual animation of what was going on inside your body. Decisions like choice of medication and dosing schedules would be made collaboratively with your doctor, and treatment regimens would be synchronized to apps on your phone that would make the task of following doctor’s orders — all too often neglected — easy and even fun. (I am an adviser to some early stage start-ups developing technologies like these.)

The United States should commit to a “moon shot” for consumer health to make this imagined world a reality. In addition to the health benefits, we would gain revenue from exports of consumer health products to countries like China and India, which are likely to become enormous health care markets. And the savings in health care costs could easily amount to a trillion dollars annually, as those costs are now about 18 percent of gross domestic product but could be brought closer in line with the 10 percent typical of modern developed nations.

I acknowledge that this goal is very optimistic, given the paternalism of the medical profession, the poor health habits of most Americans and the perverse incentives of our health care system.

But the burgeoning consumer health revolution has a powerful force on its side — American creativity. There is a rapidly growing network of inventors, academics and entrepreneurs who share a passion for empowering individuals to take control of their health. There is even a spirited health data movement, known as the Quantified Self, that is reminiscent of the Homebrew Computer Club, whose members helped spawn Apple and other companies in the early days of the personal computing revolution.

There’s also private sector money beginning to flow. Venture capitalists are ramping up their investments in health-tech start-ups. The X Prize Foundation is co-sponsoring a $10 million award for the best mobile device allowing consumers to diagnose their own diseases.

For its part, all the government has to do is to catalyze this revolution. One step in the right direction is Healthdata.gov, a free resource of public health data and tools that can help innovators quickly bring to market data-driven applications and services. A bigger step would be for Congress to pass a bill that would orchestrate the development of interoperability and privacy standards for consumer health products and actively promote the industry at home and abroad.

Recent history has shown that when the right cultural, technical and economic forces converge, people can transform fundamental aspects of society from the bottom up in a way that seemed impossible just a short time before. I believe that such a time is coming for health care.

Frank Moss, an entrepreneur and former director of the M.I.T. Media Lab, is the author of â€œThe Sorcerers and Their Apprentices: How the Digital Magicians of the M.I.T. Media Lab Are Creating the Innovative Technologies That Will Transform Our Lives.â€?

Robotic aid: Minimally invasive system allows speedy recovery By Allison Griffin

Tue, 8 Nov 2011 00:00:00 EST

By Allison Griffin, Montgomery Advertiser, Ala.

Nov. 08–It’s called “the robot,” but really the da Vinci Surgical System isn’t a robot at all. It’s a sophisticated platform that many surgeons say is just the latest innovation in modern surgical technique.

But the da Vinci does not actually perform operations; the physician is always in control.

“It’s not a program,” said Dr. Gregory Waller, an obstetrician/gynecologist at Ob-Gyn Associates who is trained on the da Vinci system. “The instruments only do what I do with my hands. It’s real time, not virtual time.”

Baptist Medical Center East launched its da Vinci system Oct. 5, said Terry Wilson, a registered nurse who is the robotics coordinator. But the nurses and scrub techs had been training on it for some time prior to the launch.

Baptist East’s robot has a simulator, which has been a big benefit for the hospital, Waller said. It allows the physicians to practice their techniques at their leisure.

Hospital officials allowed members of the media to try out the da Vinci robot, using its long instruments to maneuver pennies, pins and other small objects around on a surgical table. The surgeon — or in this case, a reporter — sits at the console and presses his or her forehead against the hood to engage the system. (The console is several feet away from the patient.) Then, the robot translates movements of the thumbs and forefingers into small movements of the instruments.

The robot is quite responsive — it takes very little effort to operate the controls.

Visuals of the procedure are transmitted to two large screens in the operating room, so the surgical team can view the surgery. And the surgeon’s voice is amplified while the da Vinci is engaged.

Waller showed a video of a previous surgery, and how the instruments retract, cut and cauterize. The video is displayed on one of the monitors in the operating room; Waller points out that what is being shown is actually very small. The magnification is quite clear.

Its high-definition camera also allows the surgeon to view the surgical field in 3-D. “It allows really good visualization,” Waller said.

Right now, the da Vinci at Baptist East is being used for gynecological procedures, but there are several specialties that could utilize the robot in the future, including urology, cardiology and otolaryngology.

The da Vinci system uses a laparoscopic approach, which is minimally invasive. The biggest benefits to the patient are less blood loss, shorter hospital stays, shorter recoveries and less pain, Waller said.

In a traditional, open hysterectomy, for example, the woman has a six- to 12-inch incision and a hospital stay of two to three days, said Gail Hughes, director of surgery at Baptist East. Using the robot, the incisions are far smaller, and the hospital stay is usually one day.

The patient also can get back to regular activities much faster, Hughes said.

Waller pointed out the advantages for the surgeon as well, including enhanced visualization and better dexterity.

In 2009, about 64 percent of all hysterectomies were done with an open procedure, Waller said, a number they hope to reduce with the robot.

Baptist East expects to have as many as six gynecologists trained on the da Vinci in the next two months.

Jackson Hospital in Montgomery also has a da Vinci system.

Various online reports put the cost of the da Vinci system between $1 million and $2 million. The cost to the patient varies: If a doctor deems a surgery is necessary, robotics is generally covered by most insurance plans, and the patient’s out-of-pocket expense would be the same. The cost to uninsured patients would differ.

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Distributed by MCT Information Services

Hit reset on cancer screening: ‘Tests not perfect’

Tue, 8 Nov 2011 00:00:00 EST

By LAURAN NEERGAARD AP Medical Writer

WASHINGTON–It turns out that catching cancer early isn’t always as important as believed.

Some tumors are too slow-growing to ever threaten your life. Some are so aggressive that finding them early doesn’t make much difference. And today’s treatments are much better for those somewhere in the middle.

Those complexities are changing the longtime mantra that cancer screening will save your life. In reality, it depends on the type of cancer, the test and who gets checked when.

“We can find cancer early. We can reduce the burden of the disease. But along the way, we’re learning our tests are not as perfect as we’d like,” says the American Cancer Society’s Dr. Len Lichtenfeld, a longtime screening proponent. “We’re learning that we’re now finding cancer that would in fact never cause harm.”

Now cancer specialists are struggling to find a new balance: to quit over-promising the power of early detection and to help people understand that the tests themselves have risks _ while not scaring away those who really need it.

Least controversial are cervical and colorectal cancer screenings. They can spot pre-cancerous growths that are fairly easy to remove, although even some of those tests can be used too frequently. More serious questions surround other cancers _ like which men, if any, should get a PSA blood test to check for prostate cancer, and whether women should start mammograms in their 40s or wait until they’re 50.

Also in question is whether doctors will be able to head off another looming controversy: Just which smokers and ex-smokers should get a pricey CT scan that can detect lung cancer but also is prone to false alarms? A recent study found the scans could save some lives. But guidelines aren’t due out until early next year that would decide who is at enough risk to outweigh the test’s potential harm _ such as a risky, invasive biopsy to tell if a suspicious spot is cancer or just an old smoking scar.

Today, guidelines for how to handle some of the most common cancer screenings conflict. And, they’re written for the average patient when many people may need a more customized decision, says Dr. Jeanne Mandelblatt of Georgetown University. She has studied breast cancer risk for a government panel that recommends most women not begin screening for the disease until age 50.

Consider this, she says: The average woman has a 3 percent lifetime risk of dying of breast cancer, a low risk for a disease that women find so scary. But the chances of getting breast cancer do gradually increase with age and other circumstances.

So if you’re 40 and have several risk factors _ like dense breasts and close relatives with the disease _ then you have the same risk as an average 50-year-old, not an average 40-year-old, and might consider earlier mammograms, Mandelblatt says. Few primary-care doctors have the time to go into that kind of detail.

Adding to the confusion are testimonials from cancer survivors that a screening saved their lives. Dartmouth researchers recently studied how often that’s true for mammograms, and estimated that about 13 percent of women in their 50s whose breast cancer is detected by the tests survive as a result.

What else plays a role? Treatments have dramatically improved in recent years, saving more lives. Also, increasingly powerful mammograms are detecting more low-risk tumors, the kind that probably wouldn’t have threatened a woman’s life in the first place.

Still, mammograms are “not perfect, but they’re the best we have,” cautions Mandelblatt. She thinks the Dartmouth estimate is somewhat low.

PSA tests for prostate cancer are a much tougher call. Last month, a government panel recommended an end to routine PSA screenings, a step further than other major medical groups that urge men to weigh the pros and cons and decide for themselves. But the U.S. Preventive Services Task Force found limited, if any, evidence that screening average men improves survival. That’s largely because so many men are diagnosed with slow-growing tumors that never would have killed them; still, they havetreatments that can cause incontinence, impotence or even lead to death.

“We really _ underline the word `really’ _ have to pull back the messaging on prostate cancer,” says the cancer society’s Lichtenfeld, who himself isn’t sure of the test’s net worth. PSA testing took off on the basis of “blind faith” that they would work, not science, he says.

What really worries Lichtenfeld is that ever more powerful cancer screenings are being developed, before doctors have a way to tell exactly which early tumors should be removed.

“We have cells in our body that are abnormal all the time, and our bodies deal with it,” he says. “Our technology takes us further and further down the early-detection path, and we need to sort through all this.”

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EDITOR’S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press.

MelaFind detects cancer ; New device uses light and photos to identify melanomas battle with cancer: new weapon developed

Mon, 7 Nov 2011 00:00:00 EST

By MATTHEW PERRONE

WASHINGTON – Dermatologists will soon get some high-tech helpdeciding which suspicious-looking moles should be removed andchecked for melanoma, the deadliest skin cancer.

The Food and Drug Administration on Wednesday approved a first-of-its-kind device, called MelaFind, that makes detailed, digitalimages of skin growths and uses a computer to analyze them for signsof cancer, offering a sort of second opinion to doctors. The deviceis approved only for dermatologists and only for use on growths thatdon’t have obvious signs of cancer but still have one or twoworrisome traits.

The hope is to find more melanomas sooner. Nearly all patientsdiagnosed with early-stage melanoma can be treated and cured, but 85percent of patients with late-stage melanoma die from it within fiveyears.

More than 70,000 people in the U.S. will be diagnosed withmelanoma this year, and 16 percent are diagnosed only after thedisease has spread to other parts of the body, according to theNational Institutes of Health.

To diagnose the disease, doctors decide which moles to remove andbiopsy using an entirely visual set of guidelines involving size,shape and color. Most dermatologists easily spot late-stage lesionsthat have obvious signs of cancer, including irregular edges, unevencolor and a width greater than 6 millimeters.

“Every day patients come in with 20 moles on their back and thedilemma is, which ones are suspicious and need to be biopsied?” saidDr. David Pariser, former president of the American Academy ofDermatology. “The diagnosis of melanoma is the most serious one adermatologist makes, and we have sleepless nights worrying aboutit,” said Pariser, who consulted for the device’s maker, MelaSciences Inc. of Irvington, N.Y., on its presentation to the FDA.

The device’s handheld attachment, about the size of a blow dryer,emits light that penetrates below the surface of the skin, takingmulticolored images that reflect the depth and shape of skingrowths. A computer compares these to a database of 10,000 archivedimages and recommends whether a biopsy should be done.

In a company-sponsored study published last year involving about1,300 patients, some with multiple growths, doctors reported thatMelaFind correctly suggested biopsies on 125 of 127 melanomas thatdoctors had removed. MelaFind correctly identified about 10 percentof non-cancerous growths, which was better than doctors in the studywho were correct less than 4 percent of the time, on average. Thestudy was published in the Archives of Dermatology.

The company’s study was not intended to show that screening withthe device saves lives, only that it can help improve a doctor’sability to spot melanoma.

For now, experts say MelaFind will help dermatologists makebetter decisions.

“There is no such thing as 100 percent certainty in medicine,”said Dr. George Elias, a melanoma expert at Georgetown’s LombardiComprehensive Cancer Center who had no ties to the company or thedevice. “Ultimately it’s the responsibility of the dermatologist touse his clinical judgment to make the best decision. This machine isthere to help him, not replace him.”

Elias voted with the majority of an FDA panel that narrowlyendorsed the device last year.

Dermatologists say it’s too early to tell whether MelaFind willlead to fewer unnecessary biopsies.

“A biopsy takes a few minutes in my hands, so if there’s an issuewith any lesion we will always biopsy, whether we have a MelaFindpicture or not,” said Dr. Leonard Goldberg, a dermatologist at theTexas Medical Center and vice president of the Skin CancerFoundation, a disease awareness group.

Originally published by MATTHEW PERRONE Associated Press.

Abstract

Mon, 31 Oct 2011 00:00:00 EST

This systematic review identified 57 studies of magnetic resonance imaging (MRI) under loading stress for musculoskeletal conditions, most commonly of the spine and the knee. Most studies had a cross-sectional or case–control design and reported on anatomical measurements rather than clinical outcomes. In 10 studies that included information on adverse effects, 5% to 15% of participants reported new-onset or worsening pain and neuropathy during MRI under loading stress. Overall, evidence is insufficient to support the clinical utility of MRI under loading stress for musculoskeletal conditions.