Healthcare's Future, There is an App for that

TED is a great site to learn from. As I write “Healthcare's Next Tsunami, the Tech Savvy Patient” this is one of my reference sites.

Today I came across this talk. Listen to it you will see what is coming down the road for both you and your children.

The talk can be found at

http://www.ted.com/talks/lang/en/daniel_kraft_medicine_s_future.html

and is about 15 minutes long


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How about a computer chip delivering your medication?

Microchip Implant Gives Medication On Command: Scientific American
scientificamerican.com


Chipping away at drug delivery: With a tiny implanted chip, filled with individual doses of medication, a patient might soon be able to forget all about daily shots—and perhaps even pills. Image: MicroCHIPS, Inc., Massachusetts

For people who face frequent needle jabs to treat chronic conditions, a new technology is on the horizon that might make treatment a lot less painful.

Researchers report that a new wirelessly controlled microchip, implanted under the skin, can safely and reliably give osteoporosis patients the daily dose of a drug that they need for at least 20 days in a row. The findings were presented at the American Association for the Advancement of Science annual meeting in Vancouver and published online Thursday in Science Translational Medicine.

Some 55,000 people in the U.S. with osteoporosis face daily injections of a bone-boosting hormone (known as human parathyroid hormone fragment, which is the basis for the drug teriparatide, sold as Forteo). But during a two-year daily regimen of the shots, close to three quarters of osteoporosis patients fail to take the drug as often as they are supposed to. High noncompliance makes this condition an especially compelling target for an automatic drug-dosing system.

“In a silent disease like osteoporosis, [patients] don’t feel any difference, and they just give up the injections all together,” says Robert Farra, co-author of the study and chief operating officer at MicroCHIPS, the company that makes the chip. Doctors can either preprogram the new device for a release schedule or send release instructions directly to it via a dedicated radio frequency.

For the study, eight postmenopausal women with osteoporosis had the chip—which is about three by five centimeters and can be implanted during an office visit—inserted under the skin around their bellies for about three and a half months. Daily doses of teriparatide were preprogrammed to release for about 20 days during the middle of the trial. Seven of the eight received most of their doses right on schedule, and each of these said they would opt in for another chip—most reported that they had forgotten that it was there.

Microchips like these could also be used for other conditions that demand discrete drug dosing, such as multiple sclerosis, for which some patients must inject a dose of interferon once every two days. Therapies that use hormones are particularly appealing for adaptation to microchip delivery because the body usually releases hormones intermittently—just as the chip does, Farra says. In the future, a device like this might also be able to help diabetics both monitor and treat their condition.

This sort of direct communication in an implanted device could help patients stick to medication regimes without having to face a syringe or pill bottle.

Remote controlled
The device can be preprogrammed or controlled wirelessly via the Medical Implant Communication Services (MICS) band, set aside for the U.S. Food and Drug Administration (FDA) by the Federal Communications Commission. And the device can also report back dose-delivery data to a computer-based system.

Scientists demonstrated that this sort of wirelessly controlled drug delivery might be possible in 1999. Some major technological hurdles needed to be cleared in the interim, Farra says.

The first challenge was figuring out how to create seals on the drug-holding wells that would stand up to moisture inside the body. Researchers solved this by using compression welding to create a hermetic seal around the well’s metallic membrane. The second hurdle was figuring out how best to open those tight seals. The scientists settled on an electrical current that would melt the membrane on command. The final hurdle involved scaling things down—getting all the components and wells onto a chip that would fit comfortably under the skin.


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A new diagnostic test for lung cancer, just breath out

Cancer Breath Test with 83% accuracy Enters Clinical Trials and next generation system is 100 times more sensitive
nextbigfuture.com

Metabolomx, has developed technology enabling the identification of lung cancer from breath. Using the first generation of our breath analysis system, the Cleveland Clinic announced the results of a 237 subject trial at the American College of Chest Physicians conference in November 2010, reporting 81%, accuracy of lung cancer detection, comparable to CT scan, the present gold standard. This study, further reported that lung cancer subtype (small cell, adenocarcinoma, and squamous cell) is identified by the breath exam. The Cleveland Clinic has now commenced testing of the current generation Metabolomx sensor, over 100 times more sensitive than the version used in the study



Human breath contains hundreds of volatile organic compounds (VOCs) produced both endogenously and from external environmental sources. To detect the few metabolite biomarkers of disease in the background of hundreds of other VOCs a breath analysis system must be highly dimensional, able to distinguish the signature pattern of diverse VOC biomarkers in a diverse chemical background. The metabolite biomarkers are often important at very low part per billion (ppb) concentrations. Therefore it is critical the breath analysis system sensor be very sensitive, able to detect diverse VOC biomarkers often in low single digit ppb concentration. The Metabolomx sensor has the high dimensionality and sensitivity to capture the chemical signature pattern of the complex mixture of VOC’s present in breath.

Technology Review - Metabolomx, a startup in Mountain View, California, recently completed a clinical trial that shows that its breath test can spot lung cancer with 83 percent accuracy and can also distinguish between several different types of the disease, something that usually requires a biopsy. The accuracy of the test matches what's possible with low-dose computerized tomography imaging of the lungs.
Colorimetric sensor array

At the core of the Metabolomx breath analysis system is a novel, proprietary colorimetric sensor array (CSA). The CSA is a matrix of colored chemical indicators of diverse reactivities embedded in a nanoporous sol-gel matrix. Each indicator has distinct chemical reactivity with volatile species and changes color differently upon exposure to analytes. The resulting pattern of color changes comprises a high-dimensional chemical signature pattern. The image below demonstrates the patterns produced by 10 distinct bacteria, all 10 of which were identified accurately (98.8%) in 50 blind trials. Note that even different strains of the same species cause distinct patterns.

The sensor is constructed on a simple plastic or paper like media. The sensor is inexpensive and disposable. The cost and performance easily match the requirements for a one time use medical exam. The CSA exam card used in the Metabolomx breath analysis instrument is printed on a plastic substrate, contained in a tube, through which breath can be passed. The exam card is disposable, one is used with each patient exam.
If you liked this article, please give it a quick review on ycombinator or StumbleUpon. Thanks Posted by bw at 2/15/2012 Labels: cancer, future, medicine, science, sensors Cancer Breath Test with 83% accuracy Enters Clinical Trials and next generation system is 100 times more sensitive Metabolomx, has developed technology enabling the identification of lung cancer from breath. Using the first generation of our breath analysis system, the Cleveland Clinic announced the results of a 237 subject trial at the American College of Chest Physicians conference in November 2010, reporting 81%, accuracy of lung cancer detection, comparable to CT scan, the present gold standard. This study, further reported that lung cancer subtype (small cell, adenocarcinoma, and squamous cell) is identified by the breath exam. The Cleveland Clinic has now commenced testing of the current generation Metabolomx sensor, over 100 times more sensitive than the version used in the study



Human breath contains hundreds of volatile organic compounds (VOCs) produced both endogenously and from external environmental sources. To detect the few metabolite biomarkers of disease in the background of hundreds of other VOCs a breath analysis system must be highly dimensional, able to distinguish the signature pattern of diverse VOC biomarkers in a diverse chemical background. The metabolite biomarkers are often important at very low part per billion (ppb) concentrations. Therefore it is critical the breath analysis system sensor be very sensitive, able to detect diverse VOC biomarkers often in low single digit ppb concentration. The Metabolomx sensor has the high dimensionality and sensitivity to capture the chemical signature pattern of the complex mixture of VOC’s present in breath.

Technology Review - Metabolomx, a startup in Mountain View, California, recently completed a clinical trial that shows that its breath test can spot lung cancer with 83 percent accuracy and can also distinguish between several different types of the disease, something that usually requires a biopsy. The accuracy of the test matches what's possible with low-dose computerized tomography imaging of the lungs.
Colorimetric sensor array

At the core of the Metabolomx breath analysis system is a novel, proprietary colorimetric sensor array (CSA). The CSA is a matrix of colored chemical indicators of diverse reactivities embedded in a nanoporous sol-gel matrix. Each indicator has distinct chemical reactivity with volatile species and changes color differently upon exposure to analytes. The resulting pattern of color changes comprises a high-dimensional chemical signature pattern. The image below demonstrates the patterns produced by 10 distinct bacteria, all 10 of which were identified accurately (98.8%) in 50 blind trials. Note that even different strains of the same species cause distinct patterns.

The sensor is constructed on a simple plastic or paper like media. The sensor is inexpensive and disposable. The cost and performance easily match the requirements for a one time use medical exam. The CSA exam card used in the Metabolomx breath analysis instrument is printed on a plastic substrate, contained in a tube, through which breath can be passed. The exam card is disposable, one is used with each patient exam.


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You are the holy grail of healthcare

Patient engagement is the holy grail of health care
kevinmd.com

For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.

But doesn’t engagement depend upon your perspective?

In a earlier life I spent a lot of time looking at health behavior. Among the many things I learned were the following:

We all define health within the context of our own lives and in our own way
We all are satisfied with different levels of health
Admittedly there are patterns of health behavior or archetypes which can be used to segment health populations. One such archetype is characterized as 1) placing a high priority on achieving a high level of personal health, 2) being very proactive in terms of achieving and maintaining their above average health, and 3) having a moderate to high distrust of the medical professionals.

Not surprisingly, people who shared this pattern of health-related thinking demonstrated lower levels of physician visits, fewer hospital and ER visits, lower health care costs. They were also the healthiest when compared to all other patterns of health thinking and behavior. Because of their trust issues with their providers, these patients were “mavericks” doing their own thing when it came to staying healthy. In other words they were not very compliant and would be considered unengaged from the perspective of health care professionals as defined above.

People can be engaged in their own health and never see a doctor, visit a hospital, or take a prescription medication.

If you were to tell these independently healthy folks that they were “not engaged” in their own health they would likely scoff and say “what do you expect … the health care industry doesn’t take the time to understand the patient’s perspective.” In truth, aren’t people like this doing a better job than the health industry when it comes to “engagement” and staying healthy?

The point is that we as health care professionals need to start looking at things like the definition of health, health goals, compliance, and outcomes from the patient’s perspective. We need to incorporate the patient’s perspective into outcome and satisfaction measures. Only then do we have the right to “judge” whether a person (aka patient) is engaged, activated, or empowered. Once the health industry gets past this paternalistic, “we know better than you do” attitude then we can expect to see real change in health behavior and outcomes.


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A Cancer Drug Shows Promise in Treatment of Alzheimer's

Cancer Drug Shows Promise for Alzheimer's - WSJ.com
online.wsj.com


By GAUTAM NAIK

A cancer drug quickly and dramatically improved brain function and social ability and restored the sense of smell in mice bred with a form of Alzheimer’s disease, suggesting a new way to tackle the illness in people.

Alzheimer’s is associated with the accumulation of protein fragments called amyloid-beta in the brain. The new research found that an existing skin-cancer drug called bexarotene cleared the protein in the brains of stricken mice within days. The study was published Thursday in the journal Science.

A skin-cancer drug has shown some success in treating Alzheimer’s disease in mice, according to a study in Science. Stefanie Ilgenfritz has details on The News Hub.

Because bexarotene is known to be safe for treating skin cancer, “it might be worth trying in Alzheimer’s patients as well,” said Rada Koldamova, a neuroscientist who works on Alzheimer’s at the University of Pittsburgh and wasn’t involved in the study. However, she added, the drug’s effectiveness against the brain malady would first have to be established in human trials. Test results in mice often don’t pan out in humans.

Everyone’s brain produces amyloid-beta protein, but while a healthy brain can efficiently remove the protein fragments, the brain of a person with Alzheimer’s can’t. The resulting buildup is believed to result in impaired learning and memory functions.

The disease is a growing problem, especially in aging societies, but no effective treatment has been found. The drugs used today work just for a short time and only relieve symptoms, instead of halting the disease. Over the years, drugs in about a half-dozen late-stage human trials have failed to make the cut.

In 2010, Eli Lilly & Co. abandoned a treatment that blocked an enzyme linked to amyloid formation after the drug appeared to worsen some patients’ condition. Another technique, currently being tested in patients, is to reduce protein formation by triggering an immune response.

The new research, funded by a number of foundations, takes a completely different approach, said Gary Landreth, a neuroscientist at Case Western Reserve University in Cleveland and a co-author of the study. His team’s method, he said, is to “help Mother Nature do what she normally does” in clearing amyloid fragments from the brain.

Scientists know that a protein called ApoE acts as a sort of garbage-disposal unit, helping to degrade amyloid-beta proteins. Dr. Landreth figured that if he could get the brain to make more ApoE, the protein clearance would be enhanced.

He set his sights on bexarotene, an orally administered drug known to activate a protein that helps switch on the ApoE gene. In 2009, Dr. Landreth asked a newly minted postgraduate student in his lab to give the drug to some “Alzheimer mice.” Three days later, the amyloid plaques in their brains had largely disappeared.

“It was unprecedented,” Dr. Landreth recalled. “I initially thought she had screwed up.”

In the Science report, Dr. Landreth and his colleagues describe similar tests done with over 100 mice. When the drug was fed to mice with Alzheimer-like symptoms, it quickly improved their cognitive, social and olfactory functions. Losing the sense of smell, a disorienting and often debilitating experience, can be one of the first signs of Alzheimer’s in humans.

Healthy mice typically will gather tissue paper strewn around their cage and use it to make a nest. Alzheimer mice stop doing that. When the drug was given to diseased mice they made nests, a sign of cognitive improvement. The benefits lasted up to three months, at which stage the scientists stopped their observations because that was sufficient time to show the drug’s effects weren’t transitory.

It is widely believed that the memory problems seen in the affected mice and human Alzheimer patients are caused by small soluble forms of amyloid beta. The researchers found that within a mere six hours of getting the drug, soluble amyloid levels had dropped by 25%. This effect lasted for three days.

In the U.S., bexarotene is sold under the name Targretin, which is owned and marketed by Japan’s Eisai Co. Patents on the drug—and hence its profitability—will start to expire this year, one reason drug companies may be reluctant to jump on bexarotene as a possible Alzheimer’s treatment.

Dr. Landreth and a study co-author, Paige Cramer, are founding scientists of ReXceptor Inc., which has licensing options from Case Western to use bexarotene to treat Alzheimer’s disease.

Bexarotene is a long way from being an approved Alzheimer’s drug, or even being deemed ready for off-label use—when a doctor legally prescribes a drug for an unapproved use. As a first step, Dr. Landreth plans to start a safety trial in a dozen patients in the next few weeks.

He needs to figure out the right dose and duration of the treatment for prospective Alzheimer’s patients, and judge the effects over several months. If all goes well, he hopes to engineer a version of the medicine that is more potent and works at a lower dose, to minimize any side effects.

Carl Wagner, an organic chemist at Arizona State University who is collaborating with Dr. Landreth on the project, said he had synthesized half a dozen such versions and was testing them.

Write to Gautam Naik at gautam.naik@wsj.com


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Gene therapy appears to improve vision on the virtually blind

Sight Seen: Gene Therapy Restores Vision in Both Eyes: Scientific American
scientificamerican.com

Gene therapy has markedly improved vision in both eyes in three women who were born virtually blind. The patients can now avoid obstacles even in dim light, read large print and recognize people’s faces. The operation, researchers predict, should work even better in children and adolescents blinded by the same condition.

The advance, reported in the February 8 issue of Science Translational Medicine, extends earlier work by the same group. Between 2008 and 2011, Jean Bennett of the University of Pennsylvania’s Mahoney Institute of Neurological Sciences and her colleagues used gene therapy to treat blindness in 12 adults and children with Leber’s congenital amaurosis (LCA), a rare inherited eye disease that destroys vision by killing photoreceptors—light-sensitive cells in the retina at the back of the eye. Typically, afflicted children start life with poor vision, which worsens as more and more photoreceptors die. The treatment grew out of the understanding that people with the disorder become blind because of genetic mutations in retinal cells. One mutated gene that causes the disorder is named RPE65. An enzyme encoded by RPE65 helps break down a derivative of vitamin A called retinol into a substance that photoreceptors need to detect light and send signals to the brain. Mutant forms of RPE65 prevent the production of this enzyme in a “nursery” layer of cells called the retinal pigment epithelium, which is attached to the retina and nourishes photoreceptors by breaking down retinol, among other cellular services.

In the initial study, retina specialist and Bennett’s co-author Albert Maguire of Penn Medicine injected a harmless virus carrying normal copies of RPE65 into an area of the retinal pigment epithelium, which subsequently began producing the enzyme. In each of the 12 patients, Maguire treated one eye—the one with worse vision. Six patients improved so much they no longer met the criteria for legal blindness. In the new study, Maguire injected the functional genes into the previously untreated eye in three of the women from the first group. Bennett followed the patients for six months after their surgeries. The women’s vision in their previously untreated eye improved as soon as two weeks after the operation: They could navigate an obstacle course, even in dim light, avoiding objects that had tripped them up before, as well as recognize people’s faces and read large signs. Bennett showed that not only were the women’s eyes much more sensitive to light, their brains were much more responsive to optical input as well. Functional magnetic imaging showed regions of their visual cortices that had remained offline before gene therapy began to light up.

Surprisingly, Bennett reports, the second round of gene therapy further strengthened the brain’s response to the initially treated eye as well as the newly treated one. “That wasn’t something we had been expecting, but it makes sense because the two eyes act in concert, and some aspects of vision rely on binocularity.” In the new paper, the authors suggest that neuroplasticity plays a role: It is possible that regions of the visual cortex responding to the newly flowing channel of information from the second eye bolster activity in areas of the visual cortex responding to the initially treated eye.

An institutional review board required that Bennett work with adults in the follow-up study, but she thinks the therapy will work even better in younger patients who have not lost as many photoreceptors. She says the results “really bode well” for restoring meaningful vision to people with LCA and other forms of inherited blindness.


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A look into the future

Check this out

http://mashable.com/2012/02/03/day-of-glass/


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