October 24, 2013
We have a drug problem.
Only this time we need drugs, specifically antibiotics. The problem is that more germs are becoming resistant to the antibiotics doctors have been using for a long time, resulting in “superbugs” from which even the National Institutes of Health couldn’t protect itself.
One reason, as the Centers for Disease Control (CDC) warned yet again in a report last month, is that doctors continue to be overzealous in prescribing antibiotics. Case in point: A new study at Brigham and Women’s Hospital in Boston found that doctors prescribed antibiotics in 60 percent of the cases where people came in complaining of sore throats—this despite the fact that only 10 percent of those patients had strep throat, the only sore throat antibiotics can cure.
On top of that, Big Agriculture aggressively uses antibiotics both to keep healthy animals from getting sick and to help them grow faster. And while all this excessive use of antibiotics is making them less and less effective, the pharmaceutical industry has dramatically scaled back research into new infection-fighting drugs because it’s not a very profitable line of business.
Some public health experts fear that unless scientists are able to develop new antibiotics soon, we could regress into pre-penicillin days, when everyday infections killed people. Even the CDC, which points out that more than 23,000 people in America die from infections caused by resistant bacteria every year, says we could be facing “potentially catastrophic consequences.”
Turning drugs off
There’s the conventional strategy to dealing with the threat—earlier this year the U.S. Department of Health and Human Services committed to pay the pharmaceutical firm GlaxoSmithKline as much as $200 million over the next five years to try to develop new antibiotics.
But more innovative approaches are also taking shape. Consider the research of a team of scientists in the Netherlands. They’re focusing on a way to deactivate antibiotics after they’ve been used, so that they no longer accumulate in the environment, which is what spurs the development of resistant superbugs. They’ve determined that if the molecules in antibiotics can be made to change their shape, they become ineffective. And the researchers have found they can use heat or light to do just that. In short, they’re developing ways to turn off antibiotics before they break bad.
Or take the researchers at McMaster University in Ontario who argue that the typical practice of growing bacteria in a nutrient-rich lab environment doesn’t really reflect what happens when we get an infection. Our bodies can be far less hospitable than that, forcing bacteria to grow their own nutrients. The researchers did an exhaustive search of 30,000 chemical compounds, with the goal of identifying some that block the ability of bacteria to create nutrients. They honed in on three. But they feel pretty good about those three. Now the trick is to see if they can be turned into effective antibiotics.
As one scientist put it, the McMaster researchers went “fishing in a new pond.” With luck, that might be what it takes.
Here’s more recent research on the battle against bacteria:
- That inner glow: It’s not unusual for bacteria to attach themselves to medical implants, such as bone screws, and develop into serious infections before anyone notices. A team of researchers in the Netherlands, however, may have developed an early warning system. By injecting fluorescent dye into an antibiotic, they were able to see where bacteria was growing. The process could lead to a far less invasive way to check for infections with surgery involving implants.
- Thinking small: Scientists at Oregon State are taking yet another approach to attacking bacteria—they’ve narrowed their targeting down to the gene level. That’s seen as a much more precise way to battle infections, one that’s less likely to cause collateral damage. Said lead researcher Bruce Geller: “Molecular medicine is the way of the future.”
- Say no to drugs: At Duke University, scientists say they’ve developed a blood test that can identify viral infections in people with serious respiratory problems. The test, they say, could significantly reduce the overuse of antibiotics. Since it can be hard to distinguish between viral sore throats, such as those that come with a cold, and bacterial infections, such as strep throat, a lot of doctors still prescribe antibiotics that end up not doing any good. The blood test could take the guessing—and pointless antibiotics—out of the treatment.
- Now will you eat your yogurt?: It figures that one way to fight the bad side effects of some antibiotics would be by loading up on probiotics. Research published earlier this year found that probiotic supplements reduced the risk of antibiotic-related diarrhea by 64 percent.
- All this and super lice, too?: Public health officials in the U.S. have told doctors to be on the lookout for a new strain of “super lice” that have become immune to shampoos and medications containing antibiotics.
- Then again, they are termites: According to scientists at the University of Florida, the reason termites are so disease-resistant is that they use their own feces in building their nests. That promotes the growth of bacteria, which stifles pathogens. The researchers said that their findings could eventually result in new antibiotics for humans, but it might be better if they spare us the details.
Video bonus: Here’s another take on the superbug threat.
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October 11, 2013
It’s hard to imagine that technology could be a friend to Obamacare, given the dismal performance of its official website last week. But it turns out that the high-speed crunching of a huge amount of information—aka Big Data—could ensure that one of the principle tenets of health care reform, known as “accountable care,” can become more than a catchy phrase in a policy paper.
U.S. hospitals have begun shifting their way of doing business. It’s long been the case that the payments hospitals received from Medicare largely were based on the tests their doctors ordered and the procedures they performed. So, strangely enough, the sicker a hospital’s patients were, the more money it tended to receive. But the Affordable Care Act is designed to change that, instead providing incentives that reward positive results. And, that seems to be prompting hospitals to move from focusing solely on treating sick people to helping patients take better care of themselves in the outside world. They want their ex-patients to stay ex-patients.
It’s crunch time
Case in point is Mount Sinai Hospital in New York. Not long ago it hired a 30-year-old named Jeff Hammerbacher to try to work wonders with the hospital’s new supercomputer. His previous job was as Facebook’s first data scientist, so you know he knows how much wisdom can be gleaned from mountains of information—if you have computers powerful and fast enough to make sense of it.
So far, the hospital has developed a computer model that crunches all the data it has on past patients—from why they were admitted to how many times they’ve been there to everything that happened during their stays—and from that, it’s able to predict which ones are most likely to return. But instead of just waiting for those patients to come back, Mount Sinai, like more and more hospitals, is turning proactive, reaching out to those frequent patients with follow-up calls to make sure they get to their doctor appointments or avoid the bad habits that end up sending them to the hospital. In one pilot program, Mount Sinai was able to cut re-admissions in half. If you don’t think that hospitals can put a serious dent in health care costs by slashing the number of repeat patients, keep in mind that nationwide, 1 percent of patients accounted for nearly 22 percent of health spending in 2009.
Methodist Health System in Dallas is going down a parallel track. It’s been analyzing patient data from 14,000 patients and 6,000 employees to identify people who are most likely to need expensive health care in the future, and it’s reaching out to help them take preventative measures before they develop costly ailments.
Here are a few other recent findings that have come from hospitals crunching Big Data:
- A health care provider in Southern California using data on the behavior of staff doctors found that one physician was using a certain antibiotic much more often than the rest of the staff—potentially increasing the risk of drug-resistant bacteria.
- At Memorial Care Health System in California, hospital management has begun tracking how doctors there perform on such things as immunizations, mammograms and blood glucose control in diabetic patients. That and other doctor data helped reduce the average patient stay from 4.2 days in 2011 to four days in 2012.
- Use of full-time nurses, rather than contract or temporary ones, coincided with higher patient satisfaction scores, according to Baylor Health Care System.
- Researchers in Ontario are working with IBM on a system to detect subtle changes in the condition of premature babies that could tip off the onset of infection 24 hours before symptoms appear.
- In another case, data analysis was able to determine which doctors were costing the most money by ordering procedures and other treatments. Hospital administrators reviewed the results with the costly doctors and suggested ways they could cut back on duplicate tests and unnecessary procedures.
Ultimately, hospitals hope to get to the point where, based on analysis of all the data of every patient who’s ever walked through their doors, they’ll have a very good idea of the risk facing each new patient who arrives.
To your health
Here’s a smattering of other recent research on hospital treatment:
- With luck, you’ll forget about the ICU: Researchers at Vanderbilt University found that 75 percent of people who spend time in a hospital’s intensive care unit suffer some level of cognitive decline. In some cases, according to the study, they can experience Alzheimer’s-like symptoms for a year or longer after leaving the hospital.
- Still need a reason to stay out of hospitals?: According to a recent report in the Journal of the American Medical Association, treatment of infections people develop in a hospital adds $9.8 billion to America’s health care costs every year. The Centers for Disease Control has estimated that one out of every 20 patients gets an infection while in the hospital. About a third of the cost comes from infections following surgery—they add an average of $20,785 to a patient’s medical bills.
- Here’s another: A study published in the recent issue of the Journal of Patient Safety estimates that as many as 210,000 to 440,000 patients each year who go to the hospital suffer some type of preventable harm that ultimately contributes to their death. If that’s the case, it would make medical errors the third-leading cause of death in America, behind heart disease and cancer.
- Must be the food: After crunching results from 4,655 hospitals, a health care economist from Thomas Jefferson University Hospital in Philadelphia found that the best hospitals, in terms of medical results, generally don’t receive the highest satisfaction rankings from patients. Instead, the top hospitals, which often are bigger and busier, tend to get only lukewarm ratings from people who spend time in them.
- But they found no link between moon cycles and back hair: Believe it or not, researchers at Rhode Island Hospital contend that their analysis showed that cardiac surgery, specifically aortic dissection, is less likely to result in death if performed in the waning of a full moon. They also said that patients who had the surgery during a full moon tended to stay in the hospital for shorter lengths of time.
Video bonus: Here’s another way Big Data is being used to predict human behavior, in this case, what we’re likely to do when we enter a store.
Video bonus bonus: And, in advance of Halloween, a little macabre hospital humor.
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July 26, 2013
I’m sure there are people who enjoy working out. I just don’t know many of them.
So, no doubt, the people I do know would be thrilled to hear that scientists at the Scripps Research Institute in Florida have made progress in developing a pill that mimics the effects of exercise. Get this: Mice injected with a particular chemical compound lost weight, lowered their cholesterol and expended more energy. And not only did all this occur while they were on a high-fat diet, they also actually were lazier and less active than they had been before they received any injections.
Sounds like magic in a bottle.
Alas, there are caveats. No one, for instance, knows how the human body would react to the compound or what risks it might bring. And the researchers themselves aren’t certain that it’s possible to create any pill that can come close to replicating all of the complex effects and benefits of true physical exercise.
Back to the grind.
The problem is that the fitness business has never been one to crackle with innovation. You can switch the soundtrack or pump up the volume or change the instructor’s outfit, but in the end, there are only so many ways you can run and step and spin.
Still, wearable sensors like the Nike+ Fuelband or Jawbone UP, are starting to make the gathering of data as much a part of exercise as sweating without shame. And now that interplay of workouts and stats-tracking is being taken to another level in a different kind of fitness center, one that its backers want to become the Apple store of health clubs.
That’s some ambition, particularly since pretty much the only equipment inside these clubs will be a line of skinny little walls. Each wall, called a Fitwall, is seven feet tall and has four stationary rungs that serve as footholds and four hand grips. It’s designed for what’s known as “vertical training”–which means you can do all kinds of exercises while you’re hanging from the wall–a “perfect pullup,” for instance, or something named the “cowboy squat.”
Still, this does not a fitness revolution make, right?
Okay, but then you add the data layer. Before he or she gets get on a wall to begin the group workout, each person straps a wearable Bluetooth monitor over their chest. This transmits data throughout the session to an iPad connected to the top of each Fitwall. And that allows each “athlete”–that’s what you’re called here, rather than member–to see how he’s doing compared to past workouts or how he stacks up against people on the walls nearby. To add a gaming element, the data is calibrated, or graded on a curve, so that a white-haired guy can compete with a 22-year-old workout warrior on the next wall.
Bring on the coconut water
But wait, there’s more. The goal is to create an experience unique enough that Fitwall will come to mean more than the thing you hang on. So there’s no front desk with a zesty greeter; each person instead checks in on an iPad, where his or her data is stored. And, apparently, no club will have more than 16 Fitwalls, meaning that counting instructors, there should never be more than a dozen and a half people in the club at one time. When each 40-minute workout is over, the trainers go over everyone’s results, then the session is wrapped with a celebratory shot of coconut water and chilled towels–scented with mint and lavender– all around.
You might say this is not for everyone and you’d be right. It’s no accident that the first Fitwall opened earlier this summer in relentlessly chic La Jolla, California, with more to follow soon in the LA area. Next year, Fitwall plans to tackle Manhattan.
But even if less trendy markets don’t embrace the full Fitwall experience, the company does seem to be on to something, with its infusion of real-time data and body-to-body competition into workout routines. At the very least, it’s something different.
Says Josh Weinstein, one of the Fitwall’s main investors:
“There are so many products out there in the fitness industry that I would call ‘me too’ products. It’s yoga–but with heat. It’s spinning–but the music is louder. There’s so little innovation in the industry and that frustrates us, not just as entrepreneurs, but also people who have a passion for working out.”
Or you can hold out for the pill.
Here’s more recent news on the fitness front:
- Or about long enough to chow down an order of fries: According to researchers at the Norwegian University of Science and Technology, four-minute bursts of intense physical activity three times a week is enough for a person to stay fit. A total of 12 minutes of vigorous exercising, they said, was enough to elevate oxygen intake levels, plus lower blood pressure and glucose levels.
- Burn, baby, burn: Japanese scientists have developed a pocket-sized sensor that can tell you if your body is really burning away fat. After a person breathes into the device, it provides a reading of acetone levels in your blood. Acetone is produced when fat is broken down.
- Unless, of course, the thought of exercise gives you stress: And there’s more evidence that physical activity reduces stress. Scientists at Princeton University found that exercise reorganizes the brain so that its response to stress is reduced and anxiety is less likely to interfere with normal brain function. When mice allowed to exercise regularly experienced a stressor — in this case, exposure to cold water — their brains showed a spike in the activity of neurons that shut off excitement in the hippocampus, a region of the brain that regulates anxiety.
- It’s always something: So much for resveratrol, the antioxidant found in red wine, being a magical compound that can help fight aging. Oh, it may still be able to do that, but a new study at the University of Copenhagen has found that for older men, resveratrol can undercut how much good exercise is doing hem.
- Drinking sweat–the final frontier: Well, it’s about time. Swedish scientists have invented a machine that turns sweat into good old water you can drink. The device spins and heats sweaty clothes to remove the moisture, then runs it through a filter that allows only water molecules to pass. While the researchers pointed out that their liquid was cleaner than the local tap water, they also acknowledged that people don’t really sweat all that much.
Video bonus: Get a little taste of Fitwall frenzy. I apologize in advance for the music.
Video bonus bonus: For old time’s sake, take a look at a mash-up of what some people still think was the last big fitness innovation.
More from Smithsonian.com
May 30, 2013
For all the misconceptions–both positive and negative–about what’s now known fondly and acridly as Obamacare, one thing that is clear is its focus on shifting the U.S. health care system from one in which doctors and hospitals are rewarded for ordering tests and procedures to one built more around preventive care and keeping people healthy.
As is often the case, technology is racing ahead of policy, finding ingenious ways to use little sensors or Big Data to devise early warning systems for health trouble. In fact, it’s fomenting medicine that’s not just preventive, it’s predictive.
Follow the behavior trail
One of the more innovative approaches is a mobile app called Ginger.io, from a company of the same name. It’s based on the idea that changes in a person’s behavior–perhaps something as seemingly mundane as a lull in making phone calls–may tip off the start of a spin into bad health or depression.
That may seem a bit of a leap, but research has found that people with chronic medical conditions, such as pain or diabetes or mental illness, tend to withdraw if their health deteriorates. They stop reaching out to friends and family, don’t go out as much, and lose interest in taking care of themselves. Often, that’s when they quit taking their meds.
So the app tracks how frequently someone uses his or her phone, how often they move and if they do go out, where they go. If it notices a change in patterns, particularly too much isolation and too little activity, it sends an alert to a designated person. It might be a doctor, it might be a family member.
Ginger.io has been described as a human “Check Engine” light in that it’s designed to flag potential trouble before a person breaks down. One of the app’s advantages is that it keeps a precise record of what a person has been doing or not doing, rather than depending on the often unreliable or skewed memories of patients.
A number of U.S. hospitals are now testing it with patients who have opted into the alert system, but it’s still not clear how effective it can be. There’s no way to tell, for instance, if a person’s been inactive because he’s depressed or just has a bad cold. Will doctors and nurses end up wasting time and money on waves of false alarms?
There’s also the question of whether patients, even though they’ve chosen to use the alerts, will start to feel they’ve given up too much privacy. For now, though, they seem to like the access the app provides to caregivers. They feel like doctors and nurses are actually keeping an eye on them.
The doctor will text you now
At the same time, patients are more in control of their personal health data than they’ve ever been. Increasingly, it’s in their smartphones, not locked away in a doctor’s office or a lab somewhere. And that, predicts Dr.Eric Topol, is going to forever change the role of doctors. They’ll still advise and treat patients, of course, but less as an authority figure and more as a collaborator, says Topol, the chief academic officer of Scripps Health and author of “The Creative Destruction of Medicine.”
As he told Forbes in an interview earlier this year:
“We are ending the era of medical information asymmetry, with most of the information in the doctor’s domain. The consumer is now center stage–he or she will drive this new medicine with a rebooted model of physician partnership. It is the consumer’s data, the consumer’s smartphone, and the consumer’s choice of who, when and how to share.”
Topol is equally evangelisitic about predictive medicine, although his focus is on early warning systems based on biology rather than behavior. He’s convinced that it won’t be long before scientists will be able to send tiny sensors into our bloodstreams that will be able to detect the first molecular signal of a heart attack or the development of the first cancer cell.
And yes, your smartphone will be the first to know.
Thoroughly modern medicine
Here are other recent health tech innovations:
- Tracking ticking brains: The Defense Department is doing a trial with a company named Cogito Health using software that tries to measure whether a soldier may be developing PTSD by identifying if he or she is withdrawing or becoming more manic.
- Stop making sense: Recently purchased by United Healthcare, a Boston firm called Humedica crunches the Big Data of patients’ electronic records so hospitals can get a much clearer idea of how often different treatments actually help people get better.
- So quit blaming the cat: An app named Asthmapolis uses a sensor attached to an inhaler that tracks where a person is and potentially what triggers are around when they have an asthma attack. And it saves that info on the smartphone.
Video bonus: Dr. Eric Topol went on “The Colbert Report” not long ago and actually managed to get in a few words about the future of medicine. He also examined Stephen Colbert’s inner ear. It’s not pretty.
More from Smithsonian.com
April 15, 2013
Last fall, shoppers outside a Macy’s store in Boston were given a chance to test drive a robot. They were invited, compliments of Brigham and Women’s Hospital, to sit at a console and move the machine’s arm the same way surgeons would in an operating room.
And why not? What says cutting-edge medicine more than robotic surgery? Who wouldn’t be impressed with a hospital where robot arms, with all their precision, replace surgeons’ hands?
The surgeons, of course, control the robots on computers where everything is magnified in 3D, but the actual cutting is done by machines. And that means smaller incisions, fewer complications and faster recoveries.
But earlier this year, the Food and Drug Administration (FDA) began surveying doctors who use the operating room robots known as the da Vinci Surgical System. The investigation was sparked by a jump in incidents involving da Vinci robots, up to 500 in 2012.
The California company that makes the da Vinci, Intuitive Surgical, says the spike has to do with a change in how incidents are reported, as opposed to problems with its robots. It’s also true that robot surgery is being done a lot more frequently–almost 370,000 procedures were done in the U.S. last year, which is three and a half times as many as in 2008.
And the procedures are getting more complicated. At first, the robots were used primarily for prostate surgeries, then for hysterectomies. Now they’re removing gall bladders, repairing heart valves, shrinking stomachs during weight loss surgery, even handling organ transplants.
Not surprisingly, FDA survey has stirred up a swirl of questions about machine medicine. Have hospitals, in their need to justify the expense of a $1.5 million robot, ratcheted up their use unnecessarily? Has Intuitive Surgical placed enough emphasis on doctors getting supervised training on the machines? And how much training is enough?
It’s not an uncommon scenario for technological innovation. A new product gets marketed aggressively to companies–in this case hospitals–and they respond enthusiastically, at least in part because they don’t want to miss out on the next big thing.
But is newer always better? A study published recently in The Journal of the American Medical Association, compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomies at 441 different hospitals between 2007 and 2010. Neither method is invasive.
But the researchers found no overall difference in complication rates between the two methods, and no difference in the rates of blood transfusion. The only big difference between the two is the cost–the robotic surgery costs one-third more than laparoscopic surgery.
Then there’s the matter of loosening training standards. When the FDA allowed the da Vinci system to be sold back in 2000, it was under a process called “premarket notification.” By claiming that new devices are similar to others already on the market, manufacturers can be exempted from rigorous trials and tough requirements. In this case, Intuitive Surgical was not formally required to offer training programs for surgeons.
The company did tell the FDA that it planned to require a 70-item exam and a three-day training session for doctors. But, as a recent New York Times article noted, Intuitive changed its policy just two years later. Instead it required surgeons to pass a 10-question online quiz and spend only a day in hands-on training.
So ultimately it’s up to the hospitals to set training standards. But in their rush to embrace the future, they can be tempted to avoid being too demanding. In one 2008 case that has resulted in a lawsuit against Intuitive, a patient suffered serious complications, including impotence and incontinence, while having his prostate gland removed. The surgeon, it turned out, had never done robotic surgery without supervision before.
A researcher at Johns Hopkins Hospital, Dr. Martin Makary, who has previously criticized hospitals for overhyping robotic surgery on their websites, has another study coming out soon that suggests that the problems involving da Vinci robots are underreported. “The rapid adoption of robotic surgery,” he contends, “has been done, by and large, without the proper evaluation.”
Dr. David Samadi, Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York, has a different way of looking at robotic surgery: “A good driver in a Lamborghini is going to win NASCAR. But someone’s who not a a good driver in a Lamborghini…he’s going to flip the car and maybe kill himself.”
Here are some other ways robots are being used in hospitals:
- Down go the mean old germs: Doctors at Johns Hopkins Hospital in Baltimore have turned to robots to take on the superbugs that have become such a threat of spreading dangerous infections among patients. After a hospital room is sealed, the robots spend the next half hour spraying a mist of hydrogen peroxide over every surface. Other hospitals are taking a a different approach in dealing with nasty bacteria–they’re using robots that zap germs with beams of ultraviolet light.
- And you’ll be able to see your face in the scalpel: GE is developing a robot that will keep the tools of the operating room sterile and organized. Instead of relying on humans doing this by hand–clearly not the most efficient process–the robot, by recognizing unique coding on each piece of equipment, will be able to sort scalpels from clamps from scissors, sterilize them and then deliver everything to the operating room.
- Bedside manner, without the bedside part: Earlier this year the FDA approved a medical robot called RP-VITA, which was developed by iRobot and InTouch Health. The machine moves around the hospital to rooms of patients identified by the doctor. Once in a room, it connects the doctor to the patient or hospital staff through the robot’s video screen.
- The buddy system: Researchers at Columbia University found that the pain ratings of hospitalized children dropped significantly when they interacted with “therapeutic robot companions.”
Video bonus: When da Vinci is good, it’s very, very good. Here’s a video of a surgeon using one to peel a grape.
Video bonus bonus: Okay, admittedly this has nothing to do with robotic surgery, but it’s the hottest robot video on the Web right now–an impressive, yet somewhat creepy demo of Boston Dynamics’ “Petman” in camo gear.
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