Molecular Imaging: SNM’s Image of the Year

2005_image_of_the_year_1Following yesterday’s imaging theme, a 3D image (at left, click to enlarge) that fuses 3D molecular and nuclear imaging was named the 2005 Image of the Year at the
Society of Nuclear Medicine’s 52nd Annual Meeting in Toronto last month. According to SNM:

The 2005 Image of the Year is "an exquisite structural
image," notes Henry N. Wagner Jr., SNM past president and historian and
professor of environmental health sciences at Johns Hopkins University The orange area indicates the uptake of F-18 FDG in a
primary cancer lesion and a mediastinal lymph node. The image is
provided by the Molecular Imaging Program at Stanford (MIPS), Stanford
University Division of Nuclear Medicine, Quon A and Gambhir SS.

Molecular imaging is a hot topic we’ll be covering at the Health IC Summit in January. It’s the medical incarnation of augmented reality, the use of overlays to give more information about the world we see, coverging x-ray, infographics, position information, video and virtual reality to give us superhuman vision.

(Thanks to Medgadget.)

CT Update: Higher Res, Higher Speed, Stunning Pictures

SomatomvascularCompared to old-fashioned monochrome x-rays, the latest Computed Tomography (CT) scanners combine innovations in digital imaging with high performance 3D and 4D volumetric computing to give diagnosticians a stunningly detailed look at our innards. Siemens Somatom Sensation 64 with z-Sharp technology, for example, delivers higher resolution 64-slice images at faster speeds by splitting the scan beam, speeding up the scan rate and exploiting high speed dual processor computer hardware to handle the stream. The resulting image (at left, click to enlarge), assembled from slices of digitized data, offers a colorized 3D view of the patient’s internal layout. Cardiac applications add the fourth dimension of time to show heart beats on the doctor’s workstation.

Siemens posts videos of doctors from various specialties demonstrating their use of volumetric data in practice. Today, CT systems are very expensive, complicated and touchy, but chip-driven, software-intensive digital imaging always gets cheaper and better over time.

CLEAR! Do-It-Yourself Defibrillator

DefibThe next time you make a run down to the local Staples for photocopy paper, floppy disks and that giant 24-pack of cookies, remember to pick up a defibrillator for those pesky occurrences of sudden cardiac
arrest (SCA). Staples offers the over-the-counter Philips HeartStart Home Defibrillator for $1,499.00, a little pricey but they include a helpful training video.

Philips points out that "it takes an average of nine minutes for emergency professionals
to reach a victim in a typical community, and today, fewer than five
percent of SCA victims survive. Nearly 80 percent of cardiac arrests
occur in the home."

According to the Staples web catalog, the HeartStart unit:

  • Comes with a convenient Quick Start Reference Guide and has interactive voice prompts that guide you.
  • Analyzes the patient’s underlying heart rhythm to determine whether or not to advise a shock, only treats shockable heart rhythm
  • Comes with a 4-year battery and performs daily self-tests, if the device detects a problem, it chirps loudly to alert you

De-skilling is a major feature of a disruptive innovation. A calm interactive voice, friendly user interface and some intelligence that stops you from zapping a healthy heart give consumers in the office and at home a lifesaving tool thta used to be reserved for trained professionals.

Continue Reading →

Dychtwald on “The Consequences of Human Life Extension”

One of the most disruptive consequences of disruptive healthcare innovation is increased longevity, the extension of the human life span to 100 or more years. We’re thinking about dedicating the third day of the Health IC Summit in January to the impact and opportunities of Life Extension. I’ve been spending a lot of time this month trying to separate the real applications from the wide-eyed fanaticisms. One of the best things I’ve heard is a 2 hour seminar by Ken Dychtwald, the pioneering author of Age Wave and other studies of the aging of America and the world.

LongnowSponsored last December by the brilliant Long Now Foundation that thinks in terms of the next 10,000 years, The Consequences of Human Life Extension is a brilliant and wide-ranging discourse on the social, political and commercial implications of longer life. Dychtwald is a great speaker, a platinum performer on the corporate conference circuit, and in this talk he riffs on big questions about the quality, purpose, cost and intergenerational equity of longer life. One of his key points ponders the prevalence of Alzheimers Disease:

The dementia rate among the 85-and-over population in the world right now is 47% … So now, we come up with a breakthrough so that nobody has heart disease. Fabulous. Except you’re going to create 20 million demented people.

Start listening after the un-miked Q&A warmup, about 13 minutes after the introduction by host Stewart Brand. Long Now posts both Ogg Vorbis Format and conventional MP3 Format. 

Operating Room E-Commerce: Live O.R. TV

BrwkneeopDemos always sell. For doctors, patients and prospective patients, slp3D broadcasts live television over the Internet from real operating rooms, complete with the play-by-play, color commentary and computer graphics …  just like a ball game.

The screen shot at left is from the Brigham and Women’s Hospital’s Minimally Invasive Knee Replacement Surgery show that was broadcast on May 20, 2005 starring Doctors Thomas Thornhill and Wolfgang Fitz. (Click "VIEW WEBCAST" from the operation web page to see a recording of the show. The operating room sequence starts at about 12:30 into the program.)  No doubt it’s a very useful way to disseminate information to doctors and staff. Viewers can email questions during the procedures, and medical professionals get Continuing Medical Education (CME) credits from the Harvard Medical School.

The program is also a pitch for surgery. The web page has links to "Make and Appointment" or "Refer a Patient" and includes some sell-copy about the hospital. Slip3D highlights the ROI for hospitals broadcasting surgeries:

  1. An average of 10-20 surgical cases booked within 3 weeks of a live event
  2. As much as 8-fold increases in patient volume for targeted service lines
  3. Up to $900K in gross revenue for Client Hospitals
  4. Registered Professional audiences averaging between 1,500 and 2,200 for CME and clinical forums
  5. Audiences from all 50 states as well as South/Central America, Asia Pacific and Europe
  6. As much as a 70% improvement in client website performance
  7. As many as 58% of Client website visitors staying 30 minutes-plus

In a competitive medical environment, an 8-fold increase in patient volume and almost $1 million in gross revenue are good things for a hospital. For someone who needs important surgery, being able to watch a typical procedure live and hear an informed description can de-mystify a scary medical event. And for doctors around the world, viewing the best practices of leading U.S. hospitals disseminates information they might not be able to get otherwise.

Healthcare Consumerism: Unleashing the Shopping Monster

OverlakecklistInside many of us lurks the unquenchable urge to shop, the hunger for a better deal. January white sales, cents-off coupons, buy-one-get-one-free, discount cards, cash-back deals: businesses know that consumers will walk a mile to pinch a penny.

Increasingly, that irresistible force is being unleashed on healthcare decisions. Web browsers visit sites like WebMD, Dr. Koop and the Digital Hospital and show up at their doctor’s office with printouts of the conditions they think they have and the remedies they think they need. The visionary Overlake Medical Center in Washington State publishes a Healthcare Consumerism Checklist (at left) with information about patient rights, health records policies and on-line quacks. Direct-to-consumer advertising pitches Cialis and Celebrex and Viagra with million-dollar prime time TV commercials.  And the U.S. Department of Health and Human Services even runs a HospitalCare analysis web site that compares key acute care indicies just like Yahoo! Shopping compares refrigerators.

The irresistible shopping monster could become a disruptive force on healthcare costs in the U.S. In a 2002 ruling, the Internal Revenue Service opened the way for Consumer-Directed Health Plans (CDHDs), one of the hottest new products in the world of employee benefits. In combination with a conventional health plan with a high deductible, consumers (and, often employers) contribute to tax-free health reimbursement accounts (HRA). The HRAs are used for normal medical expenses, but the money not spent on healthcare this year can be rolled over into following years, creating a growing asset protected from the tax man.

Traditional HMOs control costs by chiseling down invoices and denying payments to doctors through complex bureaucracies that nobody understands. Healthcare consumerism combines the need to stay healthy with the urge to save money and the desire to be in control. It may not be for everybody, but shopping has some real therapeutic possibilities.

NBIC Amok: In Vitro-Cultured Meat Production

This isn’t a healthcare issue, but it is an example of how the things we’re learning about life at the nano and bio scales have a way of changing our basic assumptions — and maybe creep us out a bit.

TissueeIn the current issue of Tissue Engineering, a team of scientists discusses culturing animal muscle cells in bulk for human consumption in an article titled In Vitro-Cultured Meat Production [PDF]. After considering embryonic stem cells (although from cows, pigs and chickens, not humans — I hope), the authors posit that "the most practical cell source for cultured meat is probably embryonic myoblasts or postnatal/posthatch skeletal muscle cells called satellite cells."

According to team member Jason Matheny, a University of Maryland doctoral student quoted in a UMD press release about the idea:

There would be a lot of benefits from cultured meat. For one thing,
you could control the nutrients. For example, most meats are high in
the fatty acid Omega 6, which can cause high cholesterol and other
health problems. With in vitro meat, you could replace that with Omega
3, which is a healthy fat.

Cultured meat could also reduce the pollution that results from
raising livestock, and you wouldn’t need the drugs that are used on
animals raised for meat.

PigartExcited about the prospect, Matheny and other scientists have even started a non-profit called New Harvest to develop the idea.

Nobody has ever tasted cultured meat, but Australian scientist/artists Oron Catts and Ionat Zurr have grown tissues like the layer of bone tissue differentiated from pig’s bone marrow stem cells pictured at right (click to enlarge) for an art project called Growing Semi-Living Sculptures: The Tissue Culture & Art Project. [PDF]

First Trial of Adult Stem Cells to Treat Heart Attack Patients

With $50 million raised in a new funding round, Osiris Therapeutics, Inc. has begun
a Phase 1 clinical trial of  Provacel, a new therapeutic
based on adult mesenchymal stem cells (MSCs) found in bone marrow.
Provacel
is a formulation of MSCs shown in preclinical trials to repair damaged tissue. It is given to patients through a standard IV line, and the delivered cells, responding to the body’s own signals, migrate to the area of
injury.

“We are extremely enthusiastic
about this study which represents the first use of an allogeneic adult stem cell
to treat the consequences of heart attack in humans,” said lead investigator Dr. Joshua Hare, Director of
Heart Failure and Cardiac Transplantation and the Cardiobiology Section of the
Institute for Cell Engineering at Johns Hopkins University School of
Medicine.

“We are investigating an exciting new approach to address
the unmet needs of cardiac patients,” said Dr. Nabil Dib, Chief of
Cardiovascular Research at the Arizona Heart Institute, another investigator in
the trial.  “According to the American Heart Association, about two thirds of
heart attack patients never completely recover. This is due to the fact that
heart cells can’t repair themselves, so we have to try innovative ways to treat
the damage that occurs at the time of heart attack. If the research conducted to
date is any indication, mesenchymal stem cells may be the answer.”

The stem cells
produced by Osiris are obtained from adult volunteer donors, not embryos, so there’s no controversy about their use. Cells are grown in culture to very high
numbers, allowing a single donor’s cells to treat hundreds of patients. These
cells are universal in that they can be used in patients unrelated to the donor,
without rejection, eliminating the need for donor matching and immune
suppression. Once transplanted, the cells promote healing of damaged or diseased
tissues.

Osiris’s goal is to use adult stem cells to improve
outcomes in bone marrow recipients being treated for leukemia, to promote
cardiac repair following a heart attack or congestive heart failure, and to
prevent arthritis. Osiris recently became the first company to receive Fast Track
designation from FDA for a similar stem cell product, Prochymal, for the
treatment of graft versus host disease in cancer patients.

For more about the the company and its money-raising, see "The other stem cells" by Diedtra Henderson in last month’s Boston Globe.

(Osiris’s web site at www.OsirisTX.com is not compatible with most web browsers. Use Microsoft’s Internet Explorer Version 6.0 to see the layout and graphics.)

Suitcase-sized Portable Brings Hemodialysis Home

Dialysis1Late last month, NxStage Medical received expanded Section 510(k) clearance from the U.S. FDA to market its System One portable daily
hemodialysis device
for home use. At 15" x 15" x 18" and about 70 pounds, the NxStage device is the smallest hemodialysis system available. Its graphic user interface, single-use filter cartridge and pre-mixed dialysate  simplifies dialysis for assisted self-care at home or on the road using standard power and water inputs.

Compare a standard four-hour session three times per week at a busy remote dialysis center with the new system’s two-hour daily at-home use. See an AP story published on CNN.com that describes the benefits to patients and the reaction of physicians. 

LASIK’s Unfair Advantage?

Tigercover_1Slate’s William Saletan recently asked the question "If steroids are cheating, why isn’t LASIK?"  Performance-enhancing drugs are generally viewed as unsportsmanlike, and last Spring’s Congressional inflammation on baseball’s use of steroids was notable for its posturing and zero-tolerance attitudes. But Saletan reports on athletes like Tiger Woods who get laser eye surgery that gives them better than 20/20 vision; Woods ended up with 20/15, meaning he can see at a distance of 20 feet what someone with normal vision sees at 16 feet, an obvious advantage on the course. Saletan notes that after LASIK, Tiger "won seven of his next 10 events."

Testimonials and videos on the LASIK.com web site describe how pro athletes improved their scores and standings once they were LASIK-enhanced, and the pitch to amateur athletes to be just like their heroes is explicit. Like Direct-to-Consumer pharma marketing, like Medical Tourism, like Viagra et al., innovations in marketing and medicine keep ratcheting up consumer expectations of health and well-being.