Medicine as a Public Good – Cardiology goes Online

 

From 6minutes.com.au:

A virtual teaching hospital has been set up in South Australia to help rural doctors keep up to date and have access to cardiologist advice.  

Cardiologist Dr Phil Tideman has been working on the project for the last eight years to create a Centre for Excellence in rural cardiovascular care at Naracoorte Hospital.  

The result is the Integrated Cardiovascular Clinical Network (iCCnet SA), which now serves all 66 rural hospitals and is funded by the SA state government.  

Dr Phil Tideman said the network was created in response to alarming levels of cardiac deaths in rural areas.  

“With the wide ranging demands on country practitioners, you couldn’t expect them to automatically acquire the necessary knowledge and skills in what has been a rapidly changing field over the last two decades,” Dr Tideman says.  

“Increasing the knowledge base in rural hospitals, providing the necessary clinical tools and giving doctors and nurses immediate access to cardiologists was the obvious solution.”    

Part of the system is an internet-based database that gives rural medical staff online access to cardiologists 24 hours a day, 7 days a week.

Local hospital staff can use the secure online system to share ECGs (electrocardiograms) and other vital patient data in ‘real time’ with other members of the health care team, particularly the on-call cardiologist, regardless of where they may be located.

EHR Plays Key Role in Personalized Medicine Study

From http://health-care-it.advanceweb.com

Through the study of genetic links between patients and chronic diseases, researchers at Geisinger Health System in Danville, Pa., are hoping to gain a better understanding of how to prevent, diagnose and treat these diseases.

A new program at Geisinger called MyCode is capitalizing on the health system’s unique ability to utilize its integrated infrastructure to link genomic information with an advanced electronic health record (EHR) system and fast-growing biobank. The result is a tool that is the bridge to Geisinger’s personalized medicine program — an initiative that promises to ultimately re-engineer the paradigm of health care from reactive to predictive and, with the help of researchers and physicians, engage patients in their personal health and wellness.

Geisinger patients learn about MyCode at Geisinger Medical Group sites, and about 90 percent choose to participate. With written consent, participants agree to provide a deoxyribonucleic acid (DNA) sample — chemical material that is inherited and extracted from a blood sample — at their next scheduled blood draw. From there, the sample is linked with EHR information and routed to the system’s biobank for quick researcher access.

Since launching the MyCode pilot program two years ago, researchers have collected 20,000 DNA samples. Samples generally fall into two groups: those from patients seeking general health and wellness care from their family physicians and those from patients seeking specialty medical care, such as bariatric surgery.

These samples are helping Geisinger researchers gain critical insight into patients’ risk of chronic health conditions, such as abdominal aortic aneurysms, severe asthma, depression, obesity, familial ureterocoele, digoxin/phenytoin toxicity, overactive bladder syndrome and various pain conditions.

“This information will ultimately improve health by motivating people to make positive lifestyle changes, such as exercising, eating healthy, quitting smoking as well as decisions to seek further medical evaluation and preventive strategies,” said Geisinger Center for Health Research Director Walter “Buzz” Stewart, PhD, MPH.

A number of safeguards protect the privacy of participants’ genetic and EHR information. Confidentiality and subject anonymity are strictly maintained by de-identifying the samples. Samples are assigned specific identification numbers, encoded, encrypted and entered into a secure database. A governance board — with Geisinger and non-Geisinger representation — meets several times a year to audit the process.

“The goal of MyCode is to translate genetic data into specific knowledge about a disease that is clinically relevant and will enhance patient care,” said Glenn Gerhard, MD, staff scientist and director of Geisinger’s Genomics Core.

“MyCode aims to discover genes that increase a person’s risk of chronic disease and help us understand why people respond differently to treatments,” explained Weis Center for Research Director David Carey, PhD. “The more we know about the causes of disease, the greater our ability to provide more effective treatment and, ultimately, prevent disease from occurring.”

According to Dr. Carey, by matching genes with a comprehensive profile of a specific chronic condition, researchers are able to study groups of patients with similar signs and symptoms, and begin to predict and understand how they will respond to a specific treatment or medication.

“This project provides the opportunity to move genetics from the laboratory directly to patient care,” explained Dr. Stewart. “MyCode is driving research that promises to improve the health and health care of patients nationwide.”

Healthcare needs innovative Processes, not innovative Products

There’s a new innovation program at Kellogs Center of Biotechnology Management (Bnet Article). And it is just the kind of program someone should have thought of decades ago. It also reminded me of what I believe is a misguided innovation mindset we foster in the business of health.

From the program director Alicia Loffler:

We started the course last year. The idea is to have an experiential class that gives students opportunities to lead and innovate — and most importantly, fail. We place the students in teams of eight: two students from Kellogg, two students from the law school, two who are fourth-year medical students, and two from engineering. We let the teams shadow doctors from the medical school in order to come up with ideas. The law students help write the intellectual property, and the engineering students lead the development of prototypes…we give each team about $20,000 to develop their prototype. They develop a business plan around the product that can be sent to our corporate partners and potential investors. What I think is interesting is that the IP belongs to the students, not to Northwestern, so whatever innovation they come up with belongs to them. Last year, for example, we had 11 teams and most of them are still working on their innovations. Three or four have started real companies…one is licensing their innovation to a medical device company. This year, we have eight items and all have already incorporated and are writing provisional patents.

BNET: You have a work called “Rethinking the Biotechnology Model.” What’s the main thing the industry needs to rethink?

Loffer: There are many reasons why this area needs to be re-thought, and the financial crisis is giving us a further wake-up call. One of the major issues here is that this industry has been very fragmented. In the past, we have built our business around the product innovation. In the U.S. our competitive edge has been based on that: we have the best universities that produce the best innovations. Now we have innovations coming from Israel, Sweden, India, China, etc. The model where VCs throw a lot of money to push innovations through the clinical trials will just not work anymore; we need to be more efficient. It’s such a crazy system of clinical trials here, and it’s extremely expensive. What needs to be done is to rethink the process from end to end and to innovate throughout this whole supply chain rather than just on the product side. What is mainly needed is process innovation, not product innovation.

I’ve highlighted this last line because it points to reality that both governments and the private sector seem to miss. Biotechnology, pharma and related companies spin out new products each year, all of which are massively expensive, but which offer only marginal benefits over previous treatments. The greatest burden, and barrier, to improved health is in fact the proper use and speedy implementation of available products.

Some experts say that as much as half of the $2.3 trillion spent in the US does nothing to improve health. Each year, for example, the United States spends $450 billion treating heart and artery disease. Much of this is spent on expensive maintenance drugs, ongoing tests and procedures such as stents. Is an equivalent amount being spent on the underlying problems such as smoking, diabetes, high cholesterol and high blood pressure?

Pick virtually any chronic disease, and you will find disease modifying treatments. We can nip most illnesses that burden our society in the bud – but we don’t do it, because we aren’t efficient or well enough managed.

This is not to say we don’t need constant innovation in pharmaceuticals and devices – that’s what I do for a living! But it should not be our primary focus. Changing the ‘system’ is where most of our efforts should go.

Said in another way, new health care technologies generally do cost more than older ones; however, the only way to keep costs down is to spend on innovations that ultimately reduce spending and/or increase the productivity of a patient.  Some health care costs can be reduced in relatively simple
ways that do not have to do with improving device or drug design, by slowing the development of conditions that would require devices.

A high-performance 21st-century health system must revolve around the central goal of paying for results. That will entail managing chronic illnesses better, adopting electronic medical records, coordinating care, researching what treatments work best, realigning financial incentives to reward success, encouraging prevention strategies and, most daunting but perhaps most important, saying no to expensive, unproven therapies.

So onward to a new healthcare system!

Study: One out of five patient visits ‘difficult’

From FierceHealthcare:

Over the last 30 years, physicians have consistently reported that at least one out of every five or six patient visits was “difficult.” A recent study published in the Archives of Internal Medicine only underscores that conclusion.

To conduct the study, researchers surveyed 449 general internists and family practitioners at 118 U.S. clinics, asking them to estimate how often they had contact with patients exhibiting any of eight behaviors considered to be the most difficult. Those behaviors include insisting on unnecessary tests or medications, dishing out verbal abuse or disrespect, having unrealistic expectations for care and persistent complaining despite a physician’s having done everything possible to assist that patient.

The researchers found that primary care doctors who said that they dealt with a large number of difficult patient encounters were typically younger and more likely to be female. The most frequently-seen difficult behavior reported was patients insisting on being prescribed an unnecessary drug, a problem cited by more than one-third of responding physicians.

Scientists Mine Drugs Database for New Diabetes Treatment

From: http://www.biocompare.com/News/NewsStory/263918/NewsStory.html

Scientists have harnessed a new drug discovery tool to identify a new player in the body’s insulin secretion process. This finding could spark a completely new class of drugs to treat type 2 diabetes.

In work published today (22 February) in Nature Chemical Biology researchers at the University of Oxford explain how they have exploited new technology to create a cheap and efficient method of drug discovery that will allow small academic labs to search a large database of drugs to find treatments for diabetes and many other diseases. They have used this new method to identify a small molecule which they are using to understand how insulin is secreted in response to increases in blood sugar.

Lead researcher Dr Grant Churchill said: “A lot of diseases are caused by problems with important proteins within cells. We need to find small molecules that change the function of these proteins both to discover how they work and in addition because these small molecules may also work as treatments for disease. The approach we have developed allows us to do this much more quickly and cheaply than many of the current methods. Ultimately this will speed up the process of getting better treatments into the clinic for patients.”

Starting with a natural chemical and systematically modifying its chemical structure is a proven technique and common drugs such as beta-blockers and anti-histamines were discovered this way. However, these discoveries involved lengthy chemical syntheses starting with the natural chemical (adrenalin and histamine respectively).

“Our method also begins with the natural chemical but rather than modifying it with a time-consuming and expensive chemical syntheses conducted by a team of chemists, ours uses computers to identify corresponding small molecules for research and medicine. The major difference is that we have linked the computational methods commonly used by pharmaceutical companies to a freely available database of 5 million existing compounds – the ZINC database. This means we cut out a hugely time consuming and financially intensive part of the process, which is difficult for small academic labs to do,” Churchill said.

The team has tested their method by successfully identifying a small molecule called Ned-19. This molecule was found after information about the natural chemical NAADP was entered into the computer system and cross referenced with the ZINC database. In collaboration with scientists at the University of Southampton, led by A.Ganesan, Ned-19 was prepared on a larger scale and separated. Further experiments were carried out with these compounds to confirm the activity of Ned-19. Using Ned-19 in experiments they have discovered that NAADP plays a crucial role in insulin secretion and therefore represents a brand new target for diabetes drugs.

The Next Class of Blockbuster Drugs?

The power of antibodies is well established. but their cost is often prohibitive in a world of already stretched health budgets.

The solution to this conundrum may have appeared. Mini or nano-antibodies from llama, camels, shark and other animals have been the subjected of much research for some years.

These animals, including the camelid family,  produce functional antibodies devoid of light chains of which the single N-terminal domain is fully capable of antigen binding. These single-domain antibody fragments (Nanobodies) have several advantages for biotechnological applications. They are well expressed in microorganisms and have a high stability and solubility. They might be administered orally, solving another of the great problems with ordinary antibodies which require regular injection.

 

These nano-antibodies look particular interesting for the treatment of cancer, inflammatory conditions and blood disorders. Clinical trials of several compounds are already underway.

Are doctors influenced by advertising?

A study published in the Internal Medicine Journal has been cited as evidence that doctors are influenced by drug advertising.

It shows a correlation between prescribing behaviour and and the launch of various advertising campaigns. It should come as no real surprise. Who would have thought that pharmaceutical companies would bother spending money if they saw no impact from their advertising?

Welcome back!

Welcome to the renewed Australian Health Analyst blog – now the Future Health Analyst.

How to help Patients make Wiser Health Choices

From Yahoo News:

There’s no single right answer for everyone yet patients often are ill-equipped to weigh increasingly complex medical options. Now there’s a small but growing movement to get unbiased reports of the pros and cons of different tests and treatments into patients’ hands before they fall back on, “Doc, just tell me what you’d choose.”

“No matter how hard I tried” to be objective, “inevitably my personal biases got involved,” recalls breast surgeon Dr. Dale Collins of New Hampshire’s Dartmouth-Hitchcock Medical Center, which helped pioneer the concept that it calls shared decision-making.

Think of it as “informed consent 2.0,” going a step beyond the brief patient education that doctors are required to provide.

Read more about these new tools for decision making.

Websites for the Connected Doctor

A continuing medical education website has been launched that provides free virtual access to educational conferences and meetings. Medical Update contains video and power point slides from events from around the country. The site has been live since October, and currently includes presentations from local and international clinicians covering a variety of topics including eating disorders, cardiology and ophthalmology. 

A Facebook-style website has also launched for Australian doctors. Multimedix is designed for both professional and social use. On the site you can search  for friends, colleagues and contacts; discuss cases, ask clinical questions in a secure forum-like setting; and form special interest groups.