Archives: 7/2008

Medgadget rarely ventures into politics. However, after one of our editors contacted the American Medical Association (AMA) public relations department to check out how the AMA is doing, we were offered a chance to talk to senior leadership in the organization. We, of course, couldn’t have missed such an opportunity! The result is an interview with J. James Rohack, MD, a cardiologist from Bryan, Texas, in the Texas A&M Health Science Center College of Medicine, and recently announced president-elect of the American Medical Association. Dr. Rohack will assume the AMA presidency in about a year from now, in June 2009.
We’d like to note and to give credit to the AMA for not officiating this discussion, for not setting limits or requesting in advance the questions we were planning to ask.


Medgadget: Dr. Rohack, my name is Michael Ostrovsky. Welcome to Medgadget, I think everything is working very well now.
Dr. Rohack: Great, very good.
Medgadget: We really appreciate you giving us this opportunity to interview the president-elect of American Medical Association. It’s a great opportunity for us. Just to let you know about Medgadget. We are a physician edited blog, and we’ve been discussing the AMA a little bit among ourselves, and would like to ask a couple questions about the AMA and its future. First question would be.. Can you give us a little summary of the mission of the AMA at the present time, in these turbulent for physicians political times.
Dr. Rohack: From a historical perspective, as well as right now, our mission is to promote the art and science of medicine, and the betterment of public health. Our three major areas of focus, however, that we are trying to accomplish is to make sure that the 47 million Americans that are uninsured do now have health insurance. And it is through a process of changing the Federal tax code so that those that can’t afford health insurance can get tax credits to purchase their own health insurance. The second is to fundamentally reform the Medicare system. Medicare was created 40+ years ago, [it] is still siloed as far is its payments, it is still backwards as far as how the system works, in that it took almost 37 years to finally get a drug benefit, and we still see that Congress, having to go to Congress to say “We need to cover immunizations” is kinda backwards. And the third thing we’re focusing on is improving the quality and safety, and that’s through not only continuation of our involvement in standard setting for medical education, both at the medical school, the graduate medical education, and continuing education, but more importantly taking a look at tools that we can help physicians in their offices how care is being provided in different ways, to reduce the duplication that maybe out there that maybe unnecessary, that physicians may not have the tools to help them. So, clearly there are many other areas we’re involved with, but those are the top three.
Medgadget: Also, I’m sure you know that there is a lot of disagreement among doctors, some would even say discontent among doctors, with the AMA, with the organization itself. Do you feel this is a time when the AMA is having more difficulty reaching physicians with its message. Specifically, are you seeing any evidence of this discontent among physicians in your membership numbers?
Dr. Rohack: Well, certainly our historical process that we’ve had for getting feedback from physicians has been tied to our house of delegates that assembles twice a year with physicians representing every state and specialty. However, it’s also a recognition that the technology has changed. We’ve also looked at weblogs and other venues where physicians are being engaged for us to get an experience if that’s something we should be more involved with, to interact with our members. A few years ago we started to do what’s called ‘Member Connect surveys’, where we sent electronically to our membership individual questions, that they could respond to, to help shape our annual agenda that we put together. So I think that one of the things that the American Medical Association has done over the last decade is recognize that the historical past of how communication occurred with doctors… that is doctors coming to the AMA twice a year, the doctors then returning back to their community, and then those doctors being responsible for communication, has left the average AMA member, in fact has left the average doctor, completely unaware of what the AMA is doing. The other recognition that we have, our house of delegates which meets twice a year, is a very open, deliberative, democratic body. We don’t bar the press from those deliberations. And it is so democratic, that any individual can bring a resolution to that debate, so that any time the resolution that is introduced happens to be on social policy, where the country hasn’t come up with a consensus, unfortunately sometimes the press, that becomes the headlines, and it really distorts all the things the AMA does to help the actual practice and doctor in their every day life.

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Genesis™ DM telehealth device from Honeywell HomMed (Brookfield, WI), one of the winners of 2008 Medical Design Excellence Awards, aims to help people living with long term health conditions, such as COPD or chronic heart failure, to maintain and monitor their health. In addition, the device was designed to help patients keep track of medical appointments and other important events.
43254gen Telehealth at Home with Genesis DM

Web-based and content-rich, the new Genesis™ DM is the latest generation of the industry’s best-selling monitor. With over 40,000 monitors in service worldwide, we provide the most complete remote biometric and symptom evaluation available.
Genesis DM is seamlessly integrated into the innovative new Honeywell HomMed LifeStream™ telehealth platform, providing web-enabled, on-demand access to disease-specific symptom management (DSSM), customizable by diagnosis and symptoms.
This telehealth device measures heart rate, blood pressure, and weight, and provides customizable subjective disease-related queries for a more complete picture of an individual’s health. Automated set up and automatic patient engagement with a friendly voice and easy-to-use interface guide the patient at every step.

Product page: Honeywell HomMed Genesis™ DM remote patient care monitor…
This is a cross-post with Scienceroll….

green cancer dots Smart Bomb Nanoparticles Show Promise for Chemo Delivery
Researchers from the University of California at San Diego School of Medicine are reporting on their efforts to embed chemotherapy drugs within tumor targeting nanoparticles.
From the abstract in PNAS:

We designed an ανβ3-targeted nanoparticle (NP) encapsulating the cytotoxic drug doxorubicin (Dox) for targeted drug delivery to the ανβ3-expressing tumor vasculature. We observed real-time targeting of this NP to tumor vessels and noted selective apoptosis in regions of the ανβ3-expressing tumor vasculature. In clinically relevant pancreatic and renal cell orthotopic models of spontaneous metastasis, targeted delivery of Dox produced an antimetastatic effect. In fact, ανβ3-mediated delivery of this drug to the tumor vasculature resulted in a 15-fold increase in antimetastatic activity without producing drug-associated weight loss as observed with systemic administration of the free drug.

Press release: “Smart Bomb” Nanoparticle Strategy Impacts Metastasis…
Abstract in PNAS
More in WIRED

46234sarc Intramuscular Endoscopy Offers a Novel Look at Muscle MachineryAt Stanford University, a research group has developed a method, called fluorescence microendoscopy, to take a peek at what’s going on inside the muscles of living, breathing creatures, like mice and humans. The research may allow for greater understanding of how muscle tissue adapts to environmental strain and in response to disease. Furthermore, this technology one day might become a diagnostic modality.

This microendoscopy technique for viewing sarcomeres—microscopic lengths of muscle fiber about 3 millionths of a meter long—has advantages over the uncomfortable alternative, a muscle biopsy in which a portion of the muscle is removed for examination.
Sarcomeres are the basic contracting engines of muscle. They generally pull in a coordinated fashion, allowing us to walk down the sidewalk or throw a sinking curveball from the pitcher’s mound. But out-of-sync sarcomeres are implicated in muscular dystrophy and other diseases of diminished muscular control. It is thought that disease may change the length of sarcomeres and cause havoc with muscle control because the force exerted by muscle is critically dependent on length.
To observe sarcomeres in action, researchers from Stanford’s Bio-X program have devised a needle-thin probe, which is inserted through the skin into muscle. When a flash of finely tuned laser light is sent through the probe, the sarcomeres respond with light of their own to form a snapshot of muscle in action.
The researchers see the images in real time on a display screen. A change in the depth of focus of the rapidly scanning device can provide a three-dimensional movie.
"This is a method that does not require any operative procedures," said Mark Schnitzer, an assistant professor of biology and of applied physics. For the first time, "it allows us to view individual sarcomeres in live humans."
The breakthrough was reported online in the journal Nature on July 6.
The technology could prove useful in understanding how muscles are altered by spinal cord injuries or strokes as well as muscular diseases, according to another of the researchers, Scott Delp, a professor of bioengineering and of mechanical engineering and, by courtesy, of orthopedic surgery.
Other areas of interest include biomechanics, orthopedic reconstructions, prosthetic devices and tendon transfers, in which tension adjustments are a crucial element for patients relearning how to walk or grasp. "If you measure the length of the sarcomeres during surgery, then you can adjust them to work at their optimal length, giving maximum muscle strength," Delp said.

Press release: Stanford researchers take first look at working muscle fiber
Abstract in Nature: Minimally invasive high-speed imaging of sarcomere contractile dynamics in mice and humans doi:10.1038/nature07104

217 Allie on SW 500 cropped The Anti Crutch from Roll A BoutExperienced skiers and other daredevils that hate walking on crutches may be pleased to know about a four-wheeler from Roll-A-Bout, a Frederica, Delaware company. The SW-500, and its ATV cousin with wider tires, feature off-center handlebars that normalize the weight of the vehicle to the center of gravity of the user.
Features from the product page:

  • Fits Patients 5’0″ to 6’4″
  • Maximum Weight 500 lbs.
  • Off-Set Wheels and Handle Bar for Stability
  • 2-Piece Cushion for Maximum Comfort
  • Tools-Free Height and Side Adjustment
  • Weighs only 19 lbs
  • Dual Brakes; Parking Brake
  • Wire Basket
  • Product page: SW-500…
    (hat tip: OhGizmo!)

    jaambaaro Human Powered Ambulance for Third World Villages
    Yanko Design profiles a concept by Benoît Angibaud of an ambulance to be engineered for people living in poor remote areas. The vehicle would be both pedal and solar powered, and is essentially a stretcher on wheels. We can envision small villages having one of these to transport patients to a regional clinic. On a sunny day, of course.
    More from Yanko Design…

    greenlightimage Viruses Help Scientists to Track Tooth and Bone Mineralization
    At the National Institute of Standards and Technology scientists are using a technique called “phage display” to track the formation of hydroxyapatite, a calcium phosphate compound that makes up teeth and bones.

    Although they have somewhat different mechanical properties, the major structural component of both teeth and bones is a crystalline compound of calcium phosphate called hydroxyapatite. Subtle variations in the way the crystal forms account for the differences. Identifying and monitoring the formation of this particular crystal is of paramount importance to biomedical researchers working on a variety of problems including the remineralization of teeth to repair decay damage, the integration of prosthetic joints and tissue-engineered bone materials for joint and bone replacement, and cell-based therapies to regrow bone tissue.
    To date, however, there is no specific, practical method to spot the formation of hydroxyapatite in living systems or tissue samples. Materials scientists can identify the crystal structure with high reliability by the pattern it makes scattering X rays, but it’s a complex procedure, requires fairly pure samples and certainly can’t be used on living systems. There are some widely used chemical assays—the von Kossa assay, for example—but these also are destructive tests, and more importantly they really test simply for the presence of the elements calcium or phosphorus. They can’t distinguish, for example, between deposits of amorphous calcium phosphate—a precursor—and the hydroxyapatite crystal.
    To find a more specific, less destructive probe, the NIST team used a relatively new technique called “phage display” that can rapidly create and screen huge numbers of biomolecules for specific interactions. Phages are a primitive and ubiquitous class of viruses that infect bacteria. Some simple phages can be genetically modified to randomly assemble short sequences of amino acids—small proteins called peptides—on their outer shells as binding sites. An engineered population of phages will synthesize billions of random peptides. If these phages are exposed to the target surface—hydroxyapatite crystal in this case—and then washed off, those left behind are the ones that tend to stick. Cloning the survivors and repeating in several cycles with increasingly stringent conditions eventually isolates a handful of candidate peptides that can be further tested to measure their affinity for the target.
    As reported in a recent paper, the NIST team used the technique to identify a new peptide that relies both on the chemical composition and the crystal structure of hydroxyapatite to bind to the mineral’s surface. The peptide’s ability to “recognize” the specific structure of hydroxapatite, say the researchers, could be exploited as a nondestructive tag to monitor the progress of bone and tooth mineralization for diagnostic and therapeutic applications.

    Press release: Toothpick: New Molecular Tag IDs Bone and Tooth Minerals
    Image: Deposits of hydroxyapatite crystal (l.) and the same mineral in a cross section of a human tooth (r.) light up bright green where they’ve been tagged with a new peptide created at NIST to bond specifically to the compound. The peptide has been linked to a fluorescent stain for imaging. NIST

    3521w3 Infrared Device to Test IVF Embryo ViabilityYale scientists have been working on a new method to screen IVF embryos for viability.
    From the BBC:

    The ViaTestE device, developed by scientists from Yale, can score the metabolic activity of a sample of the fluid from around the embryo using spectrophotometry, which uses infrared light to measure the make-up of a substance.
    For example, it is used to tell if milk is full-fat or semi-skimmed.
    In this instance, the technology checks the activity of metabolites – the substances produced by the embryo.
    The team tested around 500 samples of embryo fluid, without knowing which had implanted successfully.
    The embryos had also been assessed in the clinics using the traditional method.
    That gave around a 40% rate of accurately identifying the embryos which developed into viable foetuses.
    But “fingerprinting” using the new test increased that rate to between 60% and 70%.
    From these and other results, the scientists believe using the test could improve pregnancy rates by between 10-15%.

    More at the BBC News
    Image credit: Wellcome images: Colour-enhanced scanning electron micrograph of a human embryo at day 5 sitting on the tip of a pin….

    intel monitor At Home Monitoring Solution from Intel
    Intel, a company known primarily as a microchip manufacturer, is aggressively positioning itself in the medical device market. The FDA just gave approval to market the company’s new device that assists with monitoring at-home patients.
    From the press release:

    The Intel Health Guide is a comprehensive solution, combining an in-home patient device, as well as an online interface allowing clinicians to monitor patients and remotely manage care. The solution offers interactive tools for personalized care management and integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as video conferencing and e-mail. The Health Guide can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales. The Health Guide stores and displays the collected information on a touch screen and sends to a secure host server, where health care professionals can review the information. Patients using the Health Guide can monitor their health status, communicate with care teams and learn about their medical conditions.

    Press release: Intel Receives FDA Market Clearance on In-Home Medical Device for Management of Health Conditions
    Intel Healthcare…