My Impressions of the Star Trek Movie

Star Trek was a great movie! It had some unpredictable moments and if you're a fan of the original TV series, then I think you'll see that these young people did a great job portraying the original television characters. I don't want to say much more in case you haven't seen the new movie. My wife and I were definitely entertained and would recommend it to anyone who is a Star Trek fan. How can you go to MIT and not love Star Trek?

Double Hand Transplant!

Wow, the University of Pittsburgh is keeping busy these days! CNN has an exciting story about a pastry chef who received a double hand transplant. Can you do that? Apparently you can. Advances in surgical technology and microsurgery techniques have made this possible. Jeff Kepner is 57 and he went through a nine hour surgery that was led by Dr. W. P. Andrew Lee, chief of the division of plastic surgery and professor of surgery and orthopedic surgery at the University of Pittsburgh Medical Center (UPMC). This was the first double hand transplant to take place in the United States. What other transplants will we be seeing in the future?

Star Trek and Medicine

I realize this is off-topic, but I admit that I'm a Star Trek fan. In fact, almost everyone I met at MIT was a Star Trek fan. I never learned how to speak Klingon, but I've got the dictionary and a pass to the Klingon Language Institute. I'm excited to go and see this new Star Trek movie. The critics have given it good reviews and I'm sure the special effects will be impressive. I'm also curious to see what types of medical gadgets they show on the movie (if any). Those of you who've watched Star Trek know that some very interesting medical technology concepts appear - ranging from needless drug delivery, body scanners, bone-healing devices, wound-healing gizmos, holographic doctors, and much more. It's always fascinated me to read about medical innovations in the science fiction literature. Are you a SciFi fan? Maybe I'll see you in the movie theaters.

Health IT Policy Committee Appoints 3

The United States Department of Health and Human Services (HHS) has appointed three people to the Health Information Technology Policy Committee:

1. David Blumenthal, MD, MPP; head of the Office of the National Coordinator for Health Information Technology
   
2. Michael J. Klag, MD, dean of Johns Hopkins Bloomberg School of Public Health
   
3. Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology

Exciting news! Let's see what this committee comes up with over the next few months.

Is it Dangerous to Live Next to Power Lines?

I've been asked this question by tons of people. My honest answer is that "I don't really know." We know that some people have a difficult time selling their home because they have a power line in their backyard (well, maybe not literally in their backyard).

Do you live next to a power line?

These types of environmental and public health questions are very difficult to answer. You're certainly not going to conduct a randomized control trial (RCT) to determine whether living next to power lines poses any health hazards. The best you'll do is to collect some retrospective data from samples of patients who develop certain health ailments. Or, you may follow a cohort longitudinally, but that may take a very long time.

Here's something interesting: Researchers (Wartenberg et al.) recently found that people living within 2000 ft from high-voltage electric power transmission lines (HVTL) were more likely to be white, of higher income, more educated, home owners, and exposed to magnetic fields. This was published in the Journal of Exposure Science and Environmental Epidemiology.

Interesting? So, who's most likely to live by power lines? According to this study (which was conducted in New York), the answer seems to suggest: upper-class Caucasian radiologists homeowners who are always using their cell phones (don't get me started on the cell phone radiation issue).

A Swiss study (Huss et al.) found that people who lived near electrical power lines had higher odds of developing Alzheimer's disease and senile dementia. These types of epidemiological studies may not prove causation, but they do suggest an association. This was published recently in the American Journal of Epidemiology.

Taking Days to Finish a Marathon

When I lived in Boston, I had the chance to run the Boston Marathon. It was an exciting race and I don't think I'll ever forget that experience (especially the Wellesley mile at the half-way point).

Phil Packer is a disabled veteran who is taking days to complete the London Marathon. His story is on CNN. His goal is to raise £1 million ($1.5 million) for Help for Heroes, a British non-profit supporting wounded veterans. I admire his passion and his perseverance. Next month, Packer will be in California climbing El Capitan in Yosemite.

Is Swine Flu No Longer a Serious Threat?

CNN has an interesting Q&A formatted article on swine flu. I was captured by the photo of a little Asian girl wearing a cute mask. The swine flu mania seems to have ended, but does this mean that swine flu isn't a serious threat anymore? People seem to easily underestimate how a pandemic could impact the world. The Spanish Flu of 1918 wiped out anywhere from 70 to 100 million people around the world. That was a true pandemic. Although we have effective antiviral therapies, many are questioning whether our supplies are adequate. If swine flu disappears over the summer, it could come back in the fall (during regular flu season) and do some serious damage. We must continue to be vigilant if we are to avoid such an outbreak of H1N1.

FDA Alert: Testosterone Gel and Children

The FDA has announced that testosterone gel that gets applied to the skin can get lead to exposure in children (also known as secondary exposure). CNN is also running a report on this story. In 2007, did you know that 1.4 million prescriptions were written for AndroGel? 25,000 of those were off-label use in women. There were 370,000 prescriptions for Testim. You don't want young children exposed to testosterone. Even a little bit can lead to sexual changes and also cause kids to exhibit more aggressive behavior (is your kid acting up these days?).

The FDA recommends the following precautions be taken to minimize the potential for secondary exposure:

• Adults who use testosterone gels should wash their hands with soap and warm water after every application;
• Adults should cover the application site with clothing once the gel has dried;
• Adults should wash the application site thoroughly with soap and warm water prior to any situation where skin-to-skin contact with another person is anticipated;
• Children and women should avoid contact with testosterone application sites on the skin of men who use these products; and
• Adults should note that use of any similar, but unapproved, products from the marketplace –including the Internet– that can result in the same serious adverse effects should be avoided.
  

Image source: CNN.

Medical "Smart Patch"

Would you wear a digital patch on your skin if it could help you lose weight? Let me rephrase the question. Would you be willing to wear a "smart patch" that determines your caloric intake and expenditure? How?

PhiloMetron is developing a digital "patch" that you can wear. It uses a variety of sensors, electrodes, and accelerometers (the type of technology that auto-rotates your iPhone) to calculate your caloric I's and O's (in's and out's). This information then gets transmitted via Bluetooth technology to your mobile phone. Image source: Technology Review

VGX and Swine Flu Vaccines

John Gorge writes in his Philadelphia Business Journal healthcare blog about Joseph Kim. No, not me, but another Joseph Kim. Dr. J. Joseph Kim is the CEO of VGX Pharmaceuticals, a biotechnology company that uses some novel approaches to vaccine development. Dr. Kim also happens to be an MIT alumni, so we do share a few things in common. Like me, he has a strong passion for medical technology. That's what his company is about. He uses electroporation technology to develop DNA-based vaccines and it sounds like they're eager to work on a swine flu vaccine.

It sounds like VGX is merging with Inovio Biomedical Corp. of San Diego and they will operate as VGX.

Avastin: New Indication for Glioma

According to Genentech, the FDA granted accelerated approval of Avastin® (bevacizumab) for people with glioblastoma with progressive disease following prior therapy. Glioblastoma (also called GBM or glioma) is the type of tumor that struck Senator Edward M. Kennedy.

Two of the key studies that led to this decision were:

• AVF3708g
• NCI 06-C-0064E

Rethinking the Kindle DX

I've been thinking about the rationale behind the Kindle DX. Why would Amazon want to release something so large and expensive? You could purchase a mobile computer (like a laptop or netbook) for the same amount. Does it really make sense to release an e-book reader that's so expensive?

The folks over at Amazon must really think that people are willing to replace textbooks with e-books. I'm a big fan of being paperless, but that's why I use my convertible Lenovo Thinkpad X200 tablet PC. I have a large color screen (12") and I can read all the PDFs I want to without panning, scrolling, etc.

How will the Apple iPad (I call it that right now, but it could end up being called the MacPad, MacTablet or iTablet) change the way people view these portable digital devices? Many people read on their iPhone. Will a larger tablet-sized gadget be preferred? How will doctors react to this surge of slate tablet-type gadgets? Will physicians become more inclined to embrace pen-based input and move away from the keyboard? Will Microsoft Surface reinforce the fact that you can be so much more efficient if you're using natural touch and finger gestures?

FDA Approves Fanapt (iloperidone)

The FDA has finally approved a new drug! It's about time FDA! What's going on with all these long delays? (They must be over-worked and under-staffed). Remind me never to take a government job.

The FDA has approved Fanapt (iloperidone) for the treatment of schizophrenia. Fanapt is an atypical antipsychotic and is manufactured by Patheon Inc. of Mississauga, Ontario, for Vanda Pharmaceuticals Inc., Rockville, Md.

The last atypical antipsychotic that was approved by the FDA was aripiprazole (Abilify) in 2002. Has it really been that long? I can still remember hearing the announcement about this drug like it was yesterday.

Hazardous Drywall?

CNN has a story about a woman who was told by her doctor to vacate her house because her drywall was making her sick. Sounds a bit strange, doesn't it? Well, the drywall seems to be from China (surprise, surprise) and homes built in Florida between 2004 and 2007 may have some hazardous materials in the drywall. Here's a brief snippet from CNN:

"A study done for the Florida health department by private laboratory Unified Engineering Inc. found that samples of certain Chinese drywall gave off a sulfurous odor from "volatile sulfur compounds" when exposed to extreme heat and moisture. It also found that vapors "in the residential atmosphere created a corrosive environment in the presence of moisture."

Face Transplant and Microsurgery

If you haven't seen these photos yet, you have to take a look. CNN has posted some that require viewer discretion, but I'm sure you can handle these. Connie Culp had no nose because she had been shot in the face. Her cheeks and upper lip had literally been "blown away." Now, she resembles this photo - which is what she may look like in 2 years. If I ever need a face transplant, please take me to the Cleveland Clinic.

Top Search Terms for April 2009

Here were the top search terms that brought people to this site:

1. medicine and technology
2. dr joe kim
3. free emr
4. blackberry storm medical applications
5. rivaroxaban fda
6. cchit 2009
7. opera mini vs opera mobile
8. jobs for mds without residency
9. non clinical careers for doctors

Hacked: Medical Data on 8 Million Virginia Residents

Healthcare IT News reports that confidential healthcare data on 8 million Virginia residents may be compromised. Hacked! Here's a tiny excerpt:

• "The Virginia Department of Health Professions Web site has been temporarily disabled and now features a notice saying the site is "experiencing technical difficulties which affect computer and email systems." According to the department's director, Sandra Whitley Ryals, the breach is under federal investigation."

This does not sound good. 8,257,378 patient records and a total of 35,548,087 prescriptions may be compromised.

The Kindle DX is HUGE!

The Amazon Kindle DX is huge! Sometimes it's hard to imagine how big something will be until you compare it side-by-side. Wow! Maybe students will be able to read textbooks on the Kindle DX. I wonder how many of these we'll see at the beach this summer.

Medical Textbooks on the Amazon Kindle DX?

Will we see medical textbooks on the Amazon Kindle DX? Not until we see one that has a color screen (I think that's called a slate tablet PC).

How many medical students use tablet PCs during medical school? I think if I were to go back to medical school today, I would definitely use a tablet PC during my basic science courses and also during my clinical clerkships. I still remember using the Apple Newton during medical school. The Newton was killed by Apple in 1998 and that was a very sad moment for me.

Are You Excited about the Kindle DX?

I'm a big fan of being "green" and paperless whenever possible. We should be thinking about our environment. I read all my documents electronically. I take notes by "inking" on my tablet PC.

So, am I excited about the new Amazon Kindle DX? This thing is going to have a much larger screen. 9.7" to be exact. However, I'm willing to bet that it's also going to be priced quite high.

I love the concept of an e-book reader, but I think that the ones made by Amazon, Sony, and others are simply too expensive. If the price could come down significantly, then I think we would see a huge uptake (especially when you have celebrities like Oprah giving their endorsements).

Second Swine Flu Death in the U.S.

CNN has reported that a second person has died in the U.S. from swine flu. According to the news, "The woman... was from Cameron County in South Texas. The Texas Department of State Health Services said the woman had "chronic underlying health conditions," but did not provide more details."

Meanwhile, New York has 90 confirmed cases. According to CNN report, the H1N1 virus is no more dangerous than seasonal flu. Has the virus mutated to the point that it's no longer very dangerous?

U.S. Homeland Security Secretary Janet Napolitano was quoted as saying: "What the epidemiologists are seeing now with this particular strain of H1N1 is that the severity of the disease, the severity of the flu -- how sick you get -- is not stronger than regular seasonal flu."

So where does this put us? Are we to treat this as a simple outbreak of seasonal flu and take off our masks? Should we be fine traveling on airplanes and visiting crowded public places? No need to quarantine any longer? Did I buy all those masks for nothing?

Diet Supplements and Swine Flu

There are many floating rumors about how dietary supplements may protect you from swine flu. CNN has an article, warning the public about the lack of scientific evidence to support such claims. Additionally, the FDA has already released a warning about fraudulent H1N1 products. Currently, there are only two FDA-approved products for the treatment of influenza: Tamiflu (oseltamivir) and Relenza (zanamivir). These medications are so new that I didn't even learn about these drugs in medical school.

Face Transplant Photos

Wow, this is quite an incredible story. CNN actually has photos of the first U.S. face transplant patient and they are quite remarkable (viewer discretion is advised). Click on this link to see the photos.

Connie Culp was shot in the face in 2004 and now she has a face again. Culp received the face transplant at the Cleveland Clinic and she has publicly expressed her gratitude. Medical technology has played a tremendous role in this example and I wonder what we will be capable of doing in several years. I admire her courage and wish her the best recovery.

Would You Purchase Drugs Online?

What do you think about this concept about purchasing drugs online? How can you really trust your source? Would you buy from an online pharmacy? What if the online pharmacy was across the globe?

We live in a world where people are selling counterfeit drugs and it's becoming more and more difficult to discern the reliability of some generic manufacturers. On the flip side, because of soaring drug costs, it's becoming more difficult for patients to afford their medications here in the United States. The same drug may be much cheaper if you go to a different country. Why? That doesn't seem quite fair, does it? For instance, many generic drugs are manufactured in India. Would you feel comfortable purchasing pills directly from India? Can you trust a foreign pharmacy? Do you even need a prescription to do that? You may be surprised to know that in many other countries, you can purchase prescription medications without a prescription. Drugs like antibiotics are literally over-the-counter.

Soaring drug costs are a huge burden to our current healthcare system. New drug development costs billions of dollars. Pharmaceutical companies spend a large amount to market their drugs. As a result, new drugs are branded and no generics are available. Drug costs are high. Patients are getting desperate and resorting to unusual means. Some patients are cutting their pills in half. Others are taking their daily medications every-other-day. As a result, blood pressures are rising in those with hypertension, glucose control is worsening in patients with diabetes, and patients are ending up in the hospital.

What if Some Medical Myths Were True?

The British Medical Journal (BMJ) has several articles that attempt to dispel some common medical myths. What if some of these myths are true? What if our current limited understanding of medical science is flawed and someday we realize that we were wrong (yes, this has happened in the course of history).

So which medical myth am I thinking about today? Well, I've been thinking about the myth about hair growing back thicker if you cut it. True or myth? BMJ calls it a myth, but I'm willing to challenge that. Maybe I should submit a "letter to the editor" about that topic.

Telecommute to Avoid Swine Flu?

Someone at PC World is suggesting that telecommuting may help people avoid swine flu. Time to check all those VPN (virtual private network) connections. What do you think?

Top Posts for April 2009

Here were the top posts for April 2009:

1. Jobs for Physicians with No Residency Experience

2. Non-Clinical Careers and Opportunities for Physicians

3. Using the iPhone or iPod Touch in Healthcare

4. Tragic Story: Philip Markoff, the Craigslist Killer?

5. FREE Epocrates Cardiology through Cardiosource

Congrats to the Winners Receiving the AMDIS Awards!

According to Modern Healthcare, eight winners have been chosen for the 2009 Association of Medical Directors of Information Systems (AMDIS) Awards, recognizing accomplishments advancing the application of information systems and computer technology to the practice of medicine. The winners include five individual physicians, two organizations and one team.

They are:

• Dr. Michael Dominguez, medical informatics officer, University Health System, San Antonio
• Fallon Clinic, Worcester, Mass.
• Dr. Cynthia Herzog of MemorialCare Medical Centers, Orange County, Calif.
• Kaiser Permanente, Oakland, Calif.
• Dr. Steve Margolis, chief medical informatics officer, Orlando (Fla.) Health
• Dr. Jon Morris, medical informatics officer, WellStar Health System, Marietta, Ga.
• Dr. Matt Sprunger, medical director of clinical informatics, Dupont Hospital, Fort Wayne, Ind.
• Interoperability team, University of Pittsburgh Medical Center

People with Diabetes Get All the Cool Gadgets

Does it seem like people who have diabetes end up with all the cool gadgets and gizmos? Take a look at this thing called the OmniPod PDM (Personal Diabetes Manager). Looks like a cool gadget! The handheld PDM has a large color screen and can wirelessly program your personalized insulin delivery. It also calculates suggested doses and has a convenient, built-in FreeStyle blood glucose meter. What about all those people who use Accu-Check? I suppose they can easily get accustomed to a different system since most of these glucose meters have similar functionality. People with diabetes are constantly in need of new medical supplies because they need to check their blood glucose levels.

As these diabetes devices get more sophisticated, i wonder if we will see a truely closed-loop artificial pancreas become commercialized in our lifetime. What if we could implant an artificial pancreas and cure diabetes? Wouldn't that be fantastic? Thanks to modern technology, diagnostic and self care equipment have all gotten very sophisticated and have also become easier to use. As patients get more comfortable managing their conditions, let's hope this will reduce the chronic diseases burden on the healthcare system. Image source: DiabetesMine.

MIT Targeting Tumors Using Gold Nanorods

The researchers at MIT are at it again. This time, they're using gold nanorods to target malignant tumors. It's great to see so much research in nanotechnology. The team includes an MIT graduate student named Geoffrey von Maltzahn (who won the Lemelson-MIT Student Prize, in part for his work with the nanorods). von Maltzahn developed the tumor-homing particles with Sangeeta Bhatia, MD, PhD, professor in the Harvard-MIT Division of Health Sciences and Technology (HST) and in the Department of Electrical Engineering and Computer Science, a member of the David H. Koch Institute for Integrative Cancer Research at MIT and a Howard Hughes Medical Institute Investigator.

Doctor Sangeeta Bhatia and I actually have a few things in common: we both studied mechanical engineering at MIT (I did my undergrad while she got her master's), we were both in Boston in the late nineties, and we both went to medical school (but different medical schools). Now, she holds 12 issued or pending patents and has worked in industry at Pfizer, Genetics Institute, ICI Pharmaceuticals, and Organogenesis.

Autism and the Amygdala

CNN is reporting the results of a study published in the Archives of General Psychiatry where researchers found that the amygdala was 13% larger in children with autism. Advances in medical technology are revealing new things in the science of medicine. This is absolutely fascinating, but I wonder what it means. Could this lead to a cure someday? The topic of autism has received much attention lately, especially in the area of vaccines. So many parents are afraid to vaccinate their children because they fear that vacccines may be linked to autism. As a result, this may lead to some serious public health problems if we have all these kids out there who are not vaccinated. Thankfully, herd immunity should help a bit, but it won't protect everyone. Image source: CNN

Happy Cinco de Mayo!

Yes, it's Cinco de Mayo today!

Updates on Swine Flu

Everyone's probably getting sick (pardon the pun) of hearing about swine flu, so I'll keep this brief. The CDC chart now includes 279 cases. No new deaths. H1N1 is now in 36 states. CNN reports that swine flu is no worse than regular flu. So swine flu isn't as deadly as SARS. However, my fear is that swine flu may come back with a vengeance this fall and wipe out many people who may normally be protected by the flu vaccine. I hope and pray that this doesn't happen.

Sleep Habits and Susceptibility to the Common Cold

The Archives of Internal Medicine has an article titled, "Sleep Habits and Susceptibility to the Common Cold." This study found that "Poorer sleep efficiency and shorter sleep duration in the weeks preceding exposure to a rhinovirus were associated with lower resistance to illness."

This study evaluated 153 healthy adults who volunteered to let this happen to them: "participants were quarantined, administered nasal drops containing a rhinovirus, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 days after exposure." I wonder how many of those 153 adults were medical students. When I was in medical school, some of my colleagues were volunteering themselves for studies that involved biopsies of their leg muscles. Medical students will volunteer for anything, won't they!

Rhinovirus causes the common cold, but I wonder what this reflects about our immune system's response to other viruses like influenza and swine flu.

Jumbo Amazon Kindle?

Rumors and floating around. Will we see a jumbo version of the Amazon Kindle? I'm still waiting for the color version.

Technology Review Digital

Technology Review is now available in an environmentally-friendly format: digital. As an MIT alum, I get this periodical for free. At one point, I used to get two copies (that's because I'm also married to an MIT alum). I think it's time for us to go green. Time to sign up for the digital version.

The most recent edition has this on the front cover: "Can Technology Save the Economy? Yes. But take a deep breath."

CDC Lags Behind CNN

CNN is already reporting that health officials in North Carolina and Pennsylvania have confirmed the first cases of swine flu. Plus, Louisiana's governor said his state had seven confirmed cases of swine flu. These have not shown up on the CDC chart which was last updated today at 11 am Eastern.

Gregory Hartl, the WHO spokesman for epidemic and pandemic diseases, made this these comments in a briefing today (quotes appeared on CNN): "I ... would like to remind people that in 1918 the Spanish flu showed a surge in the spring, and then disappeared in the summer months, only to return in the autumn of 1918 with a vengeance... And we know that that eventually killed 40 million to 50 million people." Image source: CNN

Are Computers Helping Patients Self-Manage Their Diseases?

Most patients these days have a household computer. In fact, they may have two or three computers at home. However, do they use it for their health? Are computers making a difference in the way patients manage their chronic conditions?

Read about this interesting topic here: Health and Computers

Global Hysteria?

I've been writing about swine flu for several days and I wish to make one thing very clear: It is not my intent to increase national or global hysteria about swine flu. However, I want people to be aware of the POSSIBILITIES that may be associated with a true pandemic (which is another way of saying global epidemic).

Right now, we haven't even seen the tip of the iceberg. We're only seeing a tiny ice cube floating on the ocean. If things stay that way, then we have nothing to worry about. However, if things erupt around the world, then we'll see a massive iceberg come out of the sea.

I've been following swine flu on CNN and the latest is that there are 787 global cases of confirmed H1N1 and places like South Korea are sanitizing airports after a single identified case.

Meanwhile, the CDC is tracking the number of cases in each state. As of May 3, there are 226 cases. This means that almost 1/3 of the confirmed cases are in the USA. Why is that a big deal? Because people from all over the world travel to and from the USA. We are a major international travel hub. As the summer approaches, we will see a rise of tourists and other travelers. New York now has 63 confirmed cases. Yesterday, NY had 50. If there's one US city that attracts international tourists, it's NYC. We're already in May and schools are about to enter summer break. College students will be traveling home. We're about to see a major surge in domestic travel as well.

Anthrax was a scare, but it isn't transmitted as easily as the flu. SARS was a really big scare (especially because I knew friends living in Hong Kong), but Hong Kong isn't the type of major international travel hub like the USA.

Here in the U.S., we have a large supply of anti-viral therapies like Tamiflu (oseltamivir) and Relenza (zanamivir). Do other countries have the supply like we do? How much do these anti-viral therapies impact the course of the disease? It's probably too early to know the answer to that question. However, it may not be unreasonable to think that anti-viral therapy may be one of the reasons why mortality in the U.S. hasn't been as high as Mexico (but I don't have any scientific evidence to support that statement).

Swine Flu Discussions on Sermo

I've been following some of the swine flu discussions on Sermo. It's always interesting to hear what physicians have to say about these types of public health events. Since Sermo physicians are only US-based physicians, we don't get a global perspective. I'd really like to know what physicians in other countries are saying right now about swine flu. My guess is that they're telling all their patients to avoid travel to the U.S.

On Sermo, you'll find something called the "Sermo Swine Influenza Central." You have to be a US-based physician to join Sermo, but since it's free to join, why don't you?