MIracles and wonders: lab in a shoebox

Checking to see if she has a brain.

A scientific instrument featured on CSI and CSI: Miami for instant fingerprint analysis is forging another life in real-world medicine, helping during brain surgery and ensuring that cancer patients get effective doses of chemotherapy.

The instrument, called a "desorption electrospray ionization" mass spectrometer, or DESI, is about the size of a shoebox. Students have  carried it into a grocery store and held it close to fruits and vegetables to detect pesticides and microorganisms. 

It has also been used to identify biomarkers for prostate cancer and to detect melamine, a potentially toxic substance that showed up in infant formulas in China in 2008. In addition, DESI can detect explosives on luggage.

Now scientists want to  test the instrument in the operating room during brain cancer surgery, comparing it with traditional analysis of tissue samples by pathologists.

DESI can analyze tissue samples and help determine the type of brain cancer, the stage and the concentration of tumor cells. It also can help surgeons identify the margins of the tumor to assure that they remove as much of the tumor as possible.

 Innovations in medicine like this are happening all the time, and we are hardly aware of them.

MIracles and wonders: swallow this, touch that

Take two and call me in the morning.

I don't think we fully appreciate that we're in the midst of a revolution in medicine.

The US Food and Drug Administration has approved a grain-sized ingestible digital sensor that can be swallowed in a pill to track health data from inside the body. The idea is that the data can be used not only by patients themselves, but also by caregivers and doctors to individualize their care. The signal that it sends from the stomach travels through the patient's body to a patch worn on the skin. The patch contains technology that senses the signal and records the exact time the ingestible sensor was swallowed.

It is clear that all kinds of products and services  would be available online if we had the bandwidth. Programs that involve massive transfers of data or frequent two-way video communications would be two obvious examples. What’s interesting is how many of these new products and services involve healthcare: Jeff Pfaff of Overland Park, Kan., says he hopes to use the service to “push the limits” of a health-monitoring system he’s building. It would enable at-home patients to teleconference with doctors and family members via a camera hooked up to a TV set and a remote control.

European researchers say they have developed the world's first real-sized, five-fingered robotic hand able to grasp and manipulate objects with human-like dexterity. The team  built a hand using strings that are twisted by small, high-speed motors in five fingers, each with three segments. The device was able to handle a delicate Easter egg and lift a five kilogram load. Light sensors were attached to the hand, making it possible to calculate the force required for the fingers to grasp an object without squashing it or losing its grip.

The story of your health in a black box

Yikes! That hurts!

For years I thought that one answer to our broken healthcare system was electronic health records. I still think so, but with a lot of caveats.

The federal government is pushing hard for their adoption. Physicians, driven by the promise of better care, cost savings and nearly $23 billion in new federal incentive payments, are racing to turn their scribbled medical records into digital files, Smart Money reports.

Thirty-five percent of hospitals now use such systems, more than double the share two years ago, according to U.S. government figures. But for all the hype about electronic records, little attention has been paid to what some say is a serious weak spot: When those sensitive bits and bytes fall into the wrong hands, it's often patients who feel the pain.

Here's the trouble.

Since 2009, there have been more than 420 security breaches involving the records of some 19 million patients, according to the U.S. Department of Health and Human Services' Office for Civil Rights. And such breaches are on the rise. A December 2011 report by the Ponemon Institute, a security-research firm, found that the frequency of data losses and thefts among health care organizations increased 32 percent over the previous year.

This is one reason I'm a skeptic about a national healthcare system. Already too many computer systems are familiar with my body.

A doctor in your hand

Is there a doctor in the House?

Health-related apps for smart phones are coming of age. Here are some of the latest.

• One of the latest device-and-app creations to pass muster with the federal Food and Drug Administration is iBGStar, a blood glucose meter that attaches to iPhones or iPads for diabetes monitoring. It's a product of Bridgewater, N.J.-based Sanofi, and sells at Apple retail stores and Walgreens drugstores for about $100 and $75, respectively.

• Heart-EKG uses the iPhone's microphone or camera flash to calculate users' average number of heartbeats per minute or to take their pulse, after placing the phone over an artery, and activating the app. Dallas-based Surich Technologies says the app is handy for aerobic workouts, but isn't intended as a lifesaving monitoring device. It's downloadable from iTunes, for $2.99.

• The iHealth Wireless Blood Pressure Wrist Monitor, expected on the market in September, measures users' blood pressure directly from their iPhone, iPad or iPod Touch. Its app records systolic/diastolic numbers, heart rate and pulse wave, and can chart blood pressure readings, says Karyn Anderson, spokeswoman for Mountain View, Calif.-based iHealth Lab.

• AliveCor Heart Monitor has developed an electrode-studded cellphone case that turns the iPhone 4 into an electrocardiogram device that users hold in their hands or place on their chests to detect irregular heart rhythms. Combined with the app, the monitor can analyze, transmit and store an ECG reading for diagnosis. The heart monitor has been through several clinical trials, said physician David Albert, the device's inventor and co-founder of San Francisco-based AliveCor. He hopes to introduce it for veterinarians' use for dogs, cats and horses later this summer. The device doesn't yet have FDA approval.

• A cellphone-based E. coli sensor for water and other fluids is under development by a University of California-Los Angeles research team. Commercial manufacture of the system, which uses a lightweight attachment to the phone's camera, could be only two years away, said team leader Aydogan Ozcan, a UCLA associate professor for electrical engineering.

• San Francisco-based CellScope's otoscope attaches to the phone's camera lens and will enable parents to photograph their child's eardrum, and e-mail the images to medical professionals checking for an ear infection. CEO Erik Douglas says he hopes to get this to market in about a year.

Your health in digits

This could be you!

I've long believed that one answer to our healthcare mess is digital health records. I look at my family doctor's office, and I see mounds of paper, a half dozen clerks frantically shuffling them, and a wall of manilla folders holding the health histories of hundreds of people.

Above all this is a fire sprinkler. Not at all reassuring.

Last year I went to an eye surgeon who was introducing digital records to his practice. As I watched from the chair, he and his assistant labored at a laptop to enter my data into the many fields of my record.

Right there we see the problems. There's not a lot of money lying around in family practices. Given the absence of standards, why should my doctor invest in something that may be outdated next year? And given all the upcoming changes in the government's role, how could anyone make a rational decision? And as my eye surgeon demonstrated, it's not as simple as it seems.

Digitalization makes a lot of sense. Each year there are tens of thousands of phone calls from pharmacists to physicians to clarify prescriptions. I've experience this. Throw out the little paper pads, type it into a gizmo hanging on your belt and off it goes to the pharmacy. Plus, the gizmo could warn both about drug interactions and the like.

The government has got it in its head (oxymoron alert!) that it's going to push everyone to a digital world.

In the 2009 economic recovery package, the administration and Congress allocated billions — the current estimate is $27 billion — in incentives for doctors and hospitals to adopt electronic records. 

Late last year, the administration, working with health professionals and the technology industry, set out a roadmap for what digital records should include and how they should be used, for doctors to qualify for incentive payments, typically up to $44,000. The program begins this year, and the requirements for using the records to report and share health information increase in stages through 2015. After that, penalty payments from Medicare and Medicaid kick in for doctors who don’t meet the use and reporting rules.

Carrot and stick. We'll see how that works out.

New gadgets to monitor your aging parents

Here are two of the new devices you can use to remotely watch over a loved one.

Sonamba

For about $200 (plus monitoring fees of about $100 per month), you can buy any number of home monitoring devices that use sensors to alert caregivers if their charge has fallen or might need medical attention, according to Caring.com . But for an additional $349.99, you can upgrade to the Sonamba , which uses sound and motion sensors to monitor all movements, alerting caregivers with periodic text messages like "all is well," or "attention needed."

The Sonamba, which looks like a digital picture frame, is placed somewhere in the house; smaller sensors are placed in other rooms so that the device can theoretically monitor most of a home. Something else experts like: It doesn't require technical expertise on the part of the patient. Although the $549.99 price and the $39 monthly fee are higher than those of many other devices on the market, the Sonamba does have additional bells and whistles — like reminder messages about doctors' appointments and medication routines.

Lifecomm mPERS 
Lifecomm's new mobile personal emergency response system (mPERS) uses cellular network signals to transmit messages to a caregiver in the event of a fall. Just slightly bigger than an iPod Nano, the wearable battery-powered belt clip, watch or necklace has as an embedded GPS (in case help is needed away from home) and a sensor that tracks the number of steps a person takes, along with their activity level. Veer from the norm and the device sends a caregiver alert. It also comes with online support tools where caregivers can sign up for things like low-battery alerts.

The system works well as long as it's in range of a strong cell signal — and there's still no getting around the fact that its owner must remember to wear it to get the high-tech benefits. The company says the device will be "comparable" in price to other systems (Wellcore offers a similar product for $199 with a $49.99 monthly fee).

What the insurance companies are learning about you

Your online trail is being tracked, and now the insurance companies are following you. From The Wall Street Journal:

Data-gathering companies have such extensive files on most U.S. consumers—online shopping details, catalog purchases, magazine subscriptions, leisure activities and information from social-networking sites—that some insurers are exploring whether data can reveal nearly as much about a person as a lab analysis of their bodily fluids. 

In one of the biggest tests, the U.S. arm of British insurer Aviva PLC looked at 60,000 recent insurance applicants. It found that a new, "predictive modeling" system, based partly on consumer-marketing data, was "persuasive" in its ability to mimic traditional techniques. 

This data increasingly is gathered online, often with consumers only vaguely aware that separate bits of information about them are being collected and collated in ways that can be surprisingly revealing.

A key part of the Aviva test, run by Deloitte Consulting LLP, was estimating a person's risk for illnesses such as high blood pressure and depression. Deloitte's models assume that many diseases relate to lifestyle factors such as exercise habits and fast-food diets. 

Other insurers exploring similar technology include American International Group Inc. and Prudential Financial Inc., executives for those firms confirm. Deloitte, a big backer of the concept, has pitched it in recent months to numerous insurers.

Make you nervous? Let the companies know. Here are their contact pages.

Alvia

AIG

Prudential

Deloitte

Should you store your medical record online?

hIt's now possible to store all of you health information online, making it easily accessible anywhere, but only about four percent of people do. Many are afraid of the privacy implications, although these sites use the same technology as banks do to protect your information.

The Wall Street Journal has reviewed three of the most popular sites.

Google Health doesn't have many tools of its own to allow users to evaluate their health. Instead, it focuses on sharing your data with online applications that do such tasks, like the My Diabetes Health Assessment website, which evaluates users' risk of diabetes based on data from their health records.

Microsoft HealthVault, too, has a limited number of self-evaluation tools but connects to a wide variety of helpful services that can extract data from or import data to your profile.

You can accesss WebMD's Health Manager in two main ways: through its public site, WebMD.com, or through the sites of insurance companies and employers that are WebMD customers.

The Journal's assessment:

In the end, we found that each PHR offers a remarkable value for a free application, but none of the three emerged as a clear winner.

Microsoft HealthVault gets high marks for portability, but it has no features for printing. WebMD Health Manager has all of its health evaluation features built in, so you don't have to connect to external applications, but it lacks the ability to export information in some key industry formats. So does Google Health (it says it may add this later), but it does export data to online health applications.

One way to choose among the PHRs is by the applications that link to them. If you want to import data from LifeScan Inc.'s OneTouch glucose monitor into your PHR, for example, currently only HealthVault does that (Google may add this).

On the other hand, if your insurance company (yours or your employer's) is a WebMD customer, you may want to use Health Manager for its easy importing of all the health data your insurance company already has on you.

Also posted on my technology blog, Tell Your Doctor

How cell phones can track illness

I've read about putting sensors on cell phones that would automatically tell a central computer that a biological or chemical terrorist attack was underway. Here's the same idea but in a more personal use.

Epidemiologists know that disease outbreaks change mobility patterns, but until now have been unable to track these patterns in any detail. So says Anmol Madan of the Massachusetts Institute of Technology and colleagues gave cellphones to 70 students in an undergraduate dormitory. The phones came with software that supplied the team with anonymous data on the students' movements, phone calls and text messages. The students also completed daily surveys on their mental and physical health.

A characteristic signature of illness emerged from the data, which was gathered over a 10-week period in early 2009. Students who came down with a fever or full-blown flu tended to move around less and make fewer calls late at night and early in the morning. When Madan trained software to hunt for this signature in the cellphone data, a daily check correctly identified flu victims 90 per cent of the time.

Two possible uses for this have emerged.

• The technique could be used to monitor the health status of individuals who live alone. Madan is developing a smartphone app that will alert a named contact, perhaps a relative or doctor, when a person's communication and movement patterns suggest that they are ill.
• Public health officials could also use the technique to spot emerging outbreaks of illness ahead of conventional detection systems, which today rely on reports from doctors and virus-testing labs. Similar experiments in larger groups and in different communities will have to be done first though.

And you don't have to make an appointment

Folks at the MIT Media Lab are playing around with a prototype of Netra, a system that can identify problems with a person's eyesight using only a smartphone, software, and inexpensive optical add-ons. The system could help people who can't afford or get access to full-service optometry.

Ramesh Raskar, an associate professor at the MIT Media Lab and the leader of the Camera Culture group there, said it dawned on him that the 300 dpi resolution on a smart phone screen made it the rival of expensive, specialized devices.

Raskar said the ubiquity of smartphones is a key part of what makes Netra attractive. While other systems have been proposed to provide optometry where it isn't currently available, those systems were limited by needing expensive equipment, or by being complex enough that they had to be used by an expert.

Similar hardware add-ons could transform smart phones into inexpensive sensor devices that could serve many medical and environmental needs.

Medical bracelets go high tech

Not your father's medical bracelet

And not just looks, but the ability to carry a load of medical information that might be useful in an emergency. Laura Landro at The Wall Street Journal reports:

New bracelets and other medical-identification systems can fill in first responders on practically a patient's complete health history. They're a far cry from the simple identification bracelets of the past, which with a few engraved words informed medics that a person was, perhaps, allergic to penicillin. They can steer first responders to a secure website or toll-free phone number, or initiate a text message, to get the medical and prescription history of a patient who may be unconscious or unable to talk about their condition. 

If you're not the jewelry type, you can carry a specially marked USB flash drive loaded with emergency data that medics can read from any computer in an emergency.

Engraved on bracelets issued by MedicAlert are a patient's member number and a toll-free number to access a 24/7 hot line for information. The service costs adults $39.95 for the first year and $30 annually after that; children's fees are less. MedicAlert has added services like notifying family members in an emergency. 

Other options:

For people whose doctors don't keep electronic medical records, companies like MedInfoChip sell software programs for about $50 that help consumers set up their own health records on a computer and load them onto a USB device. American Medical ID offers a flash drive in a dog-tag style pendant for $44.95 that can be engraved with basic medical information and loaded with a patient's medical records.

Another program, called Invisible Bracelet, does away with the need to wear a bracelet or carry a device. The program allows members for $10 a year to upload personal medical data to a secure website and receive a personal identification number. Members get cards to place behind their driver's license, key fobs and stickers that can be put on, say, a bike helmet that show their identification number and the website address.

Also posted at Tell Your Doctor

Computers and your eyes

I have trouble looking at the computer screen, which I do all day. I use the control plus plus sign function all day long to enlarge or reduce the type on the screen. I'm not alone.

More people are showing up at eye appointments complaining of headaches, fatigue, blurred vision and neck pain—all symptoms of computer-vision syndrome (CVS), which affects some 90% of the people who spent three hours or more at day at a computer, according to the National Institute of Occupational Safety and Healthy.

Yes, I talk to my opthamolagist about it, but, as The Wall Street Journal reports:

But vision prescriptions mainly focus on myopia (nearsightedness) or presbyopia (the difficulty focusing on near objects that comes with age). Since there are no set standards for measuring mid-range vision, ophthalmologists and optometrists typically just cut any reading prescription they give patients in half for computer distance. With people sitting anywhere from 18 to 40 inches from their screens, that can be wildly off. 

What to do?

It's best to measure your work environment, noting exactly how far your eyes are from your computer screen, keyboard and desk surface, as well as from any laptop or hand-held devices you use. Some eye-care offices have a device called an accommodation rule that allows a technician to slide an eye chart back and forth to simulate different distances.

Patients should also keep track of how many hours they typically spend focusing at each distance during the day. More than 40% of Americans spend three or more hours a day staring at a computer or hand-held, according to the American Optometric Association. "Every individual is different, and too often, in the hustle and bustle of seeing patients in practice, we don't stop to ask, 'What is your working distance? What are your hobbies?' If you go fly-fishing, you need to focus up close for hooking your flies as well as seeing at computer distance," says Glen Steele, a professor at Southern College of Optometry in Memphis, Tenn. 

The Journal article lists a number of solutions involving various types of lenses and even surgery.