Mark Roth gave a great talk at TED describing how hydrogen sulfide may be the key to putting humans into suspended animation.

As anyone who reads science fiction will tell you, suspended animation is where your body is put into a state of preservation, not really living, but not dead either. It’s like a chemically induced version of hibernation, and it could help you stay alive on the way to a hospital after getting seriously hurt. Mark Roth was part of a larger DARPA initiative to extend soldier survivability after injury on the battlefield. From that research, Roth discovered that hydrogen sulfide (H2S), in small quantities, would put mammals in what was essentially a state of suspended animation. Hydrogen sulfide is toxic (it was used in chemical warfare in WWI) but in the right doses it can actively bond to oxygen receptors in your body. Replacing the need for oxygen allows mammals to lower their metabolic rates to absurdly low levels, but once the H2S is removed animals recover without any nasty side effects. Roth has found then what seems to be the perfect formula for keeping people alive after trauma. His newly formed company, Ikaria, is currently in phase II clinical trials for a liquid hydrogen sulfide product. In just a few years, suspended animation may be a common tool in hospitals and trauma centers all over the world. It almost sounds too incredible to believe. Watch Roth give an enthusiastic and really enjoyable talk at TED 2010 in the video below that explains his work and its amazing potential.

There’s a golden window after trauma, about an hour, and if you make it to a hospital in that time you have an incredibly higher statistical chance of surviving. Roth has found ways to extend that window to six hours. That’s how long he got mice to stay in hydrogen sulfide suspended animation and be revived successfully. Furthermore, those mice survived the process with only 60% of their blood! That level of blood loss represents a sever trauma – a gunshot wound or partial loss of limb. (Discussed in video around 13:00).

Hydrogen sulfide deanimation may have uses outside of severe trauma however. As Roth mentions around 14:00, H2S treatments has shown to provide a 70% reduction in damage during heart surgery in animals. Similar numbers were found for other major organ operations. Suspended animation may help the body cope with injuries and dangers of surgery. That means millions of people around the world could benefit with some well timed poison in their veins.

Roth hasn’t just experimented with poisoning animals, he’s also frozen and suffocated them, too. As he discusses in his opening, about 50% of all people who are frozen for 3 hours without a heartbeat and then resuscitated manage to live. Low oxygen levels can kill you, but very low oxygen levels (10 ppm) actually puts you in suspended animation (~5:10). Roth experimented with animals in suspended animation and found that they were protected against death from freezing (6:30). In all these cases, suspended animation kept animals alive in conditions that would normally kill them. It makes you wonder if cryogenics and long term space exploration might not be such crazy ideas.

Mark Roth has gotten a lot of attention for his work, and a MacArthur “genius” grant. Yet when you hear him describe the process by which he came to use hydrogen sulfide in his work (around 8:40) it seems more luck than genius. But that’s one of the marks of a great scientist. Most researchers are pretty smart, great researchers are smart enough to recognize luck and take advantage of it.

With a liquid dose of H2S in phase II trials, it will likely be several years before we see a suspended animation treatment on the market. Roth’s company, however, is already distributing products with a related benefit. Ikaria’s INOMAX (nitric oxide therapy) is used to treat newborns with hypoxic respiratory failure. Saving the lives of infants is clearly good news in of itself, but it has an added bonus here. With a product currently on sale, Ikaria could have the funding and savvy to gets its H2S treatments out that much sooner. Which means Roth’s vision of using suspended animation to save lives and help us achieve immortality is something to bet on. Just one of the many ways in which small doses of poison make life a little better.

[screen capture and video credit: TED 2010]
[sources: TED, Roth Lab, Ikaria]

It looks like a Star Wars torture device, but the DaVinci is a world class surgical robot.

Robotic surgery is experiencing explosive growth in America’s operating rooms, and the unquestioned industry leader in this field is the DaVinci robot, made by Intuitive Surgical. How pervasive has this robot become? Put it this way, only 14% of prostate surgeries in the US last year took place not using the DaVinci. It has grown from 210 systems seven years ago to 1,395 today. Although typically used for smaller surgeries like prostate removal and hysterectomies, it was recently used for a kidney transplant, and more complicated procedures are expected in the future. The DaVinci is really just the first wave of robotic surgery as technology continues to push clumsy human hands out of the operating room.

Although the business end bears a disquieting resemblance to the torture probe in Star Wars, robot surgery is pretty amazing to watch. There’s a  TED talk about the DaVinci from a year ago; it’s worth looking at again (after the jump).

The DaVinci is controlled using two joystick-like arms and several foot pedals. These controls move articulated robotic arms that can be fitted with a huge variety of different tools. In a typical surgery, doctors only have to cut a 1-2 cm hole to allow three or four arms to enter into the patient’s body. The controls then convert every five inches of the doctor’s movement to one inch of movement inside the patient, allowing for improved fine motor actions. The doctor sits at a station, often outside the actual operating room, and uses the built in 3-D monitor for vision as he completes the surgery. According to the DaVinci makers, using a robot leads to less tissue trauma, requires fewer surgical assistants, and is less physically taxing for the surgeon.

However, the company line on the DaVinci’s effectiveness is far from the last word. According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence and incontinence (I know which one of those bullets I’d choose to take, just saying). Costing a cool $1.7 million, plus a $100,000+ annual service fee, inconclusive results are a bit hard to stomach. There are two reasons why this ostensibly advanced surgical method can lead to mixed results. First, the DaVinci provides no tactile feedback. Doctors have to learn to use the visual environment for clues they would otherwise get by feel. Of course, with the development of haptic feedback, this flaw might be remedied soon.

The second problem is that it just takes time to get used to a whole new way of performing surgery. To help with that problem, Simulated Surgical Systems has recently unveiled the RoSS surgical simulator. The simulator is modeled on the DaVinci and allows aspiring robo-surgeons to practice their technique with virtual patients before dealing with the real thing.

This will cost more than an Xbox.

DaVinci has also made waves with its decision to direct its marketing towards consumers, in some cases even taking out billboard ads. Hospitals and doctors report having to buy the machines out of necessity, after losing so many patients to other hospitals that offer the robotic procedure. I find it telling that patients are so demanding of this new technology. Scientists worry about the public’s reaction to future advances in genetic engineering and stem-cell research, but patients seem perfectly fine with using a robot to perform surgery, even if the doctor isn’t in the room.

And while the doctor might currently not be in the room, in the future he may not even be in the country. Way back in 2001 US surgeons used a DaVinci predecessor system to perform a gall bladder surgery in France, via a secured fiber-optic connection. Although this hasn’t seemed to have caught on in regular hospital use, the US military is currently developing “trauma pods” based on a scaled down version of the DaVinci. Front line troops would carry these into battle, allowing doctors to perform complex operations while safely at base.

These systems are pointing us towards the future of surgery, which will use smaller and smaller tools to make operations less invasive, more precise, and more effective. We’re not going to get to nanobot based medicine overnight, but the DaVinci is part of the bridge that will get us there.

[image credits: WikiCommons, Simulated Surgical Systems]
[video credit: TED MED]
[sources: Chattanooga Times, NY Times]

If a blinking light and beeping sounds weren't enough to get you to take your pills, GlowCaps also send you emails and tattles on you to friends and doctors. Diabolical, but it works.

The New England Healthcare Institute estimates that patients not taking their pills when they should costs the US $290 billion dollars a year. Vitality is hoping to recover some of that money by using any means necessary to get you to take your prescription. Their GlowCaps fit on the top of prescription bottles and wirelessly communicate with the internet to know when you should be dosing yourself. If you miss a pill, the GlowCap and an associated nightlight both start glowing. If you still haven’t taken the pill an hour later, it starts beeping. After that, it calls you on your home phone. If that wasn’t enough to keep you on your medication, GlowCap sends a weekly email to you and to any family member you select reporting on your progress. Your doctor gets a monthly update on how you’ve done. There’s even a Facebook Application! Clearly the thinking is that social pressures will succeed if all other forms of harassment fail. The Wall Street Journal reports that pharmaceutical distributor Express Scripts is starting a small scale test of GlowCap in April. If successful, the program could be extended. Using electronic harassment and peer pressure to make you take your pills is just another way in which monitoring your body is going to upgrade us to healthcare 2.0.

Want to know more about how GlowCap works? This kindly old man will explain it to you.

Vitality has run a beta test of GlowCaps in Boston. The average amount of pills taken on time (the compliance rate) was 86%. That’s a major improvement over the standard rate at which daily medications are taken – typically around 50% but sometimes even lower.

GlowCaps are unique in the degree to which they use shame to keep you focused on taking your prescription. The system may only cost you around $100 to buy, but the social price you pay should you ever get too lazy, forgetful, or obstinate to take your meds is immeasurable. Why, your entire family could start doing commercials about you behind your back:

Strangely enough, GlowCap isn’t the most invasive way to insure patients take their medication. We’ve seen pills with transmitters that track whether or not they’ve been successfully swallowed. Clearly wireless technology is going to have an impact on improving your health in the next few decades. Besides pills, WiFi signals could help you track your vital signs and your emissions. Health monitoring will keep you and your doctor in a steady stream of digital data. Combined with better analytical tools, this information will provide a level of personalized healthcare you’ve never experience before. Sounds pretty good. I’m a little wary of a system that approaches prescription drugs the way that governments approach terrorist monitoring, but if it keeps the old people doped up, I’m all for it.

That was a joke. Please don’t tell my Nana.

[image credit: Vitality]
[video credits: Vitality]
[sources: Vitality, Wall Street Journal]

ThinkLabs just gave their electronic stethoscope an iPhone App. Get ready for your doctor to go digital.

Need to prove you’re human? Doctors can now email your heartbeat using a digital stethoscope and new iPhone App from ThinkLabs. While the ds32a digital stethoscope has been around for years, the recent addition of an iPhone App opens great possibilities for its use. Once an auscultation has been performed, you can look at the digital sound recording on the iPhone (or iPod touch), save it, add notes or photos, and email it. This will allow for doctors to build databases of recordings for each patient and provide them with better care. That sort of innovation isn’t exactly cheap: the ds32a retails around $250, the App is $70, and a special jack is required (the recommended one from Belkin costs $70). Yet it’s not that far from a traditional stethoscope (~$100 depending on style) and provides a distinct advantage in application. This is the coolest use of a digital stethoscope we’ve seen in a while, and it’s a sign of the coming information revolution that will lead us into Medicine 2.0.

If we want to take advantage of remarkable stem cell treatments, genetic therapies, and nanobots, we’re going to need better diagnostics to help guide their applications. That’s why the growth in health monitoring is so promising. Right now, digital stethoscopes provide an active means to track patient data over several visits. Eventually, I expect that capability to be included in the vital sign monitoring patches we’ve seen from Toumaz and WIN. Such health monitors may also be able to contain specialized diagnostics like ultrasound, which have already started to become miniaturized. Doctors will be assisted by software that analyzes the information from these devices to help them treat patients, and they’ll probably keep track of everything on their smart phone or tablet computer. There’s no doubt, digital data is going to transform the medical profession. Kudos to ThinkLabs for getting on the wagon now.

[image credit: ThinkLabs]
[source: ThinkLabs and associated users manual for App]

The Zeo Personal Sleep Coach uses a headband to measure brain activity and record how you slept.

Having a machine watch you while you sleep may seem a bit creepy, but it might be the best way to help you get the Zzzz you need. Massachusetts based Zeo, Inc is selling a system that monitors brain activity while you rest and then gives you detailed information about how the night went for you. The Zeo Personal Sleep Coach uses a headband (measuring brain activity through skin surface electrical signals) and a bedside monitor that looks like an alarm clock to track how long you spent in REM, light, and deep sleep. The system allows you to critique your sleep habits and even gives you a score (called your “ZQ”) rating how you slept. Zeo PSG comes with online analytical tools to help you further decide the best way to improve your rest. Best of all, the Zeo bedside monitor can wake you up at the time that coincides with your natural cycle, hopefully avoiding that groggy morning feeling. Price tag starts at $250, with extra online coaching available at $8 per month (or $80/year or $100 lifetime service). It’s a pretty neat device, and another example of how continuous health monitoring will improve the way we live in the future. Check out the promotional video from Zeo below.

Health monitoring has started to come into its own in recent years. Toumaz Technologies and WIN both have wearable vital sign monitoring devices that transmit information wirelessly. GE is even developing a portable ultrasound machine the size of a mobile phone. These tools will allow individuals to personally track their own health 24/7/365. That information feed will help us detect serious illnesses before they happen as well as fine tune our bodies day to day.

The Zeo PSG is unique among these devices by focusing on our sleep. Of course, I’m pretty sure most of us already know when we haven’t gotten a good night’s rest, and I’m not sure the sleep journals, ZQ scores, and guided coaching it offers can actually improve your sleep once you realize how bad it is. Still, the more information you have at your disposal the more likely you will be to pinpoint those things you can change to help you snooze better.

Right now the Zeo bedside display will just wake you up when you're least groggy. What if it could perform other cool functions to improve your sleep?

The most promising feature I can see in this system is the SmartWake application – the program that improves upon a traditional clock alarm by waking you up when you’re out of deep sleep. I’d like to see more technology like this. Maybe a system that generates white noise when it detects ambient sounds that might make you lose deep sleep. Or a program that plays interesting sounds and lights while you’re in REM to affect your dreams.

No matter how Zeo improves upon its system, it’s going to serve as another data feed we can use to guide our health habits. Hopefully the future will see all these different health monitoring devices combined into one super monitor that tracks all the pertinent medical data at once. That sort of diagnostic tool will help convert our bodies from mysteries into free floating sources of digital information. When that happens, expect doctors (or implants, or computer programs) to guide your health in real time. Yep, with all this data to analyze the future’s going to be awful busy. Better make sure to get some sleep.

*You can find more Zeo promotional videos, and testimonials on the Zeo YouTube Channel.

[image and video credit: Zeo]
[Sources: Zeo]

Medical tourism is a billion dollar industry and it's started to expand into marketing stem cell therapies.

You can’t keep a good thing down. When the US restricted stem cell research in the early part of the century that research didn’t die, it emigrated. All over the world, scientists continued to explore the efficacies of embryonic and adult stem cells with astonishing results. Now, as the public becomes increasingly aware of these “miracle” treatments, the demand for stem cell therapies has increased far beyond what institutionalized Western medicine seems able to immediately provide. The result is both exhilarating and terrifying: more and more patients from the US and Europe are traveling abroad to seek stem cell treatments. This is just a tiny fraction of the ever increasing flood of medical tourism that has struck the West. Companies like Atlanta based Global Surgery Providers (GSP) are marketing directly to patients, facilitating travel for medical procedures including stem cell transplants. While governments, doctors, and patients are still struggling to understand the dangers and advantages of medical tourism, it continues to grow. One thing is for certain, no matter what any one institution may try to do to control the use of stem cells, the demand for this technology is too strong to be stopped.

While many researchers are working overtime to get stem cell therapies safely to market, the public perception in the US is that this technology is stalled. It doesn’t help that big name studies, like the first US embryonic test by Geron, have run into bureaucratic roadblocks even after the political ones were pulled away. When the US allows stem cell treatments for animals, but not humans, this is seen as backwards, not as a necessary result of the stringent review applied to new medicine. It takes time for any new product to pass FDA approval, but patients want stem cells now.

And why wouldn’t they – have you seen some of the amazing things that stem cells can do? First there’s the eye-popping pictures of new organs grown in labs. We’ve even seen a new windpipe created and implanted in just weeks thanks to a technique that used a patient’s own stem cells. Add to that the promising results seen with diabetes and blindness…well, if I was in need of such a treatment, I would be demanding access to stem cells, too.

Which is where medical tourism comes in. Why wait years for the resolution of clinical trials and bureaucratic red tape when you can jump on a plane and get treated in a manner of weeks? Atlanta’s GSP is just one of many medical travel agencies that has picked up on the stem cell trend. They offer consultations (via phone only at this time) that could help you find a stem cell therapy center somewhere across the world. Similar agencies cater to the UK, Canada, and many different locations in Europe.

When you see a company offering to take you to a foreign country for a miraculous new medical procedure, it can all seem new and untested. Parts of it are. Yet the medical tourism industry has been growing strong for years now. Once the province of cosmetic surgeries and dental procedures, medical tourism now includes those looking for hip/joint replacement, heart surgery, even organ transplant. Some 750,000 Americans were thought to have traveled outside the US for medical treatment in 2007. A survey published by Deloitte in 2009 found that 3% of those 3000 18 to 75 year old Americans polled had used some form of medical tourism and that 27% would consider it (see page 13 of the results). A significant 40% would pursue medical travel if they could save 50% or more on costs.

Cost and availability top the list of reasons why people seek healthcare travel. In the US, a heart valve operation might run you $200k, but the same procedure in India could be done for $10k, including travel and accommodations. In countries with socialized medicine, waiting for months on necessary (but not “critical”) surgery pushes many to seek help outside their borders.

It’s no wonder that different agencies have arisen to promote medical tourism and address the concerns of its detractors. The most well known of these is the Joint Commission International which seeks to certify hospitals and other medical facilities around the world. A JCI certificate is often seen as a guarantee that a facility will live up to Western medical standards. Other organizations, like the Medical Tourism Association, offer their own certification while serving as a business networking opportunity for those institutions that want to grow the industry.

Yet if medical tourism is increasingly seen as legitimate, “foreign” stem cell therapies are still stigmatized by the established medical profession. The International Society for Stem Cell Research (ISSCR) has called for greater transparency and open evaluation of stem cell therapies. They worry about clinics directly marketing to patients and using anecdotal evidence to support their medical claims. Even those medical travel agencies (like GSP) that are venturing into stem cell treatments are quick to advise patients that many treatments are untested, and that not all therapies will work for all people.

The problem with venturing outside the (painfully) slow review process that plagues the West is the presence of crippling uncertainty. For every clinic in Germany that seems to have somewhat reputable results, there’s some clinic shut down in Hungary for being untested and unlicensed. Patients cannot know for sure if the treatments they receive as part of stem cell medical tourism will work. Or even be safe.

I don’t think that’s going to stop anything. As I said in the beginning, you can’t keep a good thing down. That’s true even if you’re uncertain about how good it really is. Stem cells therapies hold such amazing promise that they are going to be used no matter what. Years before the medical community as a whole would be comfortable with their use, stem cells have captured the hopes of patients the world over. In a sense, it doesn’t matter if medical review processes are unnecessarily slow or not. It doesn’t matter if stem cell therapies in different parts of the world are legitimate or not. Patients in need will seek out untested technologies as soon as the promised benefits outweigh the perceived risks. We’ve already passed that point. For better or for worse.

In a few years stem cell research is likely to be complete enough to produce clinically proven and nationally licensed therapies. But a few years can be a lifetime. I’m still doubtful as to whether stem cell clinics anywhere in the world really possess effective and safe treatments. Yet I know that dire situations force many to choose hope over doubt. Good luck to everyone, no matter which side of the coin you land on. And rest assured: one day recognized stem cell treatments will be available. Can’t be stopped.

[image credit: Stem Cell Blog]
[video credit: MTA]

Stem cells deal a vicious blow to HIV: A stem cell treatment in Germany seems to have removed all traces of HIV from a 42 year old man.

Add one more name to the ever growing list of diseases that have been defeated by stem cell treatments: HIV. That’s right, according to a recent report in the New England Journal of Medicine, a stem cell transplant performed in Germany has unexpectedly removed all signs of HIV from a 42 year old American patient. The unnamed white male was treated two years ago for Leukemia with a dose of donor stem cells and his HIV RNA count has dropped to zero and remained there since. While the treatment was for Leukemia, Dr. Gero Hutter and colleagues at the Charite Universitatsmedizen in Berlin had selected the stem cell donor for his HIV resistant genes. While there are still many questions unanswered, this is the first such case of stem cells treating HIV that has been reported in a NEJM-caliber publication. Ladies and gentlemen, this is not a “cure” for HIV/AIDS, but it is certainly a remarkable and promising find. There’s more you need to know about the situation, so read on.

Like so many instances of “miraculous medicine”, this case has its complexities. First, the patient was being treated for Leukemia, not HIV. The patient had been HIV positive for ten years before the first stem cell treatment. His HIV medication was actually treating his condition fairly well, and it wasn’t until a round of chemotherapy (for the Leukemia) raised his HIV count that it looked to be troublesome. The original transplant from two years ago may have dropped his HIV count, but his Leukemia returned a year later. Another dose of stem cells was given and this seems to have treated the cancer as well as maintain its effect on the HIV.

Secondly, their’s the DNA of the donor to consider. Due to a genetic mutation (CCR5), the donor has a resistance to the HIV virus. Such resistance occurs in 1-3% of white males of European descent. Furthermore, while a single copy of this CCR5 gene can grant some resistance to HIV, the donor had two copies, which often leads to a good chance of full resistance to the virus. Dr. Hutter and colleagues were fully aware of the CCR5 in the donor when selecting him.

But it gets more complicated. The patient’s form of the virus, X4, is not typically affected by the CCR5 resistance! This leads to some major questions: why would a CCR5 donor’s stem cells effectively treat a patient with X4 HIV? Is it something special about stem cells? Do we not understand the CCR5 resistance? Do we not understand the X4 form of the virus? Is there a completely unknown factor affecting the results (chemotherapy, HIV medications… solar flares?)

The doctors involved in this treatment are very quick to point out that this is not a “cure”. Due to the nature of the disease, therapies of this kind must first eradicate most of the patient’s immune system before new stem cells can be introduced. This can kill about one in three patients. Just as important, while the HIV count of the patient has dropped to zero, this does not mean that he is HIV free. The virus could be hibernating in immune cells, brain cells, etc. While the chances of passing on the virus are lower with a zero count, it isn’t impossible. I think we can safely say that this therapy is a promising sign of how the virus can be put into full regression…not cured.

And stem cells may not actually be the most exciting part of this case. The CCR5 gene variant mutation may be a key to a new and very powerful form of HIV treatment. Further research into CCR5 could give scientists the tools to develop a gene therapy or protein manipulation that could mimic the HIV resistance. In combination with promising new vaccines, and the cocktails of HIV meds already available, CCR5 could be the nail in the coffin for HIV/AIDS.

Knowing all these qualifications and complexities, I’m still really excited by these results. Even if stem cells aren’t the cure for HIV/AIDS, they continue to impress me as an insanely versatile and effective route of treatment. Undoubtedly there are many years of research and clinical trials ahead before we’ll know all the answers to the questions raised by the German study, but for now I’m just going to sit and be amazed by this case. This may not be the cure for HIV/AIDS, but we’re getting closer. I can feel it.

[image credit: Bret Newton (modified from original)]

Sorry guys, no secrets to aging yet. Don't buy the hype.

Recent work in Newcastle, UK and at the University of Ulm, Germany has been toted as discovering the “secrets to aging” but is really just another small step in understanding why our bodies wear down. The research was published in the journal Molecular Systems Biology, picked up by the Telegraph and then redistributed by the usual lot of copy and paste news feeds. Using human cells, mouse cells and computer simulations, the British-German team explored the mechanism that produces cell senescence – the state in which a cell stops dividing and eventually dies. They found a certain protein pathway was responsible for cells with damaged DNA becoming senescent. That’s a cool bit of science, but it’s not the “secret to aging” and its lightyears from a cure for aging. Unfortunately, journalists can’t sell “scientists take another steady step in large complex problem that may not be solved for decades”, so we’re left with an over-hyped, misunderstood development. Which is a shame, because the Newcastle-Ulm group actually made some interesting discoveries.

Just look at some of these hyped up headlines from the past 24 hours:

• Telegraph – British scientists discover ’secret to ageing’ bringing new hope to old-age sufferers
• Financial Times – Scientists discover the secret of ageing
• Top News – British Researchers Find Secret To Ageing
• SpiceZee – Coming soon: Elixir of youth

It’s not that these outlets get the facts completely wrong. They’ll certainly tell you that British (and German) scientists have found a way to prevent cells senescence in certain cases.

What’s that mean for you though? At this point…not much. This is where the Telegraph and other news feeds venture into pure hype. Knowing a single factor in how cells stop replicating won’t prevent aging. Aging is more complex than that. And this research, while interesting, was not aimed at extending the life of an organism. No mice lived into advanced age, no humans got suddenly younger looking, there’s nothing here that would qualify for a MPrize.

We’ve seen steady progress in how we understand the mechanisms that cause cells to stop replicating themselves. The most recent Nobel Prize in Medicine was awarded for a suite of research cases that helped define the importance of the tips of chromosomes called telomeres. These “shoe-lace” tips to our DNA help the strands of code replicate. Some believe that the shortening of telomeres over time could be a cause for cell senescence and human aging.

The recent work in Newcastle, however, underplays the importance of telomeres in favor of free radicals. Properly known as reactive oxygen species (ROS), these chemicals are released by mitochondria in cells after DNA is damaged. The British-German team explored how DNA damage response (DDR) and ROS levels created a positive feedback loop. By irradiating cells, they could induce DDR that lead to cell senescence. Scientists found, however, that this path to cell death could be prevented by manipulating proteins important in the DDR-ROS loop.

That’s a pretty important discovery. Finding those protein pathways and manipulating them is sort of like finding the phone line you can call to prevent an execution. Yet there are limits to using the DDR-ROS loop to prevent senescence. After irradiating the cells, scientists could wait a few days before blocking protein pathways and still keep these cells from fully shutting down. After 9 days, however, the path to senescence seems pretty inescapable. So, once DNA is damaged, there’s only so long you have to act before cells will permanently shut down.

We need to focus on what the research actually provides. Exploring the DDR-ROS loop does give us some new insight into how cell senescence could be stopped in some cases. Yet senescence isn’t a horrible thing. It helps prevent cancer by keeping damaged cells from replicating with mutated DNA. So really, the research explored a process that we may wish to one day selectively apply to some of our cells. It’s many years from becoming another close to a treatment, but it does highlight where in our cell chemistry a treatment may be be applied. In short, it’s a cool development in science, and something really interesting to read about. As long as you don’t expect it to turn you grandmother into a tween overnight.

[image credit: Psychology Today]

Heywood's website, Patients Like Me, uses analysis to find insight into healthcare for those with debilitating illnesses.

Jamie Heywood is out to convince you that the most powerful tool in medicine is information. He is the head of Patients Like Me, an online community of more than 45,000 patients with serious illnesses who track their experiences over time. Of all the presentations at TEDMED I’ve seen so far, Heywood’s is perhaps the most touching and personal. On a quest to save his brother from ALS, he created a system that could harness the collective knowledge of patients into a useful tool for guiding their treatment. His brother died, but now those with ALS, HIV, MS, and many other long term debilitating illnesses can compare their symptoms and healthcare choices with a larger community of patients. The same sort of analysis that we’ve been using with stocks and economic models is applied to medical records, and the result is an amazing array of predictive tools that could change the way we view healthcare. Check out Heywood’s presentation below. Many thanks to TEDMED for making these videos available online.

If you don’t have 17 minutes to watch the entire talk, here is an outline I’ve put together which can help you find the parts you’ll find most enlightening:

0:24 – Heywood begins his talk and tells the story of his brother Steven who was diagnosed with and died from ALS.
2:08 – Steven’s status (emotional, physical, etc) was recorded over time and converted into data.
3:50 – The idea of converting stories and status into computable information gave birth to the online community Patients Like Me (PLM)
5:00 – PLM lets people on prescription drugs share side effects, successes, and failures on an open network that anyone can access.
6:20 – Looking at a specific profile on PLM let’s you see how that patient fits into the wider statistical dataset. The result is stunning analysis and integrated data comparison.
7:40 – Heywood shows how PLM can take a word cloud of Steven’s data and place it into a comparison chart that gives insight into how prescriptions, lifestyles, etc may influence symptoms.
9:00 – Patients and doctors alike can use a PLM fact sheet, complete with graphs, to help make informed decisions on treatments.
10:05 – A paper published relating the use of lithium to improvements in ALS patients lead some PLM members to take the drug as a possible treatment for their condition.
11:30 – For the next several minutes, Heywood steps us through the analysis of what this non-clinical trial of lithium meant for the patients who tried it. By comparing patients with well matched datasets, you could see that the lithium didn’t lead to improvement. Heywood predicted the failure of lithium to treat ALS one year ahead of the FDA clinical trial which came to the same conclusion!
15:05 – Heywood ends his talk by looking at a stem cell treatment his brother received. Using current analysis on PLM, he can see that the trial was unlikely to work. If he had known that then, he could have saved he and his brother millions. That same tool can help save others now.

Heywood isn’t the only advocate of patient enabled data analysis.  Curetogether.com offers a similar service that has been expanding and improving in recent months.  The recent Health 2.0 conference took this issue as its central focus.  These innovators are finding that collecting and sharing data in a reliable way is an immensely powerful tool for maintaining your health. With the growing availability of continuous body monitoring systems, the available data is increasing and so must our analysis. I love Heywood’s idea of leveraging the analytical might of the financial industry for the medical field. The more we know, and the better we know it, the smarter the decisions we can make. And when it comes to medicine, living smarter means living longer and healthier.

[screen capture and video credit TEDMED]

Those looking to better understand and treat Autism Spectrum Disorders (ASD) now have a powerful new weapon in their fight. The US National Institute of Health (NIH) has developed the National Database for Autism Research (NDAR) a portal into multiple databases of ASD related information. NDAR provides qualified researchers a place to submit their data, and allows scientists access to this data in order to perform studies. The result is a growing site of indexed information that can track a patient’s results from different studies at different times. NDAR is the ultimate tool for those looking to further the fight against ASD. As it develops, it could provide incalculable insight into the disorder, and lead us to better understand its causes and its treatments.

What makes NDAR so promising is the scope of its data. The NDAR Central Repository was formed from the NIH’s Autism Centers for Excellence. Along with that repository, the NDAR portal provides access to several other stores of important ASD information: The Autism Genetic Research Exchange has data on 1000+ families with ASD members. 30,000 individuals are tracked in the Interactive Autism Network. 3000 records on ASD patietns are kept in the National Institute for Menal Health’s Genetics Repository. NIMH’s Transcriptional Atlas for Human Brain Disorders provides additional analysis and insight into ASD. The Pediatric MRI Data Repository has information on more than 500 normally developing children and youths. In total we are talking about many tens of thousands of records covering genetic, phenotypic, imaging, clinical, and pedigree data relevant to ASD.

Better still, NDAR has instituted several standards for data exchange and submission. The most important is the Global Unique Identifier (GUID). The GUID correlates each patient with a unique identifier code. Not only does this protect the privacy of patients, it allows indexing between studies. If an individual (or family) was part of one study for the NIH, and another for the NIMH, now their information is grouped as belonging together. This maximizes the benefit scientists can gain from the NDAR portal by allowing researchers to compare these studies in direct and meaningful ways. GUID based studies (meta-studies of the research performed by others) are really going to help squeeze all the meaningful information out of these separate databases.

Unfortunately, NDAR is not quite ready for full access. While the Central Repository is available now, the partnered databases are slowly being rolled out. The Pediatric MRI Data Repository will become linked sometime in spring 2010, and the rest will follow on an unspecified schedule.

The possible importance of NDAR is incredible. Scientists will be able to freely add and review a huge cross referenced database of information pertinent to ASD. Instead of being limited to just a few hundred patients, they now have effective access to the data of tens of thousands. That’s a big deal. NDAR’s data submission process will help keep that database full of only rigorously tested informaiton and the Data Access Committee will ensure it is only available to those with legitimate research credentials. It’s the best kind of system.

And it could really help. Take for instance, the case of Dr. Andrew Wakefield in the UK. In 1998 he published a paper in The Lancet (a very prestigious journal) that more or less linked increased occurrences of Autism to vaccines. This lead to a huge dip in British children receiving the Measles vaccine due to parental concern, and measles has rebounded in that country. The paper was eventually shown to be in error, but only after a long struggle. After 12 years of steady petitioning from concerned scientists, pressure from the BMJ (another journal), and the recantation of 13 of Wakefield’s fellow authors, The Lancet finally denounced the paper. Wakefield and two authors who continue to support the paper were recently stripped of their license to practice medicine in the UK. A linked database of ASD information could have more easily revealed the errors in Wakefield’s work and kept his paper from causing such terrible consequences.

Bioinformatics is going to be the key to unlocking the potential of the vast global network of medical research. Along with Biobanks and other repositories of samples, databases like NDAR will allow scientists unparalleled opportunities for performing new and insightful studies. We’re going to see better faster research for ASD, and for other disorders that develop similar portals. The future of medicine is going to be filled with vast stores of data as individuals and doctors take advantage of noninvasive and continuous health monitoring systems. Sorting that data, and analyzing it, will be a major endeavor for the 21st century that could drastically improve our healthcare. In the meantime, I have high hopes for NDAR as it completes its launch this year and continues to grow in the future. Who knows, maybe the data that finally helps us conquer ASD is already there, waiting to be discovered.

[image credit: NIH NDAR]

Toshiba's pregnant, and guess what, it's a tablet!

From the iPad to the Slate, 2010 is the Year of the Tiger Tablet, and that’s even true in medicine. Toshiba Medical’s latest ultrasound machine is a convertible tablet that can either be controlled via traditional knobs and dials or through a 15 inch touchscreen. The Viamo hosts much of the same functionality as TM’s larger ultrasound devices including embedded image processing (pulse subtraction, etc) and programmable routines and settings. It even comes with a mobile stand for those times when you need both your hands free. When you’re done with your scan, you can just pick up the Viamo and take it with you. In short, Toshiba has taken the kind of versatility and mobility we’ve come to expect from tablet platforms and placed it in the hands of a doctor. Awesome.

The Viamo originally debuted at the European Congress of Radiology (ECR) last year and is now reaching for major sales. I’m not sure how it will stack up against traditional ultrasound machines, but considering its capabilities, you’ve got to expect hospitals and doctors will want the smaller more portable device. Not that the Viamo is the smallest ultrasound we’ve seen, GE has a handheld model it debuted at the end of last year. Viamo, however, has a large screen with full color – essentially what practitioners work with now. Still, no matter if the medical industry goes towards the tablet or mobile phone model for its ultrasounds, it’s definitely going to shrink the size of these machines. Automatic defibrillators are also getting smaller. One wonders how long it will take to get all of these standard medical devices into the same all-in-one kit the size of a laptop. A hundred years ago, doctors would carry all they needed in a single bag. We could be there again very soon.

The Viamo folds to form a touchscreen tablet, or unfolds for a laptop look. The stand is optional in either configuration

Here's a better view of the Viamo as a laptop.

[image credits: Toshiba Medical]

Davenhall advocated including place history in electronic medical records at TEDMED.

Bill Davenhall gave a brief but enlightening presentation about the importance of geo-medicine at the most recent TEDMED conference. We know that your health can largely be predicted by looking at your genetics, lifestyle, and environment, but doctors almost completely ignore the last in favor of the first two. Davenhall is the head of ESRI, one of the leading producers of geographic information systems (GIS), and he believes that place history should be an important part of your electronic medical records. His talk was one of Alexandra Carmichael’s Top 10 for TEDMED 2009, and I was equally impressed with it. The presentation is now available to watch online. Check it out below.

You should really watch all ten minutes of Davenhall’s talk, but if you’re pressed for time, here are the highlights:

0:30 – Talk begins and Davenhall discusses his 2001 heart attack.
1:48 – Personal physicians ask you for a lot of information, but never seem to inquire about where you’ve lived.
3:00 – Davenhall walks you through his geographic journey. His 19 years in Pennsylvania, 25 years in Kentucky, and 12 years in Los Angeles were exposing him to known environmental health risks.
5:00 – There are many maps available that show how medical conditions correlate to geography. Turns out that Davenhall’s place history was setting him up for a heart attack.
5:50 – Davenhall had a colleague use a mobile phone to track their location continuously over two years. That person’s love of skiing was exposing them to toxic release sites that were well mapped by the US Environmental Protection Agency.
6:40 – It it’s relatively easy to keep track of your ongoing place history on a smart phone.
7:20 – The presentation offers two prescriptions for improving our health using geography: 1) teach doctors about geo-medicine 2) include place history in electronic medical records.
8:17 – These prescriptions will allow us to make informed decisions about where to live based on our medical history.

Davenhall’s talk highlights how improvements in health won’t just come from technology that heals our bodies, it will come from technology that allows us to better manage medical information. Geo-medicine is essentially a means to better access risk by keeping track of the environmental factors to which you’ve been exposed. We spend a lot of time focusing on genetics and lifestyle on the Hub, so it’s nice to have the reminder about the third leg of that risky stool. Take the cue and explore your place history on ESRI’s free geo-medicine information page. It’s very limited, but it’s a nice start. Turns out my heart and toxic release risks are a lot higher than I thought. Good to know.

[screen capture and image credit: TEDMED]

Work at Harvard University will allow scientists to observe the entire lifespan of worms. Humans could be in the far future.

The lessons of a lifetime are powerful, even if that life belongs to a worm. Harvard scientists have developed a microfluidics system so that they can observe the entire lifespan of minute water born animals . These researchers hope their observation will provide important insight into the effects of aging, and diseases like Parkinson’s and Alzheimer’s. According to a paper published on RSC, the microfluidics system allows the Caenorhabditis elegans worms to move as normal without leaving the field of view of cameras and microscopes. Their microfludic cells are sort of the worm equivalent of virtual reality treadmills. Food (in the form of bacteria) comes in, waste is removed, and the worm can swim around. There’s even a special suction system (developed by other teams) to temporarily secure the C. elegans and facilitate close observation or laser microsurgery. The microfluidics system has many different chambers so that a large number of worms can be observed while still tracking the individual identity of each one. In short, Harvard’s created a means to completely observe the entire life of an animal, and it may lead to some remarkable insights in biology.

The Harvard work is touted as medical. Observations of minute changes in swimming activity, body size, and other signs of health will allow researchers to understand how aging affects not only body chemistry but also activity. That sort of understanding could direct studies on mice, primates, right up to humans. Researchers believe that learning from worms is an important step in learning about human aging and nerve disorders. We’ve seen similar connections drawn between experiments with worms and conclusions in humans for substances like resveratrol. They are probably more tenuous than researchers would care to believe.

I think the greater implication of the Harvard work is that these scientists have created one of the first full life-logging systems for a statistically large number of animals all at once (about 16). Imagine the same in humans, you could observe an entire office; the complete life of each inhabitant. That’s a far way off for now, but if microfluidics is the answer for worms, there could be similar answers for higher order organisms. Remember that these worms are moving their bodies freely (swimming in different directions) without leaving their chambers. It really is like a VR environment for them.

Of course, humans are familiar with the life-logging concept, though it has yet to reach the level of observation we’ve seen for animals in laboratory settings. We are moving into an age of constant social networking, flickr, and YouTube. The upcoming generation may be some of the first who’s life has more recorded moments than not. That’s going to lead to a huge amount of data about how humans age. Until that time, we can learn similar information about lower animals but in a much shorter time span.  The Harvard microfluidics system, and the work with C. elegans, gives some truly unique insight into the life of animals start to finish. Pretty cool stuff.

[photo credit: RSC]

The HRS-I will monitor your health and wirelessly transmit vital signs to a mobile phone or computer.

If capturing every moment of your life on camera isn’t enough to satisfy your recording needs then you should take a long deep look inside yourself. And then record that. According to Nikkei, Japanese venture firm WIN Human Recorder Ltd is set to bring a health monitor patch to market that is capable of keeping tabs on all your vitals. The HRS-I is a small (30mm x 30mm x 5mm) lightweight (7g) device that adheres to your chest and relays the data it collects to a computer or mobile phone via wireless connection. While the HRS-I only directly monitors electrocardiograph information, body surface temperature, and movement (via accelerometers), it can connect to sensors for heart rate, brain waves, respiration and many other important health indicators. WIN is selling the HRS-I for around ¥30,000 (~$330) and providing monitoring software for around ¥10,000 (~$110). The company hopes for ¥1 billion in sales in the first year, and ¥5 billion in three years, presumably by marketing the device to the ever growing healthcare sector.

Originally developed at the University of Tokyo’s Advanced Institute of Wearable Environmental Information Networks, the HRS-I bares a remarkable similarity to Toumaz Technology’s Digital Plaster. Both are low cost wearable devices that provide some direct monitoring and serve as a hub for further sensor data. They both use wireless connections to relay data, last for a few days on a single charge, and they both are aimed at remotely monitoring patients in hospitals, nursing facilities, and homes. Having talked with Keith Errey of Toumaz, however, I believe Digital Plaster is going to be less expensive and will be marketed as a disposable item. Also, I’m uncertain if Toumaz would adopt a monthly payment system for their support software. There are undoubtedly more distinctions that will become readily apparent as Digital Plaster moves from clinical trial to market in the next year or so.

The HRS-I will come in three distinct appearances. So I guess we can choose the best health monitor to complete our ensemble? That's a little silly perhaps. Although I do have a tie that matches the one in the middle...

You can’t really establish a trend with just two data points, but I’m inclined to think that the appearances of Digital Plaster and the HRS-I are good proof that the wearable health monitor is going to be a staple of hospital stays in the future. The more information doctors have at their disposal the better decisions they can make. When paired with software designed to help doctors take advantage of bioinformatics the wireless health monitor could become a key ingredient in revolutionizing (and digitizing) health care. I’m certainly looking forward to an upgrade to Medicine 2.0…but not to the affect it may have on Facebook Status updates:

“Aaron Saenz is showing irregular brain wave activity.” [Comment * Like * Share]

Eh, it’s complicated.

[image credits: WIN Human Recorder Ltd via NIKKEI]

David Blaine's record for holding his breath is almost as long as the talk he gave at TEDMED. Coincidence...or magic?

I’m a big TEDMED fan, so it seems like magic that the videos of the latest conference are starting to go live on their website for free. The first video available was also a little magical, it’s the presentation by David Blaine about his attempt to beat the record for holding one’s breath underwater. Now, considering the serious and groundbreaking nature of most of the TEDMED presentations, I was a little disappointed that the first video available wasn’t from a major scientific mind. Still, after watching all twenty minutes of Blaine’s talk I was really impressed with the scale of his attempt. Officially, I’m still skeptical whether or not he really did what he said or if it was an illusion. Judge for yourself by watching the full presentation after the break.

If you don’t have 20 minutes, here are some highlights followed by the video:
4:54 – Blaine discusses several possible ways to perform an illusion instead of really holding his breath. Includes a very graphic image of a re-breathing apparatus.
9:10 – Blaine claims that he dropped his heart rate to 38 bpm.
10:30 – His attempt and failure at Lincoln Center.
12:10 – Using a low-oxygen tent to raise blood cell count.
13:40 – Using magic tricks to get the attention of the New York Times and reputable Science Times coverage.
15:30 – Blaine claims that he can get his heart rate to 12 bpm while holding his breath.
16:45 – Descriptions of the effects of holding one’s breath for more than ten minutes.
19:30 – Facing skepticism at the Apple Store.

Again, I’m not sure Blaine actually held his breath for that long (I’ve watched too much of Magic’s Biggest Secrets Finally Revealed) but I am sure that TEDMED is a great forum for all sorts of advancements in medical technology. Sure this video is about entertainment (and maybe personal triumph) but that’s probably just to get people to come to the YouTube channel. Once TEDMED hooks you with the fun talks, you’ll stick around for the enlightening ones. I can’t wait to see what other videos will be coming out next.

[screen capture and video credit: TEDMED]