By Anna
The news of the German farmer who has received the world’s first complete double arm transplant really makes me marvel at the wonders of modern medicine. See the whole story here.
Here’s a guy who has been living without arms for the past 6 years. Now he’s suddenly been given someone else’s arms. Surely, the transplant will feel quite alien to start with? Nonetheless, the patient, Karl Merk, is reported to be over the moon and a little overwhelmed, even after the initial two months following his operation. But will he still feel the same further down the line?
Doctors are saying that he’s already able to turn lights on and off as well as open doors; his ultimate goals are to eat and dress himself — and ride a motorcycle. However, doctor’s have stressed that it can take up to two years for him to be able to use his hands properly again and he’ll need to rely other people’s help and an intensive program of physiotherapy, electric stimulation and counselling.
It is amazing that with medical advances doctors are able to ‘reconnect’ the nerves and re-establish blood flow in an arm, face, hands, etc. What will they be able to do next?
There’s been a lot of talk in the last few years about the first face transplant, the first hand transplant, where the patient later had the hand removed as he just couldn’t get used to using someone else’s hand. There’s always going to be a risk of medical rejection, but surely emotional rejection also needs a place in any transplant story?
We are potentially wasting scarce resources by performing these kinds of transplants, which can later be rejected by the patient on emotional grounds. If we are to continue in this vein we need to ensure appropriate emotional support and counselling is given to the patient to help overcome any potential rejection.
October 10th, 2008
By Anna
The latest issue of Business Week (13th October 08, page 16) included the news that a Manchester-based private dentist, Lance Knight, has started practising in a local Sainsbury’s (one of the top three supermarket chains in the UK). The news was also covered by a number of UK national newspapers, including the Guardian a few weeks ago. According to Dr. Knight he will not be charging over the standard NHS rate, and yet one has to wonder if this is the right way to reach patients?
The UK has always suffered from a shortage of NHS dentists and while this seems a novel way to address at least the accessibility to good dental treatment, patients need to decide whether it is the right way for them. At the same time the NHS needs to find a way to address the shortage. This shortage, which is said to be due to the lack of encouragement for a career in dentistry, which is seen as the less attractive corner of working within the NHS. The time of NHS dentists is also regulated, which means that they often get to spend only very little time with their patients.
More and more dentists are taking the decision to only practice privately, often leaving those patients that cannot afford to go private out in the cold. While I agree that this needs to be addressed, I’m still unsure as to whether operating in your local supermarket aisle is the right way to go?
Additionally, there’s been a real trend in recent months for supermarkets to diversify, Tesco (Sainsbury’s biggest competitor) has branched out into pharmacies, opticians, insurance and so on. It looks like Sainsbury’s is now following that trend. So, I have to wonder, will I be able to have my appendix removed during my weekly shopping trip?
October 7th, 2008
By Cheri
DiagnosisPR recently caught up with Bertalan (Berci) Meskó, a last-year medical student, studying to become a clinical geneticist with a specialization in personalized genomics. While balancing his course work, he has also been recognized as a Medicine 2.0 expert with an award-winning blog, ScienceRoll. Berci was kind enough to provide us with some insight into how the medical community is adopting social media tools and how they are changing the profession.
1. Where do you feel the medical community is in the adoption curve of social media tools?
This year is really rich in new sites and communities focusing on the needs of medical professionals. Some weeks ago, I came up with a compilation of scientific and medical social media tools and it seems I have to update that list from time to time as the number is still growing. Though I’m not sure physicians need that many tools and are ready to join communities that are relatively new as they don’t have too much time in their practice so they need tools that can facilitate their work, for example, by reviewing the literature and finding the essential publications for them. Such a tool is Biowizard.com.
2. How do you see your acceptance of these tools blending with your daily activities post graduation?
I cannot imagine my post-graduate daily activities without the tools of web 2.0. With RSS feed, I can keep myself up-to-date in my field of interest (personalized genetics) easily. By reading blog carnivals (such as Gene Genie), I’m sure I’ll know about all the important news and announcements of genetics. As I use medical community sites (e.g. Tiromed.com), it’s quite easy to find residency places or international collaborators for my research projects. And many more examples prove, at least for me, the real power of web 2.0.
3. How do you see this changing the profession?
It is changing the profession. The reason why is not because web 2.0 is a bubble or so over-hyped, but because being more up-to-date than your colleagues, making more new contacts or being able to find collaborators more easily is a career advantage. And I must mention the role of e-patients who are really about to change healthcare and medicine. They have expectations (to communicate with their doctors on-line, to find information about their medical conditions on-line or find relevant information that can represent the practices of their doctors properly) physicians of the 21st century must meet.
4. It has been widely noted the discrepancies in how physicians are using email in interactions with patients. What are your views on this topic?
Using e-mail in physician-patient interaction can be a great communication channel. But it must be used wisely with a secure service. According to a recent study (E-mail Communication Between Physicians and Patients conducted by Mount Sinai Hospital), 50,49% of e-mails a physician (specialized in breast surgery) received were focusing on general information about breast cancer. That kind of information could be accessed through medically reliable, peer-reviewed websites. Moreover, doctors are often afraid of getting too many e-mails while this study pointed out that relatively few patients chose this way of communication although it was available to them. And last but not least, answers can be given in an organized fashion.
To sum it up, if a doctor uses a secure e-mail service and knows which reliable websites to offer to patients, e-mail can be a perfect tool that can save time and effort for both physicians and patients.
5. How do you (and other up-and-coming medical minds that are actively engaged in social media) prefer that people get in touch with you?
I receive many e-mails like that „Dear Sir, You should check this new service or product out and promote it. While I prefer getting letters like „Dear Berci, I know you’re writing about web 2.0’s role in medicine on your blog, ScienceRoll…” A few personal words can prove the writer of the e-mail spent some minutes with getting more information about that particular blogger. That means a lot to me. Maybe other bloggers have a totally different opinion.
6. Have you been taking part in any virtual learning experiences during your studies? How have these technologies progressed in the past few years?
I’ve been an organizer of several medical and scientific events for one and a half years now as the virtual world of Second Life provides medical educators and students with numerous educational opportunities. There are regular presentations about important medical issues; simulations and exercises organized weekly at the Ann Myers Medical Center; physicians and medical students can listen to cardiac murmurs and can visualize the proper stethoscope position on a virtual patient at the Heart Murmur Sim. On the Genomics Island, students get a comprehensive introduction to the education of medical genomics. On the island of Nature.com, scientific sessions are being organized for famous science bloggers and mentors.
Major organizations (Red Cross, CDC, NHS London) have already established their virtual presence in Second Life, and I’m sure, there are many more to come.
To learn more, visit DiagnosisPR’s sister blog RaceTalk, where Berci has answered some more questions about Medicine 2.0, healthcare communities in Web 2.0 and the medical education evolution community.
September 29th, 2008
by Cheri
This week I had the opportunity to do an email interview with Dr. Paul Castellanos, Associate Professor of Surgery, Division of Otolaryngology Head and Neck Surgery at
University of Alabama at Birmingham (UAB), about the use of social media, blogs and the internet in the medical field. Dr. Castellanos is certainly ahead of the curve in the field and has several Web sites (PDT Surgeon, Airway Surgeon) that detail some of the innovative procedures that he is working on including, percutaneous dilatational tracheostomy (PDT).
Here is my interview with him:
DiagnosisPR: How long have you been engaging in social media activities, including blogging? Do you participate in Twitter, Facebook or Sermo?
Dr. Paul Castellanos: I’ve been participating in social media for a couple of years and began these activities with my Web sites. Only recently have I developed my current Web sites. I do have a Facebook identity but only so I can keep up with my 15 year old who is addicted to it. Several of his friends have added me to their fiends list, much to his chagrin.
DiagnosisPR: How much time do you dedicate a day/week to these activities?
PC: This varies a lot. There are some months where I don’t spend any time with these activities not at all; other times I may spend the whole weekend updating or launching a new site.
DiagnosisPR: How has this changed your profession?
PC: Visiting one site on Tracheal Stenosis on Yahoo! has changed me professionally. It gave me an appreciation for the “lost in the woods” feeling that a lot of patients have who suffer from serious airway disease. It has also made me somewhat mad that there is so much misinformation out there (on the internet) and some pretty poor practitioners. There are also a lot of sufferers who become defacto clinicians and this is dangerous however well meant it is.
DiagnosisPR: How is it being adopted/received by your peers?
PC: So far, the few of my ENT (ed: ear nose and throat) colleagues who have seen my sites are supportive of working with social media. I’ve found that mostly non-ENT’s go to my sites to get information outside of their sphere.
Thank you again to Dr. Castellanos for taking the time to speak with DiagnosisPR.
September 17th, 2008
By Rachel
With the continuing criticism of NICE (National Institute for Clinical Excellence), it seems to me that we should be looking for new ways to address healthcare funding in the UK. This is particularly relevant as the population ages and increasingly expensive therapies are coming on to the market, such as the cancer drugs.
Perhaps we need to move on and engage the public in a new dialogue. A recent report entitled ‘Making the NHS the best insurance policy in the world’, issued by the UK think tank Reform, poses an interesting concept. The report calls for a National Health Protection System whereby healthcare systems would compete to insure patients. The aim is to create competition between private firms and primary care trusts, resulting in driving down costs and improving choice. Is this the debate we should be having rather than continuing the rage against NICE?
September 17th, 2008
By Rachel
The UK drug watchdog, NICE (National Institute for Clinical Excellence), was under fire again recently, this time from the Daily Mail (one of the UK’s most influential national newspapers). This time it’s not the guidance given on prescription drugs that are ‘too expensive’ for the NHS, but rather how much NICE spends on ‘spin’: “fury over drug watchdog’s £4.5m PR budget”. The article states that NICE spends £4.5m on ‘communications’ and £3.4m on assessing new medicines. However, a breakdown on what is included in the communications category is not divulged.
NICE is a hugely influential organisation. In 2006/7 it produced 21 technology appraisals, 50 interventional procedure reviews, 13 clinical guidelines and 2 sets of public health advice, all of which required extensive communication and collaboration with a large number of stakeholders, ranging from patients to healthcare professionals, public health experts and health economists. In addition to engaging stakeholders in the review processes, NICE reaches out to target audiences through a number of other communications channels to ensure there is a two-way dialogue between stakeholders and partner organisations.
It seems to me that the issue here is the balance of spend – as a public body, NICE cannot make recommendations without due consultation. It has a duty to communicate clearly and transparently with patient groups and healthcare professionals. This communication requirement cannot realistically be achieved on a shoestring budget, but neither should it be profligate in its spend.
September 12th, 2008
With marketing campaigns masquerading as clinical trials, how can we be certain of the safety of our treatments?
By Dana
You’ve heard this story before. Big Pharma, in a bid to stay relevant in an ever-changing landscape, sinks money and resources into a blockbuster clinical trial that appears to be on the up-and-up, but is really just a clever guise for a marketing campaign aimed at drumming up business and revenue for a drug that hasn’t been through the rigors of a traditional clinical review.
The August 19 edition of the New York Times caused eyebrows to raise at the so-called “rapid roll-out” and aggressive marketing campaigns surrounding cervical cancer vaccinations from Merck and Glaxo. Pundits fear the call-to-action messaging consumers are inundated with– in everything from movie previews to product placement on primetime TV– will mask the fact that people should proceed with caution until the impact of the drugs is better defined. As of now, we’ve got throngs of parents clambering to the family PCP to inoculate daughters who aren’t even sexually active—and we don’t even know the risks or long-term effects of the vaccines yet.
And if that weren’t bad enough, Merck also came under fire in the August 19 issue of the Annals of Internal Medicine for ADVANTAGE, a seeding trial centered on the hapless painkiller Vioxx. The group of physicians behind this exposé is scathing in its criticism of the trial, calling ADVANTAGE a “dishonest…corruption of science” and pointing out that the true aim of the study (selling drugs) is shrouded in formalities that make it appear legit. A disappointment, to be sure, for all the patients who participated and consequently doubled their risk of heart attack or stroke.
It’s clear that in the race to lobby for acceptance and drive growth, ethics are compromised, an all-too-common theme in the pharmaceutical industry. For an illustration into the magnitude of this problem, one need look no further than to the NYU study launched earlier this year that reported the U.S. pharmaceutical industry spends almost twice as much on product promotion as it does on R&D.
What effect will the marketing veil of big pharma have on the little guy? It’s simultaneously already vividly apparent and yet to be seen. In today’s world, we decree that transparency be maintained across all echelons of big business, and go so far as to destroy Wal-Mart for fleecing the American populace with a jocular blog. How could that same standard not translate to an industry so intimately connected to our quality of life?
August 21st, 2008
By Cheri
The WSJ recently published an article about the controversies surrounding the research for treatment of line sepsis. While two medical groups have already endorsed this therapy and many US hospitals have adopted it, questions are being raised about the thoroughness of the research. These concerns were amplified when the hospital that conducted the research turned out to be holding patents for a device critical to the therapy and one of the backing groups had financial support from the device manufacturer.
So the question is once again raised in the medical community about transparency. Several months ago flags were raised about ghost writing in peer-reviewed medical journals and before that studies that appeared in NEJM and JAMA fell under scrutiny as the studies were biased and inaccurately favorable to the funding company.
Is this tidal wave of negative publicity for the medical community the tip of the ice berg or has it just been an unfortunate summer for transparency in the community?
August 20th, 2008
By Jackie
A recent recommendation from the U.S. Preventative Services Task Force advised physicians to stop routine prostate cancer screening in men aged 75 and over, citing more evidence of harm than benefit for this age group. Essentially, the issue lies within the flawed PSA test, an infamously inaccurate blood test used to detect prostate cancer. This traditional approach to prostate cancer detection harbors an astoundingly high false positive rate of nearly 75%, leading to unnecessary biopsies that inherently generate significant anxiety for patients and often cause major side effects like impotence and incontinence. In addition, several studies have shown that most prostate tumors grow so slowly, they never actually seriously threaten lives within this age group. It’s no wonder the task force has asked physicians to eliminate PSAs for this age group – it’s a lot more than Grandpa bargained for at 75.
That said, one could argue, 75 is simply not what it used to be. Today’s 75-year-old man is vibrant and active, often enjoying a significantly longer life span than once ago. As such, is it fair to deny a 75-year-old man good care by ceasing prostate cancer detection methods that could potentially save his life? With the PSA’s infamously poor track record, perhaps the answer lies in new, innovative, effective detection methods. For instance, Ikonisys, a next-generation diagnostics company, is currently developing an early, more accurate screening test that identifies circulating tumor cells present in the blood. The sample is placed on a slide and analyzed by Ikonisys’ breakthrough, fully-automated, digital microscopy system which aims to detect “the one cell in a million” that matters. According to a recent article in the British Journal of Cancer, this method has proven to be the closest and most practical solution to prostate cancer detection yet. Innovations like this one show great promise with the potential to reshape the industry.
While we eagerly await these new technologies, I encourage today’s 75-year-old man to engage in discussions with your physician on the appropriate choices to best protect your individual health. In the meantime, continue embracing your youth and proving that 75 is the new 60!
August 6th, 2008
By Cheri
Several weeks ago a grievous medical error occurred at Beth Israel Deaconess Medical Center in Boston-the wrong side of a patient was operated on. The error has garnered national and local attention, bringing to light the failure to follow protocol in the operating room.
Instead of masking the event, the hospital sent a hospital wide email and the hospital’s CEO, Paul Levy, posted frequently on the subject on his blog. He even disclosed that the surgeon would not be punished for the error because he reported to his superiors and apologized to the patient. Levy believes that punishing the surgeon would discourage surgeons or doctors for stepping forward in the future when they’ve committed an error.
For me, it is disturbing to learn that the surgeon and the rest of the team involved in this procedure won’t be punished.
Certainly there should be full disclosure in the medical field but not at the expense of accountability. Perhaps I feel strongly as I have family members that are currently being cared for and the thought of them being injured by someone’s mistake is difficult to swallow.
But I’m interested in hearing your thoughts on the issue. How would you have handled this case if you were a hospital administrator?
July 21st, 2008
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