Hughesair (Inflection Point)

University of Kansas Hospital Dana Hawkinson, head of infectious disease sounded the alarm -- on Valentine's Day -- for a 100% increase in the incidence of Syphilis appearing in all age groups from teenagers to seniors. What is more alarming, Hawkinson claims that these cases are antibiotic resistant. Nothing that I know of could be more frightening. The world including the medical profession has forgotten the world wide epidemic of syphilis, the mortality and the  suffering it caused, nor do we remember the high degree of infectiousness of that little spirochete. It did not jump off the drinking fountain to infect you, but putting your mouth on the faucet got you. Syphilis was the reason for those thin paper toilet seat protectors you always wondered about. Naples 1494 French and Spanish alternately occupied Naples. Some Spanish sailers who sailed with Columbus had picked up a strange disease in the Indies. With irresistible tales to tell of their voyage...

Everybody wants to hang a stethoscope around their neck and pretend to be a doctor.  When I see a stethoscope around the neck, I think he or she pretends. My Dad use to say, "That man knows that he knows, and he knows  not, and he knows not that he knows not." A physician in those times would not be caught dead with a stethoscope around his neck. --- Ostentatious in the extreme and it remains so today. Two thousand four hundred and fifty years ago Hippocrates wrote that the science be limited to those worthy of of the privilege -- no small matter.

Apothecaries want to maintain the sponsored monopoly on dispensing over priced drugs, and the medical profession goes along with it as a convenience and to avoid an element of liability and distrust. However, in rural areas where there is no pharmacy, the trusted family physician might still engage in direct dispensing from his office. One might argue that doing so greatly reduces cost and eliminates one more level of communication wherein errors might occur. It certainly reduces red tape. My Dad did this in his early years of practice. He once told me that he dispensed medications in a bottle -- asking the patient to bring in a urine specimen in a week for follow up. "That way I get my bottle back."

My Dad was a physician from the old school. After graduation from U of Illinois’ Med school in Chicago, he did graduate work in microbiology for the meat packing industry and delivered babies in Cicero. He told many stories and I saw some of it firsthand. I followed him around on house calls and hospital rounds, waiting in the car of course from the time I was 4 or 5 years old. The second hand cigar smoke was great and so were the stories. One such tale involved a class mate of his who went into practice in a small town in Texas. Obesity was a problem as it is today and this young doctor had a solution. In secret he cut segments of the readily available beef tape worm and placed them in capsules dispensing them to his obese patients. (Emphatically not recommended) This was highly effective and when the patient became skinny enough he purged them with pumpkin seeds. It was not long, however, before the locals caught on. An outraged citizenry took matters into their own hands; they ta...

Cell 150, 1223-1234, 2012 Domenico Accili at Columbia studying mouse Foxo1 gene discovered that pancreatic Islet β cells do not die in type-two diabetes (T2D) but revert back to endocrine progenitor cells that are unable to make insulin. This opens the possibility of treating T2D by turning these dormant cells back to normal. Once more an exciting contribution from genomics.

Privatization of basic drug research takes the cost of academic grants out of the government’s budget and passes it through to the consumer along with industry profits, executive bonuses and marketing expenses. The greatest cost burden then falls to the middle class considering that the poor simply do without and land in the emergency room. Adding prescription insurance merely adds another industry’s profits, bonuses and marketing expense onto the already over burdened consumer.

I hope someone has ordered an MRI. This kind of sudden personality change, whether alcohol was involved or not, and with some retrograde amnesia, screams brain tumor. A parietal lobe seizure might account for the actions triggered by such a tumor. In Afghanistan parasites would not be completely out of the question. Remember the sniper on the U of Texas campus? The sniper was found to have a brain tumor -- presumably contributing to the behavior.

The current challenge for the medical profession seems no different than what Hippocrates faced 4,540 years ago when he proposed the scientific method for health care as opposed to the mythology, rituals and disingenuous quacks of the day. When Rick Santorum suggests that we should stop funding anti-natal care because it might lead to abortion, one wonders if there can be any political solution to our current medical care problems much less complete disaster. We already score a third world ranking by infant mortality, perinatal mortality or longevity. Can any polarized political mythology possibly make it better?

A draft genome of Yersinia pestis from victims of the Black Death maps the genome from the plague of 1347-8. Researchers obtained DNA from the teeth of plague victims buried in a mass grave in East Smithfield, (originally the Churchyard of the Holly Trinity) near the Tower of London. Alexander Yersin linked Y. pestis to bubonic plague in 1894. However, controversy and doubt exist over the identity of the plague organism in part because today’s plague does not match the virulence of the Black Death that ravaged Europe in the 1300s. The sequencing by an improved technique (molecular capture assay) apparently establishes that the organism of the Black Death is the same as today’s plague with minor differences. The bubonic plague existed in Asia with appearances in the Middle East and the Justinian plague in Rome and Constantinople in 541-542. Hippocrates describes a plague in Athens in 430-426 BC. Sanskrit tablets describe plague in Asia as early as 600 BC. Jewish physicians even asso...

Book Review John Wennberg's book, Tracking Medicine, a researcher's quest to understand health care, challenges anyone interested in health information technology or the Affordable Health Care Act to a `must read.` Wenneberg spent 40 years applying statistical analysis to the care given in various U.S. locations. Wennberg discovered an extreme variation in the manner and quantity of medical services rendered. He applied the science of epidemiology and statistics to understand these differences. What he found was a fundamental contradiction in the patterns of medical practice. These contradictions surprise and shock the medical establishment and others who believed that for healthcare more is better. Patient satisfaction, outcome and longevity -- even in some teaching centers - proved inversely related to the intensity of medical, surgical and hospital services. Furthermore, Wennberg found that the greater the capacity of the facility and number of specialists per capita, the...

How will cloud computing accommodate confidentiality and permissions to use the data for data mining? Assuming it can, the thing most needed is a linked database containing a complete and continuously updated list of every disease and syndrome known to man. Thus any provisional diagnosis or problem could in real time list every related entity (differential diagnosis) meeting the same of similar basic criteria. The inaccuracy of initial diagnosis remains an ongoing problem in US medicine, 15-17% missed or wrong diagnosis by current studies. A statistically derived differential diagnosis would go a long way towards inducing the clinician to look for possible error or deeper consideration. 

Share | Who was the genius who decided to close the AFIP as an "obscure little agency" with no current military relevance?  Nature 476 , 270-272 (2011) Announced in 2005 as part of an armed forces budget cut, AFIP will close its doors 15 September. The AFIP budget was only 93 million, yet its value to clinical medicine world wide was and is beyond calculation. AFIP would be nearing its 150th anniversary, founded by General Wm. Hammond in 1862. AFIP with pathology specimens including: 55 million slides, 31 million paraffin blocks and 500,000 wet specimens and some 800 expert employees with the most advanced equipment for the analysis and identification of submitted tissue; acted as a backup and final arbitrator of difficult medical diagnosis. AFIP received more than 50,000 requests for second opinion each year, making changes or additions to over half of these. The diagnostic capabilities were greater than even the teaching hospitals, and the AFIP was recogni...

Clinical Decision Support (CDS), a Lawyer’s View Michael Greenberg and Susan Ridgely, two lawyers from Rand Health publish in this week’s JAMA, Clinical Decision Support and Malpractice Risk. The plaintiff attorneys have it both ways. If the CDS suggests too many potential drug interactions for a new prescription and the physician ignores the lessor risks, he or she exposes himself or herself to a potential lawsuit. If on the other hand the software vender limits the number of risks on whatever basis the vendor too assumes greater risk. If the clinician withholds the medicine based on minimal risk of drug interaction, and the patient suffers, who knows, this too may be a potential tort. The article goes on to suggest that an expert consensus further endorsed by the Office of the National Coordinator (ONC), Medicare and Medicaid, may provide a safe harbor for CDS. My interest in CDS involves diagnosis rather than treatment and there may be a risk to the differential diagnosis as...

Given that American medicine now ranks at some 35th or 36th in longevity and infant mortality, and at best 15% of diagnoses are wrong, some form of clinical diagnostic decision support seems warranted. Autopsy went out of fashion for many reasons. It was once the final arbitrator of quality medicine and arguably lead to both modern scientific medicine and the high quality of our medical schools. Electronic records offer some hope of restoring a measure of that quality support. Within the electronic patient record, a differential diagnostic listing covering all of the possibilities might give the patient greater assurance that: over confidence, snap diagnosis or more conveniently reimbursable diagnosis, will not lead to some unfortunate outcome. With a sufficient differential diagnostic listing, the physician will likely consider the person’s true condition, even the rare ones. Problem oriented charting went a long way to meet the need for considering all of the patient’s problems....

The ongoing revolution in medical science, molecular biology, may in time give way to a yet smaller and far more complex scale of quantum biology. Coherence, entanglement and "spooky behavior at a distance" may once again re-define medical science. Even now, evidence of quantum physics emerges in plant photosynthesis and the shore-birds ability to navigate by the Earth's magnetic field. Did you ever wonder how the Golden Plover Chicks can navigate from Alaska to Fiji alone long-after their parents make the journey. The Fijian language expresses foolishness by the phrase, "looking for the eggs of the Golden Plover." Such foolishness might evolve an undreamed of future.

Book Review John Wennberg’s book, Tracking Medicine, a researcher’s quest to understand health care, challenges anyone interested in health information technology or the Affordable Health Care Act to a `must read.` Wenneberg spent 40 years applying statistical analysis to the care given in various U.S. locations. Wennberg discovered an extreme variation in the manner and quantity of medical services rendered. He applied the science of epidemiology and statistics to understand these differences. What he found was a fundamental contradiction in the patterns of medical practice. These contradictions surprise and shock the medical establishment and others who believed that for healthcare more is better. Patient satisfaction, outcome and longevity -- even in some teaching centers – proved inversely related to the intensity of medical, surgical and hospital services. Furthermore, Wennberg found that the greater the capacity of the facility and number of specialists per capita, the great...

In 2005, Nico Schlaefer, a grad student at Carnegie Mellon University, built a statistical query system and wrote a thesis he called Statistical Thought Expansion later named Ephyra. IBM was impressed. Nico worked three summers on Watson. He is now a PhD candidate at CM and an IBM PhD Fellow. In the Tourette syndrome example given below, Watson was unable to answer until they included more of the symptoms and signs in the database. Q & A as done with Watson seems analogues to Clinical Data & Differential Diagnosis. To make Watsons job easier, enter clinical data in a relational database in simple consistent terms. Likewise, list the sum total of medical diagnostic information in the same simple consistent terms. The relational database can correlate and list the match ups as diagnostic possibilities. A statistical program -- and here is where Watson comes in -- can list the probility of each. Furthermore, a statistical program can conduct an ongoing adjustment to the probable...

Julia Kubanek a chemical ecologist at the Georgia Institute of Technology identified a seaweed, a red alga, Callophycus Serratus, in the oceans around Fiji that prevents the Malaria parasite from living and reproducing inside of red blood cells. Maybe that's why Malaria is not a problem in the Fiji Islands. I thought it was the Kava. http://news.sciencemag.org/sciencenow/2011/02/seaweed-a-source-of-potential.html?ref=hp

Eric Green, director of the National Human Genomic Research Institute writes in Nature, “Charting a course for genetic medicine from base pairs to bedside.” This research perspective comes about as close to must reading as anything in the medical literature. Not much happened in the ten years since the completion of the human genome to improve health care, but significant advances in understanding the complexities and cataloging the data, sets the stage for the next ten years during which genetic information will contribute hugely to the health care of our Nation. As a participant, I have been away from medicine. When I sold the clinic, I came north to fly in the bush. The closest I came to medicine was the evacuation by floatplane of a fisherman with a gaff hook through his hand from a cove north of Kodiak Island. Away from medicine, however, I had time to think about the problems. I don’t think they have solved them yet, but I am fascinated by the potential for the electronic heal...

Last week at the advances in Genome Biology and Technology meeting in Florida, Eric Schadt, CSO of Pacific Biosciences in Menlo Park touted a radically new procedure for sequencing. A much faster process, last week Schadt and his team traced the source of the Cholera in Haiti, sequencing five strains of cholera in less than an hour. It would have previously taken a week or more. Uniquely, the Pacific Bioscience machine sequences single molecules of DNA by adding fluorescent labelled bases that flash a defining color as they are added to the DNA strand.1 This technique eliminates averaging and amplification. The company projects a human genome in fifteen minutes by 2013. However, limitations of high cost, lower accuracy, 85%, and the number of sequences that they can read per run all require further evolution. The genome and molecular biology in general will add vast amounts of raw data to the patient medical record. The implications of this vast database will be largely unknown. The...