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Posts from the ‘Prevention’ Category

H1N1 vs Tuberculosis

My friend, Francisco Grajales III shared this great video with me. Hans Rosling has something very important to say about H1N1:

13 days H1N1 Tuberculosis (TB)
Death 31 63 066
News 253 442 6 501

Check his wonderful TED presentation out as well.

Grand Rounds 4.22: The Future of Medicine

It’s a great pleasure for me to host Grand Rounds again after almost a year. The idea of Nick Genes shines more than ever so I hope I can show you plenty of useful and valuable submissions from the medical blogosphere. So this time, the topic is the future of medicine which means I’ll feature some blogposts about genetics and web 2.0 as medicine might be centered around these two terms in the future. Enjoy it!

Editor’s Choice (Genetics or Web 2.0):

Karina S. Descartin at The story of healing talked about Jay Parkinson, the web-savvy doctor and use of media in medicine.

At Scienceroll, I had an interview with Jay Parkinson, or if you would like to know more about web 2.0 and medicine, check out my recently published slideshow.

Joshua Schwimmer at Tech Medicine featured the impact of Google Book Search on medical education. At Efficient, MD (one of his 4 blogs), you can also send him your productivity tips for being on call.

Y. S. at My MD Journey gave all medical students the opportunity to promote their blogs by taking an interview.

Hsien-Hsien Lei at Eye on DNA examined the genetic differences between identical twins.

Paul Levy at Running a Hospital thinks the future of medicine in the UK should utilize the opportunities Second Life provides.

Steven F. Palter at Docinthemachine weighs in with How Smartdust, Souveillance, Web 3.0, and Personalized Genetics Will Transform the Future of Medical Diagnostics.

Steve Murphy at The Gene Sherpa talked about the fear of genetic discrimination.

John Sharp at eHealth found a new way to promote patient safety – talk to your doctor.

Imre Kissík and András Székely at Tomography Blog promoted 10 great Web 2.0 tools for Diagnostic Imaging Professionals.

Hamza Emadeen M. at GooMedic introduced web 2.0 as a research tool for collaborative softwares.

Bob Coffield at Health Care Law Blog mentioned the Google Health project as Google Partnered with Cleveland Clinic.

The Digital Pathology Blog says computer programs may help physicians avoid diagnostic mistakes — so why aren’t more doctors using them?

Abel Pharmboy at Terra Sigillata blogged live about a vasectomy from his Palm Treo 700. More than interesting!

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Health and Healthcare:

David C. Harlow at HealthBlawg focused on preventing, reporting and not paying for hospital-acquired infections.

Sam Solomon at Canadian Medicine asked the question why the media mucks up health coverage? and presented “Canada’s Terry Schiavo” case.

David E. Williams at Health Business Blog is curious about how much we should expect from patients.

Louise at Colorado Health Insurance Insider wrote: “A list of eight preventable medical errors that result in extra medical charges will no longer be reimbursed by Medicare”.

According to Clinical Cases and Images, if you keep residents happy, it is better for patients.

Laurie Edwards at A Chronic Dose had a recent issue with her health insurance to explore preventative health and offer resources to think critically about the future of healthcare.

Michael C Hébert at Dr. Hébert’s Medical Gumbo pointed out the problem with Economics Stimulus Package is that, like taking antibiotics for a cold, it fails to properly address the problem.

Jan Gurley at Black Future Month stated that it’s a call for investing in a long-term, detailed cohort study of African Americans, like the Framingham study.

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Medical Stories and Cases:

ER nurse tells us what it is like to start the day two nurses short.

Bongi at Other things amanzi shared a monstrous story with us; two experiences he had, both of which he found disturbin.

Keith at Digital Doorway helps us how to talk to a patient who is scared to die.

Doctor Anonymous described his own flu and the Flu Epidemic as well.

Thomas Robey at Medscape told us his first experience losing a patient after an attempt at resuscitation. He had another post mentioning some personal experiences with drug reps he has had as a medical student.

Paul S. Auerbach at Medicine for the Outdoors posted the second story about his recent volunteer work in Guatemala.

MC at Neurophilosophy introduced the man who never forgets. Check out the trailer of a forthcoming documentary focusing on him called Unforgettable:

Medical Research and Information:

Amy Tenderich at Diabetes Mine had a great list about 10 little-known facts about your immune system.

How to Cope With Pain reviewed what we know about chronic itch, an interesting symptom.

David Rothman shared the Human Brain Atlas, a useful educational resource with us.

Walter Jessen at Highlight Health presented ScienceCures, a new website dedicated to today’s science, tomorrow’s cures.

Kerri Morrone at SixUntilMe had plenty to say about the MiniLink trial. That’s how an honest opinion can be valuable to the community.

Matthew Mintz at Dr. Mintz’ Blog had a comment on an article that appeared in the Washington Post about studies of treatments.

Henry Stern at InsureBlog informed us about Swedish scientists who discovered fast food and the lack of exercise are not healthy.

Clinical Cases and Images presents all the 3 “organ”-renal syndromes.

Exhaled nitric oxide (FeNO) could be a marker of bronchial inflammation? Check it out at Allergy Notes.

JC Jones at Healthline Connects says there is something we can all agree on – New Stem Cell Source.

The editors of LymeHealth.com talked about the Rife frequencies for treatment of Bartonella infection. Rife treatment is used by some Lyme disease patients who are coinfected with a species of Bartonella.

Medical research in a different way:

Other posts from the blogosphere: interesting surveys, interviews, speeches:

Vitum Medicinus, a Canadian medical student, shares a speech he gave to the families of his anatomy lab cadavers at a memorial service for body donors.

The bloggers at SharpBrains have come up with three interesting articles: Minding the Aging Brain and Maximize the Cognitive Value of Your Mental Workout and Self-Regulation and Barkley’s Theory of ADHD.

Barbara Kivowitz at In Sickness and In Health examines a strange question: Are Certain Illnesses More Likely to Lead to Divorce?

Kenneth F Trofatter at Fruit of the Womb addresses a query from a reader who wonders if abnormal sperm morphology, in the absence of other maternal or paternal indicators, might be associated with recurrent early pregnancy loss.

At Dailyinterview.net you can read more about Dr. Silly Reba (AKA Reba Strong) – Hospital Clown and Magician.

The Samurai Radiologist at Not Totally Rad gave us some tips on how to surprise your loved one: with a skull.

David Bradley at ScienceBase is curious whether our doctor inhales or not. “A survey of medical students in Brazil found that more than 80% use alcohol, while cannabis use is limited to about one in four, a quarter use solvents and just over 25% use tobacco.”

Christine at ButYouDontLookSick.com interviewed Nick Genes about Grand rounds and his medical career.

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That’s all for now. I always enjoy hosting Grand Rounds because I come across new blogs and make contact with great medical bloggers. Thank you, Nick Genes, for giving me the opportunity again. I hope to host a third one in 2009. The next edition will be hosted by ChronicBabe on the 4th of March.

Personalized Genetics: Dangers

When I decided some months ago to try to keep you up-to-date in the field of personalized genetics, I only could include 2-3 articles in an edition. Now it takes at least a half an hour to reduce the number to 10. So here are the latest and most interesting announcements about individualized medicine.

The world took another baby step toward personalized medicine today, as the FDA said people of Asian descent should be screened for a particular genetic variation before they take carbamazepine, a drug used to treat epilepsy and bipolar disorder.

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One form of the gene, TCF7L2, is strongly linked to type 2 diabetes. Having two copies of TCF7L2 (one from each parent) doubles your risk of getting diabetes—that much is well established. But some researchers reckon that if you do not have any of the other risk factors for diabetes, your chance of getting the disease will be so low in the first place that this doubling is not worth knowing about.

  • Human Genome Rug at Art Basel Spinoff, Design Miami (Wired):

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Photo Credit: Robyn Ross

Let’s finish today’s edition with the words of Larry Moran, a Professor in the Department of Biochemistry at the University of Toronto:

I still find it curious that there are “science bloggers” who promote these for-profit companies without ever mentioning the scam that they’re perpetrating by misleading the general public about what the tests can achieve. The kit from 23andMe costs $999.00 (US).

Knome: The Review

As today is the day when Knome launches the first commercial whole-genome sequencing and analysis service for individuals, I thought it’s time to write the review about them. If you want to read the review about 23andMe, Navigenics or Helix Health, check out this post.

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Website:

  • Design: Too simplified. It looks like the site of 23andMe in the old days, so I’m pretty sure it’ll change a lot soon.

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  • Informativeness: An About me page that mentions the founders; and a FAQ page that aims to answer all the important questions. Anyway, they fail to mention the details of their “comprehensive” analysis and the other team members like clinicians or geneticists. They don’t tell us how they predict disease-associated risks neither.
  • Team: The main advisor is unquestionably the best in the field of personalized genetics: George Church, the Professor of Genetics at Harvard Medical School. He is a good reason to choose Knome, but he also is an advisor for  23andMe.

Service:

  • Method: Whole-genome sequencing which means not only the essential SNPs (single nucleotide polymorphisms) will be analyzed, but the whole genetic code of an individual. Though, only the first 20 clients will have this historic opportunity. In my humble opinion, it’s too brave to say that in this period of research:

Whole-genome sequencing allows for the analysis of up to 2,000 common and rare conditions, and over 20,000 genes – numbers that are rapidly growing.

“Whole-genome sequencing is the endgame. It will enable us to look at nearly 100% of your genetic code compared to the less than 0.02% currently available on SNP chips. This is the approach that most fully reveals what our genomes can tell us about ourselves.”

  • Cost: The service will start at $350,000, including whole-genome sequencing and an analysis from a team of geneticists, clinicians and bioinformaticians who will also provide continued support and counseling.
  • Target, Research: The medical conditions they plan to analyze are not specified. Regarding research:

Another complementary mission of Knome is to provide researchers with access to sequenced whole genomes in order to enable Genome Wide Association Studies (GWAS). We believe that approaching interested individuals directly is the fastest way to create the critical data needed to make significant scientific breakthroughs. That is why we also offer each client the option of allowing researchers to have access to their anonymous sequenced genome. While we hope that a significant percentage of our customers will do so, it is not required.

Of course, it’s going to be the service of the richest people on Earth, but the 1000$ genome could also become reality maybe in the next year. I’m still skeptic as Knome doesn’t say a word about how they can connect the data of whole-genome sequencing to the future of my health.

Look, I’d be the happiest person in the world, if personalized genetics could be reached by anyone. Personalized genetics must be about science and not business. I couldn’t find a word mentioning the scientific background behind Knome or the scientific method they plan to work with.

At this time, it’s nearly impossible to tell specific disease-associated risks based on SNP analysis or even whole-genome sequencing. Let me know if I’m too skeptic.

Personalized Genetics: It has officially begun!

Do you think it’s enough to share some links about personalized genetics with you once a week? Of course, not! The live webcast of 23andMe finished some minutes ago which means I should write some thoughts on this.

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I had several questions answered including (their answer):

  • When do you plan to expand your service to Europe? (Later, later…)
  • How effective do you think your risk predictions are? (Just as much as current scientific research can be.)
  • Do you plan to help patients with genetic counseling? (Yes, through online tutorials, but not in person.)
  • Do you think your prediction models are well established? What can you tell your patient about his risk for obesity based only on one or just a few genes? (It seemed they didn’t accpet long questions.)

Check out the questions of Attila Csordás at Pimm. Attila had an other post about the subject as well: Genetics brings people together, rather than differentiate.

Steve Murphy, our gene sherpa, has been working really hard in the last few days:

Without further examination, the advice 23 and Me, Navigenics etc. are giving now is just plain useless. That is precisely why deCODE has stated that their test should not be used for medicine. Only healthcare practitioners trained in interpreting your data should be… Too bad there are only 100 geneticists who are trained in adult disease :( As for the disclaimer not to be used to diagnose or treat…last time I checked, I am ordering the same tests as 23andME to diagnose and treat! Maybe they should add a caveat “But to steal your genome” at the end.

Deepak Singh at BBGM posted some interesting videos, interviews about 23andMe’s privacy issues and many more.

Ricardo Vidal at My Biotech Life talks about the spitting business.

Thomas Goetz published some incredibly intersting material at Wired. The first article contains a timeline of the age of genome. He also had his genome analyzed by 23andMe and Navigenics with these results.

Nicholas Wade also expressed his opinion on the story in New York Times.

I’m thrilled by the power of 23andMe ( 23andMe for geneticists is something like Google for programmers), but I would love to watch some interviews taken with medical professionals of their company. Where are they? From this point of view, Helix Health seems to be a better option, although I think it’s still too early to launch a personalized genetic service. Not just the public, but even the scientific community doesn’t seem to be ready for this. We’ll see what happens…

Stay tuned!

23andMe: The Re-Review

A week ago, I wrote a review about the three major companies focusing on personalized genetics. That time, I couldn’t include all the required information in the section of 23andMe. Now, here is the re-review:

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Website:

  • Design: Great! Clear structure, big buttons, nice colors. That’s how it should look like because all the functions are easily accessible.

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  • Informativeness: I must say, nearly perfect. Own pages for experts and laypeople as well. Sections for the scientific and the medical communities. Tutorials, descriptions, explanations about the basic concepts of genetics and their service. Like David P. Hamilton noted that more information about genetic counseling would be needed.

Service:

  • Cost: Price per kit is $999 plus shipping.
  • Target: Breast Cancer, Crohn’s Disease, Heart Attack, Multiple Sclerosis, Obesity, Prostate Cancer, Restless Legs Syndrome, Diabetes Type 1 and 2, Venous Thromboembolism, Bitter Taste Perception, Earwax Type, Lactose Intolerance and Muscle Fiber and Sports. Read about the genetic associations here.
  • Media Coverage: BBGM, My Biotech Life and VentureBeat.

Just one more note about direct-to-consumer genetic testing:

Some argue it is too early to make personalized genetic information directly available to consumers, contending that the level of public understanding has not matured to the point that most people are able to understand their results, and that genetic associations discovered to-date have little actual significance.

23andMe believes people have the right to access their personal genetic information. Genetic information is a fundamental element of a person’s body, identity and individuality. As such, the rights that people enjoy with regard to financial, medical and other forms of personal information should apply to genetic information as well.

I’ve always been optimistic, but I don’t think the public is ready right now. Can you really tell the patient about his/her susceptibility to medical conditions? I’ve been working with COPD-related SNPs and there are plenty of SNPs that indicate a higher risk for COPD, there are others that indicate lower risk, and there are many more that we know nothing about. The only thing I can tell my patient is that based on the SNPs I analyzed, he/she has a risk regarding that specific condition, but that’s all. Forget about universal susceptibility rates! Is this information worth $999?

One example is the risk for obesity. They analyze a SNP of the gene FTO (rs3751812 – Nature article requires subscription). Maybe the reason is my lack of expertise, but can we tell the patient anything about the risk for obesity by analyzing one gene’s one SNP? Or do they make only one SNP public for business reasons? The answer of 23andMe would be most welcome!

I understand that they had to launch the service, but we’ll need years of research to make it really useful. Anyway, it’s very important to promote the work of the first personalized genetic companies including 23andMe as I believe, they hold the key to the future of medicine. What do yout think?

Personalized Genetics: Coffee, Cancer and a Pharmacogenomic Therapy

Even if I should study emergency medicine now, I would like to share interesting and useful links with you. Here are the most important articles, announcements of personalized genetics from the last few days. This edition focuses on breast cancer:

  • Pharmacogenomics Rising (The Gene Sherpa): LabCorp will study the role of polymoprhisms in cytochrome p450 2D6 and women’s response to breast cancer.

A cardinal rule in clinical cancer genetics is that you always want to do the genetic test on someone in the family who has had a cancer diagnosis that is suspicious for the risk syndrome that you are considering. If either of this woman’s aunts were alive, they would clearly be the best people to test first.

However, they both died of their disease. In the absence of other individuals with cancer to test, the patient’s healthy father would be the next best person to test.

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Almost a decade later, this vision of personalised medicine has yet to become reality. People with hard-to-treat diseases like depression are still being prescribed drugs by trial and error. Adverse drug reactions are still one of the leading causes of death in the developed world.

  • Integrative Medicine and Experimental Pharmacogenomic Therapy in a Child with Niemann-Pick Disease (NPD), Type A (Slideshare.net)

Further reading:

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