Advertisements
Feeds:
Posts
Comments

Posts Tagged ‘Medscape’


The Young Surgeon and The Retired Pathologist: On Science, Medicine and HealthCare Policy – The Best Writers Among the WRITERS

Curator: Aviva Lev-Ari, PhD, RN

Updated on 2/18/2016

Since January 2005, I am a Reader, Curator and Author of scientific articles in Life Sciences and Medicine.

On 2/18/2016, the Open Access Online Scientific Journal launched in 4/2012,

Open Access Online Scientific Journal

http://pharmaceuticalintelligence.com

Site Statistics

Date

Views to Date

# of articles

NIH Clicks

Nature Clicks

6/24/2013

199,857

1,034

1,275

661

 7/29/2013  217,356  1,138  1,389  705
       12/11/2013  293,694  1,464  1,693  828
10/17/2015  765,762  3,444  2,726 1,683 
02/18/2016  886,454 4,162  2,911 1,813 

By 2/18/2016, I have curated 2,333 articles, the list of titles is on 109 pages on http://pharmaceuticalintelligence.com

Links to each article to be found at

https://pharmaceuticalintelligence.com/?s=Aviva+Lev-Ari%2C+PhD%2C+RN

Frontiers in Cardiology – 653 articles

https://pharmaceuticalintelligence.com/?s=Frontiers+in+Cardiology

These articles have been viewed, since the first article was published on 4/30/2012, by +886,454 viewers.

Author and Curator e-Readers since

4/30/2012

Journal Articles

on

2/18/2016

Aviva Lev-Ari, PhD, RN 248,163 2,333
Larry H Bernstein, MD, FCAP  

155,253

 

1,183

Of all the readings and reviews I completed to date, my appreciation got bonded to two Science and Medicine writers:

and

I am inviting the e-Readers to join me on a language immersion during a LITERARY TOUR in Science, Medicine and HealthCare Policy. 

Part One: The Young Surgeon

Eric J. Topol, MD: Editor’s Note on The Young Surgeon

Atul Gawande, MD, MPH, wears many hats, including that of a surgeon, researcher, journalist, and author. In this segment of Medscape One-on-One, Dr. Gawande talks with Eric J. Topol, MD, about what inspires him, his plans for the future, and why he’s secretly a frustrated rock singer.

WATCH the INTERVIEW of December 06, 2013 on VIDEO

Eric Topol on Medscape > Medscape One-on-One

Atul Gawande on the Secrets of a Puzzle-Filled Career

, Atul Gawande, MD, MPH

http://www.medscape.com/viewarticle/815241?nlid=41903_2105&src=wnl_edit_medp_card&uac=93761AJ&spon=2

Atul Gawande is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital in Boston, and is Director of Ariadne Labs, a joint center for health systems innovation. He is Professor in the Department of Health Policy and Management at the Harvard School of Public Health and Professor of Surgery at Harvard Medical School. And he is also co-founder and chairman of Lifebox, an international not-for-profit implementing systems and technologies to reduce surgical deaths globally.

Soon after he began his residency, his friend Jacob Weisberg, editor of Slate, asked him to contribute to the online magazine. His pieces on the life of a surgical resident caught the eye of The New Yorker which published several pieces by him before making him a staff writer in 1998.

A June 2009 New Yorker essay by Gawande[12] compared the health care of two towns in Texas to show why health care was more expensive in one town compared to the other. Using the town of McAllen, Texas, as an example, it argued that a revenue-maximizing businessman-like culture (which can provide substantial amounts of unnecessary care) was an important factor in driving up costs, unlike a culture of low-cost high-quality care as provided by the Mayo Clinic and other efficient health systems.

Ezra Klein of The Washington Post called it “the best article you’ll see this year on American health care—why it’s so expensive, why it’s so poor, [and] what can be done.”[13] The article was cited by Pres. Barack Obama during Obama’s attempt to get health care reform legislation passed by the United States Congress. The article “made waves”[14] and according to Senator Ron Wyden, the article “affected [Obama’s] thinking dramatically”, and was shown to a group of senators by Obama, who said, “This is what we’ve got to fix.”[15] After reading the New Yorker article, Warren Buffett‘s long-time business partner Charlie Mungermailed a check to Gawande in the amount of $20,000 as a thank you to Dr. Gawande for providing something so socially useful.[16] Gawande donated the $20,000 to the Brigham and Women’s Hospital Center for Surgery and Public Health.[17]

In addition to his popular writing, Gawande has published studies on topics including military surgery techniques and error in medicine, included in the New England Journal of Medicine. He is also the director of theWorld Health Organization‘s Global Patient Safety Challenge. His essays have appeared in The Best American Essays 2003, The Best American Science Writing 2002, The Best American Science Writing 2009 andBest American Science and Nature Writing 2011.

He has been a staff writer for the New Yorker magazine since 1998. He has written three bestselling books: Complications, which was a finalist for the National Book Award in 2002; Better, which was selected as one of the ten best books of 2007 by Amazon.com; and The Checklist Manifesto. He has won two National Magazine Awards, AcademyHealth’s Impact Award for highest research impact on health care, a MacArthur Fellowship, and he has been named one of the world’s hundred most influential thinkers by Foreign Policy and TIME.

ADDITIONAL LINKS

http://gawande.com/about

RESEARCH by Dr. Atul Gawande

Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in Surgical-Readmission Rates and Quality of Hospital CareNew England Journal of Medicine Published online September, 2013.

Funk LM, Conley DM, Berry WR, Gawande AA. Hospital Management Practices and Availability of Surgery in Sub-Saharan Africa: A Pilot Study of Three HospitalsWorld Journal of Surgery Published online August, 2013.

Nehs MA, Ruan DT, Gawande AA, Moore FD Jr, Cho NL.Bilateral neck exploration decreases operative time compared to minimally invasive parathyroidectomy in patients with discordant imagingWorld Journal of SurgeryPublished online July, 2013.

Joynt KE, Gawande AA, Orav EJ, Jha AK.Contribution of Preventable Acute Care Spending to Total Spending for High-Cost Medicare PatientsJAMA Published online June 24, 2013.

McCrum ML, Joynt KE, Orav EJ, Gawande AA, Jha AK.Mortality for Publicly Reported Conditions and Overall Hospital Mortality RatesJAMA Published online June 24, 2013.

Spector JM, Lashoher A, Agrawal P, Lemer C, Dziekan G, Bahl R, Mathai M, Merialdi M, Berry W, and Gawande AA.Designing the WHO Safe Childbirth Checklist Program to Improve Quality of Care at ChildbirthInternational Journal of Gynecology & Obstetrics Published online June 5, 2013.

Barnet CS, Arriaga AF, Hepner DL, Correll DJ, Gawande AA, Bader AM. Surgery at the End of LifeThe Journal of the American Society of Anathesiologists Published online June, 2013.

Bowman KG, Jovic G, Rangel S, Berry WR, Gawande AA.Pediatric emergency and essential surgical care in Zambian hospitals: A nationwide studyJournal of Pediatric Surgery Published online June, 2013.

Rice-Townsend S, Gawande A, Lipsitz S, Rangel SJ.Relationship between unplanned readmission and total treatment-related hospital days following management of complicated appendicitis at 31 children’s hospitalsJournal of Pediatric Surgery Published online June, 2013.

Eappen S, Lane BH, Rosenberg B, Lipsitz SA, Sadoff D, Matheson D, Berry WR, Lester M, Gawande AA. Relationship Between Occurrence of Surgical Complications and Hospital FinancesJAMA April 17, 2013;309:1599-1606.

Kwok AC, Funk LM, Baltaga R, Lipsitz SR, Merry AF, Dziekan G, Ciobanu G, Berry WR, Gawande AA. Implementation of the World Health Organization Surgical Safety Checklist, Including Introduction of Pulse Oximetry, in a Resource-Limited SettingAnnals of Surgery April 4, 2013.

Molina G, Funk LM, Rodriguez V, Lipsitz SR, Gawande A.Evaluation of Surgical Care in El Salvador Using the WHO Surgical Vital StatisticsWorld Journal of Surgery Published online, March 2013.

Arriaga AF, Bader AM, Wong JM, Lipsitz SR, Berry WR, Ziewacz JE, Hepner DL, Boorman DJ, Pozner CN, Smink DS, Gawande AA. Simulation-Based Trial of Surgical-Crisis ChecklistsNew England Journal Of Medicine 2013;368:246-53.

Spector JM, Reisman J, Lipsitz S, Desai P, and Gawande AA.Access to Essential Technologies for Safe Childbirth: A Survey of Health Workers in Africa and AsiaBMC Pregnancy and Childbirth February 20, 2013;13:43-49.

Wong JM, Panchmatia JR, Ziewacz JE, Bader AM, Dunn IF, Laws ER, Gawande AA. Patterns in neurosurgical adverse events: intracranial neoplasm surgeryJournal of Neurosurgery 2012;33(5):E16.

Wong JM, Ziewacz JE, Ho AL, Panchmatia JR, Kim AH, Bader AM, Thompson BG, Du R, Gawande AA. Patterns in neurosurgical adverse events: open cerebrovascular neurosurgeryJournal of Neurosurgery 2012;33(5):E15.

GO TO the First article

http://gawande.com/articles

FIRST ARTICLE

Nanevicz TM, Prince MR, Gawande AA, Puliafito CA. Excimer laser ablation of the lens.Archives of Ophthalmology. 1986;104(12):1825-9.

Selected References

  1. Dr Atul Gawande – 2014 Reith Lectures. BBC Radio 4. Retrieved October 18, 2014.
  2. Atul Gawande on Twitter
  3.  Atul Gawande: ‘If I haven’t succeeded in making you itchy, disgusted or cry I haven’t done my job’, The Guardian
  4.  Former Policymaker Opts for Hands-On Health Care – International Herald Tribune
  5. MacArthur Fellows 2006. Atul Gawand
  6. “Atul Gawande Named MacArthur Fellow”. Press release by Brigham and Women’s Hospital. September 19, 2006. Retrieved February 25, 2010
  7. “Q&A with Atul Gawande, Part 2” H&HN. June 30, 2011. Retrieved July 7, 2011.
  8. Why Do Doctors Fail?The Reith Lectures, Dr Atul Gawande: The Future of Medicine Episode 1 of 4, BBC
  9. “Atul Gawande: surgeon, health policy scholar, and writer”.Harvard Magazine. Sep–Oct 2009
  10. Bates, D. W.; Gawande, A. A. (2003). “Improving Safety with Information Technology”. New England Journal of Medicine 348 (25): 2526. doi:10.1056/NEJMsa020847.
  11. Weiser, T. G.; Regenbogen, S. E.; Thompson, K. D.; Haynes, A. B.; Lipsitz, S. R.; Berry, W. R.; Gawande, A. A. (2008). “An estimation of the global volume of surgery: A modelling strategy based on available data”. The Lancet 372 (9633): 139. doi:10.1016/S0140-6736(08)60878-8.
  12. Gawande, A. A.; Studdert, D. M.; Orav, E. J.; Brennan, T. A.; Zinner, M. J. (2003). “Risk factors for retained instruments and sponges after surgery”. New England Journal of Medicine 348 (3): 229–35. doi:10.1056/NEJMsa021721. PMID 12529464.
  13. Gawande, A. A.; Thomas, E. J.; Zinner, M. J.; Brennan, T. A. (1999). “The incidence and nature of surgical adverse events in Colorado and Utah in 1992”. Surgery 126 (1): 66–75.doi:10.1067/msy.1999.98664. PMID 10418594.

Dr. Atul Gawande’s Articles in the New Yorker

States of Health
New Yorker
October 7, 2013

Slow Ideas
New Yorker
July 29, 2013

Why Boston’s Hospitals Were Ready
New Yorker
April 17, 2013

Big Med
New Yorker
August 6, 2012

Something Wicked This Way Comes
New Yorker
June 28, 2012

Failure and Rescue
New Yorker
June 4, 2012

200 Years of Surgery
New England Journal of Medicine
May 2, 2012
Documentary

Personal Best
The New Yorker
September 26, 2011

A Townie Speaks
Ohio University Commencement Address
June 11, 2011

Cowboys and Pit Crews
2011 Harvard Medical School Commencement Address
May 26, 2011

The Hot Spotters
The New Yorker
January 17, 2011

Seeing Spots
The New Yorker News Desk
January 27, 2011

Letting Go
The New Yorker
July 26, 2010
(citations)

Now What?
The New Yorker
Apr 5, 2010

Testing, Testing 
The New Yorker
Dec 14, 2009

The Cost Conundrum Redux
The New Yorker
News Desk Blog
Jun 23, 2009

The Cost Conundrum 
The New Yorker
Jun 1, 2009

Hellhole
The New Yorker
Mar 30, 2009

Getting There from Here 
The New Yorker
Jan 26, 2009

The Itch 
The New Yorker
Jun 30, 2008

A Lifesaving Checklist 
The New York Times
Dec 30, 2007

The Checklist 
The New Yorker
Dec 10, 2007

Sick and Twisted
The New Yorker
Jul 23, 2007

The Obama Health Plan
The New York Times
May 31, 2007

A Katrina Health Care System 
The New York Times
May 26, 2007

Rethinking Old Age
The New York Times
May 24, 2007

Let’s Talk About Sex 
The New York Times
May 19, 2007

Doctors, Drugs, and the Poor 
The New York Times
May 17, 2007

Bad Medicine, Sneaking In 
The New York Times
May 12, 2007

Curing the System
The New York Times
May 10, 2007

Can This Patient Be Saved? 
The New York Times
May 5, 2007

The Power of Negative Thinking
The New York Times
May 1, 2007

The Way We Age Now 
The New Yorker
Apr 30, 2007

The Score
The New Yorker
Oct 9, 2006

The Malpractice Mess
The New Yorker
Nov 14, 2005

Piecework
The New Yorker
Apr 4, 2005

The Bell Curve
The New Yorker
Dec 6, 2004

The Mop-Up
The New Yorker
Jan 12, 2004

Desperate Measures
The New Yorker
May 5, 2003

Cold comfort
The New Yorker
Mar 11, 2002

The learning curve
The New Yorker
Jan 28, 2002

The man who couldn’t stop eating
The New Yorker
Jul 9, 2001

Final cut
The New Yorker
Mar 19, 2001

Crimson tide

The New Yorker

Feb 12, 2001

Under suspicion
The New Yorker
Jan 8, 2001

When good doctors go bad
The New Yorker
Aug 7, 2000

GO TO the First article

FIRST ARTICLE
The Gist: Persian Gulf War Syndrome
The Gist
Slate
Oct 25, 1996
BOOKS

THE CHECKLIST MANIFESTO

A New York Times Bestseller and an Amazon Best Book of the Month: December 2009

http://gawande.com/the-checklist-manifesto

BETTER
One of Amazon.com’s 10 Best Books of 2007
Complications
“Essential Reading For Anyone Involved In Medicine”–Amazon.com –  2002

Overkill
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
Annals of Health Care MAY 11, 2015
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.
tests, drugs, and operations

tests, drugs, and operations

Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.
Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine — with fewer cowboys and more pit crews.

Being Mortal: Medicine and What Matters in the End – Deckle Edge, Oct 7, 2014

Part Two: The Retired Pathologist 

On Science, Medicine and HealthCare Policy – The Best Writers Among the WRITERS

Roles at http://pharmaceuticalintelligence.com

Chief Scientific Officer, Member of the Board

Research Categories OWNER:

  • Biomarkers & medical diagnosis in Pathology (Co-Owner)
  • Clinical Trials and IRB related Issues
  • Acute and Chronic Disease Classifications
  • Biomarker Discovery and Validation
  • Cardiovascular Research
  • Clinical Laboratory-Related Issues
  • Healthcare and Hospital Costs
  • Health Information Technology  and Workflow Redesign
  • Metabolomics
  • Metabolic Derangements
  • Nutraceuticals
  • Nutrigenomics
  • Nutrition
  • Nutrition and Phytochemistry
  • Proteomics
  • Statistical Methods for Research Evaluation
  • Systemic Inflammatory Response Related Disorders

 

Larry H. Bernstein, M.D., FCAP – My Life in Medicine 

www.linkedin.com/pub/larry-h-bernstein/a/599/50

I retired from a five year position as Chief of the Division of Clinical Pathology (Laboratory Medicine) at  New York Methodist Hospital-Weill Cornell Affiliate, Park Slope, Brooklyn in 2008 folowed by an interim consultancy at Norwalk Hospital in 2010.  I then became engaged with a medical informatics project called “Second Opinion” with Gil David and Ronald CoifmanEmeritus Professor and Chairman of the Department of Mathematics in the Program in Applied Mathematics at Yale.  I went to Prof. Coifman with a large database of 30,000 hemograms that are the most commonly ordered test in medicine because of the elucidation of red cell, white cell and platelet populations in the blood.  The problem boiled down to a level of noise that exists in such data, and developing a primary evidence-based classification that technology did not support until the first decade of the 21st century.

Realtime Clinical Expert Support and Validation System

Gil David and Larry Bernstein have developed, in consultation with Prof. Ronald Coifman, in the Yale University Applied Mathematics Program, a software system that is the equivalent of an intelligent Electronic Health Records Dashboard that provides empirical medical reference and suggests quantitative diagnostics options.

Our dashboard is a visual display of essential metrics. The primary purpose is to gather medical information, generate metrics, analyze them in realtime and provide a differential diagnosis, meeting the highest standard of accuracy. The diagnosis provides a risk assessment to the patient’s medical condition, while locating and presenting similar cases of other patients with the same anomalous profile and their corresponding treatment and followup. Given medical information of a patient, the system builds its unique characterization and provides a list of other patients that share this unique profile, therefore utilizing the vast aggregated knowledge (diagnosis, analysis, treatment, etc.) of the medical community.

The main mathematical breakthroughs are provided by accurate patient profiling and inference methodologies in which anomalous subprofiles are extracted and compared to potentially relevant cases. Our methodologies organize numerical medical data profiles into demographics and characteristics relevant for inference and case tracking. As the model grows and its knowledge database is extended, the diagnostic and the prognostic become more accurate and precise.

We anticipate that the effect of implementing this diagnostic amplifier would result in higher physician productivity at a time of great human resource limitations, safer prescribing practices, rapid identification of unusual patients, better assignment of patients to observation, inpatient beds, intensive care, or referral to clinic, shortened length of patients ICU and bed days.

[Second Opinion 2009-2011 Proprietary]

As an example, inputs from test data such as Hematology results are processed for anomaly characterization and compared with similar anomalies in a data base of 30,000 patients, provide diagnostic statistics, warning flags , and risk assessment . These are based on past prior experience , including ,diagnostics and treatment outcomes (collective experience). The system was trained on this database of patients, built the learning knowledge base and used to analysis and diagnosis 5,000 new patients. Our system identified successfully the main risks with very high accuracy (more than 96%) and very low false rate (less than 0.5%).

The main benefit is a real time assessment as well as diagnostic options based on

comparable cases, flags for risk and potential problems as illustrated in the following case acquired on 04/21/10. The patient was diagnosed by our system with severe SIRS at a grade of .61 .

The patient was treated for SIRS and the blood tests were repeated during the following week. Following treatment, the SIRS risk as a major concern was eliminated and the system provides a positive feedback for the treatment of the physician.

To experiment with our demo system using our existing database or your own data it  resides online at:

http://netlab2.math.yale.edu:30049/cgi-bin/second opinion.py

[Second Opinion 2009-2011 Proprietary]

I have been reviewing manuscripts somewhat frequently for Nutrition, Clin Chem Lab Med, Clin Biochem, and J Ped Hem Oncol., and serve on the Editorial Advisory Board of Nutrition.

I was the Chief, Clinical Pathology at NY Methodist Hospital, a 600+ bed hospital in Park Slope, Brooklyn, 2 hours from Bridgeport, CT, where I worked for 5 years,  and was previously Chief of Clinical Chemistry and Chief of Blood Bank at Bridgeport Hospital for 20 years, and Acting Chairman of Yale University Department of Pathology at Bridgeport Hospital for one year prior to my experience at NY Methodist Hospital Weill-Cornell.

My work with nutrition is extensive as a consulting pathologist on the Nutritional Support Team and I worked closely with the Burn Unit at Bridgeport Hospital, led by Dr. Walter Pleban, the first physician expert in burn and wound care to use TPN in Connecticut.  I rejected the dependence on serum albumin and implemented the first use of prealbumin (transthyretin)(half-life of 2 days) to follow the return to anabolic status of severely stressed patients, starting with Immunodiffusion plates from Behring Diagnostics, then converting to running batch turbidimetric assays on the Roche centrifugal analyzer, and finally running on a Beckman. My lab was the only one to get down to reliable measurements of 20 mg/L.  I co-chaired the First International Transthyretin Congress in Strasbourg, chaired the 14th and was an invited participant in the 17th Ross Roundtable on Nutrition, Organized and Chaired the Beckman Roundtable on Prealbumin in Los Angeles, was responsible for the AACC first document of Standards of Clinical Laboratory Practice with Lawrence Kaplan, and was recipient of the Labbe/Garry award of the Nutrition Division of AACC).  I did some of the earliest work on point of care diagnostics in neonatal care. My work with Creatine kinase isoenzyme MB and the isonzyme 1 of LD goes back to my residency and my long term contact with Burton Sobel. The improved use of troponins and NT-proBNP and have  been ongoing projects for the last 10 years, some of which was supported by Roche Diagnostics on the recommendation of Pauline Lau and Bernard Statland. The projects in normalizing the NT-proBNP for age and estimated glomerular filtration rate (eGFR), was successful, but widespread implementation is even more gradual than was TTR.

I have served on the Board of Directors of NAACLS and the American Library Association Commission on Accreditation, am listed in America’s Top Physicians, Marquis Who’s Who in Science and Engineering and Marquis’ Who’s Who in Medicine, Who’s Who in Pathology, Continental Who’s Who, Strathmore’s Who’s Who, and have 3 patents.

BIO
Selected Peer Reviewed publications

1. Rosser A. Rudolph, Larry H. Bernstein,and Joseph Babb. Information Induction for
Predicting Acute Myocardial Infarction. CLIN CHEM 1988; 34(10): 2031-2038.

2. Zarich SW, Bradley K, Mayall ID, Bernstein LH. Minor elevations in troponin T values enhance risk assessment in emergency department patients with suspected myocardial ischemia: analysis of novel troponin T cut-off values. Clin Chim Acta 2004; 343:223-29.

3. Bernstein, L.H.; Devakonda, A.; Engelman, E.; Pancer, G.; Ferrara, J.; Rucinski, J.; Raoof, S.; George, L.; Melniker, L. The Role of Procalcitonin in the Diagnosis of Sepsis and Patient Assignment to Medical Intensive Care.  J Clinical Ligand Assay, 2007; 30 (3-4):98-104

Older patients, make up a large part of the ICU population and tend to have an acute stressful condition superimposed on chronic illness.  The effects of anorexia, hypermetabolism, and malabsorption on these patients lead to substantial nitrogen losses. The most widely used methods for assessing malnutrition are the Subjective Global Assessment (SGA); TTR, and a combination of laboratory and biochemical features. The simplest of these, transthyretin (TTR) has become a commonly assayed protein in assessing PEM status. Clinical studies indicate that determination of the TTR level may allow for earlier recognition of malnutrition risk and timely intervention. Since TTR has a relatively short circulating half-life, it is expected to respond rapidly in response to metabolic support. TTR production decreases after 14 days of consuming a diet that provides only 60% of required proteins. Rapid turnover proteins, such as transthyretin (half-life < 2 days) respond early to nutrition support, and reflect a delayed return to anabolic status.It is particularly helpful in removing interpretation bias, and it is an excellent measure of the systemic inflammatory response concurrent with a preexisting state of chronic inanition. In the ICU patients we studied, TTR removed interpretation bias because the sickest patients experienced an uncommon delayed return of TTR to normal levels with adequate nutritional support.
DevakondaA, et al,Transthyretin as a marker to predict outcome in critically ill patients,ClinBiochem(2008),doi:10.1016/j.clinbiochem.2008.06.016
Protein energy malnutrition; Critically ill patients; Stress hypermetabolism; Transthyretin;  Multivariate classification.

4. Bernstein LH, Zions MY, Haq SA, Zarich S, Rucinski J, Seamonds B, Berger S, Lesley DY, Fleischman W, Heitner JF: Effect of renal function loss on NT-proBNP level variations. Clin Biochem; 2009;42(10-11):1091-8 [PMID: 19298805]

OBJECTIVE: NT-proBNP level is used for the detection of acute CHF and as a predictor of survival. However, a number of factors, including renal function, may affect the NT-proBNP levels. This study aims to provide a more precise way of interpreting NT-proBNP levels based on GFR, independent of age. METHODS: This study includes 247 pts in whom CHF and known confounders of elevated NT-proBNP were excluded, to show the relationship of GFR in association with age. The effect of eGFR on NT-proBNP level was adjusted by dividing 1000 x log(NT-proBNP) by eGFR then further adjusting for age in order to determine a normalized NT-proBNP value. RESULTS: The normalized NT-proBNP levels were affected by eGFR independent of the age of the patient. CONCLUSION: A normalizing function based on eGFR eliminates the need for an age-based reference ranges for NT-proBNP.
Kidney Function Tests. Natriuretic Peptide, Brain / blood. Peptide

5. David G, Bernstein LH, Coifman RR.  Generating Evidence Based Interpretation of Hematology Screens via Anomaly Characterization. The Open Clinical Chemistry Journal, 2011; 4:10-16. ISSN 1874-2416/11. Bentham Journal.
Introduction: We propose an automated nutritional assessment (ANA) algorithm that provides a method for malnutrition risk prediction with high accuracy and reliability. Materials  and Methods: The database used for this study is a file of 432 patients, where each patient is described by 4 laboratory parameters and 11 clinical parameters. A malnutrition risk assessment of low (1), moderate (2) or high (3) was assigned by a dietitian for each patient. An algorithm for data organization and classification via characteristic metrics is proposed.  For each patient, the algorithm characterizes its unique profile and builds a characteristic metric to identify similar patients who are mapped into a classification. Results: The algorithm assigned a malnutrition risk level for each patient based on different training sizes that were taken out of the data. Our method resulted in an average error (distance between the automated score and the real score) of 0.386, 0.3507, 0.3454, 0.34 and 0.2907 for 10%, 30%, 50%, 70% and 90% training sizes, respectively. Our method outperformed the compared method even when our method used a smaller training set then the compared method. In addition, we show that the laboratory parameters themselves are sufficient for the automated risk prediction and adding the clinical parameters does not improve the accuracy. We present an organization of the patients into several clusters and sub-clusters. These  clusters  correspond to low risk areas, low-moderate risk areas, moderate risk areas, moderate-high risk areas and high risk areas. The organization and visualization methods provide a tool for exploration and navigation of the data points. Discussion: The problem of rapidly identifying risk and severity of malnutrition is crucial for minimizing medical and
surgical complications associated with previsit under-nutrition, chronic illness affecting swallowing, eating, and weight loss.

6. Brugler L, Stankovic AK, Schlefer M, Bernstein L. A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition 2005; 21(6): 650-658

Results:  The analysis demonstrated the characteristics that correlated best with MRC risk level assignment were: the occurrence of a wound (p=2.5e14), poor oral intake (p=3.2e-14), malnutrition related admission diagnosis (p=3.9e-9), serum albumin value (p=1.4e-31), hemoglobin value (p=3.3e-10), and total lymphocyte count   (p=1.4e-29). The 6 variable model had an R2 of 0.773 and p = 4.6e-116. A second model had 4 variables (malnutrition related admission diagnosis, serum albumin value, hemoglobin value and total lymphocyte count) and 3 (high, moderate and low) versus 4 (high, moderate, low and no) MRC risk levels with an R2 of 0.721 and p = 1.6e-104. Discussion: The ability of admission information to accurately reflect MRC risk is crucial to early initiation of restorative medical nutrition therapy (MNT), the efficient utilization of nutrition care resources and compliance with regulatory requirements. There is currently no uniform or proved standard for identifying MRC risk within 24 hours of acute care admission. The ideal nutrition screen correlates well with the occurrence of MRCs and also contains parameters that can be quickly and routinely obtained at admission. The six and even four parameter models described above meet both criteria and they can be uniformly used by hospitals to screen patients for MRC risk.7. Larry H. Bernstein, and James Rucinski. The relationship between granulocyte maturation and theseptic state measurement of granulocyte maturation may improve the early  diagnosis of the septic state,   Clin Chem Lab Med 2011;49   DOI 10.1515/CCLM.2011.688

Methods: This study calibrates and validates the measurement of granulocyte maturation with Immature granulocytes (IG) to the identification of sepsis, a study carried out on a
Sysmex Analyzer, model XE 2100 (Kobe, Japan). The Sysmex IG parameter is a crucial measure of immature granulocyte counts and includes metamyelocytes and myelocytes,
but not band neutrophils. Results and conclusions: We found agreement with previous work that designated an IG measurement cut-off of 3.2  as optimal. The analysis was then carried a step further with a multivariable discriminator.

8. Larry H Bernstein and Johannes Everse. Studies on the Mechanism of the Malate Dehydrogenase Reaction. J Biol Chemistry.  Dec 25, 1978; 253(24): 8702-8707.

These studies determine the levels of malate dehydrogenase isoenzymes in cardiac muscle by a steady state kinetic method which depends on the differential inhibition of these isoenzyme forms by high concentrations of oxaloacetate. This inhibition is similar to that exhibited by lactate dehydrogenase in the presence of high concentrations of pyruvate. The results obtained by this method are comparable in resolution to those obtained by CM-Sephadex fractionation and by differential centrifugation for the analyses of mitochondrial malate dehydrogenase and cytoplasmic malate dehydrogenase in tissues. The use of standard curves of percent inhibition of malate dehydrogenase activity plotted against the ratio of mitochondrial MDH activity to the total of mMDH and cMDH activities [ malate dehydrogenase ratio] (percent m-type) is introduced for studies of comparative mitochondrial function in heart muscle of different species or in different tissues of the same species.

9. MB Grisham, LH Bernstein, J Everse. The cytoplasmic malate dehydrogenase in neoplastic tissues” presence of a novel isoenzyme? Br J Cancer 1983; 47: 727-731

Malate dehydrogenase (MDH,EC1.1.1.37) catalyzes the reversible reduction of oxaloacetate tomalate in the presence of NADH. In eukaryotic cells the enzyme is generally found to be present as two distinct isoenzymes; one form is present in the cellular cytosol and the other is present exclusively in the mitochondria. These 2 isoenzymes form part of a shuttle system (the malate-aspartate shuttle) that functions as the major mechanism for the transportation of reducing equivalents between the cytosol and the mitochondria. As part of our ongoing studies on the mechansim of action and metabolic function of the malate dehydrogenases (Bernstein,etal. 1978; Bernstein & Everse, 1978; Bernstein & Grisham 1978), we recently
investigated the kinetic properties of the 2 isoenzymes present in rat Novikoff hepatoma tissues.These studies were initiated to evaluate whether or not the enzymes in the malate-asparate shuttle of tumour tissues are structurally and functionally identical to those of normal tissues. Fresh tumour or liver was homogenized with a glass tissue homogenizer in 0.1M potassium phosphate buffer, pH 7.5, containing 0.25M sucrose, centrifuged to remove tissue debris, and the supernatant was then centrifuged to obtain a supernatant that contained the cytoplasmic enzymes. The supernatantant did not contain any isocitrate dehydrogenase activity or transhydrogenase activity and was therefore judged to be free of mitochondrial enzymes.This high-speed supernatant was used without further fractionation for the determination of the cytoplasmic MDH activity. Mitochondria were prepared by suspending the pellet in 0.1M phosphate buffer, pH7.5, containing 0.25M sucrose and centrifuging the suspension at 600 g,  and re-centrifuged at 20,000 g for 30 min, and the precipitate was collected and washed, then suspended in phosphate buffer and sonicated for 1 min. The resulting solution was used for the assays for the mitochondrial enzyme. The assays were performed in 0.1M phosphate buffer, pH 7.0, at room temperature with a Beckman Model 24 recording spectrophotometer. We found that the Km values of the mitochondrial enzyme from the hepatoma tissue were identical with the values obtained with the enzyme from normal liver mitochondria. The cytoplasmic enzymes also have identical Km values for the coenzyme; however,the Lineweaver-Burk plots for oxaloacetate were non-identical. Whereas the Km value for oxaloacetate obtained with the liver enzyme was- 55 M, the Lineweaver-Burk plot obtained with the hepatoma enzyme displayed 2 slopes. One of the slopes corresponded with a Km value that is approximately identical to that of the liver enzyme, whereas the other slope yielded a Km value for oxaloacetate of-1mM. We interpret these data to indicate that Novikoff hepatoma tissue contains 2 cytoplasmic enzymes that possess MDH activity, one of which closely resembles that present in the rat liver cytoplasm. The other enzyme, having a Km of-1mM, is not found in normal liver tissue.

Is the Warburg Effect the Cause or the Effect of Cancer: A 21st Century View?

Author: Larry H. Bernstein, MD, FCAP  

Article Published 10/17/2012 — 4,111 VIEWS on 12/10/2013

Top Author Views in 12 mo
larryhbern 40,730

Electronic Books EDITORIAL 

Series A: e-Books on Cardiovascular Diseases

Content Consultant: Justin D Pearlman, MD, PhD, FACC

Volume One: Perspectives on Nitric Oxide

Sr. Editor: Larry Bernstein, MD, FCAP, Editor: Aviral Vatsa, PhD and Content Consultant: Stephen J Williams, PhD

available on Kindle Store @ Amazon.com

http://www.amazon.com/dp/B00DINFFYC

Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation

Curators: Justin D Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP, Aviva Lev-Ari, PhD, RN

  • Causes
  • Risks and Biomarkers
  • Therapeutic Implications

Volume Three: Etiologies of CVD: Epigenetics, Genetics & Genomics

Curators: Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

  • Causes
  • Risks and Biomarkers
  • Therapeutic Implications

Genomics and Medicine by Prof. Marcus Feldman, Stanford University

Volume Four: Therapeutic Promise: CVD, Regenerative & Translational Medicine

Curators: Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

  • Causes
  • Risks and Biomarkers
  • Therapeutic Implications

Volume Five: Pharmaco-Therapies for CVD

Curators: Justin D Pearlman, MD, PhD, FACC and Aviva Lev-Ari, PhD, RN

  • Causes
  • Risks and Biomarkers
  • Therapeutic Implications

Volume Six: Interventional Cardiology and Cardiac Surgery

Curators: Justin D Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP, Aviva Lev-Ari, PhD, RN

  • Causes
  • Risks and Biomarkers
  • Therapeutic Implications

Series B: e-Books on Genomics & Medicine

Content Consultant: Larry H Bernstein, MD, FCAP

Volume 1: Genomics and Individualized Medicine

Sr. Editor: Stephen J Williams, PhD

Editors: Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

Volume 2: Latest in Genomics Methodologies for Therapeutics: Gene Editing, NGS & BioInformatics, Simulations and the Genome Ontology

Editor: Stephen J Williams and Aviva Lev-Ari, PhD, RN

Volume 3: Institutional Leadership in Genomics

Editors: Marcus Feldman, PhD and Aviva Lev-Ari, PhD, RN 

Series C: e-Books on Cancer & Oncology

Content Consultant: Larry H Bernstein, MD, FCAP

Volume 1: Cancer and Genomics

Sr. Editor: Stephen J Williams, PhD

Editors: Ritu Saxena, PhD, Tilda Barliya, PhD

Volume 2: Radiation Oncology & Immunotherapy in Cancer

Editor: Larry H Bernstein, MD, FCAP

Volume 3: Nanotechnology and Drug Delivery

Editor and Author: Tilda Barliya, PhD

Series D: e-Books on BioMedicine

Volume 1: Metabolomics

Sr. Editors: Larry H Bernstein, MD, FCAP

Series E: Patient-Centered Medicine

Expert, Author, Writer: Larry H Bernstein, MD, FCAP

Editor: Larry H Bernstein, MD, FCAP

Editor: Larry H Bernstein, MD, FCAP

Expert, Author, Writer: Larry H Bernstein, MD, FCAP

ARTICLES on http://pharmaceuticalintelligence.com

12/10/2013: 276 Scientific Articles
FIRST Article on This Open Access Scientific Journal, 7/28/2013, 569 Views:
  • Vegan Diet is Sulfur Deficient and Heart Unhealthy
  • Erythropoietin (EPO) and Intravenous Iron (Fe) as Therapeutics for Anemia in Severe and Resistant CHF: The Elevated N-terminal proBNP Biomarker

Selected citations to peer reviewed publications

 Clinical value of NT-proBNP assay in the emergency department for the diagnosis of heart f…
Archives of gerontology and geriatrics 05/2015; 61(2). DOI:10.1016/j.archger.2015.05.001
 Diagnostic Yield of Targeted Next-Generation Sequencing in Various Cancer Types: An Inform…
Cancer Genetics 05/2015; 208(9). DOI:10.1016/j.cancergen.2015.05.030
Information induction for predicting acute myocardial infarction…in –
The economic cost of hospital malnutrition in Europe; a narrative review
e-SPEN the European e-Journal of Clinical Nutrition and Metabolism 04/2015; DOI:10.1016/j.clnesp.2015.04.003

Plasma Transthyretin as a Biomarker of Lean Body Mass and Catabolic States

Sep 2015 · Advances in Nutrition  Yves Ingenbleek  Larry H Bernstein

Transthyretin as a marker to predict outcome in critically ill patients
Devakonda, A., George, L., Raoof, S., Esan, A., Saleh, A., Bernstein, L.H.
Clinical Biochemistry  2008; 41(14-15):1126 – 1130

Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium
Brodska, H., Valenta, J., Malickova, K., Kohout, P., Kazda, A., Drabek, T.
Journal of Trace Elements in Medicine and Biology 2015; 31:25-32View all citations to your article in Scopus
Advertisements

Read Full Post »


Reporter: Aviva Lev-Ari, PhD, RN

 

Spotted on

Exclusive: How US and UK Physicians’ Ethics Differ

Harris Meyer

Nov 20, 2012

 

Introduction

US and UK physicians receive medical training so similar that they can readily practice in either the United States or the United Kingdom. They share a common history and culture and speak the same language, more or less.

There were notable contrasts on attitudes toward what doctors regard as

  • futile care,
  • maintaining patient confidentiality in certain situations,
  • alerting patients about poor-quality physicians, and
  • telling patients the truth about terminal conditions.
  • Their biggest difference seen was about whether to defer to the treatment wishes of patients’ families (Table).

But a newMedscape survey of nearly 25,000 US and UK physicians found that doctors in the 2 nations hold markedly different views on some thorny medical ethics issues.

Table. Differences in Attitudes Between US and UK Physicians, Medscape 2012 Ethics Report

Question US Physicians UK Physicians
Would you ever go against a family’s wishes to end treatment and continue treating a patient whom you felt had a chance to recover? Yes: 23% Yes: 57%
Is it ever acceptable to perform “unnecessary” procedures due to malpractice concerns? Yes: 23% Yes: 9%
Is it right to provide intensive care to a newborn who either will die soon or survive with an objectively terrible quality of life? Yes: 34% Yes: 22%
Would you ever hide information from a patient about a terminal or pre-terminal diagnosis if you believed it would help bolster the patient’s spirit? Yes: 10% Yes: 14%
Would you give life-sustaining therapy if you believed it to be futile? Yes: 35% Yes: 22%
Should physician-assisted suicides be allowed in some situations? Yes: 47% Yes: 37%
Would you inform a patient if he or she were scheduled to have a procedure done by a physician whose skill you knew to be substandard? Yes: 47% Yes: 32%
Is it acceptable to breach patient confidentiality if a patient’s health status could harm others? Yes: 63% Yes: 74%
Would you ever decide to devote scarce or costly resources to a younger patient rather than to one who was older but not facing imminent death? Yes: 27% Yes: 24%

© Medscape 2012

Several factors contribute to the differences: different views toward patient-centeredness; different medical liability climate; the way physicians are paid; national religious attitudes; and the nature of the relationship between physicians, patients, and patients’ families.

The survey was conducted as part of Medscape’s Physician Ethics Report 2012. Survey questionnaires were sent to physicians in a wide range of medical specialties in each country. Completed questionnaires were received from more than 24,000 US physicians and 940 UK physicians. The statistical significance of the differences in responses between US and UK doctors was not calculated.

One obvious difference that could affect attitudes is that most US physicians work either independently or for private hospital and medical groups and receive fee-for-service payment, while most UK physicians work directly or indirectly for the country’s socialized National Health Service (NHS). In Great Britain, most medical specialists work as salaried staff in publicly operated hospitals, while most primary care physicians work independently and receive a mix of fee-for-service payments, per-patient global payments, and salary.

“The big difference is the way the system is funded and the culture of the United Kingdom,” says Brian Jarman, MD, a medical professor at Imperial College in London who serves on the NHS’s advisory committee on resource allocation. “I don’t think our decisions are as affected by financial considerations as in the US.”

Another major distinction: There’s less medical malpractice litigation in the UK. On top of that, UK medical specialists receive liability coverage through their hospital, while general practitioners have their premiums offset by NHS payments. In the US, physicians worry a lot more about malpractice suits, and doctors in independent practice are responsible for paying sizable liability premiums on their own.

The largest percentage difference in the survey — and one of the most provocative findings — was seen on the question of whether the doctor would ever go against a family’s wishes to end treatment and continue treating a patient who the doctor felt had a chance to recover. Most UK physicians in the survey — 57% — said yes, compared with just 23% of US physicians. That finding cut against the view that UK doctors are more likely to ration, and it also highlighted an important cultural gap.

“In most places in the world, doctors think they know the right treatment and do it,” says Dr. Lachlan Forrow, MD, a Harvard University medical ethicist and palliative care specialist. “My German friends say patients and families expect doctors to make decisions. In the US we might defer more to the patient and family.”

On top of that, he adds, families in the US probably express their wishes with more vehemence than in the UK and are more likely to file a lawsuit if the doctor goes against their wishes.

Differences Were Surprising

But differing attitudes and responses to survey questions didn’t always fall along lines predictable by economics.

It’s often thought that UK doctors are more cost-conscious and more apt to ration services than US doctors are, given that US doctors are paid more for providing more procedures and services, while UK doctors work in a budgeted, socialized medicine environment. The responses to the survey, however, suggest that this is true in some situations and not true in others.

Even so, the experts found more similarities than differences in the responses, with large percentages of doctors from both countries responding to many of these tough ethical questions by choosing “it depends.” Indeed, the responses of US and UK doctors were comparable on most of the questions, including informing patients about medical errors, reporting impaired colleagues, performing abortions regardless of personal beliefs, and notifying patients about risks of a procedure when obtaining informed consent.

“One of the findings is how remarkably small the differences are,” says Don Berwick, MD, a pediatrics and health policy professor at Harvard University and former head of the Centers for Medicare & Medicaid Services who has done extensive quality-improvement consulting work with the UK’s NHS.

For a majority of issues, US and UK physicians are generally in agreement. For example, on the question of whether it’s right to provide intensive care to a newborn who either will die soon or survive with poor quality of life, US physicians were more likely than UK physicians to say yes — 34% to 22% . But the largest group in both countries — about 40% — said that it depends.

Dr. Forrow says this finding shows that doctors in both countries properly base decisions on individual circumstances. “What if grandma wants to see the baby before she dies and the baby won’t suffer? So it does depend.”

Candor With Patients

Another intriguing difference came on the question of whether the doctor would hide information from a patient about a terminal or pre-terminal diagnosis if the doctor believed it would help the patient’s spirit. Far more US than UK doctors – 72% vs 54% — said, “No, I am always completely truthful about diagnoses,” while more UK than US doctors — 33% vs 18% — said that it depends.

Dr. Berwick says this difference may result from a stronger sense of customer focus in the US. “Patient-centeredness as a fundamental property is better developed in the US than in the UK,” he says. “US doctors say it’s the patient’s right to know, while British doctors might say, ‘In my judgment it would be better for patients for me to not always be completely truthful.'”

Doctors in the 2 countries also differed on the question of whether they would ever give life-sustaining therapy that they believed to be futile, with 35% of US doctors and just 22% of UK doctors saying yes. About 40% of both groups said that it depends.

“The implication is that there is a financial incentive in the US to maintain the end-of-life patient in the hospital, and that incentive is not there in the UK,” Dr. Jarman says.

Societal and Religious Differences

Similarly, US and UK doctors differed on the question of whether it’s right to provide intensive care to a newborn who either will die soon or survive with poor quality of life, with US physicians more likely to say yes.

Both Dr. Forrow and Dr. Jarman agreed that there likely are societal religious factors influencing these differences over whether to provide what could be called futile care.

“The US is a more religious society,” Dr. Forrow says. “We do all kinds of things that are not medically necessary but the patient thinks they are necessary. When doctors think something is futile, patients and families object more. They say, ‘Give God a chance.'”

In contrast, Dr. Jarman says, “The UK is not a religious country and people don’t go to church as much, so those considerations wouldn’t be there.”

Despite greater religiosity in the US, American doctors were somewhat more likely than UK doctors to say that physician-assisted suicide should be allowed in some situations — 47% to 37%. That could be related to the fact that physician-assisted death for terminally ill patients is legal in 3 US states but remains illegal in the UK.

Protecting Other Physicians?

US doctors also were more likely than UK doctors to say that they would inform a patient if they felt a doctor scheduled to perform a procedure on the patient had substandard skill levels — 47% to 32%. Nearly 40% in both countries said that it depends.

“British doctors are more protective of their colleagues than US doctors are,” Dr. Berwick says. “This implies that US doctors are getting a little more comfortable about transparency on clinical performance.”

Dr. Jarman said that this difference in attitude could be a holdover from his country’s old General Medical Council rule, abolished in the 1980s, under which a doctor who reported a colleague for doing something wrong risked being barred from practice.

Finally, the survey showed a difference in attitude toward patient confidentiality and reporting communicable diseases. UK doctors were more likely than US doctors to say that it’s acceptable to breach patient confidentiality if a patient’s health status could harm others — 74% to 63%.

Dr. Berwick explained that by saying that more UK doctors than US doctors receive public training that encourages reporting of communicable diseases, and that the US has a very strong patient confidentiality and privacy law.

Dr. Jarman noted that the General Medical Council rules encourage physicians to break confidentiality and report patients’ communicable diseases or other conditions posing harm or risk to others. “If someone is causing harm to others, doctors are correct in breaking confidentiality for the good of the state,” he says.

Dr. Berwick says that the results of the Medscape survey are complex, revealing some important differences between US and UK physicians. But overall he feels reassured by their shared ethical values.

“A significant portion in both countries say that they will make decisions based on the details of the case,” he says. “They are willing to consider treatment efficacy. They are sensitive to the social world of the patient and what the families are feeling. They are connecting in the most humane way to the patient’s entire circumstance.”

Dr. Jarman says he found the survey interesting and challenging. “You know the correct answers but you also know that with certain patients you’ve got to be human and not totally follow the rules,” he says. “You have to be a little bit human about it.”

SOURCE:

http://www.medscape.com/viewarticle/774737

 

 

 

Read Full Post »


Reporter: Aviva Lev-Ari, PhD, RN

From MedscapeTopol on The Creative Destruction of Medicine

Topol: Consumer-Driven Healthcare Is an Uncomfortable Concept

Eric J. Topol, MD

Posted: 09/17/2012

Hi. I’m Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org.

In this series, The Creative Destruction of Medicine, emanating from the book I wrote, I am trying to zoom in on critical aspects of how the digital world will create better healthcare. The segment that we are getting into today is on consumer-driven healthcare.

This is a concept that a lot of physicians are very uncomfortable with. If you go back to the Gutenberg printing press, it was only then in the Middle Ages when the Bible and all the printed information could be read by others besides the high priest. In fact, that’s an analogy of what is going to happen in medicine, because until now there has been this tremendous information asymmetry.

Essentially, all the data, information, and knowledge were in the domain of doctors and healthcare professionals, and the consumer, patient, and individual was out there without that information, not even their own data. But that’s changing very quickly.

Patients will have the capability of accessing notes from an office visit and hospital records, as well as laboratory data and DNA sequencing — and on one’s smartphone, for example, blood pressure and glucose and all the key physiologic metrics.

When each individual has access to all this critical data, there will be a real shakeup to the old way that medicine was practiced. In the past, the Internet was supposed to be empowering for consumers, but that really didn’t matter because what the consumer could get through the Internet was data about a population. Now, one can get data about oneself, and, of course, a center hub for that data-sharing will be the smartphone.

Even critical information based on one’s genomic sequencing, such as drug interactions, will have a whole different look. We’ve already learned so much about the direct-to-consumer movement from the pharmaceutical industry in which patients were directed to go to their doctors and ask them for a prescription drug. That had a very powerful impact.

But in the future, with each person potentially armed with so much data and information, the role of the doctor is a very different one: It is to provide guidance, wisdom, knowledge, and judgment and, of course, the critical aspects of compassion, empathy, and communication. That is a whole different look for the consumer-driven healthcare world of the future.

Thanks so much for your attention to this segment. We will be back with more on The Creative Destruction of Medicine.

 VIEW VIDEO

 

Read Full Post »