Harvard medicine for the masses: Mini-med meets start Tuesday

Damn, there’s a waiting list. If you can’t get in, we’ll do our best to offer reports.

Registration for the 2011 Longwood Seminars has closed. If you would like to be added to the waiting list, please contact us at longwood_seminars@hms.harvard.edu or 617-432-3038. Thank you.

 

2011 Longwood Seminar Schedule:

Tuesday, March 1, 6:00–7:30 pm
The Race to Grace: Surviving stress

In today’s 24-7 world, it’s common to feel anxious, overburdened and stressed periodically. At this seminar, you’ll hear from doctors who will explain how the body responds to stressful situations, and describe how stress affects psychological and physiological well-being. Faculty members will also share insight about how stress can be effectively managed.

 

Tuesday, March 15, 2010, 6:00–7:30 pm
Living Long, Living Well: Aging with flourish

As life expectancy continues to rise throughout the US, many of us can look forward to a longer life. In this seminar, you will learn about the biology of aging to help explain the changes that take place in the body as people age, as well as hear practical advice from a physician about how to live a long and healthy life.

 

Tuesday, March 29, 6:00–7:30 pm
From Vision to Touch: Exploring the five senses

The senses make it possible to explore our surroundings and communicate in the world, but do you understand their role in the body? At this seminar, a panel of Harvard faculty members who specialize in each of the five senses will share their expertise on touch, vision, hearing, smell and taste, and in some cases will discuss ways the senses can be leveraged to affect our health.

 

Tuesday, April 12, 6:00–7:30 pm
Food for Thought: Genetically modified nourishment

Since the early 90’s when it was first produced in the US, the value of genetically modified (GM) food has been challenged and debated. In this seminar, you will learn about how GM foods are produced and how the process may change in the future. The relative benefits and controversies surrounding GM foods as well as policy issues associated with their production will be discussed. Faculty members knowledgeable about GM goods will share what is known about the technology and how it may in time be used to address worldwide problems, such as hunger and disease

Health info tech chief, NYTimes, wrap it up

As David Blumenthal heads back up here to Harvard, he offers his view of what he’s accomplished as the generically named “national coordinator.” That is, head of Office of the National Coordinator, which is charged with bringing doctors into the digital age. The NYTimes Business page offers an update as well.

 And while reading the above, keep in mind some of the issues raised by the Huff Po’s investigative series on HIT. Here, we’re less worried about medical errors – the system should prevent more than it causes. Still, the series calls for needed oversight.

  We worry about those who would use fraud to cash in on this effort.  And, we feel kind of bad that well-heeled doctors need a $40,000 bribe to get on line.  That’s where that other piece of jargon comes in. In order to qualify for the money, doctors need to meet certain standards which the feds call “meaningful use.”  In other words, they can’t just use the cash to buy iPads for the staff. They can – but staff members have to use the computers in ways that could cut costs and improve care.

  Here from today’s Times Sunday Business section

THE United States is embarking this year on a grand experiment in the government-driven adoption of technology — ambitious, costly and potentially far-reaching in impact. The goal is to improve health care and to reduce its long-term expense by moving the doctors and hospitals from ink and paper into the computer age — through a shift to digital patient records.

Step back from the details and what emerges is a huge challenge in innovation design. What role should government have? What is the right mix of top-down and bottom-up efforts? Driving change through the system will involve shifts in technology, economic incentives and the culture of health care.

“This is a big social project, not just a technical endeavor,” says Dr. David Blumenthal, the Obama administration’s national coordinator for health information technology.

 In his letter, Blumenthal talks about a vision of how information can be brought to bear in new ways for the improvement of health and health care. That vision is a device for defining, encouraging, and supporting the optimal use of information for patient care. It is likewise a device for reaching consensus on specific goals, and the pace at which they should be pursued. Finally it is a device for encouraging development and innovation in the technology itself.

This vision really calls for a new perception of clinical care and what we can do for and with patients. We have been accustomed to thinking of medical information as being statically recorded on paper. Meaningful use challenges us to imagine the way electronic information can “take on life” and serve providers and patients in entirely new ways.

Electronic information, especially standards-based information, can become dynamic, interacting with other information to (for example) generate useful safety alerts, call attention to treatment alternatives, enable instantaneous assessments of quality of care or outcomes for patients, or contribute to public health surveillance. We have never, in the history of medicine, had such tools at our disposal. Meaningful use will help usher them into routine, widespread, and effective use.

 And here from Huff Po:

The federal grants reflect a growing view that technology, including everyday tools such as cell phones and computers, can help change behaviors and poor health habits that lead to chronic illness. In some cases, technology’s advocates argue, seemingly simple solutions such as sending an email reminder to patients about taking the next dose can help.

The grants also offer an early test of a $27 billion gamble by the Obama administration that medical records technology can achieve specific cost reductions and health improvements, critical tenets of health reform.

Here from the series on medical errors.

 

 

 

Did journalists overstate the promise of the human genome project?

 Note that in the Nature Network Boston report on Tuesday’s panel on the human genome project, Broad Institute chief Eric Lander says that journalists naively reported that the genome map would rapidly lead to cures for many diseases.  

 Lander said that expectations for the impact of the research were  “fabulously naïve. Journalists wrote about how we were going to have drugs for all these disease in the next decade. Somebody was smoking something. This was just nuts.”

They say journalism is the art of verification. So we went back to try to find some of these stoner reporters and their overblown claims by reviewing reporting in The New York Times and USA Today. 

Although the paper on the research was published in 2001, the results were announced in the summer of 2000 at a White House press conference. A June 27  NYTimes package entitled ”READING THE BOOK OF LIFE: A Historic Quest; Double Landmarks for Watson: Helix and Genome” seemed pretty measured: 

The human genome project may be the gateway to the biology and medicine of the 21st century…

Identifying the genetic variations that predispose people to diseases like cancer, diabetes and schizophrenia was a major purpose of the Human Genome Project…

Even incomplete, the databases of DNA sequences are a treasure trove for researchers, providing answers in a few minutes at a computer terminal rather than after months of laborious, expensive laboratory experiments. For pharmaceutical companies, that speeds the development of new drugs with several promising compounds already undergoing human clinical trials.

For university researchers, that opens up areas of inquiry that would previously not have been worth the time and effort.

More than a year later, on December 25, 2001, a Times update read:

With the Human Genome Project — the effort to work out the sequence of the three billion chemical letters that embody human heredity — nearly complete, biologists are facing a daunting transition.

They must move from their traditional pursuit of understanding one gene at a time to the challenge of figuring out how tens of thousands of genes work in concert in the human cell.

Should they succeed, in 20 years it may be possible to compute the behavior of a cell, perhaps of a living organism, and to calculate how changing one unit of DNA may affect human health or performance.

 Now, here’s a little hyperbole, but from a scientist, not a journalist. Granted, the reporter chooses who to quote.

…Dr. Richard Lifton of Yale predicted that in 20 years researchers would be ”able to identify the genes and pathways predisposing to every human disease.” A panel of biologists led by Dr. Michael Snyder, also of Yale, said that in two decades they would like to know the effects on the organism of the smallest possible change in the genetic programming, the switch of a single unit of DNA.

Here’s how USA Today reported on the genome map on June 23, 2000:

Generations of scientists will spend most of the next century interpreting the code’s meaning and learning to play it on computers in increasingly complex ways that they believe will lead to treatments for most, if not all, human diseases.

 The genetic code also will launch a mammoth growth industry and marry the new darlings of Wall Street: computer technology and biotechnology. Scientists from the public and private projects predict that the information contained in the genetic code will allow them for the first time to study the interactions of many different genes involved in
complex diseases such as cancer and heart disease and to develop drugs that target these diseases at their most fundamental root levels.

Were they generating this hype or just reporting it? And, is there any difference? Here’s more from that story:

(Francis) Collins, the U.S. leader of the international Human Genome Project, are expected to announce the completion of their projects at news conferences Monday in Washington….

“Achieving this milestone is an exhilarating moment in history, and a credit to the ingenuity and dedication of some of the brightest scientists of the current generation,” Collins told USA TODAY. “Even more importantly, it brings us a major step closer to understanding and better treating a host of diseases for which genomics offers the best hope of prevention and cure.”…

Some predict the expected health benefits will beginto appear with regularity in about 10 years.

“We will see an increasing proportion of gene-based medicines coming to the market that are targeted to the disease process,” says Paul Herrling, director of global research at Novartis Pharmaceutical Corp. in Basel, Switzerland. “Many traditional therapies address the end stages of disease. These new therapies will address the disease process, so if a person has Alzheimer’s disease or diabetes, we will develop medicines that stop or slow down the disease process.
Having the human sequence is just the beginning.”

 And, do note that Lander was the first author in the  actual paper on the findings, which was, published ten years ago in Nature, concluding:

The scientific work will have profound long-term consequences for medicine, leading to the elucidation of the underlying molecular mechanisms of disease and thereby facilitating the design in many cases of rational diagnostics and therapeutics targeted at those mechanisms.

Finally, Lander made a bold prediction of his own at Tuesday’s panel:

He cited ” an explosion of work that will culminate, I think in the next five years, in a pretty comprehensive list of all the target that lead to different kinds of cancers and give us a kind of roadmap for finding the Achilles heel of cancers for therapeutics and diagnostics.”

 

BHN report: Hackers, health and the Boston Code-a-thon

Sometimes,  hackers have to work on meaningless problems in windowless cubicles. But on Saturday, a group of number crunchers and tech enthusiasts gathered at Microsoft’s sun-soaked Cambridge offices to find new ways to use health data.

Last week’s “code-a-thon” was the latest “Developer Challenge” hosted by a Health 2.0, a group that organizes conferences around the rich possibilities at the intersection of data, technology and health.

Here’s how Health 2.0 puts it on their website:

Healthcare has big challenges. And technology might not solve them all. But we believe in progress one app at a time. Have a technical problem that needs working out? An app you wish existed? Data that’s sitting on the shelves getting dusty that could be made more useful?

In other words, hospitals, insurers and policy makers have been capturing huge amounts of health data and mining it for years. This effort aims to use that information — much of it in public data sets– for more than claims analysis, and utilization review. With the rise of mobile communication, do-it-yourself science and the quantified self, it’s time to let the hackers at it.

So, with the sponsorship of DIY magazine “Make,” the event attracted about a 100 people, including programmers, web designers and wired epidemiologists. Sitting with his laptop open in an airy space overlooking the Zakim Bridge, Jason Morrison said he is a big fan of gatherings like this one. A web developer for a Boston company called thoughtbot,  he finds it satisfying to work on health problems.

“It is a very ripe field for people to come in and use all this data and then turn it into information and knowledge people can use,” Morrison said. Ideally, the event would produce “actionable” tools that people can use to change their behavior or find information on treatments they might be interested in, he said.

At the end of the day, coders were expected to regroup and present their ideas. Click here for a link to Health 2.0 news site to find out who won.

In this video report, Morrison (in the black jacket) and others talk about what brought them to the meeting.  Postdoc Rumi Chunara of the Children’s Hospital Boston made a presentation on using HealthMap for real time epidemic surveillance.  Psych resident Daniel Karlin wants to track prescribing trends and Bio-hacker Mac Cowell, of DYI Bio Boston, talks about inventing a home PCR kit for those interested in DIYgenotyping.

Electronic disease management: Two steps forward, one step back #EHR

Recent research out of BWH suggests: 

1) It can be hard to get docs to use chronic disease management software but “documentation-based decision support shows promise and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.”

2) Docs who use “Acute Respiratory Infection (ARI) Quality Dashboard, an electronic health record (EHR)-based feedback system,  improved antibiotic prescribing. But, even with access to the program, many docs failed to use it.

3) A small study found that “system to automatically send electronic drug side effect reports to the FDA in real-time…was efficient and acceptable to clinicians, provides detailed clinical information, and has the potential to greatly increase the number and quality of spontaneous reports submitted to the FDA.”

Mass towns work together to improve publichealth

When it comes to public health, not every town can do everything. So, the state, with help from researcher at BU, is in the midst of creating regional health systems. Starting in March, the DPH will hold hearing across the state to gain insight into the specific health issues in different parts of the state. Boston area meetings are scheduled for March 4. Click here for the full schedule.

 MetroBoston
Friday, March 4, 2011
10:00 AM -12:00 PM
Morse Institute Library,
14 E. Central Street, Natick

Boston
Friday, March 4, 2011
2:00 PM – 4:00 PM
Boston Public Health Commission
Carter Auditorium
35 Northampton Street, Boston

Here’s how the state spells out the problem.

•  Of Massachusetts towns with less than 5,000 residents (there are 105), 78% have no full-time public health staff, 58% have no health inspector and 90% have no public health nurse. The staffing of the 71 towns between 5,000 and 10,000 residents is not much better.
•   Over 70% of local health officials report they do not have enough staff to consistently fulfill their responsibilities to the public.3 Further, according to a 2004 MDPH statewide needs assessment of local health boards and departments, nearly all responding communities reported they found it challenging to prevent chronic and infectious disease and injuries (98%), ensure a competent public health care workforce (97%) and apply basic environmental public health regulations (89%).
•   That same assessment found major regional disparities in public health system capacity–22% of western MA communities had no public health director/agent, compared to 3% for metro Boston; 17% of western MA communities did not  keep records of reportable diseases, compared to 1.6% for metro Boston.
•   According to the Trust for America’s Health, Massachusetts scored 6 out of 10 onvarious measures of Emergency Preparedness in 2008, which ranks the Commonwealth 37th in the nation• That same study ranks the Bay State 9th worst with regard to 2010 public health nursing  shortage estimates.

 Here’s how BU puts it:

 The Need

Massachusetts has over 300 Local Boards of Health, many of which are chronically underfunded and not able to maintain the 10 essential services of public health departments, putting their communities at risk.
Click here to learn more about the BU program.
Why Regional Public Health Agreements?

Regional public health cooperation agreements:

•  Facilitate creative resource sharing among municipalities.
• Augment rather than reduce the existing public health workforce.
• Respect existing local legal health authority.
• Are supported by a voluntary initiatives.

 

$$$: Not enough for asthma, nurses?

The Globe reports on federal cuts to the asthma research program:

Budget cuts proposed today by the Obama administration would strike heavily in Boston’s health care community, threatening the training of young pediatricians and imperiling a program that tackles asthma in older homes.

Commonhealth reports on complaints from union nurses at Tufts. Also see the ad on the Globe op/ed page.

Budget cuts proposed today by the Obama administration would strike heavily in Boston’s health care community, threatening the training of young pediatricians and imperiling a program that tackles asthma in older homes.

For the other side, sort of,  see this website from Tufts on its nursing program.

On Valentines day, feed a heart attack or stop a heart attack

In Boston, you can feed a heart attack or stop a heart attack or do both. Kind of like riding a bike while smoking a cigarette. (We took down the link to the heart-shaped Boston Pizza becasue it wasn’t in Boston. It’s a Canadian chain.) But, we link to:

•  Heart-shaped Boston Cream donuts
• Chocolate: L.A. Burdick in Harvard Square. Made in New England. Pricey. Good.  
• Universal Hub brings us to heart-shaped meat but points out that Shaws also offers a heart-healthy shrimp cocktail.
• Take a heart shaped run

Globe story: Poor response to health monitor alarms proves deadly

The Globe hired a number crunchers to help the paper  make sence of a government database on hospital alarm system breakdowns. Not the machines, which work. But a system that cries wolf– sending out so many false alarms that nurses can’t keep up or simply don’t respond. Commenters blame Obama health reform, system breakdown, unionized nurses, too few nurses and too many alarms.

 The lead tells the tale of just two of more than 200 hospital patients nation wide whose deaths between January 2005 and June 2010 were linked to problems with alarms on patient monitors that track heart function, breathing, and other vital signs, according to an investigation by The Boston Globe. As in these two instances, the problem typically wasn’t a broken device. In many cases it was because medical personnel didn’t react with urgency or didn’t notice the alarm.

They call it “alarm fatigue.’’ Monitors help save lives, by alerting doctors and nurses that a patient is — or soon could be — in trouble. But with the use of monitors rising, their beeps can become so relentless, and false alarms so numerous, that nurses become desensitized — sometimes leaving patients to die without anyone rushing to their bedside. On a 15-bed unit at Johns Hopkins Hospital in Baltimore, staff documented an average of 942 alarms per day — about 1 critical alarm every 90 seconds.

More comments.

2011 Flu season in Mass: It’s here

Check out the Department of Public Health web site for a reality check on the flu.The state tracks the percentage of patients who show up at doctors’ offices with “influenza-type illness.” The spike in late 2009 marks the time when many thought the H1N1 virus was coming to kill us all. 

Luckily, it didn’t turn out that way. HINI– AKA swine flu — is still around but no one seems worried about it this year since it was not as deadly as many expected. And, the standard flu vaccine offers some protection.