Our most recent water bill was about 5 times higher than the one for the preceding quarter, so I called the local water authority to see if there had been a mistake. With a few keystrokes, the woman with whom I spoke was able to tell me exactly which days over the previous months appeared to have high usage, and asked if we had a leaky faucet or a running toilet. Well, yes, I explained, we did have a toilet that had been running (which I have since fixed), but I was surprised that it could lead to such an outsized bill. The response was more or less, “oh yeah, that can do it” and the more medically resonant “we see this.”
I was disappointed that the bill was real, but also sort of impressed that the water-works was able to pinpoint my usage, so I asked her about the metering. She explained that we have a smart-meter that transmits our usage on a daily basis to the central office. When I heard that, I asked why, if they could tell we had a problem, that they didn’t notify us or provide us with access to the data. Turns out they intend to make that information available to users in the near future. Cool.
Continue reading Heart Monitors and Running Toilets
I believe strongly that “data about patients should be patients’ data.” That is why I support the OpenNotes movement and the push to provide patients with access to data from their cardiac implantable electronic devices. Last week, I had the opportunity to spend the day among an eclectic group of pioneers who are taking the principle of patient empowerment through data to its next logical step – patients generating their own data in order to understand their own state of health, and expand the understanding of health and illness in general.
The occasion was a symposium on cardiovascular health, sponsored by the Quantified Self. Quantified Self (QS) is described on its website as a “company” but it is also a movement. A slightly dated but useful description of the movement is available here. Its members are people who are using new tools in new ways to learn more about themselves. Most of these tools are electronic, often wearable, sensors that can easily and continuously track parameters such as heart rate, blood pressure, temperature, activity, etc., but some go way beyond that, to track things like the composition of the gut microbiome. Other participants were creating new technologies to make tracking and data sharing and analysis easier.
Continue reading Quantified Self
A recent FDA advisory panel recommended the approval of 2 new agents in a novel class of cholesterol lowering drugs known as PCSK-9 inhibitors. What makes this remarkable is that these drugs illustrate all the promise and pitfalls of modern pharmaceutical development.
First, a little science. The target of the new drugs – a protein named proprotein convertase subtilisin/kexin type 9 (PCSK-9) – was discovered in 2001. Two years later, investigators reported that “gain-of-function” mutations in the gene that codes for PCSK-9 were associated with familial hypercholesterolemia and high rates of atherosclerotic vascular disease. Mutations of the gene that led to reductions in the function of PCSK-9 were associated with low LDL-cholesterol levels, and a lower incidence of vascular disease. That made the compelling case that PCSK-9 had a counter-regulatory function in LDL-cholesterol metabolism, so that interfering with its function would lead to lower cholesterol levels.
Continue reading The New Paradigm
I have written previously about the potential impact of mobile apps and ubiquitous computing on health and healthcare delivery, but I admit I did not see this one coming. The current issue of The New England Journal of Medicine has a report from a research group in Sweden that developed a system – and tested it in a randomized controlled trial – to use smartphones to alert CPR-trained bystanders when there was a nearby cardiac arrest. This figure from the paper describes how it works:
Continue reading Crowdsourcing CPR
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way.
The guy – Steven Keating – is not your average Joe. He is a graduate student at MIT who trained as a mechanical engineer and is working in the cutting-edge MIT Media Lab. He also had a brain tumor the size of a tennis ball. His website hosts all of his medical records, including his pre- and post-op brain scans and, believe it or not, a video of his tumor resection surgery.
Continue reading Whose Record Is It?
If you were the right age to have been watching television in the mid-1970s, you probably remember “The 6 Million Dollar Man.” The show was about an astronaut who is critically injured in a test-mission gone bad, and is “rebuilt” with bionic (nuclear powered!) limbs and sensors to be “better than he was.” The campy intro, complete with scenes from the operating room, is, of course available on YouTube. Continue reading Better than new
I felt a little sad when I read the “perspective” piece in the New England Journal of Medicine this week about the introduction of point-of-care ultrasound in medical education. Continue reading Death of the stethoscope?
I recently read two books that both have a powerful “wow” factor, which has kept them on my mind. In thinking about them some more, it also seems that there are some connections to medicine that could also be quite profound. Continue reading Globalization and Extinction
For years, I have been hearing about how new technology will transform every day clinical practice, and I have been looking forward to it. Who wouldn’t want to be able to understand better the basis of human disease based on the “new taxonomy” of precision medicine? Or offer personalized therapeutics based on full genome sequencing? Or have the ability to predict better which patient will decompensate based on advanced analytics? And yet… most of us are pretty much doing what we have always done – diagnosing disease based on signs and symptoms, prescribing drugs based on their likelihood of efficacy in a population that more or less looks like the patient in front of us, and waiting for patients to decompensate and then reacting to it. Yes, we are doing all this while using (struggling with?) an EMR, but still, the basics are all pretty much the same. Continue reading The Future Arrived for Me Last Week
I think I am like many practicing physicians in my “love-hate” relationship with clinical practice guidelines. On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice. On the other hand, I am well aware of the shortcomings of practice guidelines, including the limitations of the underlying evidence base, the challenge of synthesizing the available evidence into guidelines, and the often limited applicability of recommendations to clinical practice. Continue reading Practice Guideline Overload