Future Health - 12/31/18

Delivering care in the new virtual world…

The Dawn Of A New CRISPR Horizon – It was only a matter of time before it would finally happen.  And, I have to pile on!!  A Chinese scientist – He Jiankui,  Ph.D. from  Southern University of Science and Technology of Shenzhen – claimed just before the holidays that he had edited the DNA of twin embryos with the work being completed in secrecy and outside the realm of a peer-reviewed journal.  Specifically, he announced that he had disabled the gene that allows HIV to infect cells.  The stated reason for conducting the procedure was the fact that the father of the two twins – Lulu and Nana – is HIV positive.  While there were initially some who questioned whether or not the claims were real…it was finally announced that they apparently were!  As you can imagine, the ethernet was alight with reactions – many, if not most, of which called into question whether or not this had breached the ethical constraints the scientific community had previously placed on CRISPR research.  But, as I note rather cynically, did we really think this wouldn’t happen at some point. 

Now just for the record, I’m VERY concerned about the announcement.  I believe it calls into question all sorts of issues which have not been fully debated, accounted and accepted not just by scientists but all of society.  The announcement has clearly breached the “God point” in human creation.  Now that the cat is clearly out of the bag, we need to define it, deal with it and manage it rather than simply surmising and talking about it.  What will that take?  It’s clear that the theoretical has now moved into the realm of the real.  Therefore, a much more concerted effort by the entire international community needs to be convened to address the potential of CRISPR technology as well as the threats – and, how we as a human society will manage it.  For the lay reader, this is crucial since the focus of the International Summit on Human Gene Editing which met in 2015 was focused on CRISPR editing on disease-causing DNA by the human body’s somatic cells.  These are the cells that are not involved in reproduction which means that any changes cannot be passed along beyond the individual.  By venturing into the realm of reproductive cells, changes made by scientists will clearly be passed along to subsequent generations into perpetuity if reproduction is allowed to occur – which is only inevitable. 

Future Health - 11/5/18

Deferred until the next issue in a couple of weeks :-)

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NOTE: I thought it more important to encourage everyone to vote - regardless of your perspective - than to discuss the future. The here and now is right in front of us...

Future Health - 10/11/18

Delivering care in the new virtual world…

 From Bullets to Bytes – There’s a new kind of warfare being used at the forefront of international conflicts that has troubling implications.  According to a new report by CB Insights the exploitation of data is on a very troubling increase. Here are some data points to consider:

  • 3 billion – the number of compromised accounts in the Yahoo breach where thieves were able to obtain names, email addresses, phone numbers and other data
  • 200 million – the number of registered US voters whose personal information was accidentally exposed online,
  • 146 million – the Equifax breach affected this number of folks and it contained SSA numbers, birth dates, addresses and the like affecting about 50% of the USA population,
  • 57 million – data stolen from Uber customers where the thieves extorted $100,000 from the company, and,
  • On and on and on…

But as troubling at these points are, the even more challenging piece is the use of inaccurate data and information to sway people.  And, it’s not just emails that are being sent. It’s pictures that have been photoshopped, it’s queries from people that are simply fishing, it’s a whole range of strategies designed to upset the apple cart of opinion, perspective and thoughts.  In particular, these attacks are using “bytes” instead of “bullets” to engage in a type of warfare that we’ve never experienced before.  I’m not panicking.  But, I am forewarning.  As a country, we need to be investing much more aggressively in developing capabilities to counteract these byte-size warfare patterns.  Health care – in particular – is an industry that is ripe for invasion.  We need to be on the alert to a much higher degree than currently exists within our community.  While some attention is being given to cybersecurity and the needs within the health care community – we could be doing better.  The problem with “bytes” is that they can hurt just as much as “bullets” and even more so in some cases.  Stay tuned. 

 Kaiser Reports on Video Visits – Just today as I was writing my blog, a report came out from Kaiser in the New England Journal of Medicine on the use of telemedicine by Kaiser physicians.  Since 2015 when the program was implemented, there have been over 200,000 scheduled video visits for a variety of problems.  The bulk of the visits were for issues related to medicine, pediatrics, dermatology, after-hours care and psychiatry.  Importantly, over 90% of the patients who access telemedicine services had accessed in-person health care services in the prior year.  Finally, among the visits – 70% were completed with the patient’s own primary care provider.  Now this is an integrated approach.  It’s what’s missing from much of the health care community. 

Future Health - 9/14/18

Delivering care in the new virtual world…

 Let’s Be Careful – You will not find a bigger fan on the use of artificial intelligence and machine learning as a tool for “augmenting clinical intelligence” among providers.  At the same time, I took pause at a recent issue of JAMA Network Open (2018;1(3): e180926.doi: 10.1001 – 2018-0926) which report on the application of machine learning as an approach toward assessing short-term mortality among cancer patients who were starting chemotherapy.  The study included a cohort of 26,946 patients with cancer who were starting a wide variety of discrete chemotherapy regimens.  With the use of machine learning and AI, those patients who were at high risk of 30-day mortality were accurately identified across palliative and curative chemotherapy regimens and across many different types/stages of cancer. The researchers also compared the computer algorithm to more conventional tools such as predictions based on randomized clinical trials and population-based registry data. The algorithm did a far better job.  Their conclusion is what drew my attention.  It said:

“A machine learning algorithm accurately identified individuals at high risk of short-term mortality and may help to guide patient and physician decisions about chemotherapy initiation and advance care planning.” [emphasis added]

Lest we forget, it is an imperative – from my perspective – to always keep in mind their conclusion that the use of machine learning and AI is a “guide” – not the definitive approach.  In our enthusiasm to embrace new technologies, we always need to keep at the forefront that computers and machines still do not think – and, until they do, we should always hold their outcomes as support for “clinically augmented intelligence”.  Make sense?

Bioprinting Your Medications – The new HP D300e Digital Dispenser BioPrinter technology is being tested by the company and the CDC on the effectiveness of printing (i.e. making and dispensing) and testing antimicrobial resistant strains of “super bugs” which is an increasing problem.  The idea is to provide a select number of hospitals access to the technology nationally to cut down on the drug resistance problem by identifying the bugs earlier and dispensing the appropriate medications quicker.  In addition to identifying resistant strains, the HP BioPrinter can also dispense medications in many doses thereby alleviating the frequent “wait” in pharmacies who need to obtain the correct dose prescribed by the clinicians. Soon, the antimicrobial resistance testing will become a common place component of dispensing medications for patients with the end result being a reduction in the 23,000+ people that die in the USA every year from infections by super bugs that are not treated as rapidly as can be managed using the new HP Bioprinter devices.  But, the use for drug dispensing is only the beginning of a revolution in the “printing” business.  Bioprinters are also being explored for use in human tissue and organ production, drug research and other clinical areas.  Amazing!!

Future Health - 8/17/18

Delivering care in the new virtual world…

Keeping Up Or, Not – The explosion in medical knowledge is daunting.  Last year, more than 2.5 million clinical studies were published, and the rate of increase is accelerating.  For example, in 1950, it took 50 years for medical knowledge to double.  By 1980, that had reached just 7 years. In 2020, the projection for the doubling of knowledge in medicine is 2.5 months.  Imagine that!!  I think it is amazing how much has changed since I graduated (a ways back :-)  ) but those changes pale in comparison to what the future physicians will be managing.  It’s all happening because of artificial intelligence, machine learning and the like.  AND, it’s one of the reasons that we need to reconsider the medical school curriculum to integrate the use of information technologies as a core component of medical school training.  I don’t believe doctors will be replaced anytime soon – unless they don’t learn how to use these new and evolving tools which provided “clinically augmented intelligence.”  Those skills are as important – if not more important – than the biochemistry, physiology and anatomy of yore. 

GAFABAT – Have Your Heard About It? – There’s a new term that’s beginning to float around the ethernet = “GAFABAT”.  If you have not heard about it, you should know about it because GAFABAT is working to change your life in both direct and indirect ways – at home, in the office while working, while sleeping and even while simply contemplating.  So, what is it?  It is short for “Google, Apple, Facebook, Amazon, Baidu, Alibaba and Tencent or, GAFABAT.  This small group of seven companies is all about artificial intelligence and changing the way work, life, living is done.  These companies have attracted the very best talent in the world to help them make changes across the board in our lives.  Their data sets are massive – so massive that you are most likely not even able to comprehend their increasingly ability to not only understand any number of work-related activities but, also to understand you.  While I am a big believer in artificial intelligence and machine learning, I’m also increasingly of the opinion that we need to keep a watchful eye on the developments of this field.  For example, in China there are all sorts of reports on the use of government surveillance to manage the populace that are powered by computer vision and face recognition technologies. In that nation, you can be followed anywhere.  But, it’s not just China.  The same applies to London and increasingly in many urban areas throughout the world.  And, it’s not just our faces.  It’s what we buy, what sites we visit on the Internet, what programs and songs we download from Apple, what items we buy at the grocery store.  In essence, what we do every minute of every day in our life.  While there is incredible good that will no doubt come of this knowledge there is also the potential for “not so good”.  We should consider those issues.  We should debate them.  We should deal with them rather than brushing them aside.  I offer these thoughts after two cups of coffee on a Saturday morning.  Imagine what my thoughts will be by this afternoon…

The Reality Of Our Reality – There is an evolving technology that is likely to change health care in some very substantial ways.  It’s been primarily a focus of the gaming industry but all of that is about to change.  Specifically, Virtual Reality (VR) and Augmented Reality (AR) are coming of age.  These two technologies are increasingly being used in various industrial sectors and only now coming to health care.  While it’s clear that the technology has a bit of further development and is only at the very formative stages of development, it’s also clear that it could very easily alter our whole notion of how, where, who and when care is delivered.  Let’s consider just two examples: 

  • Training – The process for educating health professions students and for orienting our staff to the workflow of our organizations hasn’t changed much until recently. We’re clearly at the formative stages of a disruption in how training will occur through the use of VR/AR technologies. Some non-health care examples include Walmart’s introduction of Strivr – a VR tool that helped to prepare employees for its Black Friday sales in 2017. It created an alternative, lifelike environment that immersed the new sales associates in experiences with long queues and crowds in order to prepare them for all sorts of happenings that occur on Black Friday at Walmart stores throughout the nation.  Or, consider another VR training tool, Oculus VirtualSpeech which helps users hone their public speaking skills in a simulated environment. Distractions and other occurrences that are part of engaging with people are built into the Oculus experience.  Imagine how these two tools could be used in health care to help workers learn how to manage busy emergency rooms and to engage with patients who are experiencing health problems in the acute care setting.  In particular, the VR/AR tools will enable healthcare professionals to practice in a risk free environment.  Think it’s not possible?  Think again.  Children’s Hospital of Los Angeles (CHLA) is already using Oculus to train staff for pediatric trauma cases.  And, there are more opportunities on the horizon. Beyond these ideas, we are now seeing VR/AR used for training surgeons in the OR, technicians for all types of procedures, and administrative/clinical personnel for enhancing their interactions with patients. 
  • Building Care Delivery Facilities – The construction of health care facilities continues to be one of the most expensive efforts in the building business. The use of VR/AR offers a host of benefits for reducing costs, creating efficiencies, avoiding construction mistakes and enhancing the end-user experiences once the facility is opened.  The technology actually lets the future patient and clinician walk through the environment so that the architects can finalize their designs before construction starts.  It provides the bridge between the imagination of the architect and the reality of end users who will live in these facilities. 

It’s a new day in health care.  Keep your eye on the VR/AR world.  It’s going to change how we prepare everyone for doing everything in health care.  The imaginary worlds are becoming reality and, if you can imagine it, you can create it and, prepare for it!

 

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