Archive for November 20, 2012

Mind-Pops

Brilliantly timed Shot

Why do odd images suddenly pop into your head for no reason?

You’re walking down the street, just like any other day, when suddenly a memory pops into your head from years ago. It’s about a person you haven’t thought of for years. Just for a moment you’re transported back to a time and place you thought was long forgotten. In a flash, though, the memory has vanished as quickly as it appeared. This experience has been dubbed a ‘mind-pop’ and sometimes it is prompted by nothing your conscious mind is aware of. There is, perhaps, an even weirder type of ‘mind-pop’. This is when all you get is a word or an image which seems to have no connection to anything at all. Like suddenly thinking of the word ‘orange’ or getting the image of a cheese grater. They seem weirder because they feel unconnected to any past experience, place or person—a thought without any autobiographical context.

Not everyone has these experiences, but many do. When psychologists have recorded these involuntary memories, they find that, on average, people have about one a day. They are most likely to occur during routine, habitual activities, like walking down the street, brushing your teeth or getting dressed. They are also more likely to come when your attention is roaming and diffused. Some of these mind-pops can even be traced back to their causes. Here is one psychologist describing some mental detective work "…while throwing a used bag in a dust bin the word “Acapulco” popped up and since she had no idea what it was and where she might have come across the word, she turned to a member of family for help. To her surprise, it was pointed out to her that Acapulco was mentioned on the TV news some 45 minutes ago. This ability to trace a mind-pop back to its source wasn’t an isolated case. When they surveyed people, Kvavilashvili and Mandler found that the words and images that seemed to pop up randomly didn’t actually come from nowhere.

Sometimes it was an associative mind-pop, like being reminded about Christmas and later having the words ‘Jingle Bells’ pop into your head. It could be a sound-a-like, for example having the image of a sandy beach appear after you see a banana (Bahamas sounds like bananas). The fact that many mind-pops could not be traced back to their source is probably the result of how much of our processing is carried out unconsciously. The fascinating thing was that many of these mind-pops occurred weeks or months after exposure to the original trigger. This suggests that these words, images and ideas can lie in wait for a considerable period. Some even think that experiencing mind-pops could be associated with creativity as these apparently random associations can help to solve creative problems.

Mind-pops are another hint that we are recording more information than we know. Fortunately, our minds mostly do a good job of suppressing random thoughts and images, as they can be extremely distracting. So next time you have a mind-pop, remember that, however weird, it has probably been triggered by something you’ve seen, heard or thought about recently, even if you can’t remember what. Of course, why we get these particular ones and not others is still a mystery.

End of Medicine As We Know It

I’m trying to zoom in on critical aspects of how the digital world will create better healthcare. George Orwell once said that the hospital is the antechamber to the tomb. That was written decades ago, and unfortunately there’s still truth to that today. It’s really sad to think that 1 in 4 hospital patients in America have a problem with medical errors or that they have problems like nosocomial, or hospital-acquired, infections and medication errors.

There’s a book that was recently published called Unaccountable, by Marty Makary, MD, a surgeon at Johns Hopkins Hospital, and it’s quite an alarmist view of this problem with lack of accountability in hospitals and in the medical profession in general. The digital world could potentially help this; we’ve seen some disappointing aspects with respect to electronic medical records, which haven’t really been shown to markedly reduce medical errors. They certainly haven’t done anything to reduce hospital-acquired infections.

What will be interesting to see in the future are things like scorecards of hospitals. You saw, in recent months, Consumer Reports’ cover article about rating hospitals. This is just the beginning of where we can go to give direct information, transparency, accountability, and data to consumers and that Consumer Reports story is just going to be amplified over time, and not just through one particular magazine.

When we give a window to the consumer using real data, they can select a physician. Consumers can go to Google Scholar and figure out who the experts are in a particular field, just as we in the medical community can when we’re trying to find a physician to refer to and we can pick anywhere in the world. This is the sort of thing that can be digitally available for consumers. We as peers can put together the information that’s necessary for the proper transparency, selection of physicians, and selection of hospitals. Hopefully, that’s one way to make improvements in the future.

One of the interesting things why trustees volunteer to serve on hospital boards is that when you talk to them, they say they volunteer to be trustees so they can get access to information on which doctor is the right doctor to go to when they have a problem and, of course, there are very few people who can serve as hospital trustees, but that’s the equivalent of where we need to go with transparency, accountably, and scorecards in the future.

Consumer-Driven healthcare 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.

We can get rid of the randomized trial and here is a better way. How we can Schumpeter or reboot the future of healthcare by leveraging the big innovations that are occurring in the digital world, including digital medicine. But one of the things that have been missed along the way is that how we do clinical research will be radically affected as well. We have this big thing about evidence-based medicine and, of course, the sanctimonious randomized, placebo-controlled clinical trial. Well, that’s great if one can do that, but often we’re talking about needing thousands, if not tens of thousands, of patients for these types of clinical trials, and things are changing so fast with respect to medicine and, for example, genomically guided interventions that it’s going to become increasingly difficult to justify these very large clinical trials.

For example, there was a drug trial for melanoma and the mutation of BRAF, which is the gene that is found in about 60% of people with malignant melanoma. When that trial was done, there was a placebo control, and there was a big ethical charge asking whether it is justifiable to have a body count. This was a matched drug for the biology underpinning metastatic melanoma, which is essentially a fatal condition within 1 year, and researchers were giving some individuals a placebo.

Would we even do that kind of trial in the future when we now have such elegant matching of the biological defect and the specific drug intervention? A remarkable example of a trial of the future was announced in May. For this trial, the National Institutes of Health is working with Banner Alzheimer’s Institute in Arizona, the University of Antioquia in Colombia, and Genentech to have a specific mutation studied in a large extended family living in the country of Colombia in South America. There is a family of 8000 individuals who have the so-called Paisa mutation, a presenilin gene mutation, which results in every member of this family developing dementia in their 40s.

Researchers will be testing a drug that binds amyloid, a monoclonal antibody, in just [300] [1] family members. They’re not following these patients out to the point of where they get dementia. Instead, they are using surrogate markers to see whether or not the process of developing Alzheimer’s can be blocked using this drug. This is an exciting way in which we can study treatments that can potentially prevent Alzheimer’s in a very well-demarcated, very restricted population with a genetic defect, and then branch out to a much broader population of people who are at risk for Alzheimer’s. These are the types of trials of the future and, in fact, it would be great if we could get rid of the randomization and the placebo-controlled era going forward.

One of things that I’ve been trying to push is that we need a different position at the FDA. Now, we can find great efficacy, but the problem is that establishing safety often also requires thousands, or tens of thousands, of patients. That is not going to happen in the contrived clinical trial world. We need to get to the real world and into this digital world where we would have electronic surveillance of every single patient who is admitted and enrolled in a trial. Why can’t we do that? Why can’t we have conditional approval for a new drug or device or even a diagnostic test, and then monitor that very carefully. Then we can grant, if the data are supported, final approval.

I hope that we can finally get an innovative spirit, a whole new way of a conditional and then final approval in phases in the real world, rather than continuing in this contrived clinical trial environment. These are some things that can change in the rebooting or in the creative destruction, or reconstruction, of medicine going forward.

Social networking is having big impact on medicine. Social networking is changing the practice of medicine. Everybody is familiar with Facebook, which soon will have 1 billion registrants and be second only to China and India as far as a community or population. What isn’t so much appreciated by the medical community is that our patients are turning to online health social networking. These are such Websites as PatientsLikeMe, CureTogether, and many others.

Interestingly, patients with like conditions — often chronic conditions, such as multiple sclerosis, diabetes, or amyotrophic lateral sclerosis — will find patients with the same condition on these networking sites, and these virtual peers will become very much a key guidance source. This is so different from the past, when all information emanated from physicians. In fact, now many of these individuals who use social networks trust their virtual peers more than their physicians, so this is a real change that’s taken place. In addition to this, the social networking platforms, which are free, offer an opportunity we haven’t seen before.

If you combine the capability of monitoring such things as blood pressure or glucose with social networking, then you can have managed competitions with your friends, your family, or your social networking cohort, and you can start to compete for such things as who has the best blood pressure or who has the best glucose level. This, of course, is beyond competitions as simple as who has the best weight or does the most activity in terms of number of steps.

What we’re going to see going forward is the leveraging of social networking for improving healthcare. This is really taking advantage of a preexisting platform of digital infrastructure, and something that we did not anticipate would be so popular in the medical sphere. This is superimposed on Facebook, for example, which has already had individuals who at least claim that their lives were saved on the basis of pictures of themselves and their condition.

In fact, there was a young boy who was desperately ill and undiagnosed, but a Facebook friend of the mother of this boy made the diagnosis of Kawasaki disease. Historically, this is the first case in which social networking supposedly led to saving one’s life. There have been many other cases like this one that have been subsequently documented.

This is really an interesting trend, social networking. I’m really big on Twitter. My handle is @ nishanil1, and I get my most useful information in the whole biomedical research digital health arena through that mechanism. I’d encourage you to try it out or get active on it if you haven’t. Social networking is having a big impact on medicine at multiple levels.

Five devices physicians need to know about in digital revolution occurring in the practice of medicine and how this revolution can radically improve the healthcare of the future. I’d like to show you many of the devices that I think are transforming medicine today. These devices represent an exciting opportunity as we move forward in the practice of medicine.

This is 2012, obviously, and this is something that we’re going to build upon. You’re used to wireless devices that can be used for fitness and health, but these are now breaking the medical sphere. One device you may have already noticed turns your smartphone into an electrocardiogram (ECG). The ECG adaptor comes in the form of a case that fits on the back of a smartphone or in a credit card-size version. Both contain 2 sensors. With the first model, you put the smartphone into the case and then pull up the app — in this case I’m using the AliveCor app — and put 2 fingers on each of the sensors to set up a circuit for the heart rhythm. Soon you’ll see an ECG. What’s great about this is you don’t just get a cardiogram, which would be like a lead II equivalent; using the "credit card" version, you get all the V-leads across the chest as well. I have found this to be really helpful. It even helped me diagnose an anterior wall myocardial infarction in a passenger on a flight.

The second device I will enumerate is another adaptation of the smartphone, but this one is for measuring blood glucose. Obviously we do that now with finger-sticks, but the whole idea is to get away from finger-sticks. I’m wearing a sensor right now that can be worn on the arm. It also can be worn on the abdomen. What’s nice about this is that I can just turn on my phone, and every minute I get an update of my blood glucose right on the opening screen of the phone. It’s a really nice tool, because then I can look at the trends over the course of 3, 6, 12, or even 24 hours. It plays a big behavioral modification type of a role, because when you’re looking at your phone, as you would be for checking email or surfing the Web, you also are integrating what you eat and your activity with how your glucose responds. This is going to be very helpful for patients — not only those with diabetes, but also those who are at risk for diabetes, have metabolic syndrome, or are considered to be in the pre-diabetic state.

The third device I’d like to talk about is another device from the cardiovascular arena that comes in the form of an adhesive patch. It’s called the iRhythm, and I tried this out on myself. It’s really a neat device, because the results are sent by mail to the patient. You put it on your chest for 2 weeks, and then you mail it back. It’s the Netflix equivalent of a cardiovascular exam. The company then sends the patient 2 weeks’ worth of heart rhythm detection. I think it’s a far better, practical way, as compared to the Holter monitor wireless device. It’s not as time-continuous as the ECG or glucose device, but it’s in that spectrum.

I want to now explain a fourth device, which I use on my iPad. This device allows physicians the ability to monitor patients in the intensive care unit on their iPads. I use it to monitor patients at the ICU. You can use it for any ICU that allows for the electronic transmission of data. Right now, I’m monitoring 4 patients simultaneously. You can change the field to monitor up to 8 patients simultaneously. This is a great way to monitor patients in the ICU because you can do it remotely and from anywhere in the world where you have access to the Web. This is just to give you a sense of what this innovative software sensor can do to change the face of medicine.

Finally, I wanted to describe is something that I’ve become reliant upon, and that’s this high-resolution ultrasound device known as the Vscan. I use this in every patient to listen to their heart. In fact, I haven’t used a stethoscope for over 2 years to listen to a patient’s heart. What’s really striking about this is that it’s a real stethoscope. "Scope" means look into. "Steth" is the chest. And so now I carry this in my pocket, and it’s just great. I still need a stethoscope for the lungs, but for the heart this is terrific. You just pop it open, put a little gel on the tip of the probe, and get a quick, complete readout with the patient looking on as well. I’m sharing their image on the Vscan while I’m acquiring it and it only takes about a minute. It is validated of its usefulness in an Annals of Internal Medicine paper, in July 2011, [1] describing how it compares favorably to the in-hospital ultrasound echo lab-type image. This could be another very useful device in emergency departments, where the wireless loops could be sent to a cardiologist. Another application it could be used for is detecting an abdominal aortic aneurysm. Paramedics who are out in the field, or at a trauma case, could use this to wirelessly send these video loops to get input from a radiologist or expertise from any physician for interpretation.

These are just a few of the gadgets that give you a feel for the innovative, transformative, and really radical changes that will be seen going forward in medicine.

Live Forever

Given the chance, would you want to live forever? In the Epic of Gilgamesh, written over 4,000 years ago, a Sumerian king seeks eternal life. And 500 years ago, Spanish explorer Ponce de Leon came to the Americas searching for the fountain of youth. Every generation, a new ploy for outsmarting the reaper emerges–always futile, always in vain. But is the key to immortality within reach? Some people think that technology will help us cure diseases, build new organs, and essentially reprogram our bodies’ faulty software. Futurist Ray Kurzweil calculates that 20 years is all it’ll take for this exponential boom in computing power to help us live forever. But other scientists are more skeptical. They say that to understand immortality, we must understand our own DNA.

Have you heard of the Turritopsis nutricula? It’s a type of jellyfish, said to be biologically immortal. Now, this doesn’t mean that it’s immune to disease or injury, but it is immune to the leading cause of death: aging. That’s because it can revert back to the polyp stage even after it reaches sexual maturity. In essence, it can stay alive forever, since every time it grows up, its cells undergo trans-differentiation to become young and sexually immature again. That’s one way to live forever. So if this special jellyfish can do it, why can’t we?

It’s a complicated question, and scientists think the answers may be deep within the nuclei of our cells, where the building blocks of life are stored. See, every time one cell replicates to become two, its DNA also has to replicate, and when it does that, little bits at the end break off. These areas are called telomeres, and they’re there for that very reason: to buffer against breakage when DNA replicates, so the important bits don’t get lost. But eventually, after enough replication, the telomeres get broken off too. It’s called the Hayflick limit, named for Leonard Hayflick, the first dude to notice that there is finite number of times a cell can divide. But if we can use special enzymes, like telomerase, to increase the life of the telomere, we may also be able to prolong the life of the cell.

If we can get a handle on how to prevent cellular aging, in theory, we can extend life, potentially indefinitely. We may also be able to fight cancer, since the cellular mechanism involved in this deadly disease is closely related to that in aging. In fact, cancer is a type of cell that simply doesn’t die. That’s why it’s so hard to treat. This wouldn’t be a problem, except that cancer cells also divide uncontrollably and invade the healthy cells around them. In fact, biomedical researchers routinely use HeLa cells in their studies. They’re named for Henrietta Lacks, a woman dying of cervical cancer in 1951. Her cells were harvested without her permission, and grown in culture. Since they are so hearty and easily divide; this exact same cell line is used today in labs all around the world and if that doesn’t blow your mind, think about this.

In a way, we’re all already immortal. Think about it: there’s a line of cells, traceable to the earliest human being–in all of us. See, before I became me, with ten fingers and toes, brown hair and eyes, and a funny birthmark on my arm, I was a single cell. That cell eventually divided over and over to make the person you see today. But that single cell was nothing more than a combination of my father’s sperm (with half the chromosomes necessary to make me) and my mother’s egg (also with half of my chromosomes). Together, they made a single cell, and that single cell divided to become all the cells in my entire body, including my own eggs. One day, one of those eggs may combine with sperm to make another human being and so it goes, down the line, until those branches of the family tree end. But if you trace the branches backward, earlier and earlier in time, you’ll find a common ancestor to us all. Really think about it. The cells in your body, in my body, are traceable to the earliest cells of the very first humans and not just figuratively. We are literally made of the same DNA, the same cytoplasm, the same molecular ingredients as those who harnessed the energy of fire, invented tools, developed language, and first stepped out of Africa, the seat of all humanity. They are physically within us. We are made of them and in that way, we are all immortal.

So you tell me. Would you want to live forever? Or do you feel that you already are, being part of the great lineage of humankind, a lineage that will never die?

Safe Haven of the Soul

On this day, I see clearly that we must explore and develop those ways to engender the passion for the possible in our human development while discovering what that "possible" is. In so doing we will discover ways of transcending and transforming the local self so that extraordinary life can arise. There is no question but that a larger life is latent in the human species and that we live only a small part of the life that is given. Thus it will require from those of you who are really serious about making a difference something that astronauts, sportspeople, great artists and inventors, mystics, social artists, and co-creators are always open and available to–the acquiring of a greater nature. This means however that one agrees to relinquish those limited and limiting patterns of body, that is sensory and motor patterns, of emotions, of volition, of intelligence and understanding, and of spirit that have been keeping you from becoming all that you can be. Stop it. You are boring God.

One also must agree to allow yourself to instead become available to the extraordinary dimensions that each of you contains for much larger life in body, mind, and spirit. This, I absolutely believe is what is required of us if you who will continue to live are going to help our era survive and grow. Now what is going on in our era that is unique in human history? Get beneath the patterns of chaos and this is what I think you can detect. We are in jump time, also called whole system transition. This means that we have a rare choice point both for the world and for ourselves. As you all know, the current movements of change are accelerating radically, with new happenings in structural and social development, complexity, behavioral variety, and awareness. There is a multileveled transformation of our entire nature in the works as well as in the very nature and function of society. This includes the democratization of our human potential, as well as the wide scale experience of aspects of ourselves that we never thought to have.

I believe that the very evolution of life is asking us to co-partner with it and to make choices that will serve the greater story. We must come to realize that grace, or, if you will, the larger reality structure, the Field of Being within which you are embedded, the Divine Reality is always and everywhere present, ever near, utterly available, and totally responsive to our desire for it. We are at the stage where the real work of humanity begins. This is the time and place where we partner Creation in the re-creation of ourselves, in the restoration of the biosphere, and in the assuming of a new kind of culture–what we might term a culture of kindness wherein we live daily life in such a way as to be connected and charged by the Source of our reality and become liberated in our inventiveness as well as deeply engaged in our world and our tasks.

Now there is a quickening, a tremendous sense of need for this possible human in all of us to help create the possible world if we are to survive our own personal and planetary odyssey and come safely home – to the sanctuary of the soul.

Human Pheromones—Fact-or-Fiction

Pheromones are naturally occurring odorless substances the fertile body excretes externally, conveying an airborne signal that provides information to, and triggers responses from, the opposite sex of the same species. In 1986 Dr. Winnifred Cutler, founder of Athena Institute, and her colleagues conducted the first controlled scientific studies to document the existence of pheromones in humans. Prior to their landmark research, there were no conclusive indications that pheromones were excreted by humans. In animals, it had been known that pheromones served to promote behavior that perpetuated the species. Pheromones elicit unlearned behavioral or developmental responses from others of the same species – act to regulate sexual and reproductive behavior in many nonhuman mammals. We can see examples of this throughout the animal kingdom. The human body produces chemical secretions that have pheromonal properties.

What does science tell us? Do we produce pheromonal secretions? Men and women do have odor-producing apocrine glands in their underarm, nipple, and genital areas. Also, biochemists have isolated compounds that have pheromonal properties in pigs from the urine and sweat of men and, to a lesser extent, women. So, we give off body odor and our bodies excrete substances that pigs find sexually stimulating.

Assuming the human body can secrete pheromonal substances, are we capable of detecting them? Here, the evidence is a bit more solid. Scientists have found that human infants, children, and adults are able to discriminate between other individuals on the basis of olfactory cues – we can tell each other apart using our noses. It seems possible that we have the capacity to detect pheromones, should they exist.

The question that interests most of us, of course, is whether pheromones actually influence species perpetuation behavior. Certainly many perfumes and colognes contain pheromones or their synthetic equivalents from a variety of mammals, including the musk deer, civet cat, beaver, and pig. Studies find that exposure to these substances either has no effect at all or decreases sexual feelings among adults. So exposure to pheromones produced by other mammals doesn’t seem to do much for us. Pheromones are species-specific. Thus, it really isn’t surprising that exposure to nonhuman pheromones does not directly influence sexual attraction in humans. However, it is possible that these substances have an indirect effect on desire – a scent or odor may elicit a pleasant emotional response which, in turn, may increase sexual feelings. In addition, it is likely that a particular scent or odor that has been paired repeatedly with a sex partner or with sexual activity, for example, a specific brand of cologne or perfume may come to produce a learned desire response. Of course, these types of elicited or learned responses do not constitute a true pheromone reaction.

Science will continue to advance, and the quest to identify a human pheromone will undoubtedly go on. Maybe in a year or two, I’ll be able to post a new, updated entry that presents more conclusive evidence with respect to pheromones. Human sexuality is multifactorial, and much more complex. Our responses are much less biochemically-dependent than those of other mammals. Men and women don’t require the presence of a particular hormone or chemical secretion to feel desire, want sex, or become attracted to another member of the species. No single substance would have the power to produce those animalistic, primal sexual and aggressive behaviors.

Follow

Get every new post delivered to your Inbox.

Join 3,777 other followers

%d bloggers like this: