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Somewhere along the road from sickness to health, the American medical system took a wrong turna big one.
The cost of care in our country is sky-high, yet our population health outcomes tend to be worse than those of other developed countries (many of which have universal health care). Major surgeries, treatments for long-term illnesses like cancer, and medical attention for catastrophic injuries are so expensive that people can lose their homes or be forced to declare bankruptcy. Even a routine visit to a general practitioner can cost hundreds of dollars. Yet Americans have some of the highest rates of heart disease, diabetes, and obesity in the world.
How did we get here?
In a talk at Singularity Universitys Exponential Medicine summit this week in San Diego, Dr. Jordan Shlain shared his thoughts on that question, as well as a framework for moving American healthcare forward. The first step, he believes, is a new Hippocratic oath, one thats been updated for our high-tech age.
It was the fifth century BC when Hippocrates put forth the idea that physicians should try to help people and do no harm (a pretty intuitive concept, one would think), among other ethical standards. The Hippocratic oath was born, and over time its been modified to reflect shifts in medicine and society. But the field of medicine has changed even more than the oath has, and Shlain believes its time for another overhaul.
He pointed to the beginning of early modern medicine as pivotal to the field. As new technologies came along that had potential to treat people more effectively, everyone wanted access to those technologies, so someone had to start manufacturing themand the incentive to do so was a profit.
When X-rays and penicillin were invented, we could see things wed never seen before and treat things wed never been able to treat before, Shlain said. Someone had to make X-ray machines and someone had to form a pharmaceutical company. But the convergence of medicine and business fed mounting costs, conflicts of interest, bureaucracy, and a focus on profits over patients.
Medical technology companies and pharmaceutical companies are now massive and complex, as are the medical and regulatory systems. Theres a lot standing between physicians and patients, Shlain said. It leads us to reactive medicine, and theres physician burnout.
The root of this problem, he believes, is that a corporate oath has superseded the Hippocratic oath in healthcare. The corporate oath says to increase shareholder value, generate profits, and constantly grow margins. But they dont know the outcomes on the other side, Shlain said. Exhibit A? The opioid crisis.
Since 1970, the costs of medications and medical devices have only gone upand so have corporate revenues. went up, cost of devices went up. But despite spending all this money and having all this expensive technology and medications, were not doing too well, Shlain said, pointing to a graph that shows life expectancy in the US falling since 2014. We need to differentiate between consumers and patients.
Shlains new oath consists of nine different statements.
1. I shall endeavor to understand what matters to the patient and actively engage them in shared decision making. I do not own the patient, nor their data. I am a trusted custodian.
Shlain pointed out that rather than asking patients What matters to you? physicians ask, Whats the matter with you? But to get the right answer, it should be a combination, and not just between doctors and patients, but in every interaction in the healthcare system.
2. I shall focus on good patient care and experience to make my profits. If I cant do well by doing good and prove it, I dont belong in the field of the healing arts.
We need to have some version of transparency for our outcomes, Shlain said.
3. I shall be transparent and interoperable. I shall allow my outcomes to be peer-reviewed.
Silicon Valley has gotten better at embracing a culture of learning from failure and even encouraging failure as a path to eventual advancement, but the medical field hasnt done the sameand perhaps rightfully so, since failure can mean a life lost. However, Shlain added, a byproduct of failure is almost always some sort of lesson.
4. I shall enable my patients the opportunity to opt in and opt out of all data sharing with non-essential medical providers at every instance.
Data privacy should be respected both as a path to trust and as a basic patient right.
5. I shall endeavor to change the language I use to make healthcare more understandable; less Latin, less paternal language; I shall cease using acronyms.
I would rename type two diabetes the over-consumption of processed food disease, because thats what it is, Shlain said. You dont get it, you participate in its process. But you didnt know it, because the language obfuscates that. So we really need to dig into language here, because language does tie to the metaphors we live by.
6. I shall make all decisions as though the patient was in the room with me and I had to justify my decision to them.
7. I shall make technology, including artificial intelligence algorithms that assist clinicians in medical decision making, peer-reviewable.
Everyone has proprietary technology and were supposed to use it despite not knowing how it works, Shlain said. Its in the interest of both practitioners and patients for this to change.
8. I believe that health is affected by social determinants. I shall incorporate them into my strategy.
Someones zip code can tell you more about their health than their genetic code, Shlain said. We need to focus on community.
9. I shall deputize everyone in my organization to surface any violations of this oath without penalty. I shall use open-source artificial intelligence as the transparency tool to monitor this oath.
Shlain pointed out that feedback loops in big corporations often arent productive, because people worry about losing their jobs. We need to create some mechanism of a feedback loop to ensure that this happens, he said.
This new oath isnt just for clinicians, Shlain emphasized. Its for everyone who touches the healthcare system in any way. That includes pharmaceutical companies, device manufacturers, medical suppliers, hospitals, and so on.
Given how fast new technologies are changing the healthcare landscape, we may need a totally new oath in ten years; what happens when robots are performing surgery, AI systems have taken over diagnosis, and gene editing can cure almost any congenital disease? Well need to continuously stay aware of how doctors roles are evolving, and update the ethical codes they practice by accordingly.
What we need is a culture of care, at every level, Shlain said. In order to change our paradigm, we need to have a set of principles that get us there.
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Researchers Identify Genes With Potential to Predict Progression and Severity of MS – AJMC.com Managed Markets Network
Researchers have identified complement genes that appear to play a role in vision loss associated with multiple sclerosis (MS), and this finding could help researchers monitor and predict the progression and severity of MS, according to a study published in Brain.
Even though previous studies have identified gene variants associated with the risk of developing MS, until now, there have been no identified gene variants associated with MS severity.
Multiple sclerosis is a heterogeneous disease with an unpredictable course and a wide range of severity; some individuals rapidly progress to a disabled state whereas others experience only mild symptoms, the authors explained.
In 374 patients with all types of MS, the researchers used an imaging technique that allows them to assess damage to the nerve cells in the retina. Patients underwent an average of 4.6 scans between 2010 and 2017, and the authors reported that the rate of deterioration was a loss of 0.32 micrometers of tissue per year per patient, on average.
After they identified the patients who had the fastest deterioration rates, the researchers collected DNA through blood samples to identify genetic mutations. They identified 23 DNA variations that mapped to the complement gene C3.
Once they identified the variants, they analyzed DNA from blood samples of 835 patients with MS in an existing clinical trial who underwent periodic vision testing. The researchers noted genetic changes in the complement genes C1QA and CR1 in patients whose ability declined the fastest in the vision tests. Patients with mutations in C1QA were 71% more likely to develop difficulty with the vision test and patients with changes in CR1 were 40% more likely.
The authors plan to repeat the studies in larger populations and conduct animal studies investigating the function of complement proteins to better understand the mechanism behind their ability to kill nerve cells in patients with MS.
"Although we have treatments for the type of MS where symptoms come on in burstscalled relapsing-remitting MSwe don't have any way to stop the kind of MS in which the nerve cells start to die, known as progressive MS," Peter Calabresi, MD, professor of neurology and neuroscience at the Johns Hopkins University School of Medicine and codirector of the Johns Hopkins Precision Medicine Center of Excellence for Multiple Sclerosis, said in a statement. "We believe that our study opens up a new line of investigation targeting complement genes as a potential way to treat disease progression and nerve cell death."
Fitzgerald KC, Kim K, Matthew D Smith, Aston SA, et al. Early complement genes are associated with visual system degeneration in multiple sclerosis. Brain, 2019; 142(9):2722. doi: 10.1093/brain/awz188.
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Her daughter may die by age 10, but this mom keeps fighting to cure her rare disease - GMA
Dashing through the snow at 25 miles an hour,Heather Huson97 got her first thrill as a musher at age 7. From then on, she was hooked on dog sledding, and raced competitively for almost 30 years throughout North America.
By the end of her racing days, she had competed twice in sled dog racings equivalent to the Olympics the International Federation of Sleddog Sports World Championships. And she ended her racing career with a bang, winning an extremely competitive six-dog class race at the 2004 Tok Race of Champions in Tok, Alaska.
Heather Huson shares time with a sled dog at the Baker Institute.
Now an assistant professor of animal science, Huson is co-leader of a $4.2 million project studying close to 100 Alaskan sled dogs between the ages of 8 and 13, former athletes past their glory days. The study, which began in 2018, is a quest for one of the holy grails of medicine: how to slow aging.
This project allows me to work with sled dogs again, but now Im studying their aging and health, said Huson, a molecular geneticist in the College of Agriculture and Life Sciences.
Huson and co-leaderDr. John Loftus, assistant professor of small animal medicine in the College of Veterinary Medicine, are trying todetermine whether a drug that inhibits an enzyme called reverse transcriptase can mitigate aging and extend life in older dogs. Private donations fund the project through the Vaika Foundation, a nonprofit group of scientists and veterinarianson a mission to extend the health and life span of domestic animals.
The project will serve as a proof of principle for whether reverse transcriptase inhibitors could be an elixir. If confirmed, new finely tuned drugs could be developed for both dogs and humans.
While we love dogs, and we care about extending the life span of dogs for its own right, this is also a really good model for people, hopefully, in the future, Loftus said.
Genetics of aging
Other researchers, including project collaborators at the Roswell Park Comprehensive Cancer Center in Buffalo, New York, have found evidence in mice that reverse transcriptase inhibitors suppress tumors and extend life span.
The next step was to go to a model organism thats more closely related to humans in similar environments, and more similar to the types of diseases that people get, Huson said.
While we love dogs, and we care about extending the life span of dogs for its own right, this is also a really good model for people, hopefully, in the future.
In mammals, viruses that infected distant ancestors left behind some of their DNA, which are called genetic elements.
As we age, were finding these normally dormant DNA elements get turned on and then behave like viruses in the body, said Loftus, a veterinarian and researcherwho leads the immune system analysis on this project.When DNA elements get turned on, they can encode [for] a number of proteins, and reverse transcriptase is one of them.
In turn, reverse transcriptase plays a role in duplicating more of these genetic elements, which become randomly inserted in the genome and can lead to mutations and cancer.
And since these elements act like viruses in cells, they also trigger an immune response, which creates inflammation.
The federally approved drug being tested in the sled dog project is commonly prescribed to people for viral infections.
Our approach is going to be to give the dogs a reverse transcriptase inhibitor to turn the transcriptase off, Loftus said, and hopefully reduce inflammation, reduce the incidence of cancer and other diseases related to mutations and DNA damage, and ideally increase life span.
Heather Huson watches as a sled dog runs during play time in a fenced field at the Baker Institute for Animal Research at Cornell.
Why Alaskan sled dogs?
Dogs offer many advantages over mice as research subjects. They share with humans similar lifestyles and aging-related diseases like cancer and cognitive dysfunction, and serve as a model for studying Alzheimers disease.
Originally, the researchers proposed to study pet dogs. But maintaining a uniform diet for all participants and trusting owners to administer the drug consistently proved too unreliable.
We had the idea instead to create a colony of dogs we had control over, Huson said. They realized athletic dogs were housed in groups, in kennels, and as they age, owners kept their best dogs and often sold the rest to hobbyists or as pets.
So that gave us an avenue for how we could get these dogs, Huson said.
For her doctorate, Huson studied the genetics and selective breeding in Alaskan sled dogs at the University of Alaska, Fairbanks. She discovered that sled dogs are a genetically distinct breed. They have undergone intense selection for such traits as athleticism, but at the same time are subject to an open breeding scheme,with a diverse gene pool that makes for fewer genetic issues and diseases than pure breeds.
John Loftus greets a sled dog at the Baker Institute for Animal Research.
Yet they create a unique population that is still homogenous that we can study and say, this response to the drug is potentially related to the drug and not because its a poodle versus a beagle, Huson said.
In late May 2018, Huson and Loftus began acquiring dogs, which they kenneled at the Baker Institute for Animal Research at Cornell. Huson traveled twice to Alaska, and she and others, including students, picked up dogs from Canada, Michigan, Minnesota, Oregon, Washington and other states.
Locating dogs and bringing them to the Baker Institute required countless cross-country trips on planes and by vehicle. By September 2018, they had 102 dogs for the study. In March 2019, the researchers collected the firstbaseline data.
Testing aging over time
To test the drugs effectiveness, Huson and Loftus have been quantifying aging in the dogs every six months through three avenues immune function, behavior and physical condition. All the tests are noninvasive or minimally invasive.
They are testing two types of immune responses: adaptive responses that react quickly to infections; and innate responses where the immune system recognizes and delivers specific antibodies to fight a pathogen that previously entered the body. They are also checking blood for increases in markers for inflammation.
Four cognitive dysfunction behavioral tests involve an empty behavioral testing room with a video camera to record lone dogs as they encounter such things as a stranger sitting still in a chair, a familiar or novel toy, or a mirror.
Heather Huson racing in an Alaska Dog Mushers Association Challenge Series race in 2005 at the Jeff Studdard Sled Dog Race Track in Fairbanks, Alaska.
For physical tests, dogs are fitted with a racing harness and are trained to run on a treadmill with heart rate and electrocardiogram monitors. The treadmill has special sensors under the belt to record the pressure of each footfall, to detect limping that could come with arthritis. Another test times dogs as they pull one-and-a-half times their weight a distance of 40 yards using a pull harness.
It will take years to gather enough data for the researchers to make a definitive statement about the drugs effects. But funds have already been allotted to provide the dogs with a high quality of life until they die of natural causes.
Twice a day the dogs go outside for play time. As soon as the kennel doors open, the dogs, tongues flapping, scurry excitedly down a long hallway toward the light of an open door that leads to three separate fenced fields where they play, run, sniff the grass and greet the student volunteers outside.
It reminds Huson of her childhood, when her family owned as many as 50 sled dogs.
I used to train dogs to run all the time, Huson said. Now were training them to run in a slightly different scenario. Its fun and rewarding. And, its therapy for us.
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Sled dogs lead the way in quest to slow aging - Cornell Chronicle
Conceptualised by Optimal Media Solutions, a division of the Times Group, Times Health Excellence 2019, is a platform to celebrate and honour outstanding achievements in Indian medicine. Optimal Media Solutions has over the years emerged as an integrated media solutions partner; going beyond conventional advertising, to provide customized and innovative options to clients.
The 2nd edition of this milestone event culminated in a glittering ceremony at Sheraton Grand Bangalore Hotel at Brigade Gateway, Yeshwantpur on 17th October 2019. The august gathering included the presence of distinguished guests and illustrious awardees from the field of medicine. Conceived as an innovative approach to document, disseminate and project new approaches that involve medical and health professionals, the event was envisioned to provide a boost to the way success stories are preserved and shared. As a part of this initiative, the pioneering contributions of some eminent medical practitioners were presented and applauded. Several thought provoking and enlightening presentations were made by renowned doctors, who are eminent practicing professionals.
The proceedings began with a brilliant presentation by Dr. Meenakshi Bhat, Professor & Mazumdar-Shaw Research Chair in Clinical Genetics, Centre for Human Genetics Bangalore. Her presentation titled Rare Genetic Disorders: Every Life Matters was an eye-opener on medical conditions that are largely ignored, but can be identified through medical advancements.
Dr. N K Venkataramana, Founder Chairman & Chief Neurosurgeon BRAINS, followed with an engaging presentation on Frontiers in Neurosciences. He spoke about the various developments in the field with regard to cutting edge services in prevention, awareness, advocacy, acute and chronic care, regeneration, rehabilitation, research and training.
Dr. Ann Agnes Mathew, Paediatric Neuromuscular Specialist, Sagar Hospitals Bangalore, then made a presentation on Inherited Muscle and Nerve diseases: Can India lead the world? that outlined the challenges faced in the industry.
Dr. Sandeep Nayak, Director of Surgical Oncology, MACS Clinic & Fortis Hospitals, Bangalore, made a presentation on the topic Revolutionising Cancer Care: Which Way Are We Heading? He spoke at length about several surgical innovations in oncology, which have changed the way the disease is tackled.
Dr. Mahendra S K, Senior Consultant Orthopaedic surgeon and Chairman, Matru Multispecialty Hospital, made a presentation on Orthopaedic surgeries, reviving quality of life...empathy above techniques. His inspiring speech highlighted several case studies, where those who suffering chronic conditions that had been given up on, were treated successfully with appropriate interventions.
Celebrity guest, Ms. Swara Bhasker, a popular Bollywood actress was also in attendance at the event. She added a touch of glamour with her gracious presence.
Those who were applauded at Times Health Excellence 2019, were trailblazers who have pushed all possible boundaries, and nurtured a passion for innovation, continuously seeking out ways to make things better for the holistic development of our nation. Their skill, talent, discipline has paved the way for many game changing initiatives and helped fuel their growth and strengthen Indias position in healthcare.
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TIMES HEALTH EXCELLENCE 2019 - HONOURING OUTSTANDING CONTRIBUTIONS IN MEDICINE - Times of India
Will we one day combine tardigrade DNA with our cells to go to Mars?
Chris Mason, a geneticist and associate professor of physiology and biophysics at Weill Cornell University in New York, has investigated the genetic effects of spaceflight and how humans might overcome these challenges to expand our species farther into the solar system. One of the (strangest) ways that we might protect future astronauts on missions to places like Mars, Mason said, might involve the DNA of tardigrades, tiny micro-animals that can survive the most extreme conditions, even the vacuum of space!
Mason led one of the 10 teams of researchers NASA chose to study twin astronauts Mark and Scott Kelly. After launching in 2015, Scott Kelly spent almost a year aboard the International Space Station while his twin brother, Mark Kelly, stayed back on Earth.
Related:By the Numbers: Astronaut Scott Kelly's Year-in-Space Mission
Geneticist Chris Mason discusses the genetic effects of spaceflight at the 8th Human Genetics in NYC Conference on Oct. 29, 2019.
(Image credit: Chelsea Gohd/Space.com)
By comparing how they biologically reacted to their vastly different environments during that time, scientists aimed to learn more about how long-duration missions affects the human body. Mason and the dozens of other researchers who worked to assess the genetic effects of spaceflight uncovered a wealth of data that has so far revealed many new findings about how space affects the human body.
Researchers hope that this work, which continues today, might inform strategies to support astronaut health on future missions. Mason discussed some of the results of this research at a talk at the 8th Human Genetics in NYC Conference on Oct. 29.
In addition to the research Mason discussed at the conference, these researchers are working on seven more papers incorporating the data from the twins study. However, they also hope to use new data from a larger sample.
"We want to do some of the same studies, longitudinal studies, with people on Earth, people in space," Mason told Space.com at the conference.
By studying, specifically, how certain genes are expressed during the different stages of spaceflight (including the intense return to Earth), these research efforts could support future efforts to mitigate the dangers of spaceflight, Mason said.
For instance, if further studies were to confirm that landing back on Earth were harmful to the human body, scientists could develop ways to prevent those detrimental effects. But with such a small body of data (the twins study was just two people), scientists aren't ready to prescribe any specific treatment or preventative medicine to alter how humans genetically react to spaceflight.
"I think we do what is normally done in science We see something interesting; let's try it in mice first," Mason said.
He noted that they might not even find it necessary to prescribe anything to alter the effects they've seen in astronauts like Scott Kelly. "Some of those changes, even though they're dramatic, maybe that's how the body needed to respond," Mason said.
Related: Space Radiation Threat to Astronauts Explained (Infographic)
While, Mason noted, future astronauts might be prescribed medicine or other tools to help to mitigate the effects which they've uncovered with this research. However, new studies are investigating how tools such as gene editing could make humans more capable of traveling farther into space and even to planets such as Mars.
One of the main health concerns with space travel is radiation exposure. If, for example, scientists could figure out a way to make human cells more resilient to the effects of radiation, astronauts could remain healthier for longer durations in space. Theoretically, this type of technology could also be used to combat the effects of radiation on healthy cells during cancer treatments on Earth, Mason noted.
However, the idea of tinkering with human genes is controversial. But Mason emphasized that there will likely be decades of research completed before this kind of science is applied to humans.
"I don't have any plans of having engineered astronauts in the next one to two decades," Mason said. "If we have another 20 years of pure discovery and mapping and functional validation of what we think we know, maybe by 20 years from now, I'm hoping we could be at the stage where we would be able to say we can make a human that could be better surviving on Mars."
But what does it mean to genetically engineer a person to better survive in space or on another planet? There are multiple possible approaches.
One way that scientists could alter future astronauts is through epigenetic engineering, which essentially means that they would "turn on or off" the expression of specific genes, Mason explained
Alternatively, and even more strangely, these researchers are exploring how to combine the DNA of other species, namely tardigrades, with human cells to make them more resistant to the harmful effects of spaceflight, like radiation.
This wild concept was explored in a 2016 paper, and Mason and his team aim to build upon that research to see if, by using the DNA of ultra-resilient tardigrades, they could protect astronauts from the harmful effects of spaceflight.
Genetically editing humans for space travel would likely be a part of natural changes to the human physiology that could occur after living on Mars for a number of years, Mason said. "It's not if we evolve; it's when we evolve," he added.
While changes to the human body are to be expected as our species expands off-Earth, there is a way to do this science responsibly, Mason said. "In terms of a question of liberty, you're engineering it [a future human] to have lots more opportunities, again assuming we haven't taken away opportunities," he said. "If we learned that, in some way, when we decided to try and prove the ability of humans to live beyond Earth, and we take away their ability to live on Earth, I think that would be unjust."
Genetically engineering humans could be ethical if it makes people more capable of inhabiting Mars safely without interfering with their ability to live on Earth, Mason said.
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