Vol. 189 March 15, 2018 Future Medical Breakthroughs

March 15, 2018

Hub thumbnail 2015

Some predictions from the internet (“fake news?”) and some from investors ( “real news?”)

 

This first set of predictions, though reported on the internet, is from an interview with the CEO of Mercedes Benz who listed Tesla, Google, Apple, and Amazon as his current competitors, not other auto companies.

The Tricorder X price will be announced this year:  “There are companies who will build a medical device (called the “Tricorder” from Star Trek) that works with your phone, which takes your retina scan, your blood sample, and you can breathe into it. It then analyses 54 biomarkers that will identify nearly any disease.  It will be cheap, so in a few years everyone on this planet will have access to world-class medical analysis, nearly for free.  Goodbye, medical establishment.”

3D printing:  “The price of the cheapest 3D printer came down from $18,000 to $400 within 10 years.  In the same time, it became 100 times faster.  [3D medical devices like heart valve replacements are already being used in some major medical centers] All major shoe companies have already started 3D printing shoes.”

Alternative protein source:  “There are several startups that will bring insect protein to the market shortly. It contains more protein than meat.   It will be labeled as “alternative protein source” (because most people still reject the idea of eating insects).”

“All in” on smart phones:  “If it doesn’t work with your phone, forget the idea. There is an app called “moodies” which can already tell in which mood you’re in.  [MGH is currently testing such an app’s ability to accurately monitor cell phone self-reported feelings by high-risk psychiatric patients, so that any imminent suicide action can be identified and treated.] By 2020 there will be apps that can tell by your facial expressions, if you are lying.  [Current face-recognition programs at airports already are used to spot “potential terrorists”.] Imagine a political debate where it’s being displayed when they’re telling the truth and when they’re not.”

Longevity:  “Right now, the average life span increases by 3 months per year. Four years ago, the [U.S.} life span used to be 79 years, now it’s 80 years. The increase itself is increasing and by 2036, there will be more than one year increase per year.   So, we all might live for a long time, probably way more than 100.”

That’s it for the “pie in the sky” walk, but it’s money that talks. Where is it going?

Lab-cultured burgers
Edible animal protein that is brewed from animal stem cells in a bioreactor has passed the “taste test” for beef, chicken, fish, and duck, so that “this potentially trillion-dollar market opportunity” has attracted several Venture Capitalist funds. MosaMeat, the creator of the first “clean burger”, has received millions of dollars of VC investments. “The biggest challenge is taking what’s in the lab and making it commercially viable.” A pound of Memphis Meat costs about $2,400 to produce in the lab. That is about $600 for a Quarter Pounder. The company aim is to get it down to $5 – a true Value Meal. (Wired March 2018, pg.15)

Surgery-free biopsies looking for cancer
The detection of cancer cells circulating in our blood by identifying bits of cancer DNA shed into our blood by tumors is already used to “personalize” (i.e. adjust type of chemotherapy agents) in patients already diagnosed with cancer.  VC’s are currently investing billions (yes, that is a “b”) in several companies that are racing to develop DNA and genome-sequencing identification technics to detect tiny, currently non-suspected cancers in healthy people, all from a simple non-invasive blood sample.  The hope is to make an even earlier diagnosis of cancer. “Liquid biopsy detection” is still years away from being patient-ready, but it is not lack of money that is blocking sight of these “blood unicorns”; it is basic biology. (Wired, February 2018, pg. 16)

“Transparent Larry” guides robotic operation on real Larry
Larry Samrr (there should be a terminal “t” in his last name, but there isn’t) is an astrophysicist and astronomer at the University of California Davis who has been keeping precise records of his intake, energy output, and excretions (another output measure) for years. That data along with periodic MRIs, frequent blood and stool analyses, annual colonoscopies (real and virtual), and complete DNA sequencing (genome identification) data has been entered into a super computer at the California Institute for Telecommunications and Information Technology, (Calit2).  The super computer produces a constantly-updated 3D image of Larry’s insides, “Transparent Larry.” The computer made the diagnosis of Crohn’s disease in Larry way before clinical symptoms appeared. In 2016 it guided the removal of a diseased portion of his colon. The “Larry Transparent” image was fed directly into a da Vinci Xi robot his surgeon was using. It reduced the operation duration by about an hour. “Experimenting with fancy new technology is not always a surgeon’s top priority.” It helped that Larry’s surgeon was from a family of engineers and was immediately intrigued by “Transparent Larry”. (The Atlantic, March 2018, pg.28)

Nanoinfusions of DNA to regenerate, restore, and reprogram cells
Cells can be reprogrammed to do different functions by injecting them with different mixtures of DNA, RNA, and proteins, usually delivered by a virus. Such a method can produce indiscriminate immune responses to the virus, unintended injection into non-target cells, and other undesirable effects. Scientists have developed a tiny electronic chip (“nanochip”) that creates holes by electric current in only a portion of a mouse cell surface, so that a reprogramming mixture can be inserted at a precise dose  without “upsetting” the entire cell (“nanotransfection”). In mice this has allowed skin cells to build new blood vessels to help heal a damaged limb and to restore brain cells damaged by a stroke. “Human trials may begin in a year.” (Scientific American, December 2017, pg. 20)

I see by the old clock on the wall that I have run out of time (I seem to be about an hour late everywhere I go this week for some reason), so I can’t go on about other future medical breakthroughs in wearables, probiotics, medical marijuana, robotics, cryptocurrencies for your health insurance plan, obesity control, understanding teens’ brains, and, of course, many, many more apps.

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Vol. 66 May 1, 2012 A Medical Business and Marketing Report

May 1, 2012

TOOTH FAIRY PRICE FUTURES UNCERTAIN

The price the tooth fairy pays has increased nearly 90% since 1998 to a high of $2.50 in late 2009, but after a 2010 correction in the average price Delta Dental has downgraded its future to “uncertain”. Delta has been tracking how much money kids have been getting for teeth left under pillows for their more than 100,000 subscribers. As illustrated by the graph showing the Dow Jones average and the tooth fairy average price, both took a hit in 2008. (1)

WHOOPING COUGH SURGES TO HIGHEST LEVEL SINCE WW II

There were more than 9000 whooping cough cases in California in 2010, a level unseen since 1940s. The number of cases in Vermont has gone from 18 to 102 in two years. The number of kindergartener who have been vaccinated against whooping cough (aka pertussis, or the “P” in the DPT vaccine) has dropped from 93% in 2005 to 83% in 2010. In Ashland Oregon the rate of unvaccinated children reached about 30%. Though the link between vaccinations and autism has been shown to be wrong, and it’s author a fraud, the far-fetched rumors on the internet continue to feed the unfounded fears about vaccinations held by many young parents. (2)

ROBOT’S STOCK VALUE ON “HOLD”

A survey of 600 men over the age of 65 who were operated on for prostatic surgery revealed that 27% of those undergoing open-surgery radical prostatectomy still suffered from significant urinary incontinence 14 months after surgery. But, 33% of those undergoing robotic-assisted laparoscopic radical prostatectomy reported urinary incontinence. After the usual caveats about differences between surgeons, the long learning curve for robotic surgery, and the lack of information in the survey about pre-surgical urinary incontinence, the editorial comment casually mentioned that 88% in BOTH groups had “moderate or big problems” with sexual function post-operatively.(3)

RAW MILK ADVOCATES CHEERED BY MARKET PRICE UPTICK

Between 1993 and 2006 over 4000 in the U.S. were affected in 121 infectious outbreaks from raw (unpasteurized) milk or cheese. Two-thirds of those affected were children who had more hospitalizations for these illnesses than adults. Most of these outbreaks occurred in states where the sale of raw milk and milk products is legal. (4) “Advocates of raw milk hold that pasteurization kills enzymes that make food digestible and bacteria that contribute to a healthy immune system….it tends to be richer and sweeter, and, sometimes, to retain a whiff of the farm – known to connoisseurs as ‘cow butt’.” But, raw milk is profitable. The largest raw milk diary in the world, with 430 cows in Southern California, produces 2400 gallons of milk a day which retail at $16 a gallon.(5)

SATISFIED PATIENTS PAY MORE FOR HEALTHCARE

A four-year study of over 34,000 adults interviewed about 18 variables revealed that the “most satisfied” patients had a 12% higher hospital admission rate, had 9% more drug prescriptions, and a death rate 26% higher than the “least satisfied” patients. The correlation between higher mortality and more patient satisfaction seems to contradict the adage that “more is always better.” (6)

STARBUCKS TO STOP USING MEAT BY-PRODUCTS

In response to an on-line petition with 6000 signatures Starbucks has announced it will stop using cochineal dye to color its strawberry and raspberry products. Cochineal dye is widely used in the food industry and is extracted from a tiny beetle. The petition against the bug-based dye was started by a South Carolina woman who “wanted to inform customers that the chain’s strawberry drinks weren’t vegan-friendly.” (Now THAT’S an “angry vegan”) (7)

PARTNERS HEALTH CARE VALUE HITS THE ROOF

Partners Health Care is building a new rehab hospital across the harbor from Boston on the edge of the Charlestown Navy Yard. The architects assume the building will have a 80 year life span, and that with global warming the worst storm within 80 years might cause floods up to 5.5 feet above previous flood levels. “Looking at long-term risks, benefits, and costs the Spaulding Hospital design team decided it would be a prudent investment to put the hospital generators on the roof… And 61% of Americans don’t think global warming will pose a serious threat to them or their way of life in their lifetime.” (8)

ZOCOR’S SUCCESS MAY BECOME A DIM MEMORY

In February the US Food and Drug Administration began requiring that drugs that lower cholesterol, statins like Lipitor and Zocor, carry a new warning that cognitive side effects such as memory loss and confusion can occur while taking statins. About 10% of statin takers already suffer from muscle ache side effects from the drug. People take statins to prevent heart disease, of course, but a 2011 Cochrane review of 14 trials of statins found that 1000 patients need to be treated for a whole year to prevent one death. (9)

WEIGHT LOSS SECRET OF HOLLYWOOD STARLETS NOT WORTH ITS WEIGHT

Having sex does not help you lose weight. Twenty minutes of running burns about 261 calories, swimming about 182 calories, jogging about 159 calories, while twenty minutes of vigorous sexual activity for a 150-pounder burns a paltry 35 calories. It may be aerobic, but it won’t make you lighter. (10)

DOCTORS LIST 45 UNNEEDED AND COSTLY TESTS

Nine medical specialty groups have developed a list of 45 “routine” tests  and procedures they consider unnecessary, a waste of money, and can expose patients to some risks. The list includes annual electrocardiograms for healthy people, CT scans for low back pain, chest X-rays before surgery, giving antibiotics in the first week of a cold, brain MRIs for headaches in healthy patients, and CT scans or antibiotic treatment for sinusitis . The physicians involved in the groups project (“Choose Wisely”) think that patients do play a role by asking for tests or procedures they have heard or read about, but don’t need. The groups also think that the list may help reduce the amount of “defensive medicine”, performing tests out of fear of malpractice if something is missed. (11)

MEDICAL MALPRACTICE REFORM SAVINGS MAY BE OVERSOLD

A recent Avoiding Avoidable Care Conference reported that the $10 Billion a year is paid to medically injured patients (and their lawyers, of course), and that another $46 Billion is spent on “doing more than we should because we want to reduce the threat of litigation”. The total of $56 Billion represents about 8 days or only 0.02% of our annual health care spending. “It is not clear to me that [medical malpractice reform] is really going to be the thing that changes the cost curve.”said Amitabh Chandra, an economist and Professor of Public Policy at Harvard. (12)

CURVEBALL FUTURES IS PROMISING BUT CHANCY

Pitchers elbow” in Little League pitchers used to be attributed to their throwing the curveball, and its use was severely curtailed for the youngsters, but it is now making a comeback as new studies indicate that it is total number of pitches thrown rather than the type of pitch that causes the inflammatory condition. As is common in predicting future values, the range of maximum pitches allowed per week to avoid the development of “pitchers elbow” is from 150 to 300 depending on the source. Some orthopedic surgeons still feel that the curveball should remain banned from Little League play. Dr. Lyle Micheli, director of Sports Medicine at Children’s Hospital in Boston, recommends that young pitchers learn how to throw the knuckleball instead. (13)

References:
1. Boston Globe, April 24, 2012, G 13, Rachel Zarrell
2. Boston Globe,  April 22, 2012, editorial page
3. N Engl J Med 2012 Mar 15;366 and Journal Watch General Medicine April 1, 2012;vol.32,7,p.54
4. Emerg Inf Dis 2012 March; 18:385 and Journal Watch General Medicine April 1, 2012;vol.32,7,p.56
5. New Yorker Magazine, April 30, 2012, p.32, Dana Goodyear
6. Arch Int Med 2012 Mar 12;172 and Journal Watch General Medicine, April 1, 2012;vol. 32, p.59
7. Cape Cod Times, April 20, 2012, C5
8. Boston Globe, April 20, 2012 Opinion, Joan Wickersham, A 11
9. Boston Globe, April 16, 2012, G 12, Deborah Kotz
10. Consumer Reports on Health, May 2012, p. 12, “Tip of the Month”
11. Boston Globe, April 4, 2012, B 11, Liz Kowalczyak
12. Boston Globe, April 20, 2012, B 6, Chelsea Conaboy, “White Coat Notes”
13. Boston Globe, April 1, 2012, C 2, Kevin Paul Dupont, “On Second Thought”

THIS IS NOT THE APRIL FOOLS ISSUE!  


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