Hibernating Humans: A Look into the Future
Medical scientists have studied, in interest and in awe, bears and smaller mammals that about this time of year effectively shut down their systems and “got to sleep” until spring. Their bodies cool far below normal, their hearts slow to five or six beats a minute, they nearly stop breathing. They don’t eat, don’t drink, their brains seem to effectively turn off. About their only action is a periodic bout of intense shivering; this in an apparently involuntary effort to get what has temporarily become a too-low body temperature up a bit and to fill their organs with blood.
They seem close to death, but remain quite alive in this state till early spring, when they literally snap back to life. Quickly regaining the muscle loss that comes from lack of use.
Scientists have probed hibernation for decades, convinced that if we put the sickest patients into such a state for hours, days, even weeks there might be a better chance to make them well again. High among the possibilities is the hope to temporarily slow down the rapid reproduction of cancer cells, which have a higher metabolic rate than normal cells. Totally uncharted medical territory; but the opportunities and possibilities seem endless to scientists who have studied hibernation for dozens of years. Eventually creating such a temporary state in humans -- and using it as some part of a cure -- has remained little more than a vague hope.
Until recently, when a group of scientists from the Hutchinson Cancer Research Center in Seattle reported an apparent major breakthrough in the journal Science. They reported achieving a form of hibernation -- called torpor -- by exposing laboratory mice to small amounts of normally-toxic hydrogen sulfide gas. The compound apparently limited the animals’ ability to produce body heat, a key element in the hibernation process, placing each of them for six hours in a suspended state.
The mice appeared unconscious within minutes of inhaling the gas. Their body temperature dropped from 98 to 59, their respiration dropped from over 100 to 10 breaths a minute. Effectively, their lives reached close to a virtual standstill. The animals snapped back to “life” when the gas was replaced by oxygen, seemingly unaffected by the experiment.
Admittedly, torpor is not the same as hibernation, which is much more than achieving a low metabolic state. But the intriguing point is that the researchers completely controlled what happened…slowing down the metabolism of a small non-hibernating animal and then bringing its systems back at will and without apparent physical damage.
We’ve all heard stories of people falling through the ice, seeming close-to-death, then recovering when their bodies were brought up to normal temperature. So effectively, what has been basically but successfully attempted with lab animals in a controlled setting, has happened to humans in life situations…if only with occasional and haphazard results that were welcomed but not fully understood.
Now their seems to be hope that someday in the future we will understand and hibernation-therapy will become a useful medical tool.
Marginal note…this treatment, its handling and expectations are in no way connected to cryogenics, the totally-unproved system that deep-freezes and then “stores” a deceased’s body in the hope that somehow, someday a great medical breakthrough will make it possible to cure their ills and bring them back to life.
Biotech Expanding its Reach
For years scientists have realized that some “wonder drugs” work more of their special magic on certain patients -- ethnic groups, families or even individuals -- and are relatively-ineffective when used for the general population and that certain groups are more-susceptible to a specific disease. Too often it has been a hit-and-miss-and-hope-for-the-best situation. Now these same scientists are discovering more and more “biomarkers” that can identify susceptible patients early-on…simply by analyzing specific and well-selected genes.
Biotechnology is commonly referred to as the manipulation or “rearrangement” of organic materials (genes for example). It has been around in unrealized and simpler forms since earliest civilizations began using yeast to ferment beer and to make cheese. More-recently it has been used to cross-breed animals and to create a wider variety of beautiful plants and flowers. Now the science itself seems about to flower as it begins to target, mark and hopefully-destroy some of our most-fearsome illnesses in selective groups of patients.
Johns Hopkins has developed such a marker for patients at risk of liver cancer. Other scientific groups claim they have developed or are close to developing biomarkers that identify high-risk patients for breast cancer, Hodgkin’s Disease, Alzheimer’s and pancreatic cancer as well as some patients racked by depression or constant pain.
They are however still far away; biotech companies readily admit it takes about ten years to get from initial testing to approvals-for-use. But it is just possible that vaccines can be developed which will protect certain patients before the disease develops…or will be better able to attack and defeat the disease while it is still in a more-treatable stage.
In addition, biomarkers also could be used to protect the rare patients who react negatively -- sometimes violently -- to seemingly-harmless drugs that work wonders for the general population. And lastly, testing will possibly be simpler than almost anything known now in “high science”: in many cases using a drop of blood or saliva to analyze a patient’s DNA.
If you can’t believe that seemingly far-out medical miracles like this can happen, consider the following. A Boston company named Biopure has been producing “artificial blood” for several years. Product acceptance has been spotty but growing slowly in pockets of need across the globe. While the FDA has not approved its use here at home, eventual agency approval under certain condition is anticipated. Now that would be miraculous!
HIPAA Progress Report
More than six months after the fed’s mandated date -- many healthcare companies are still not in full HIPAA compliance with HIPAA’s clearly-stated mandates. Budgetary issues and technology “gliches” are blamed the most for these failures. And admittedly some providers are simply adapting a slower and more-careful path in the face of what are both their tight budgets and a current low level of enforcement.
In early summer, the Health Information Management Systems Society (HIMSS) sent a “HIPAA compliance” questionnaire to more than 350 healthcare insurers and providers. Of those responding, only 74% of the insurers and 43% of the providers that responded reported they were in “full compliance” with the HIPAA rules that had taken effect in April. General impression given was they had done the reasonable best they could with the tools on hand.
HIPAA’s security rules are administered by CMS and include stiff noncompliance penalties. But the agency has implied they will tread lightly, investigating only specific and fairly-extensive complaints…with the intent of seeking corrective action rather than imposing fines. A CMS spokesperson said only 26 complaints have been received.
Pharmacists Wanted
Seems that one of the best jobs young people can train for these days is registered pharmacist. The need for them has exploded in the past several years and America’s 89 colleges of pharmacy regularly turn away highly-qualified applicants simply because they don’t have the space or the faculty (faculty vacancies currently total about 11% and growing) to teach all the students eager to get into the field. Currently there are over 8,000 pharmacist’s jobs unfilled across the country…even though so-called “technicians” are drafted in most locations to work beside most of the registered pharmacists and to do a lot of the work under their general supervision.
Latest reports are that average starting salary for a recently-graduated pharmacist is running close to $100,000…and can come with a signing bonus. Currently there are about 200,000 registered pharmacists; best estimate is that twice that number will be needed in about fifteen years.
One of the reasons for this crush is that Americans fill 3.2 billion prescriptions a year. Another is that Americans are living longer and need more prescription drugs to support them in their increasingly-longer lives. And yet another reason: Medicare’s new prescription plan includes a provision which will pay pharmacists to counsel and monitor some patients on their drug use.
Putting Kids at "Minimal Risk"
It is commonly accepted that the vast majority of drugs prescribed for youngsters have never been tested on youngsters…though it is an accepted fact that kids often respond quite differently than adults to a given drugs. They are simply smaller in size and body mass. Because they are still growing and their bodies are still forming. Doctors are most-often undecided whether to prescribe or not to and whether to prescribe a smaller-than-normal dose or not to.
After admittedly years neglecting the problem because it is such a dangerous “minefield”, the NIH and the Institute of Medicine are leading the drive to get more testing, so we have more answers…and can learn how safely pediatricians can safely prescribe major drugs for ailing youngsters. In an effort to make it all happen, the government is offering valuable incentives such as patent extensions to pharmaceutical companies that make the effort to get out in front of this problem after years of understandable dithering.
Another problem is that many of these proposed tests must have some kinds of control and will therefore include healthy children who will be exposed to “minimal risk”, which is defined as minor harm and discomfort. What parent wants to expose their child in this manner? At the same time, what parent wants the doctors to “keep guessing” when prescribing drug usage, strength or doses?
It is being called an “ethical minefield, with no one involved knowing quite which way to go but all parties seem happy that at least the discussion stage has finally been reached.
More IT Help for Small MD Offices
Ten small and/or rural physician’s practices in the state of Washington will be awarded grants of up to $20,000 each… designed to help them get “up to speed” in electronic medical records. Two healthcare organizations -- First Choice and Qualis Health are collaborating in offering $200,000 in total grants to practitioners who can prove they just can’t afford the initial cost of moving to IT systems. First Choice will supply the funding and Qualis will provide the hands-on support.
A number of practices have submitted proposals to the program and these are currently being evaluated.
The program is being developed with the support of CMS; another example they say of their continuing effort, on a variety of fronts, to use technology to improve the quality of medical care…and to hopefully also reduce this cost-of-care in the future.
This of course has no direct relationship to the Medicare VistA-Office program which is currently being broadly offered to physician’s practices across the country. A number of similar programs reportedly are working or are in a developmental stage.
State-of-the-Art IT
A lesson of New Orleans: always be prepared! Yet a recent IT Architect survey concluded that more than 25% of American companies and service organizations still do not have a written and detailed continuity plan ready-if-needed.
According to the experts, such a plan must list who is in charge of what in an emergency...and to at least describe the location and infrastructure of any hot sites or alternate locations that may be available. The more clear and factual information, the better!
Worth checking...the NEMA (National Electrical Manufac-turers Association) ruggedness evaluation of your equipment. NEMA level 6 means that it satisfactorily withstood both dust and immersion-in-water tests.
Upgrading
Pity the poor patient no more. The latest symbol of affluence seems to be the “superior” hospital room that offers extra space, privacy and a host of premium features for the patient willing to spend a couple of hundred not-covered-by-insurance dollars a night.
These luxury rooms and suites are usually available only in major teaching hospitals and/or near the most-affluent areas of the country. So their locations are spotty, but their amenities are eye-stopping. Standard upcharges average in the $200-300 a night range, but at least one New York City hospital has suites available that cost an extra $700 per.
The medical care level reportedly remains the same whether all the patients are two in a room or in a giant and very-personal suite. But almost all the suites offer high-speed internet connections and giant flat screen TVs…while the top-of-the-line suites also provide amenities such as concierge services, a fax machine, high-quality marble bathrooms, refrigerators, round-the-clock visiting hours and sleep-over facilities for family members.
One of these hospitals offer a “virtual tour” of its luxury pavilion on the internet. Shown are single rooms and suites…even the luxury baths that are an important part of the perks.
What the Egyptians Knew
An exhibit running through January 15 at New York’s Metropolitan Museum of Art puts on display a 4,000 year old knowledge of medicine, surgery and treatment that was almost modern in its approach; this level of understanding apparently disappeared rather quickly and didn’t begin to surface again until 3,500 years later…in the 17th century.
Center of the exhibit is a papyrus fragment that documents treatments for 48 distinct injuries running from the top of the head to the chest… dealing mainly with punctures and broken bones, but including a discussion of the removal of a cyst or tumor. Since the papyrus was torn, it seems logical that the missing pieces cover continuing groups of injuries that ran right down to the soles of a patient’s foot.
The exhibits show the Egyptian doctors had an understanding that blood was pumped from the heart and flowed through the body. And that a wound on one side of the head could cause paralysis on the opposing side.
They used honey, which is a natural bacteria-killer, on open wounds. They also used a concoction of willow bark (a chemical relative of aspirin) to treat pain. They applied moldy bread – which is a real but quite-distant relative of penicillin – to treat wounds. Metal knives were available for surgery, but they preferred flint, which is both sharper and basically sterile if sharpened just before use. Did they realize all this or even a bit of it? No one can say, of course.
Just as no one can also say why following generations and civilizations weren’t able to discover and build on all this basic but quite-advanced ancient medical knowledge.
Fountain of Youth Discovered
Perhaps. And it just may be right inside our body.
Scientists have identified a hormone -- apparently produced naturally in all mammals -- that, if channeled correctly, can lengthen the life span of the being, mice to man.
So far the idea is in early stages of testing and has been restricted to mice but it has extended their life spans an average 25% longer than normal, which in a mouse is about two years, without side effects.
Through genetic engineering, it has continued to similarly extend the life span of succeeding generations of these carefully-monitored mice at basically that 25% increase level.
According to a recent article in the journal Science, a University of Texas research team has been conducting these tests. They claim to have apparently isolated a peptide within a single gene -- that, if controlled and monitored, enables this longevity to be achieved.
Next step is to learn if they can induce the basic substance into “non-genetically-engineered” mice with similar results. If such results are achieved -- and it obviously is both still a big “if” and a long way into the future at best -- the final step just could be a regimen of “live longer” pills that activates this hormone and thereby increases the normal human life span close to 100 years.
Transcription Tips
Homonyms (words which sound alike, but are spelled differently and have different meanings) are a daily occurrence in transcription and most of the time, the correct word to type "comes naturally." However, there are some words which sound SIMILAR and are often incorrectly dictated within context and need to be edited: (As always, if unclear, leave a blank or type as dictated.)
D: His speech came easily and was fluid and legible.
T: His speech came easily and was fluent and intelligible.
Explanation: "Fluid" could be used, in a general sense, but since "came easily" and "fluid" (smooth, easy style) are redundant in meaning, "fluent" (specifically referring to speech) is substituted.
"Legible" refers to the written word and NOT to speech, "intelligible" is what was meant.
Replacing "Superman"
The passing of Chris Reeve naturally removed a high-profile spokesman for spinal cord injury…and with it a sharp drop in research dollars specifically targeted to help similarly-afflicted patients.
Each state currently spends at least $1 million on spinal cord research; a good percentage of these dollars come from a penalties imposed by 14 states -- including New Jersey and New York, but not Pennsylvania -- against drivers found guilty of unsafe driving. (Car wrecks are the accepted major cause of spinal cord injuries suffered by Americans.)
But the days of the big national drives are over, at least for now. NIH research money has been reduced as part of their belt-tightening in a number of areas. And grants from pharmaceutical companies have also dropped off. About 11,000 Americans suffer spinal cord injury each year...and though they suffer mightily and their cost-of-care is enormous, their numbers pale before the sufferers of many other afflictions; unless there is a Chris Reeve to capture the spotlight for them.
It’s most frustrating to the centers dedicated to bridging and even regrowing the “communication links” among severed nerves. One of the leaders in this area is at the Drexel University College of Medicine.
Reportedly they are practicing rehab methods on lab rats with compressed backs -- this mimicking spinal cord injury in humans -- that hold much promise and could someday hopefully be applied to human patients. The Drexel scientists stress that no one is hoping for another celebrity disaster; but they are hoping for ideas that will target additional research funds to help rehabilitate many terribly-crippled people.
Medical Minutia
A change in our usual approach this month; this is much more than minutia…
A stroke occurs when oxygen fails to reach a part of the brain. Minutes count and lack of awareness of friends and family can spell disaster. How does the lay person know what steps to take?
The answer came at an earlier-in-the-year presentation at the American Stroke Association. It consists of asking the patient to react to three specific requests.
(1) Smile.
(2) Raise both arms.
(3) Speak a simple sentence.
If the patient cannot quickly and easily perform all three tasks, call 911. Immediately!
Auditing the News
Employer-based health insurance declined in 2004, offset a bit by government-sponsored (basically Medicaid) coverage. The number of uninsured rose to 45.8 million, but the percentage without health insurance remained constant at 15.7% due to population growth.
NJ had 1.32 million uninsured people and hospitals in the state provided $812 million in uncompensated care in 2004, with the state government reimbursing $583 million. PA figures were similar.
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Erie is the latest New York State County to join the “Verify New York” system, developed by IBM, that is designed to tag potential irregular Medicaid billing practices. Its target is to identify and curb what is called “10% outright fraud and 30% bordering on system abuse”.
“Verify New York” is an adaptation -- tailored for Medicaid clients and information -- of a program IBM originally created for major healthcare insurers. It is being offered on a countywide basis, but NYC, the state’s giant exception, has already signed-on.
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Duane Reade is moving – carefully and slowly -- into the ATM-like kiosk prescription business, partnering with DrugMax of Connecticut. Patients reportedly will be able pass through their prescriptions, make payments and even discuss their needs by video conferencing on-site with pharmacists and technicians.
Duane Reade says it feels that pharmacy kiosk technology is where ATMs were twenty years ago…and that a similar rapid rate of consumer acceptance can be anticipated.
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Apparently the pharmaceuticals believe in building physician loyalty early-on. According to a recent article in the Journal of the American Medical Association, third year med students on average receive one gift or are invited to one school-approved drug company-sponsored activity each week. Most students (68.8%) believe the gifts would not influence their choice in future practice, though it might influence their fellow students.
However, the author of the study, Chicago Medical School professor Dr. Frederick Sieries, feels that these students just have to be impressed and influenced by so much attention. The president of the American Medical Student Association seems to agree, saying that med schools should consider restricting their exposure to these early-marketing efforts.
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A number of studies have surfaced recently, all praising the positive value of drinking reasonable quantities of coffee each day. It’s all about antioxidants, which are credited with reducing the risk of developing several types of cancer and type 2 diabetes. Antioxidants are abundant in a wide variety of fruits, vegetables, nuts, spices and oils; but most people too-often pass them by. But they drink coffee.
One research team, using Agricultural Department data, analyzed a hundred different food items that appear in typical Americans’ regular diets...and coffee won.
Of the top 5, average daily consumption was 1,299 milligrams of antioxidants from coffee...294 from tea…76 from bananas…72 from dry beans…and 48 milligrams a day from corn. That is based on an average consumption of a bit more than a cup-and-a-half of coffee each day. While fruits and vegetables are better sources; we just don’t eat enough of them.
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California has filed a lawsuit against 37 pharmaceutical companies, accusing them of inflating drug prices to the state’s Medicaid program, which is called Medi-Cal.
The action was initiated due to a pharmacy whistle-blower’s report that claimed there were effectively two sets of books kept by the companies…which led to increased dispensers’ profits, which in turn was designed to earn the companies’ allegiance.
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A small city-supported hospital in Brooklyn has come up with a unique barter system…asking uninsured free-lance artists to perform for their patients in return for healthcare services. Every hour of performance earns 40 credits -- about $40 value -- into a hospital healthcare account for the artists, most of whom have a limited income which is above the Medicaid level, but not nearly enough to cover a personal healthcare policy.
About 40 people reportedly have signed up for this exchange-of-service program, which may be headed for networking across the City’s hospital system.
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Based on several recently-released large studies, it is now estimated that nine million Americans, mostly women, suffer from consistent “dry eye syndrome” …which feels like sand in the eye all day long. It can come from allergies, constant computer work, aging, use of contact lenses, medicines taken for others ills, or rarely-but-possibly cornea damage.
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