New Online Cyber Journal Club Platform Launched


I am thrilled to share that we have launched the world’s first journal club of tomorrow bringing a 200 year-old mainstay of medical education into the 21st century.

For the first time, using the latest in video technology, the American Society for Reproductive Medicine (ASRM) participated in a live online transcontinental Journal Club for practicing physicians, academics and students. The Journal Club Live™ platform featured a ten-way discussion of fellows and professors from the USA, Europe, and India well as the article’s author.  Free open video group chat is a mainstay of gamers worldwide – now this technology transforms medical education.

Every physician and scientist used journal clubs during their training to learn the latest breakthroughs in their field and to lean how to critically read research.  Unfortunately once they finish their training this beloved tool is lost.  Even worse, skyrocketing responsibilities and workloads are cannibalizing the time previously reserved for journal clubs in even the best academic institutions.

Since the 1800’s Journal Clubs, or closed research critique sessions have been a mainstay of medical research and education. With the launch of the Online Cyber Journal Club™ platform, the conversation among academics, patients and students can be shared worldwide and disseminated in real time.

The reader of the journal can now become part of an ongoing, dynamic, live discussion that enhances the value of the original research.  With this effort, we have bridged the gap separating the digital and traditional medical literature and embraced the global technological future of medicine. This integration will lead to exciting new directions in research.

The sessions are archived and accessible to anyone anywhere.  No fees, no registration, no membership , no subscriptions, and no firewalls.  The first international one is at and the first test proof of concept is at  These were fertility-based discussions on controversial subjects related to the best medications to use to prepare the uterus for pregnancy and the best timing of embryo development – however the platform works equally well across all specialties and disciplines.

An online real-time live journal club has never taken place before. We are very excited about this new digital expansion of what has been a mainstay of medical research and education, now taken into the 21st century as a powerful new teaching tool for physicians and patients.

The entire event was live-streamed on YouTube using technology from Google with custom modifications from the Journal Club Live™ platform and was open to comments and questions and free participation from anyone around the world.

I knew we were onto a great idea when I performed our initial needs assessment.  Even informally discussing the idea among fellows and professors led to an excitement I had not seen for any other on-line educational venture.  They were clamoring to have the first one and fighting to join in.  I followed this with a formal survey of the trainees and program directors in our specialty and found 100% support for the concept.  A majority went so far as to say they would even make participation manditory for those in their department.

The Three classical goals of Journal Clubs:

  1. to keep up with the cutting new developments in your field
  2. to learn to classical references from the past
  3. to learn how to critically read new research and decide how to critique them

Today’s New barriers to medical education and journal clubs:

  1. There is an exponential increase in the number of new high quality research publications but less time to read them
  2. There are more journals than ever but less funds to subscribe to them
  3. The departmental journal clubs of the past are largely gone – victims of shrinking budgets and time
  4. Physicians have less time and money to attend local or national medical meetings

New Opportunities of the Journal Club Live™ Platform- the Online Cyber Journal Club™ Platform:

  1. all of the opportunities of traditional journal clubs
  2. 24/7 365 access to video archives of the discussions
  3. an international community of participants building collaboration
  4. direct access to the leading experts in the field
  5. ability to be mentored by experts from around the world
  6. collaborative discussions between physicians patients and industry
  7. for the first time ever participation by the journal article’s  author

Not unexpectedly the top benefits of participation as ranked by trainees from the needs assessment survey were:

  1. keep up with the latest research
  2. learn the classical references
  3. interact regularly and network with fellows from other programs
  4. have an opportunity to personally interact with leading professors from other departments
  5. learn how to critique research studies
  6. develop collaborations for new projects

What was so rewarding was to see how much all the participants enjoyed coming together with this new platform.  “This was a terrific way to share results and to discuss an article. I learned a lot more by actually being able to interact with people from different places and the author and moderators than I would have just sitting in a cold room even though my colleagues are wonderful,” said Dr Kurt Barnhart, William Shippen, Jr. Professor of Obstetrics and Gynecology at the University of Pennsylvania, Associate Editor of Fertility and Sterility, and a participant in the event.

Happily , the same reaction came from the author who had the never to sit in the hot seat and defend her research.  The author of the study discussed participates in the event as well. “It was great. Sometimes when you have your article critiqued…you learn something about your research that you had not thought about before,” said Dr Elizabeth Ginsberg, Medical Director, Assisted Reproductive Technologies, Brigham and Women’s Hospital, and Associate Professor, Harvard Medical School.

Further information is available at Journal Club Live

More information about Dr Steven Palter, MD the creator of the Journal Club Live™ Platform is at Gold Coast IVF where he is the Medical and Scientific Director .  He is the Video and New Media Editor for Fertility and Sterility an Elsevier Journal .

Link to the press release from ASRM is here


How Much is Your Baby’s Life Worth? Experts Use Economics to Decide on Genetic Screening

Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether genetic tests are worth the cost.   The research is reported in the new issue of AMJOG and reported in summary here.

While scientists can already screen for SMA, allowing parents to seek an abortion or decide against having children, doctors are split on whether or not to recommend routine screening due to cost concerns.

The new study analysis comes to $5 million for each case of SMA avoided by prenatal screening- and decides its too expensive.

“We found it to be too expensive,” said Dr. Sarah Little of Massachusetts General Hospital, who worked on the study. She added that the value for money was a tiny fraction of what is generally considered acceptable by health economists.

While a genetic test for SMA costs just under $500, more than 12,500 women would have to be screened to prevent one case of SMA, which affects only about 1 in 10,000 newborns.The results bolster guidelines from the American College of Obstetricians and Gynecologists, which recommends that only parents with a family history of SMA get screened.

However, another professional association, the American College of Medical Genetics, was not impressed with the study, which was published in the American Journal of Obstetrics and Gynecology.

“They came to the wrong conclusion because they used the wrong tool to do the evaluation,” said Michael Watson, executive director of the American College of Medical Genetics, which recommends universal screening for SMA.The team used the standard method of calculating cost-effectiveness, which naturally favors screening for diseases such as cystic fibrosis in which patients live long lives and require expensive treatment.

When patients die young, in contrast, they don’t incur a lot of expenses, and so the dollar value of preventing such diseases is smaller.  “It’s just not a practical approach,” said Watson, adding that “we could save a ton of money in the US if everybody died.”  I have often pointed this out to those who criticize fertility care as being too expensive for the health care system.  Cancer care and  intensive care units are very expensive.  If we only use cost effectiveness analysis then we would only offer preventive health, nutrition, smoking cessation, and vaccinations.  Much more cost effective then treating elderly sick people!

As a fertility specialist I deal with the SMA genetic screening test on a daily basis.  I advise all infertile couples of the existence of the test and the risks of being a carrier and having an affected child.  As is the case with cystic fibrosis and fragile X most couples do want to be screened once they know the test exists.  For those who test positive in both male and female some have chosen to have PGD where I test the embryo during IVF to see if it is affected and only replace those that are not.  I have had couples use this test to successfully have a healthy child unaffected by SMA.  Just recently I saw couples who came specifically for PGD having lost more than one child who died from SMA– and they were unaware that testing existed before.

This reminds of when a west coast state (think it was washington) used a cost effectiveness analysis to decide which medical treatments their public health insurance would cover.  Treatments were ranked and they went down the list until the budget ran out.  This system was very poorly received.

I hate to rock the boat but as advances in genetic diagnosis are exploding this problem is going to go through the roof.  I can now test for far more genetic diseases than tests existed for 10 years ago.  Using DNA chip technology I can now screen for over 200 diseases.  Is this cost effective?  Would you want to have it done?  When I thought about having children I wanted to be tested for everything possible!  Just last week I had a Yale student on a research elective with me.  He could not believe we don’t universally screen everyone for everything possible–yet many patients don’t want any test not 100% needed.  Others striving so hard to have a baby want to be tested for everything possible.  As the number of diseases we can test for heads north of 1000 in the next years our ability to test has outpaced policy decisions and protocols of what should be done for the couple who never had a child.   The bigger issue as we enter the future of Obama health care is where does genetic screening for low risk couples for diabling or fatal diseases (the ultimate preventative care) fit into the economic analysis.  How much is too much?  I guess it depends on who you ask and who’se paying…

Free DITM Podcast With Jeff Cohen-CEO Halt Medical on Medical Device Invention Process


I’m so excited to share with you my latest docinthemachine podcast with Jeff Cohen — serial entrepreneur and current CEO of Halt Medical (a gyn fibroid treatment statup), Voyage Air Guitar (the world’s best foldable guitar),  and Nashville publishers Savannah Music Group just recorded live at the 38th Global Congress of Minimally Invasive Gynecolog in Orlando Florida.

You might recognize Jeff who was recently featured on ABC’s Shark Tank where he turned down the shark’s offer of $500,000 for his guitar idea.  In the podcast we discussed the unique opportunities and challenges of medical device development- and innovation in general.

I was immediately struck by Jeff’s unique perspective and vision when I met him.  He has innovated in so many different areas and has successfully partnered with physician inventors for blockbuster devices.

Topics We Cover in the Podcast:

  • What’s unique about medical device development and how the potential returns differ from other industries
  • Advice for the physician/inventor where to go with your idea–pitfalls, how to protect your intellectual property and how to partner and start a company
  • Is your idea good enough to form a company?
  • The dangers of big companies and the opportunities of start-ups
  • All you need is a fantastic idea and where to go from there
  • What to look for in a business partner
  • What’s similar between innovation in any industry-medical,  music publishing, and internet?
  • What is the unique opportunity in today economic climate?

Hope you enjoy and get inspired…  All you need is a great idea– and as Jeff says- I believe everyone has one.

You can listen to the podcast below or download it in 3 versions — a single file or split into part 1 and 2.


6 Steps To Getting More Accurate Medical Diagnoses

6 Steps to get more accurate medical diagnoses was just printed by US News and World Reports along with Newsday.  I was interviewed for this segment and asked to share some of the methods I developed and use to deliver the best possible results for my patients with infertility at Gold Coast IVF in Syosset, NY.  I provided tip # 1 — don’t assume just because you have been given a diagnosis that it’s complete or accurate and make sure you have a chance to share all the details of what’s happening to you with the doctor.  This is the most vital step to start the diagnostic process to help maximize results. 

Thea article describes an all too common problem I see in fertility treatments (and medicine in general) -  doctors who jump to conclusions and make diagnoses based on assumptions rather than facts- and then lead the patient down treatment paths that may not be optimal – or even correct!

The article goes on to say some doctors mistakenly decide in 18 seconds!  I usually spend more than an hour with a new infertility patient asking and listening to determine exactly what the potential issues are.  Unfortunately the article says some decide in just 18 seconds.

My Threshold First Step – Make sure you can tell your whole story- insist on an accurate diagnosis before treatments begin.  As it states in the article:

If your doctor appears to be in a rush and interrupts frequently, you’re at greater risk of being misdiagnosed. “Don’t assume that just because someone has given you a diagnosis that it’s necessarily accurate and complete,” says Dr. Steven Palter, medical and scientific director of Gold Coast IVF of Syosset, a reproductive medicine and surgery center. “The patient should communicate to the physician all of their concerns and symptoms. . . . There’s rarely only one treatment option, so the patient should ask what are the risks and benefits, and what options does the doctor have experience with and what they don’t.”

The Six Steps:

  1. Make sure you can tell your whole story
  2. Ask your doctor three questions after he or she comes up with a possible diagnosis
  3. Verify any shocking results
  4. Don’t discount doctor-patient chemistry
  5. Acknowledge your quirks
  6. Allow for the possibility of uncertainty

For an explnation of each step and thte specific questions to ask your doctor go here to Newsday for the full text of the article and the full 6 steps:

New Program for Centers of Excellence in Minimally Invasive Gynecologic Surgery Launched at International Congress of the AAGL

BREAKING NEWS: First description-  full free slideshow with audio of project and podcast
I am honored to share with you on my Presidential Report from the CGE of the launch of the Center of Excellence Program of the AAGL CGE.  With 38 years leadership in Gyn Minimally Invasive Surgery the AAGL is uniquely qualified to share its educational mission by verifying those Centers that meet these standards.

The AAGL Global Society for Gynecologic Minimally Invasive Surgery Launches Center of Excellence in Minimally Invasive Gynecologic Surgery Program at Annual Meeting November 16-20, 2009 in Orlando, Florida —dedicated to establish and verify standards at surgical facilities and hospitals.

(click green play arrow to hear presentation audio and automatically advance slides)

The primary objective of the AAGL and its professional interest partner the Council of Gynecologic Endoscopy (CGE) is to promote the adoption of minimally invasive gynecologic surgery with its reduced morbidity, shorter post-operative recovery time, less invasiveness, and reduced costs.

Our Analysis of patient and provider needs worldwide showed that there are widely divergent qualities of practice and that patients and providers have difficulty in identifying excellence.  There is a lack of national standards to improve outcomes.  While payors seek to control costs/outcomes patients lack access to the educational resources to direct them to the appropriate center to meet their needs in many cases.  As I stated in my address:

We recognize in the modern era of health care we have a unique opportunity as well as an obligation to use our educational resources and multidisciplinary expertise to help promote those systems and procedure which can improve patient outcomes in women’s health while reducing costs to both patient, payor, and society as a whole.

The CGE has therefore launched two new programs to address these needs.

First is an individual registry of physicians based upon peer review of operative experience and complications. The CGE, founded in 1996 has over 1100 individual gyn surgeons who have meet its standards.  The new program integrates an evaluation based on today’s complexity of procedures in minimally invasive surgery.  It is a tiered system with 3 levels of practice (based on procedure complexity) and 4 areas of proactive experience and specialization (General Gynecology Procedures, Fertility Enhancement Surgery Procedures, Repair of Pelvic Floor Defects & Urogynecology Procedures, Gynecologic Oncology Procedures)

Second is a Center of Excellence Program In Minimally Invasive Gyn Surgery.  This is in recognition  of the modern notion that to achieve best-in classs surgical outcomes requires not only an expert surgeon, but an integrated multidisciplinary surgical facility with systems and procedures in place to maximize quality cost effective safe outcomes for patients.

9 Requirements: Areas of Review To Qualify as a COEMIG:

  1. Institutional Commitment to MIGS
  2. Director of Division
  3. Medical Staff Physician Qualifications
    -Dedicated Educational Program
    -Formalized Credentialing Guidelines & Systems to Introduce New Procedures
    -Procedures for Minimizing Complications
  4. Sufficient Experience with Procedures
  5. A Full Complement of required Non-Surgeon Consultative Staff
  6. Ancillary Staff
    -Dedicated Team-Based Concept
    -Dedicated non-physician Educational Program
  7. Equipment Guidelines
    -Availability & maintenance
  8. Treatment pathways
    -Linked to Peer reviewed Practice Guidelines
  9. HIPAA Compliant prospective Outcomes Data Tracking

In my presentation launching this program at the AAGL annual meeting I shared

The AAGL is extremely excited and totally committed to the concept of Gynecologic Minimally Invasive Surgery Centers of Excellence.  It represents a unified vision for women’s health that integrates our entire educational mission and expertise over the past 38 years.

First Ever Global Opportunity for Standards of Excellence:I was equally excited to present the concept to the Affiliated Societies of the AAGL which is made of representatives of National Minimally Invasive Gyn Societies from around the World.  Our dedication to this concept and recognition of its value was shared by representatives of Partner Societies from South America, Europe, and Asia.  We agreed to work together collaboratively to establish a shared Global Standard and to establish a shared program to advance Women’s health under the AAGL CGE COEMIGS program in cooperation with each Nation’s Society.

I will share further details of the program with you here as they are released!

Details of the society are are on the website of the AAGL

Information on the CGE

Information and Applications for the COEMIG Program


I Scammed the scammers calling from “Microsoft” to save me from Mexican hackers

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New Online Cyber Journal Club Platform Launched

Tuesday, April 2, 2013

I am thrilled to share that we have launched the world’s first journal club of tomorrow bringing a 200 year-old mainstay of medical education into the 21st century….

future publishing

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How Much is Your Baby’s Life Worth? Experts Use Economics to Decide on Genetic Screening

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Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether…

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Free DITM Podcast With Jeff Cohen-CEO Halt Medical on Medical Device Invention Process

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I’m so excited to share with you my latest docinthemachine podcast with Jeff Cohen — serial entrepreneur and current CEO of Halt Medical (a gyn fibroid treatment statup),…

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6 Steps To Getting More Accurate Medical Diagnoses

Tuesday, November 24, 2009

6 Steps to get more accurate medical diagnoses was just printed by US News and World Reports along with Newsday.  I was interviewed for this segment and asked to…


New Program for Centers of Excellence in Minimally Invasive Gynecologic Surgery Launched at International Congress of the AAGL

Monday, November 23, 2009

AAGL CGE Center of Excellence Program In Minimally Invasive Gynecologic Surgery Launch Information by Steven Palter, MD President CGE

New Endometriosis Fertility Scoring System Predicts Fertility: Exclusive Podcast With Author

Friday, November 20, 2009

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New Groundbreaking Endometriosis Staging System Presented is 1st to Predict Fertility- First Anouncement

Thursday, November 19, 2009

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Listeriosis Risk to Fetuses Higher than Thought

Monday, November 16, 2009

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Report Releases Top 10 US Healthcare Systems By Revenue: VA is #1

Monday, November 16, 2009

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USPSTF Drops Breast Self Exam- Delays Mamogram Until 50- OBGYN Groups Disagree

Monday, November 16, 2009

U.S. Preventive Services Task Force issues new breast cancer screening recommendations. See ACOG’s response and more details on the methodology and implications.

Breaking News: New Recommendations for Women’s Health To Be Released 11/16/2009

Thursday, November 12, 2009

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Thursday, November 12, 2009

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Tuesday, November 10, 2009

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Get Ready for TSA-Like ID Checks in Doctor’s Offices!

Monday, November 9, 2009

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Encrypt EHR — Else HIPAA Violations Need Be Reported To Government & Media

Monday, November 9, 2009

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Medicare Ends Reimbursement for Consultation Codes January 1, 2010!!!

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Obesity Proven to Decrease IVF Success Rates

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Verizon Blitzes Smartphone Releases Next 60 Days

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Monday, November 2, 2009

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New 5K+ Res Video/Still Camera Blows Away All

Friday, October 30, 2009

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New Method of Embryo Genetic Testing: Changing Fertility Treatment

Thursday, October 29, 2009

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Thursday, October 29, 2009

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New 4K and 3D Tools at HD Expo– As I Predicted For the Operating Room

Monday, October 26, 2009

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World’s First “4k” Laparoscopy Performed- Surgery in 4X HD!

Thursday, October 22, 2009

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Robotic Sperm Injection Into Egg Developed!

Monday, October 19, 2009

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Military Prototype “Blob” Robot–Countless Medical Potentials!

Monday, October 19, 2009

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It Is Possible to Reverse Sexes!

Monday, October 19, 2009

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Monday, October 19, 2009

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Monday, October 19, 2009

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Tuesday, November 4, 2008

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