Docinthemachine Guest Blogging at Medgadget!

Posted on March 30, 2007 by Steven F. Palter, MD

I am very excited to begin guest blogging over at Medgadget! I am sure many of you are familiar with the site. Medgadget is a hugely popular site that reviews new medical devices. My first post is Bionic Implants Available Today: Docinthemachine Guest Post and reviews the state of the art of current human bionics; technology and ethics.

Medgadget is edited by Michael Ostrovsky, M.D. & Nicholas Genes, M.D., Ph.D. (of blogborygmi and grand rounds fame) & Timothy Odell along with webmaster Gene Ostrovsky. After admiring their work from when I began blogging, I was honored to be one of their finalists for best medical technology blog 2006. Then the real suprise cam when I received an email from Nich & Michael asking if I would consider guest blogging on medgagdet as a regular feature.

They wrote:

I was also talking this over with my colleagues at Medgadget.com, we’re grateful for your comments to the site and were wondering if you’d like to formalize your relationship, which is to say, write for Medgadget. As we talked about it, you could post about your research, other technology that catches your eye, your expectations for future development.

Since I have ideas galore and love their site I quickly wrote back – YES!

Thank you so much for the kind words and your support. As far as medgadget, I know the site well and greatly respect and enjoy it. I am honored by your request.

After we got this arranged I found out Nick and Gene were both invited to the J&J Blogging Summiit in NYC along with me. We had a great discussion and exchange of ideas and made arrangements for me to start guest blogging.

Gene, myself, and Nick at the Medical Blogging Dinner

I hope you will all go check out my gest blogging. Please send comments to me here or the medgadget people over on their site and let us know if you enjoy my visit over there. I plan on posting on their site very other week or so.

New Genetic Pap Smear Can Easily Diagnose Hidden Sexually Transmitted Diseases

Posted on March 28, 2007 by Steven F. Palter, MD

Undiagnosed sexually transmitted diseases are a major health epidemic in the world. Some of the worst ones have no symptoms. The cervical cancer screening pap smear has been updated with new genetic technology to identify bioth gonorrhea and chlamydia- two of the most serious dangers.

The standard pap smear is a decades old technology where a doctor wipes the cervix (or mouth of the womb inside the vagina) with a brush and sends the cells to a lab. There, they are examined for precancerous or cancerous cells. Pap Smears save lives from cervical cancer. In the last 50 years, it has helped reduce the number of cervical cancer deaths from 35,000 a year to less than 5,000 today.

The first imprevment in the pap smear- thin prep: A major improvement came with the development of liquid based , or thin-prep, technology. Here the cells are collected into a fluid that is processed through proprietary machinery to remove the often overwhelming background debris that can hide the cancerous cells. It is becoming a standard with some estimates of more than 85% of doctors using it.

(The evolution of this technology and the company behind it will be the topic of an upcoming review here at DITM)

What’s New: Hidden Sexually Transmitted Disease (STD) Screening: STD’s are major health crisis. Two of the most common in the USA (chlamydia and gonorrhea) are often asymptomatic in women. Unfortunately, these hidden STDS are major causes of internal scarring and infertility in women. In advanced cases each pelvic infection episode dramatically increases the risk of infertility with almost half of women with three episodes developing tubal infertility. As Gen-probe reports the problem is severe especially in young women and teens:

Each year, close to four million cases of chlamydia and one million cases of gonorrhea occur in the United States. In fact, up to half of patients diagnosed may be infected with both … therefore, it is important to test all sexually active individuals for both… Further, the complications that can result from untreated chlamydia and gonorrhea can be serious. Recent CDC recommendations call for expanded chlamydia testing. It is recommended that all sexually active adolescent women be screened for chlamydia at least once a year. Close to half (46%) of chlamydia cases occur in women ages 15-19 and another one third (33%) of infections occur in females between the ages of 20-24. Young individuals are also at an increased risk for gonorrhea. In fact, seventy-five percent (75%) of all reported cases occur in individuals between the ages of 15 to 29 years.

How does it work?: This test is based on genetic nucleic acid technology. That is, after the cancer screening part is done the sample is tested for the STD infection’s unique DNA. It is close to 98% sensitive in picking up these hidden diseases.

(technical explanation: The APTIMA COMBO 2 Assay is a second generation nucleic acid amplification test that uses target capture for in vitro qualitative detection and differentiation of rRNA from CT and GC. The assay uses a family of Gen-Probe’s proven technologies including target capture (TC), Transcription-Mediated Amplification (TMA) and Dual Kinetic Assay (DKA). This is the same family of technologies used to screen the nation’s blood supply.)

Now that the FDA has cleared this test to be combined with the pap smear it is possible that millions of women could be screening with one test for these hidden dangers.

For extensive information on STD’s from the CDC read here.

An amazing resource for information on the STD epidemic and its devastating effects on fertility are at the American Society for Reproductive Medicine’s Protect Your Fertility Campaign. Here is a white paper on the epidemiology of the infections and the effects on fertility.

Human-Animal Mutant Animal Developed: It’s Not the First!

Posted on March 27, 2007 by Steven F. Palter, MD

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Many reports on-line are coming out about chimeric man-sheep creatures developed.

Scientists have created the world’s first human-sheep chimera – which has the body of a sheep and half-human organs. The sheep have 15 per cent human cells and 85 per cent animal cells – and their evolution brings the prospect of animal organs being transplanted into humans one step closer. Professor Esmail Zanjani, of the University of Nevada, has spent seven years and £5million perfecting the technique, which involves injecting adult human cells into a sheep’s fetus.

What is the promise:

He has already created a sheep liver which has a large proportion of human cells and eventually hopes to precisely match a sheep to a transplant patient, using their own stem cells to create their own flock of sheep.

The process would involve extracting stem cells from the donor’s bone marrow and injecting them into the peritoneum of a sheep’s foetus. When the lamb is born, two months later, it would have a liver, heart, lungs and brain that are partly human and available for transplant.

What many don’t realize is that chimeric, transgenic, and xenograpted human-animal research has been going on for some time. THe genetic research focuses on placing the genes of one species inthe cells of another. Xenograft research has not gotten much press. This is what I was extensively involved in. Here we actually graft human tissue into animals (usually mice) that lack an immune system

My research involved grafting human ovarian tissue into immunodeficient mice and then allowing it to grow, develop, and function. This ia called a xenograft and the technique has now been developed by several groups. The hope was to develop techniques to preserve fertility in cancer patients. There has now been a case reported where human ovarian tissue was frozen, reimplanted (into the woman not a mouse) and resulted in a pregnancy.

The biggest controversies

1. this could potentially lead to a mouse ovulating a human egg that gets fertilized and become a person
2. there is unknown potential for interactive effects between the species
3. there is possibility for new animal viral contamination of the human cells that can be transmitted

When I did xenograft research the animals were locked down as if they has Ebola. Made Alcatraz look like a Holiday Inn.

The top photo is NOT MY RESEARCH —it is a human ear growing on the back of an immunodeficient mouse by a group working on growing human organs for replacement. This is part of the emerging field of tissue engineering where human tissue and even organs are gorwn in lab dishes. Read more on that subject ere: Creating tissues that can augment or replace injured, defective, or diseased body parts.

Yes, it is real…

FDA Warns About All Natural Products- With All Natural Arsenic

Posted on March 27, 2007 by Steven F. Palter, MD

Everyone is jumping on the natural product and herbal bandwagon. What many don’t know is that all-natural is often far from all-safe. Almost all of these producs remain highly unregulated and untested in their claims (therefore the need for the blanket disclaimers that the products are not intended to diagnose of treat any condition).

One of the problems with herbals is the huge rate of contamination with other ingredients. This may be inadvertant such as mercury in fish oil capsules, heavy metals in herbs, or intentional such as the well-reported spiking of herbal viagra with real drug viagra.

I know a manufacturer of herbal supplements. He used to sell electronics but now sells herbal supplements. I think it’s a more lucrative business.

Today the FDA issues a warning out arsenic contamination in mineral water. Just realize that when these contaminations occur in herbal supplements it is often buyer beware before its discovered. Low level contamination often is never discovered.

FDA Warns Again About Arsenic in Mineral Water – Five Brands Recalled Within Last Month

The Food and Drug Administration (FDA) is re-issuing its warning to consumers not to drink “Jermuk” brand mineral water due to the risk of exposure to arsenic, a toxic substance and a known cause of cancer in humans. The agency is providing this information again to consumers due to an expansion of the recall initiated by the products’ importers and distributors. “Jermuk” water is imported from Armenia and distributed under different labels in California. Five brands of these products have been recalled since March 7

The good news is you probably won’t die

Although arsenic is a well known human poison, there is little chance that someone would become seriously ill after consuming the recalled products over a brief period of time (days to weeks). However, it is likely that the person would experience nausea, abdominal pain and possibly vomiting, which are indicators of arsenic toxicity.

FDA has sampled the contents of 500 milliliter (mL) green glass and/or plastic bottles of all of these brands and found they contained 454-674 micrograms of arsenic per liter of water. FDA’s standard of quality for bottled water allows no more than 10 micrograms per liter.

UPDATE: wow two recalls in one day of natural health products!

Another fDA recall is in effect this time for some vitamins. Unfortunately, the manufacturer faled to fully list the ingredients onthe label. As I said it happens all the time. This one had fish products but never listed them posing a severe allergic reaction risk for some.

FiberChoice Plus Multivitamins Issues Allergy Alert Fish Allergen Not Declared on Label

FiberChoice® fiber supplement is recalling the newest variant of FiberChoice® plus Multivitamins fiber supplement. This recall affects 90 count (16oz.) plastic bottles.

This recall was initiated after we discovered fish gelatin, a known allergen, contained in one of the raw materials of the product, which was not declared on the product label for the multivitamins being recalled. The fish gelatin consists of the following species of fish: cod, pollock, hake, cusk, haddock, redfish, sole, and flounder.

Grand Rounds Is Up!

Posted on March 27, 2007 by Steven F. Palter, MD

Grand Rounds is upat medviews - this weeks he has a very wide range of great pieces – unencumbered by themes. I appreciate him including my post on cadaveric surgical implants – and why synthetic is a much better route to take.

Doc in the Machine takes exception to the use of cadaveric disks for spinal surgery, pointing out the advantages of using synthetic disks.

Biotech Missteps: Would You Prefer a Synthetic Implant or One From A Human Cadaver?

Posted on March 23, 2007 by Steven F. Palter, MD

Yahoo is reporting on a Lancet study of a new spinal surgery “breakthough” today – the use of a spinal disk transplant from a cadaver by Chinese doctors. One step forward, two giant leaps backwards. The move towards cadaveric implants in a era of evolving synthetic disks is a move in the wrong direction. Reasons follow the details of the news.

Study Details First

Chinese surgeons are reporting long-term success with the first use of transplanted spinal discs to relieve back pain. Spinal discs from human donors were transplanted five years ago into five patients with chronic back pain caused by disc degeneration, physicians at the University of Hong Kong and the Naval General Hospital in Bejing said. As reported in the March 24 issue of The Lancet, the five-year follow-up found an improvement in symptoms, no signs of immune rejection and only mild degeneration of the transplanted discs.

Why This is a Step in the Wrong Direction

There is a huge movement in biomedicine to move away from products derived from humns, cadavers, and animals and move towards synthetics. The reasons are many and profoundly important. Anything derived from a human source has biological variability- that is the implants are all as different as we are from each other. This variability leads to unpredictable outcomes. A huge step away from this happened in my field of infertility with our major drugs – gonadotropins. These for decades were extracted from the urine of cloistered menopausal nuns and when they became more scarce grandmothers in the Netherlands. Millions of gallons of urine was processed to extract the hormones. Unfortunately the spectre of contamination, infection, and variability between lots not to mention the cost and logistical issue of manufacture have led to replacement to a great extent with pure forms of the hormone quietly created in the laboratory. No human extractions, no variability, no contamination, and pure consistant results. Sorry to the nuns.

Next, there have been horrific recent scandals regarding horrific and dangerous procurement (Mastromarino case) of cadaveric tissue or selling stolen body parts for medical use without consent and there is great concern about the methodology potentially used in China where organs are harvested and sold from executed prisoners.

There are now synthetic spinal disks approved for use.

I don’t know about you but I’ll take a synthetic cyborg implant over a cadaver anyday. More exciting is the idea I keep shouting about- that in the near future synthetic implants will outperform natural human abilities anyway and enhance performance. Read about that idea here and here!

Bionic Friday Posts

Posted on March 23, 2007 by Steven F. Palter, MD

For your enjoyment today – a collection of forward thinking docinthemachine posts about robotics and bionic humans. Take a minute today to push your mind a decade into the future. Ponder with me roboic amoeba rovers inthe body, bionic retinal implants, and humanoid androids.

Finish the day with a post on the singularity and mind transfer into a computer.

What makes a human human? While you may think you know, the distinction is blurring as a result of medical technology advances.

Robotic Amoeba Created: Teens Fear Bionic Blob

Posted on March 23, 2007 by Steven F. Palter, MD

Dennis Hong, of Virginia Tech College of Engineering is designing a Whole Skin Locomotion (WSL) mechanism for robots to work on much the same principle as the pseudopod — or cytoplasmic “foot” — of the amoeba. With its elongated cylindrical shape and expanding and contracting actuating rings, the WSL can turn itself inside out in a single continuous motion, mimicking the motion of the cytoplasmic tube an amoeba generates for propulsion.

The inventor says:

“Our preliminary experiments show that a robot using the WSL mechanism can easily squeeze between obstacles or under a collapsed ceiling,” Hong said. The mechanism, which can use all of its contact surfaces for traction, can even squeeze through holes with diameters much smaller than its normal width.

“This unique mobility makes WSL the ideal locomotion method for search-and-rescue robots that need to travel over or under rubble,” said Hong, who hopes his research will help promote the concept of bio-inspiration in robot design. “The mechanism also has the potential for use in medical applications — such as robotic endoscopes, for example, where a robot must maneuver in tight spaces.”

Of course my mind sees yet another version of an impnatable robot for medical diagnosis and treatment in the evolving realm of what I call “Future Vision”: the coming radical transformation of medicine.

Better Retinal Implants for Blindness Cure Coming

Posted on March 23, 2007 by Steven F. Palter, MD

I previously wrote about retinal implants that might cure blindness. This idea is yet another in the line of machine-human implants that will first replace natural abilities – aqnd ultimately augment human abilities. Look here for a video fest and link fest of bionic human implants in development.

Researchers now claim to have developed another retinal implant to cure blindness now with four times the resolution of previous implantable chips

Scientists at the University of Southern California (USC) announced their plans to test an improved retinal implant in blind patients. The new implant, which scientists hope will improve patients’ vision even more, has four times the resolution of the previous version.

Details of the chip and it’s challenges:

The device, developed by Mark Humayun and colleagues at USC, consists of a tiny chip dotted with hair-thin electrodes. When implanted in the retina, the electrodes transmit electrical signals from the chip to neural cells in the eye, which then send the message to the brain. A wireless camera mounted on glasses and a video processing unit worn on the belt capture and process visual information from the wearer’s surroundings and wirelessly transmit those signals to the chip.

The new version of the implant… has quadrupled the number of electrodes–from 16 to 60.l. The researchers recently received permission from the Food and Drug Administration to start human tests.

It is just a matter of time until night vision and superhuman quality vision chips will be available for elective implantation. Would you get one?

If You Transfer Your Mind to Robot Which One of You is “You”?

Posted on March 23, 2007 by Steven F. Palter, MD

Kurzweil and others have been forecasting the coming of the technological singularity for some time. The term, coined by Vernor Vinge, describes the creation of “humans 2.0″ when man and machine become connected in the creation of a new type of being. For more background information on this concept and predictions for it s coming in the future read here. As Vinge writes:

The acceleration of technological progress has been the central feature of this century. We are on the edge of change comparable to the rise of human life on Earth. The precise cause of this change is the imminent creation by technology of entities with greater-than-human intelligence.

Potential ways this may happen

Computers that are “awake” and superhumanly intelligent.

Large computer networks become superhumanly intelligent entities.

Computer/human interfaces blur distinction between man and machine.

Biological science may provide means to improve natural human intellect.

Betterhumans ponders a technological question which really delves into a metaphysical question of what makes a human human and where is the seat of the soul. If you download increasing amounts of your memory and consciousness into a machine at what point does it become human and “you”

(If) we have the technology to constantly back up our brains onto a computer through some wireless connection so that at any one time the computer has a snapshot of your brain in its current state. Now lets say that you get in an accident and 50% of your brain is damaged, so they take that backup and use it to replace 50% of your brain. Would you still consider yourself to be you and not some copy? what about 40% or 20%? What about 5%? Are you still you?

If you get in an accident and need 95% of your brain replaced and you use the backup image of your brain, are you still the original? Lets say that you get in an accident and are killed and lose 100% of your brain. But doctors take the image of your brain and put it into a new body that is exactly like your old body with all your memories right up to and including the accident which caused your death, are you still you? What if they replaced your brain while you were still healthy?

Consider now a future technology which allows for the slow conversion of your brain from flesh and blood to hardware. It’s a slow process taking up to 3 years, no one really knows when the process is entirely finished. You notice no difference in your daily life as the process occurs but at some point in the future your brain goes from being 100% natural to being 100% artificial. Are you still you? Are you still the original? You obviously feel like the original but your brain is no longer original it’s just a pattern of your old brain running on hardware.

Generally speaking a person would be far more accepting of the slow replacement that isn’t noticeable over a complete replacement at one time but the two processes give the exact same result. It’s a pattern of your flesh and blood brain in hardware. So why is it that people have such a difficult time with the idea of mind uploading? It seems like the issue in the end is that people want a sense of being original. That is to say when you go to sleep and then wake up in the morning you believe that you are the same person that went to sleep in the same bed last night, but what if you aren’t? Would it really make any difference as long as you thought that you were the original?

Image that when you die you wake up in a new body right after you die and you say, oh shit I just died. But you are on a bed in some room in a building with a new body but all your memories including every memory up until the moment of death are in your mind and you start thinking about how much it sucked to die but how happy you are that you woke up in this bed and are alive and well. How is that any different than the idea of a soul being transfered at the moment of death from one body to another? Your soul if there is such as thing is nothing more than the sum total of who you are so it would be essentially the same thing? Your are just transferring the essence of yourself.

If you have brain damage you are no longer yourself, it’s your mind not your body that makes up the essence of who you are, so why fight mind uploading when it makes so much sense?