How Smartdust, Souveillance, Web 3.0, and Personalized Genetics Will Transform the Future of Medical Diagnostics

Posted on February 25, 2008 by Steven F. Palter, MD

There has been a flurry of debate in the military, industrial, and privacy sectors on “smartdust” and the concept of “souveillance” – but no one has yet realized this technology is poised to springboard into medicine and transform medical diagnostics. Here I wanted to give you an overview of what this idea is and why you should keep your eye on it.

First the general concept background:

“Smartdust” refers to micro devices (called motes) which are detection microchips each potentially the size of a speck of dust. These grains of sand however can automatically self-network. So far people have conceived of these low-power distributed sensing networks as having functions for climate control systems, entertainment devices and especially for big brother type surveillance systems.

Wikipedia wrote “the smartdust concept was introduced by Kristofer S. J. Pister (University of California) in 2001 , though similar ideas existed in science fiction before then. A recent review discusses various techniques to take smartdust in sensor networks beyond millimeter dimensions to the micrometre level. A typical application scenario is scattering a hundred of these sensors around a building or around a hospital to monitor temperature or humidity, track patient movements, or inform of disasters, such as earthquakes. In the military, they can perform as a remote sensor chip to track enemy movements, detect poisonous gas or radioactivity. The ease and low cost of such applications have raised privacy concerns.” Beyond web 2.0 vast networks of these real time sensors are once possible technology leap of the yet inknown web 3.0.

General concept – What is Souveillance?: is a term from Steve Mann that refers to “bottom up” surveillance using smart dust as opposed to “top down” big brother networks looking at us little people. Here instead activities are recorded from the “perspective of a participant in the activity, typically by way of small portable or wearable recording devices that often stream continuous live video to the Internet.” Remember the impact of the Rodney King video and of all the user generated video content on the web. Now fast forward to a world where a large segment or even a majority of the populice had real time streaming video devices on all the time (no we are not going to discuss the porn angle on this). This has also been called “inverse surveillance”.

Privacy advocates have been debating the merits or horrors of this type of sensor technology. I serve on the Scientific Advisory Board of the Lifeboat Foundation which is dedicated to protecting us from future technological threats through advocacy research and education. They have been having a heated debate on the “paradox of smart dust: we may not live without the greater security provided by smart dust, but many think they could not live with smart dust impinging on our privacy.’

Medical Implications: I have a vision that once this type of low power networked microsensor technology exists it will logically lead to medical sensor technology. Potential uses I see include:

mass screening for infectious disease or bioterror agents. Subjects walking into screening areas could be checked for signature molecules associated with infectious agents. Just as we have metal detectors and now have molecular signature detectors (the litle wipe test for explosives at the airport) we will have such biological screening techology.
The next step will be similar screening for disease states. Metabolomics is one such technology. Metabolomics is the study of the small-molecule metabolite byproducts left behind from cellular processes. In simple terms it’s like examining poop. The concept is that by measuring the collection of all the byproducts of the cells metabolism you can get a snapshot of the physiology of a cell or organism that translates to health. One such sensor is being developed as a breath sensor for disease. This could lead to Star Trek like medical sensors.
Similarly, such technology will lead to individual genetic screening for disease risk using chips that interact with the tiny bits of DNA we shed every time we touch something. Companies commercializing this approach also already exist and have products.
Taking a clue from smart dust we will then inject such sensors into our bodies where thy could circulate in the bloodstream or sit in the abdminal cavity silently sensing for disease, infectious agents, or the DNA or signature molecules of a cancer cell. Alternative chips could exist that sit and slowly release drugs when such cell reappear once a patient is diagnosed.

I will be writing more about the details of these concepts and devices being developed in future posts now that I have introducted the concepts. Let me know what you think!

Retraction From Pointe Conception Medical

Posted on February 15, 2008 by Steven F. Palter, MD

As a practicing physician, consultant to industry and the investment community, and medical technology blogger, my independence is of utmost importance to me.

Pointe Conception Medical issued the following statement today:

“Pointe Conception Medical (PCM) regrets the use of the quote from Dr. Steven Palter in our presentation materials. Dr. Steven Palter did not provide PCM permission to use his name or any type of endorsement from him in any of our promotional materials. Steven Palter is not affiliated in any way with Pointe Conception Medical.”.

Second Life for Medicine

Posted on February 14, 2008 by Steven F. Palter, MD

More and more social networking sites, web 2.0 sites, and other initially recreational new internet systems are migrating to work and educational related functionality. The potential for medical uses, online research, education, and patient networking is seemingly endless.

This wiki lists general grid and teen grid educational sites on second life as does this very comprehensive one.

On May 25, 2007, 1300 educators from around the world gathered at the Second Life Best Practices in Education: Teaching, Learning, and Research 2007 International Conference in the virtual world of Second Life. The event was the first 24 hour, international conference ever to take place entirely within a virtual world. Details are here.

My award winning friend-blogger Bertalan Mesko has the most comprehensive blog on web 2.0 medical resources has put together this great list of everything about seond life and medical education.

Check this out. I’ll be writing much more about vitual communities in the future and medical uses.

New HD Disk Format

Posted on February 13, 2008 by Steven F. Palter, MD

EngadgetHD reports on New 3xDVD;

Comin’ straight outta Thuringia is the first news we’ve heard in a year about HD DVD’s red-laser cousin, 3X DVD. CDA Datenträger Albrechts GmbH has announced its started production of 3X DVDs, which are basically HD content, compressed with VC-1 or MPEG-4 and AACS DRM, on a standard red laser DVD that is readable only by HD DVD players. The advantage is that it costs the same to produce as a regular DVD, and CDA is apparently producing dual-sided DVD-10 discs, with standard DVD content on one side, and HD on the other. Of course, with several German studios dropping HD DVD support (along with a few others you may have heard of) its hard to see who will take advantage of CDA’s new capabilities.

Someone needs to step up and put a recordable HD format onto the HD endoscopy sets in the OR. Even the HD systems record in SD. I am waiting for recordable Blu-ray or even better a flash or disk based AVCHD solution.

New Generation of Performance Enhancing Drugs

Posted on February 12, 2008 by Steven F. Palter, MD

NatureNews has just reported on a new drug that plugs calcium leaks in muscles and boosts stamina (in mice). I have previously written of the next wave of what I call “designer drug abuse” coming- performance enhancing drugs. The first batch are called eugeroics and offers improved memory, mood enhancement, improved alertness and cognitive powers without any of the nasty side effects and mass murder of speed and crank. This new class is a physical performance enhancer. You can read my thoughts on how far people will go in the future to enhance their bodies here. If you think plastic surgery is the rage of body enhancement – wait until we get performance and congnitive enhancing bionics, drugs, and implants!

Nature writes of the published in the online edition of the Proceedings of the National Academy of Sciences today (Bellinger, A. M. et al. Proc. Natl Acad. Sci. USA 105, 2198-2202 (2008).

Researchers have shown how intense exercise can damage muscles, and developed a drug that can hinder the effect in mice. Mice on a taxing work-out schedule were stronger and had more endurance when given the drug.

The drug, called S107, prevents calcium from leaking into muscle cells. Calcium causes muscles to contract, but calcium leaks can reduce the force of contraction and activate an enzyme that chews up muscle protein.

They go on to say that “leaky calcium channels have been associated with the fatigue and soreness that follows intense, sustained exertion, such as running a marathon or long-distance cycling. This weakness can last for days or weeks, and is not the same as the brief discomfort that follows a typical work-out.”

As expected there is a start-up ARMGO Pharma, that plans to develop S107 and others like it for clinical use in patients with chronic tiredness from disease.

Nature hits upon the potential for abuse just as I predicted. “Don Catlin, director of the Olympic Laboratory drug-testing centre at the University of California, Los Angeles, says that a drug such as S107 could also become prime fodder for athletes looking to improve their stamina.

I myself had dinner with the former chief medical director of the olympic committee (the guy in charge of thesting if the women really are women and vice versa). He told me he is very concerned about athletes and students using performance enhancing drugs. Imagine a high school athlete or student offered a pill that could makethem run faster or longer or increase memory without adverse effects. How many do you think would take them. I recall his worry- your child saying daddy I want to be a track star- can you amputate my legs so I can get the new bionic ones.

Friday Fun Post- Human Statue Video

Posted on February 8, 2008 by Steven F. Palter, MD

‘Duct tape is like the Force. It has a light side, a dark side, and it holds the universe together’ – Carl Zwanzig

My sci-fi writer wifeinthemachine being the creative type posted 2 funny videos – one is a mind-freak experiment where a couple of hundred people in NYC Grand Station simultaneously freeze and freak people out

the second is a song from India featured in the end credits of Inside Man that will get stuck in your brain- everyone loved the song but no one knew who or what it was. Here it is- she calls it her writer muse-crack

Next Gen Mini-PS3 Cell Chips -Next Medicine Imaging Revolution?

Posted on February 8, 2008 by Steven F. Palter, MD

“ Though sold as a game console, what will in fact enter the home is a Cell-based computer. ” – Ken Kutaragi

“Cell-based computers will revolutionize medical imaging” – Docinthemachine

The IBM Cell graphics processor at the heart of the PS3 is a remarkable chip. Cell is shorthand for Cell Broadband Engine Architecture. It has been described as “seemingly obscene computing capabilities for what will rapidly become a very low price.”

A newer miniaturized lower power version has just been announced by ars technica that I predict will make it to medical video and VR processing. I recently led a session on the use of VR in medicine where Andy Van Dam (VR pioneer , professor of computer science at Brown, and founder of Siggraph) and I spoke about the future of VR processing. He predicted that the video grame industry hardware innovations will make the most dramatic strides and that this technology will then trickle down to VR due to its sheer massive computational power- beyond that of the old CAVEs of DARPA.

You may be unaware that this represent a new form of computer processing:

The Cell concept was originally thought up by Sony Computer Entertainment inc. of Japan, for the PlayStation 3. The genesis of the idea was in 1999 when Sony’s Ken Kutaragi “Father of the PlayStation” was thinking about a computer which acted like Cells in a biological system. A patent was applied for listing Masakazu Suzuoki and Takeshi Yamazaki as the inventors in 2002

The architecture as it exists today was the work of three companies: Sony, Toshiba and IBM. Sony and Toshiba previously co-operated on the PlayStation 2 but this time the plan was more ambitious and went beyond chips for video games consoles. The aim was to build a new general purpose processor for a computer.

In lay terms here is the muscle behind the processor:

The setup of the Cell processor is like having a team of processors all working together on one chip to handle the large computational workload needed to run next-generation video games. In order to understand how the Cell processor works, it helps to look at each of the major parts that comprise this processor.

The “Processing Element” of the Cell is a 3.2-GHz PowerPC core equipped with 512 KB of L2 cache. The PowerPC core is a type of microprocessor similar to the one you would find running the Apple G5. It’s a powerful processor on its own and could easily run a computer by itself; but in the Cell, the PowerPC core is not the sole processor. Instead, it’s more of a “managing processor.” It delegates processing to the eight other processors on the chip, the Synergistic Processing Elements.

The computational workload comes in through the PowerPC core. The core then assesses the work that needs to be done, looks at what the SPEs are currently processing and decides how.

Watch out for our robot PS3 overloards. This Chip has the potential to expand itself and distribute workloads over networks. Don’t worry this is not some Singularity scenario where the chips start to think on their own. Here is a review of the potnetial of the chip:

Chip giants such as Intel have already started working on dual-core chips, but Cell goes several steps further by giving processing units a measure of independence. Current multicore chips typically chop a single computing task into parts, which are distributed among processing units. Cell’s processing units–called “software cells”–can handle completely separate jobs.

“The software cells are designed to be kind of self-contained–they can kind of roam around,” Halfhill said.

Cells can even roam over a network, allowing the processor to perform a type of distributed or grid computing, an increasingly popular enterprise technique in which demanding tasks are divvied up among a gang of networked computers. A PlayStation 3 could borrow unused processing power from other consoles on a network, for example, to complete a demanding task such as delivering streaming video.

“The Cell architecture is designed to make grid computing almost universal,” Halfhill said. “It makes distributed processing part of the design. If you have several of these machines on a network, the work can be spread across a network.”

The cell design can allow cooperation between video devices: “This architecture is not fixed, if you have a computer, PS3 and HDTV which have Cell processors they can co-operate on problems. They’ve been talking about this sort of thing for years of course but the Cell is actually designed to do it. According to IBM the Cell performs 10x faster than existing CPUs on many applications. This may sound ludicrous but GPUs (Graphical Processors Units) already deliver similar or even higher sustained performance in many non-graphical applications.”

Medical uses: We are at the cusp of a revolution due to the integration of computer video processing and surgical and radiological imaging. Details of this concept of mine are here and a podcast here. As we move ahead with virtual imaging and newer forms of optical processing it is the computational power of these kinds of chips that will be enabling.

Disclosure: As I previously wrote, I was chosen to be a Sony Medical HD Luminary Site. I receive no financial payment for this relationship which is only with Sony’s Medical division and is part of my medical research work on surgical tools and imaging. Heck- I had to buy my PS3 at Best Buy just like anybody else.

Study Shows Accupuncture Boosts IVF Success Rates 65%

Posted on February 8, 2008 by Steven F. Palter, MD

A new study published today in the BMJ showed that the use of accupuncture boosted IVF success rates 65%. They used the statistical tool called meta-analysis. Here several small research studies each showing a possible effect are combined to create a virtual huge study that can demonstrate the clear power of an intervention.

The full report can be read here. They found a 65% increase in pregnancy rates. Using another mathematical tool they found that for every 10 women having IVF one additional will become pregnant.

How it can work: There are several theories. One is the accupuncture could increase blood flow to the uterus and help implantation. Another is that it could relax the uterine muscles. We have also known for some time anyhting that causes tiny uterine contractions (such as poor embryo transfer techniques) can lead to expulsion of the precious microscopic embryos out of the uterus.

Some Fertility specialists have been using this approach: I have been offereing accupuncture to my IVf patients at Gold Coast IVF for years since a German study initially reported benefits.

They missed some studies showing negative effects: I was at the Annual meeting of the American Society for Reproductive Medicine in October in Washington DC. There was a lead study there that showed accupuncture dramatically reduced pregnancy rates. Had this been included in the BMJ study their results would have been less positive. The study was conducted by friends of mine at a well known Seattle fertility center. One possible explanation is that they made the patients get right up after their procedures and drive across town in traffic to get the accupuncture and stress levels were huge – another known negative factor. They also did not use the standard needle placement of earlier studies.

Cell Phones Are Not Reliable Contraception!

Posted on February 7, 2008 by Steven F. Palter, MD

Good old MSNBC is reporting a story today that heavy cell phone usage leads to lowered sperm counts in men. Before you throw them out the window there are some serious flaws with the study. They report: “In a study of 361 men seen at their infertility clinic, researchers at the Cleveland Clinic found an association between the patients’ cell phone use and their sperm quality.”

On average, the more hours the men spent on their cell phones each day, the lower their sperm count and the greater their percentage of abnormal sperm.

The study comes out of the Cleveland Clinic from a fertility group I know very well and was published in Fertility and Sterility. MSNBC is not correct that this is the first such study, there are in fact two others previously.

The authors write on the general risks of cell phone use that they “operate between 400 MHz and 2000 MHz frequency bands and emit radiofrequency electromagnetic waves (EMW). Reports of potential adverse effects of radiofrequency EMW on brain, heart, endocrine system, and DNA of humans and animals are widely reported in the literature.” If routine use has clear clinical risks remains unclear.

What the study shows: Cell phone users groups showed a decrease in sperm count, motility,viability, and normal morphology with the increase in daily use of cell phones.

Their Overall Results Data:

Why You Should Not Worry Yet: There are some significant problems with the study. First the differences seen may not be clinically relevant nor even lead to infertility. Second they relied on self-reporting of past usage of cell phones (hey bud – thanks for the sperm specimen- can you tell me how many minutes you used last month?). third, cell phones drastically differ in the radiation they emit so it does not make sense that the effect would not be brand specific. Also thanks to the inverse square law the radiation from the phone falls off by hte square of the distance to the organ. I do not know about you but when I speak on my cell phone I tend to keep my testicles a bit far from the phone.

The Biggest problem: The association does not mean causation. We have known for years that very prolonged sitting in a hot car, obesity, smoking, and possibly stress can adversely affect sperm numbers and function. I guarantee you that the guys talking on their cell phones for 4-6 hours a day are more likely in the car, yelling at the driver next to them with a cigarette hanging in the mouth and a big mac on the seat next to them then calmly doing yoga while sipping vitamin water and eating a salad.

Studies in animals have not shown any direct toxic effects.

Quote of the Day: In reviewing the limitations of the animal studies I would have guessed it was really hard to get the rats to talk on their cell phones for 4-6 hours a day. They are such busy little animals scurrying about looking for food all the time and their paws are so little to hold a blackberry. The authors however point out: “it is impractical to compare a rat model to humans because of its small testicular size, nonpendulous scrotum, and the fact that its testis can migrate.” No need to say any more…

New Laparoscopic Device Stops Harpooning of Patients

Posted on February 6, 2008 by Steven F. Palter, MD

While at the Global Congress of Gyn Endoscopy I saw a really neat new device called LapCap designed to reduce the risk of entering the abdomen in laparoscopic surgery.

What is the problem- why is this needed? In laparoscopy the first step where the surgeon gains access the abdominal cavity is often a blind entry step. There is a risk of injury to internal organs such as the bowel, bladder, or blood vessels. While rare, these injuries can be severe or even life threatening. If you want to read more about laparoscopic access and the risks of entry into the abdomen here is a link to an article I wrote for a Master’s Class in Gyn Surgery on this topic.

What is done in standard surgery: The most common method used by gyn surgeons is the insertion of a needle (the veress needle) which fills the abdomen with carbon dioxide gas (called insufflation). Then a tool called a trocar is inserted into this space and the instruments go through this. The needle insertion step is the most dangerous because it is the blind step. various techniques are used including elevation of the abdominal wall to lift it off of and away from the underlying organs expecially the large vessels like the aorta nad vena cava. The second common method is the open or Hasson technique (invented by my good friend Gyn surgeon Harry Hasson) where the surgeon opens a small 10 mm incision and then inseted the trocar. Injuries occur with all known techniques.

The New System: The LapCap is a new system that puts a plastic dome on the abdomen attached to suction that then pulls a full thickness of the abdominal wall high up into it then allowing the veress needle to be inserted into a potentially larger and they claim safer spot. The LapCap device received 510(k) approval from the FDA and is sold by Aragon Surgical. It won an award from the SLS for new device innovation. Here is a video from the company of it in operation. I know surgeons who have used and were quite impressed and I will likley be involved with surgery using it soon. I know that laparoscopic innovator and friend of mine Camran Nezhat is one of their advisors. I will be speaking with him more about his experience.

Potential problems: Two major issues- first statistical proof of demonstration of increased safety is nearly impossible for access devices such as this because the injury it might reduce so very rarely happens. One study on this problem estimated that it would take a study of more than 200,000 people having the operation to adequately demonstrate reduced injuries statistically. Second- one of the major risks for this sort of injury is when the bowel is adherent to the abdominal wall at the site of entry from previous surgery. I would not expeect this device to help at all in this situation because the adherent bowel will be picked up with the abdominal wall. However it is the vessel injuries that ar emost dangerous and this device might reduce the risk of those if it places the needle much farther away.

About the company: They appear to have acquired the device via an acquisistion of starup Verisure. It was reported last month that they “raised $25 million in a Series B round of venture capital with the hopes of having five products on the market within two years. In a statement on Monday, Jan. 7, Aragon said new investors Bay City Capital of San Francisco and Integral Capital Partners of Menlo Park, Calif., joined original investors Delphi Ventures and Onset Ventures, both of Menlo Park. They formed Palo Alto, Calif.-based Aragon in May 2005 to advance radio frequency technology developed at Stanford University Medical School for use in laproscopic and other surgeries. Bay City Capital was the lead investor in the most recent round.”

I have spoken about the use of RFID for surgical and laproscopic procedures for several years and look forward to seeing where they go with it. I know they also have tissue sealing and dividing technology and are part of the Delphi portfolio. I had a phone call with Delphi last year as part of due diligence they were doing for another company and did think highly of them and their approach. More details of the deal are here.