DITM Blog Upgrade Coming! New Logo is Here

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Thanks to the loyal readers coming.  I really appreciate you!  I appologize for the wave of database page errors many of you have seen and the site starting to crash.  We have had somedatabase issues with wordpress and sql and have called in the big guns to get all databases in line.  They know what happens to bad databases that do not behave.   Let’s just say all databases have been taken out back and have been spoken to.

 Stay tuned for a major upgrade and site redesign.  For now enjoy our new logo– let me know what you think of it!  Thanks so much to Lana for designing it.

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Top 6 Most Dangerous Medication Abbreviations Now Banned in Hospitals

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Medication errors in the hospital are a major cause of preventable suffering and death. I wanted to share with you the top 6 handwriting errors of doctors in the hospital that have been banned in to prevent these errors.

First some background:  You may recall the landmark Institute of Medicine (IOM) study that found medication errors injure 1.5 million people and cost billions of dollars annually.  Their report found “the extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and  productivity or additional health care costs.”  The press release of the report and summary is here and the enormous full report can be searched and read here

Every hospital I go to has implemented warning sheets (some in bright yellow with red stop signs on them) of the “Top 6 Forbidden Medication Orders”  These are abbreviations so often misread or mistranscribed that they have been banned in the hospital!  (not the drug or the order but the abbreviations have been banned!).  You all know how awful doctor’s handwriting is!

  1. U for units with heparin insulin and pitocin can be misread as zero or cc’s causing dangerous overdoses
  2. IU for nternational units can be mistaken for IV (intravenous) or 10 (ten)
  3. q.d. means once a day in latin but can be mistaken for qid or qod (four times a day or every other day) if the period is written above the line
  4. .1 must be written as 0.1 else 10 fold dose errors can occur
  5. 1.0 should never be written – the decimal can be missed and a 10 fold dose error occur
  6. morphine and magnesium can be mixed up with lethal consequences- the use of MS, MSo4, or MgSO4 have been banned

a fun view of how bad the handsriting is can be read here

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Fertility Treatment is the Likely Cause of the Identical Triplets

Many are reporting today that a woman on Long Island gave birth to rare identical triplets.  She actually gave birth at one of my main hospitals and I know her Ob.  The story goes on to say she had IVF but only one embryo was replaced.  I was not her treating fertility doctor.  However, this event raises and important fact.  More and more fertility specialists are turning to a technique called blastocyst transfer.  Here we let the embryo grow and additional 2 days in the dish in the lab.  Instead of transferring it on day 3 we let it grow until day 5 (occasionally 6).  By letting them grow more each embryo that survives has a greater chance of implanting.  Therefore we can transfer less of them, reduce the risk of multiples (usually!) and keep pregnancy rates high.  The risk is if the embryos are not very strong then none may survive.

Why this may be the cause:   It has been know for some time that when we use this technique the rate of identical twins (ie a single embryo splits into two) is significantly great – up to 5% or so.  Therefore it makes perfect sense that the rate of identical triplets could rise as well.  Since a single embryo was transferred they say- this is usually done in blastocyst cases.

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Google Finished With Cataloging the Internet Moving on to Your DNA

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It was just reported today that: “A Harvard University scientist backed by Google Inc. and OrbiMed Advisors LLC plans to unlock the secrets of common diseases by decoding the DNA of 100,000 people in the world’s biggest gene sequencing project.”

What nothing better to spend $1Billion on?  Why are they doing this you ask….

Harvard’s George Church plans to spend $1 billion to tie DNA information to each person’s health history, creating a database for finding new medicines. The U.S., U.K., China and Sweden this year began working together to decipher the genetic makeup of 1,000 people at a cost of $50 million.

Google, owner of the most popular Internet search engine, is looking for ways to give people greater control over their medical data. Along with the unspecified donation to Church, the Mountain View, California-based company said last week that it would work with the Cleveland Clinic to better organize health records, and last year gave $3.9 million to 23andme Inc., a seller of genomic data to individuals.

Church’s plan “would be the largest human genome sequencing project in the world,” Stephen Elledge, a geneticist at Harvard Medical School in Boston, said in a telephone interview today. “The genetic variations are what make people different, and we need to understand the connections to human disease. They’ll get a tremendous amount of information from this,” said Elledge, who isn’t involved in the project….“If we can expand the project, we’ll probably go for a million genomes,” Church said.

Personalized genetics and genomics are hot topics – Read more about the concepts here.  With these two you either look to an individual’s genetics to see how it will impact a disease or a treatment (a single gene) or with genomics “This is the dream of everyone gets a genome sequenced at birth, we assess risk, create prevention plans, identify idosyncratic drug reactions prior to medication therapy”.

The medical and financial impact for the company owning this data in unimaginable.  The source of individual variability of response to drugs and individual susceptability to disease could be greatly unlocked – as well as mined for new therapeutics.  Google of course is getting into all medical databasing starting with your health record and I predict images of your diseases next.

 

 

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New Visual Search Engine Debut-Works with a cell phone photo! Medical Uses Next?

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I have been following the consumer device CeBIT show in Germany.  Pocket-lint UK reports:

At the CeBIT show in Germany, Vodafone is demonstrating a trial service called “Otello”, which is a search engine that uses images, rather than words.  Rather than use a word as a search term, Otello users can send images via MMS from their mobiles and the search service which then returns the results to the user’s phone as an “ordinary” search result.

A picture from a newspaper, billboard, book cover or place are all examples of what can be searched for.

Vodafone is running trials with a German newspaper that lets users find out more about stories by photographing the images that appear in the article and MMSing the images.

There’s no word on breaking this out of trial phase at this stage.

I just had a meeting with reps from a major medical device company where I discussed the potential for smart image tagging and identification in medical imaging.  Just think of the potential when this smart technology could be applied to image pattern recognition for skin lesions, radiologic images, and pathology slides.  Rural medicine will never be the same!  Cell photo snap an image and link to a search engine to get a diagnosis (we know who wants that to happen).  Right now the system is prepopulated with images then recognized.  In the future neural net and patern recognition technology will take this a step forward.  Similar systems already exist for pap smear screening of cytologic abnormalities including a commercially available system papnet (made by Neuromedical Systems, Inc. who filed for chapter 11 and sold their intellectual proprty to Autocyte Inc). 

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The Bigger Story Behind the 3 Parent Embryo- Human Embryo Genetic Experimentation

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Countless sources are reporting on the “three parent embryo” created as a potential treatment for infertility.  What has not been reported is that ther is an almost 10 year history of unreagulated human experimentation in this arena which led to a rare federal ban on specific fertility treatments.  Is this hope, hype or dangerous human experimentation?  Read on to see!

Background- what are mitochondria?  Mitochondria are tiny primite organisms that millions of yers ago became incorporated into human cells.  They exisit in every cell but have their own unique genetic material. They function as the engines of the cell providing energy for metabolism.  I wrote an review of how they got there and what they do that you can read here.  In short mitochondria have their own DNA (similar to that of bacteria) and reproduce independently of the cell in which it is found.  We now have a symbiotic relationship with them.  

First – the details receontly reported by the BBC.  Diseases of the function of mitochondria exist.  “About one in every 6,500 people is affected by such conditions, which include fatal liver failure, stroke-like episodes, blindness, muscular dystrophy, diabetes and deafness.”  Details of their human experiment:  Scientists in the UK experimented on 10 embryos left over after IVF fertility treatments.  They microsurgically removed the nucleus, containing the embryo’s DNA  and implanted it into a donor egg whose DNA had also been removed. The donor egg while missing its DNA still contained its mitochondrial DNA.  They watched these embryos grow in the petri dish for 6 days. 

Therefore the resulting embryo will have the DNA of the donated nucleus but the mitochondrial DNA of the host cell- curing and potentially eradicating – the mitochondrial illness. 

This is not the first time this has been done.  The fertility treatment history of human experimentation on this:  While I was teaching at Yale Medical one of my partners and mentors in the fertility department (Dr David Keefe) was actively pursuing research on mitochondrial dysfunction as a cause of human infertility.  At that time a few fertility doctors in the US theorized that one cause of human reproductive aging was accumulated damage to the mitochondria in the egg. They thought the genes of the egg could be healthy but the rest of the egg that supports its become faulty.  They experimented with a technique called cytoplasmic transfer.  Using a microscopic needle tiny drops of fluid were sucked out of a donor’s egg and injected into that of an older infertile woman hoping to breath new energy and life into it.   Unfortunately most research groups found it did not seem to offer any benefit.

Reasons why it likely did not work:

  1. using minute drops of fluid from a donor egg into a recipient is just not enough to correct the metabolic problem or defect
  2. my collegues at Yale found that the mitochondria in the egg is often tightly joined to the nucleus so the cytoplasmic transfer did not move enough of them
  3. a huge proportion of age related egg defects are related to nuclear not mitochondrial DNA defects.

The federal government banned this treatment in 2001.  Some feared that chromosomal abnormalities and birth defects could result if there were three people’s DNA in one embryo.  Federal officials decided that any method involving the transfer of genetic materials without the fusion of egg and sperm requires the oversight and involvement of the Food and Drug Administration.  The US legislation leading to the FDA taking jurisdiction over human eggs sperm and embryos is a whole other topic to be covered in later posts.   A brief overview of this from Rodger Gosden (who I know and respect as a leading reproductive biologist) is posted here from 1999 when this treatment was at its heyday with references justifying its use from mouse research.

The next brouha using the technique in humans in 2003:   Related research on nuclear transfer was again presented at the annual ASRM meeting in San Antonio in 2003.  I was in the audience for the talk and remember it well.  One of the researchers was an American out of NYU Dr Jaime Grifo who also used to be in my ex-department at Yale.  He is also a repected researcher who I know well.  Unable to perform the research in the US- the experiment was performed in China.  as reported here and here 

Researchers at Sun Yat-sen University in Guangzhou implanted three embryos in the womb of a 30-year-old infertile woman… A triplet pregnancy resulted, they announced at the annual meeting of the American Society for Reproduction Medicine in San Antonio, Texas this week. One of the foetuses was “reduced” to ensure the viability of the pregnancy, but the other two died anyway at 24 and 29 weeks.

With this technique, called nuclear transfer, the doctors fertilised an egg from their patient and an egg from a donor. Two embryos resulted. The nucleus of both women’s embryos was extracted, and the patient’s genetic material was inserted into the empty “eggshell” of the other embryo which, however, contained mitochondria with the other woman’s DNA. The procedure gives the infertile woman’s embryo the healthy mitochondria it needs to develop — but it also results in a child with genetic material from one father and two mothers.

Dr Grifo has maintained that he was an advisor and did not partake in the actual experiment.  NYU issued a statement that if the research was performed in China their IRB did not have oversight (different than my department where all work I did anywhere fell under the IRB as a faculty member).  I have never asked him his take on this but do respect him and strongly do not believe he is someone who would knowingly break the law or do what he felt was wrong.

Nonetheless- the ASRM responded with a moratorium on any future presentations on cloning (whether this was cloning is a whole other debate- many feel not). 

The technique is still undergoing related research:  I chair the video committe of the American Societry for Reproductive Medicine (ASRM) the largest international fertility research society.   Just this past year we accepted a video presentation on how to technically perform the procedure from a research team in Japan.  The paper- Embryonic Development Following the Nuclear Transfer of In Vitro Matured Metaphase-II Oocytes into Enucleated Freshly Ovulated Metaphase-II Oocytes by Tanaka and collegues investigated the possibility of repairing either mitochondrial diseases or female infertility due to ooplasmic deficiency and abnormalities. They demonstrated embryonic development following the nuclear transfer of in vitro matured metaphase-II oocytes into enucleated freshly ovulated metaphase-II oocytes and concluded it could be applied to the treatment of mitochondrial diseases or female infertility due to ooplasmic deficiency and abnormalities. 

More is certainly to come. 

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