Docinthemachine Expands Fertility Analysis and Reporting

Since its inception docinthemachine has focused on sharing a vision of how technology can transform medicine.  I am excited to expand my postings and analysis of all things related to fertility diagnosis and treatment.  As most of you are aware I am a board certified reproductive endocrinologist — which is an Ob Gyn with addition training and expertise in infertility.  i am currently the Medical and Scientific Director at Gold Coast IVF in Syosset, NY.  When I first started DITM I planned on setting up a second blog solely focused on infertility.  With the efforts required to post here and continue my clinical practice and research that idea sat on my “to do” list.  I have frequently posted on fertility topics here nonetheless.

After some sould-searching and planning and discussions with my good friends and fellow med bloggers Nick Genes and Gene from Medgadget  I have decided to jut add all that content here to docinthemachine.  While it does not have a sexy-fertility name its a part of me that has a fantastic group of readers…  Everyone I spoke with unanimously agreed to just expand the content here!

So stay tuned for more fertility related posts in the days to come. 

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The Future of Medical Video: DITM Reports From NAB 2008

I had the distinct pleasure of attending the 2008 National Association of Broadcasters (NAB) meeting last week in Las Vegas. As the foremost event for the TV, broadcast, and media industries this is the venue to see and explore the future of all things video and media.

The Floor of the Meeting and a Sea of Humanity- Why I Went

the floor of the nab 2008 meetingBeing probably the only physician in a sea of 105,000 TV and media folks raises the inevitable question- why did I go?

Endoscopic surgery (laparoscopy hysteroscopy arthroscopy etc) all share the common use of video equipment. Since the late 70′s these procedures are performed as remote surgery looking through a thin telescope inserted into a body cavity and observed on a TV monitor.

The progress we make in medical video surgery is a direct trickle down of innovations from the broadcast arena. From the first CCD camera hooked to a laparoscope and suspended from the ceiling via a jerry-rigged boom to the first use of HDTV in the OR – broadcast and TV technology drives innovation in surgical video.

I thrive on researching new technology and then extrapolating new solutions to medical problems using these developments. This meeting provides the raw material for my creative process.

I was honored to accept invitations from several major broadcast, video, computer, and even surgical companies to attend the meeting, walk the floor with them, brainstorm new ways of helping patients with new devices and predict future needs and uses for technology in medicine.

Everybody kept asking me: What was the most important development I saw at the show? What future technology do I predict is poised to transform medicine?

Beyond the entire rooms filled with the latest newschoppers and remote satellite trucks

I was most impressed with the following technologies which have the potential to transform both consumer entertainment and medical devices- I will be posting further about each of these and what I saw (including a series of interviews):

  1. Beyond HDTV- “ultra HD” 4k cameras and displays
  2. 3D video technology in SD and HD
  3. OLED display technology
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Top Scientists Using Performance Enhancing Drugs

This is your brain on performance enhancing drugs

Perhaps the top science journal in the world - Nature – reported today on epidemic-like levels of cognitive performance enhancing drug abuse by top academic scientists.

why they began the survey

The survey was triggered by a Commentary by behavioural neuroscientists Barbara Sahakian and Sharon Morein-Zamir of the University of Cambridge, UK, who had surveyed their colleagues on the use of drugs that purportedly enhance focus and attention (Nature 450, 1157–1159 ; 2007). In the article, the two scientists asked readers whether they would consider “boosting their brain power” with drugs. Spurred by the tremendous response, Nature ran its own informal survey. 1,400 people from 60 countries responded to the online poll.

They looked at illegally obtained (no prescription) use of three drugs: methylphenidate (Ritalin), a stimulant normally used to treat attention-deficit hyperactivity disorder but well-known on college campuses as a ‘study aid’; modafinil (Provigil), prescribed to treat sleep disorders but also used off-label to combat general fatigue or overcome jet lag; and beta blockers, drugs prescribed for cardiac arrhythmia that also have an anti-anxiety effect.”

One in five respondents said they had used drugs for non-medical reasons to stimulate their focus, concentration or memory. Use did not differ greatly across age-groups

Favorite drugs of the performance enhancing professor:

For those who choose to use, methylphenidate was the most popular: 62% of users reported taking it. 44% reported taking modafinil, and 15% said they had taken beta blockers such as propanolol, revealing an overlap between drugs. 80 respondents specified other drugs that they were taking. The most common of these was adderall, an amphetamine similar to methylphenidate. But there were also reports of centrophenoxine, piractem, dexedrine and various alternative medicines such as ginkgo and omega-3 fatty acids.

As I have srtten many times before. Prepare for the upcoming epidemic of performance enhancing drug abuse. I predict these drugs will be used at rates surpassing any other illegal drug in history. They have minimal side-effects and are becomming increasing viewed on college campuses as nothing more than a no-doze.

Read my previous posts on this topic here:

  1. New Drugs Enhance Performance, Eliminate Need to Sleep
  2. New Generation of Performance Enhancing Drugs
  3. How far would you enhance your body for performance?

Would you use it? My history of working to the limit. I was in an accelerated 6-year combined college and medical school program. Balancing the advantage of being accepted to medical school while still in high school was taking full years of college courses ever summer to catch up on the skipped time. At one point I had medical school 8-5 followed by college classes from 6-10. All was manageable until med school finals hit the same week as college midterms. I remember giving up sleep and filling 2-liter soda bottles with iced coffee to get through the day. We moved onto iced coffee in Captain Crunch next. I stopped at this point (actually at two of these bottles a day= 3000 mg caffeine). I knew others who went the route of amphetamines no-doze and pizza. While an intern my worst shift ever in the hospital was 7AM Friday until 4PM monday= 81 hours. By sunday night I was unwell to say the least. Will drugs help this? I have a good friend who is a leading academic physician. He is a brilliant physician, professor and inventor. He could not believe I had not taken modenifil and raved about how well it worked for him.

Apparently other experts agree with me:

“Neuroscientist Anjan Chatterjee of the University of Pennsylvania in Philadelphia predicts a rise in the use of these drugs and other neuroenhancing products and procedures as they become available (A. Chatterjee Cam. Q. Healthc. Ethics 16, 129–137; 2007). Like the rise in cosmetic surgery, use of cognitive enhancers is likely to increase as bioethical and psychological concerns are overcome and as the products gain cultural acceptance. One difference, Chatterjee says, is that use of cognitive enhancers doesn’t rely on training of medical specialists such as surgeons. Internet availability will also greatly accelerate use, he says.”

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DITM is Back Blogging! Blog Database Error Fixed!

Good News!  The sql database errors and wordpress corruption have all been fixed!  Thanks to the brilliant work of Gene the site is up and alive again.  In the process we upgraded WP 2.5.  No thanks go to my ISP who moved and hid my entire blog sql database without ever telling us as they went thrrough a server upgrade- making it totally inaccessible to us. 

Well at the end of the day we are back online.  If the site stays up and running trough our testing today I will launch the new site redesign this week. 

Thanks for coming by and I look forward to seeing you all again.

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DITM Blog Upgrade Coming! New Logo is Here

 docinthemachine logo

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

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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:

  1. 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.
  2. 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. 
  3. 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
  4. 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! 

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New Generation of Performance Enhancing Drugs

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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 hereIf 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. 

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