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

ps3cell.jpg

“ 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. 

Share

EMR=CloneWars? – Hidden Dangers to Patient Care

clonewars.jpg

CRMbuyer is reporting on the benefits of using voice recognition for EMR’s in medicine and presents a series of case studies from the ER.  There is a danger here in EMR’s I have not seen reported that voice recognition may help with  – but first some of their stats on adoption rates in the ER

A 2006 Healthcare Information Management and Systems Society survey found that 65 percent of chief information officers planned to get it by 2008. It’s being touted as a natural add-on to the electronic medical record, since doctors are used to recording their notes, says Harry Rhodes, director of practice leadership for the American Health Information Management Association.

They list all the usual benefits, speed, digital readability, access, yada yadda yada.  The obvious danger is misrecognitions since 2% error rates are not insiginifcant in large volume medical records.

But What is the hidden danger of EMRs docinthemachine you ask?  It is the inadvertant cloning of patients. 

Let me explain.  If you are an ER doc an EMR is fine.  Patient comes in with one line chief complaint.  History of illness simple fact based.  Short and to the point.  But for detailed problems in the primary care and specialists’ office too much detail is getting lost in the EMR’s.  That is because inmost cases docs are using template driven systems where they click off prepopopulated answers to questions or even touch screen menu choices.  This is done to speed up data entry when there is no voice recognition.  Most docs do not type well or when they do enter minimal info. 

I am a fertility specialist.  My practice Gold Coast IVF in New York has a set process we use to completely assess a patients’ past history and treatments and to really get to the nuances this requires quite a bit of narrative of question and answer info.  When I am done I have an individualized picture of that patient that is totally unique from other patients due to the details.  I know what her problem is and why and how she differs from others with the same diagnosis.  Furthermore, during her treatment I can go back to the record and reassess all this wealth of information.  What I see constantly when I receive EMR records from other practices (where the patient was first treated elsewhere and the treatments were not successful so they are now coming to me) is that the patients look identicalThat is – I can see histories populated from checklists and quick electronic choices.  Instead of all the details of a past treatment cycle it will list drug dose and failure with no detail of WHY it did not work.  The diseases all look the same.  There is never any detail on the nuances and subtle aspects of that individual’s condition.  So when a group uses these records and they review a treatment every single person with the same disease (the “patient clones”) end up looking identical and treated identically.  Cookie cutter assembly line medicine.

Perhaps voice recognition will allow the details to come back into medical EMR’s.  That or a lot more typing by the doc…

 

Share

Docinthemachine is Back!

[youtube]v/C1iSKw5vieY[/youtube]

Hello again all my friends, supporters, and loyal readers! After far too long of an absence I am back. So much time has passed and so much has happened that I wanted to fill you all in and welcome you back to my regular schedule of postings on all new in medical technology.

So you may ask- what the heck happened to you? We thought you were dead? Here is my free form list of all that has happened to tie me up and take me (temporarily) off-line. Here is a list of just some of things that took my attention in the last few months.

1) First and foremost my wife gave birth to our son the babyinthemachine. Despite being old pros at this a newborn really takes a hit to your free time! Happily she did awesome in pregnancy and labor and all went perfectly. It is always a bit of an event when an Ob Gyn’s wife gives birth we have really seen it all before, but that gets mixed up with the knowledge of every little thing that could go wrong at every step and trying to stay at the correct end of the bed (the head) ! The little guy came home and has been a delight. This led to the quick realization that these kids no way fit in our car we had to buy some new transportation. Thanks to Edmunds – remember never pay over invoice I won’t say what we got but I am sure you can guess…

Here’s the little guy in utero

[youtube]v/up2vpWyFSow[/youtube]

2) All of my research of the use of High Definition video for Surgery got picked up by the medical and lay press and I was doing a fair bit of lecturing and speaking. This was a real pleasure for me having worked on the development of these tools since 1999.

3) National Geographic featured footage from my high def surgery on their special Inside the living body. This led to a series of interviews and lectures including the peculiar thing that is morning drive FM radio shock jocks. No need to go any further. I’ll post some excerpts coming soon.

4) 20/20 did a piece on my research on visualization in surgery including high def and future vision autofluorescent laparoscopy. What a delight that was to do. Bob Brown and crew were great to work with and they then invited me back onto ABC News for a show about innovators. I’ll be posting video clips from this too.

5) DITM – this blog- hit its one year anniversary and I celebrated all that the experience has brought to me and allowed me to share.

6) My wifeinthemachine Michele Lang sold and published a major future tech-sci fi-romance Netherwood which included dozens of examples of current and future med tech from the pages of this blog in the Shomi Line from Dorchester Publishing. All this is woven into a story of a technological future world where computers become sentient and the local sheriff must destroy the man set out to destroy the network but learns he is her virtual reality lover who holds the secret to the survival of mankind. The book can be ordered at Amazon now and has gotten amazing reviews. She be posting some updates and interviews here to come!

7) I was honored to be chosen to be a High Definition Visionary Site by Sony Medical. As one of the few MD’d chosen for this distinction I have access to their wealth of electronic knowledge and product engineering. For full disclosure I do not receive any financial payments for this relationship. They are helping me with a demo research project for HD surgery education on the internet and on improving visualization and archiving of surgery. I’ll be posting more from this to come.

8) I was involved in the keynote general session at the 38th Annual International Congress of Gynecologic Endoscopy (The AAGL). A true honor, this was the third time I led a session on new technology in medicine and the second year in a row. This year I focused the session on NOTES – or natural orifice surgery. This amazing new technology still in development is where physicians pass special flexible never before seen endoscopes through natural body openings (mouth, anus, vagina, etc) to reach any part of the body without any incisions at all. Needless the say the audience was in awe of the video of an appendectomy removed without external incisions and pulled out the patient’s mouth! More from this session will be posted with updates and excerpts on this technology.

9) As part of this session I presented new research of mine on the transformation of medical technological research and mathematical modeling that shows we are on the cusp of unparalleled explosive growth in med tech innovation. Of course more to come on this!

10) I was elected vice-president of the ACGE (Council for Gynecologic Endoscopy) – established to elevate standards in operative endoscopic procedures performed by gynecologists. We will be continuing our efforts on surgeon and facility standards and review including the validation of simulator based evaluations. More to come!

11) I was chosen by the AAGL as well on a special ongoing press conference panel on the future of gynecologic endoscopy. I have to say it was a real honor and validation of years of work when The President of the society Dr Charles Miller introduced me as the visionary of the society. Videos and transcripts will be posted.

12) Related to this I began an advisory role for a company developing a gyn NOTES procedure which will likely begin clinical trials for infertility very soon.

13) We had the Annual meeting of the American Society for Reproductive Medicine (ASRM) – the largest infertility meeting where I serve on the program committee and chair the video program. I’ll be posting updates of new research including a dinner I had with the world’s expert on human pheromones.

14) The Society of Reproductive Surgeons (SRS) of the ASRM invited me to chair their postgraduate course on fertility surgery at next year’s meeting. Of course the topic I chose is “New Technology in Fertility and Reproductive Surgery”. I’ll run the course as a lecture and hands on lab and we will include robotic surgery, alternatives to hysterectomy, surgical simulators, Natural Orifice Surgery, Autofluorescence, Office Surgery, High Definition, High Intensity Ultrasound surgey and many others. I’ll post updates as we go along.

15) I continued my usual lecturing, research, publications, and the development of a new innovative DITM podcast series.

16) Had some minor surgery- I am really an expert on edoscopes and the entire GI track as well now.

17) My clinical practice Gold Coast IVF had our busiest and most fertile year ever! Countless pregnancies in my usual mix of complex cases left me grateful and delighted to be a part of this specialty. Using all the tools in my armamentarium (drugs, surgery, IVF, egg and sperm donation, etc) allowed me to help create more families than ever. I treated local patients and those who traveled from around the country and from Nations as distant as Russia, China, and Nigeria.

OK – it has been a busy few months here but I am ready for 2008 to do even more! Welcome back to docinthemachine!

Share

Docinthemachine Research Featured on 20/20! MedTechno Insights From the Day

2020logo.jpg

I previously wrote about the upcoming National Geographic Special Inside the Living Body and my work featured in the special. I was delighted when the producers of 20/20 called to request an interview with me on my research featured on the show and my vision of the future technological transformation of medicine.   Bob Brown was interested in coming to interview me.  They have already posted a description of the upcoming interview and a summary of the show. 

They call it an “Unprecedented Journey Inside the Living Body- ‘We’re Seeing Things That We Had Never Seen Before,‘ Says Scientist (that’s me).

On their website they write:

Recent technological advances have allowed for such dramatic and amazing views of the inside of our bodies that watching the footage can feel like you’re in a science fiction film or on an imaginary expedition…In such a science fiction journey, the 1966 film “Fantastic Voyage,” a group of scientists and their submarine were miniaturized so they could be injected into a body in order to eliminate an otherwise unreachable brain clot.

“I use clips from that movie when I lecture about these new technologies,” said Dr. Steven Palter, the medical and scientific director of Gold Coast IVF in Syosset, N.Y. “Now, physicians can actually see the workings of the body and understand it in a way that they never could before.”

Palter, who has a medical technology blog called docinthemachine.com, is a pioneer of methods capable of producing spectacular high-definition surgical images.  Palter obtained his footage by advancing well-established procedures that allow doctors to insert cameras through small incisions and view the target areas of their surgeries. He successfully hooked up high-definition cameras and, he said, was awestruck by the results.

“With high definition, we’re seeing things that we had never seen before … with depth perception, clarity and detail … because now it’s enormously clear and magnified. We have views that you don’t get with your naked eye.”

They also write about my autofluorescent laparoscopy research: “New Way of Seeing Ourselves”

The technology used for the National Geographic Channel is also clearly on its way to helping revolutionize medical care. Palter contributed to the development of what’s called an auto-fluorescent laparoscope, which exposes diseased tissue inside the body that a surgeon couldn’t otherwise see.

“Instead of using visible light, it makes the disease fluoresce,” Palter said. “If you look with your naked eye, you see nothing. When you switch on the light and the filters, all of a sudden the disease is glowing green, and you can see disease that’s beyond the resolution of your naked eye.”

setup.jpgThe setup

Details and Insights from the Interview: It really was an amazing morning.  I have done countless interviews and seminars with the media over the years and this really stood out for me.  Perhaps most enjoyable was the genuine interest and fascination with the topic of their correspondent Bob Brown (who was also a first rate nice guy).  They showed up at 8AM and took 1.5 hours to dismantle my office and set up the lighting.  We started extra early with the fertility patients that day so they could be finished and out the door before the TV crew came in to protect their confidentiality and to not make them feel uncormfortable (always a key issue in my fertility practice Gold Coast IVF).

joep.jpgDirecting the shoot

The cameras and the Crew:  Being the techno videophile guy that I am I jumped at the chance to talk with independent film crew brought to shoot me.  They had 3 cameramen/directors and there were 2 producers from 20/20, Bob Brown the correspondent, and a media relations rep from National Geographic (in case questions came up about their part).  They set-up a 2 camera shoot in my office with blazingly hot spot lights to ensure I would be nice and sweaty on camera.  They shot in standard BetacamSP.  Of course I could not resist to ask them why they did not shoot in HD.  They answered that the news shows inthe studios shoot in HD but that in the US all field work is done in SD.  This is because there are countless freelancers and crews out there all using different equipment and all waiting for some semblance of an HD standard to evolve before they invest hundreds of thousands of dollars in new HD cameras and editing and risk it being the “wrong format”.  Wow- how similar to the confusion in the medical and consumer video sectors! I continued my fact-finding quest and asked about who was using what systems and the relative advantages of each- panasonic sony JVC image sensors, color fidelity, native chip resolution tape vs disk vs solid state recording editing etc etc all trying to gleam insights I could take back to medicine and the OR. 

bobandi.jpgShowing Bob Brown (and cameraman) a Laparoscope  

The interview and turning the tables:  Bob interviewed me for 2.5 hours until they ran out of film. I was excited to share my excitement and passion for the subject of the future of medicine and surgery and how my work fits into this vision.  Bob was interested in the medical technology behind the show.  He asked a very wide range of questions from how I thought to merge HD video and surgerr back in 1999 to what I think is more beautiful – the earth from space or the vista of the internal human organs, to how will we pay for these new technology developments.  He was interested in everything I was working on and what I thought would have the most impact.  We discussed robotic assited surgery, natural orifice surgery (NOTES), augmented reality and head mounted displays, surgical simulators for training and the potential for real-dataset preoperative practice, virtual colonoscopy and 3D/4D ultrasound etc etc.

I had a chance to turn the tables a bit and ask him why they chose this topic and how they felt it would appeal to the lay public.  He told me that TV shows like 20/20 they basically track viewers interest levels minute by minute as they shows air.  He added that the medical pieces they ran have huge audience ratings and the more real the higher the appeal.  We discussed how the netorks know that on shows like CSI it is often the medical technology that draws the audience in.  He has a special talent in reporting human interest segments and has an amazing ability to distill down the high tech medicine we discussed and share with non-medical viewers how it will affect their lives. 

Sharing the footage:  After the interview he wanted to watch some of my HD surgical footage that I shot for National Geographic with the true HD 1080 16:9 system which I fortunately had available on HD XDCAM with a Sony ultrahigh resolution 24″ LCD HD monitor. Both the 20/20 people and the video crew were amazed by the resolution of the images and one of them remarked “If I need surgery I want them to use that   Being video people the film crew and director’s understanding of the power of HD in the OR was immediate when they saw just a few seconds of the images.  I continue to have the same degree of awe and fascination each time I operate with these systems.

Bob Brown was especially interested in my research on the development of autofluorescent laparoscopy and my concept of “FutureVision“- where surgical technology surpasses inate human senses and we watched those videos as well.

They finished off with few minutes of B-roll footage of Bob and I walking and talking in front of the hospital and requests for room cam OR footage and my AF surgery footage(all of which I was happy to share with them).

all4.jpgBob Brown, the Producers, and the docinthemachine

The 20/20 show airs this Friday September 7th at 10PM on ABC- check it out!

Share

DITM NG Special Website up- Interview with Wired Magazine

wired.gif

I previously wrote about the upcoming National Geographic Special Inside the Living Body and my work featured in the special.  I was also interviewed by Wired Magazine about the show and the technology behind it.  You can read their take on it here (note – I have to email the author Sonia and explain that it is not a good idea to use the descriptor “Organ Porn” in conjunction with the work of  gynecologist!). 

ng.jpgOne of the CG shots from the show

nglogo.gif 

National Geographic has set up a website dedicated to the show with photos videos and facts.  Lot’s of fascinating info and images to check out!  They write:

From our first cry to our last breath, our bodies undergo a continuous second-by-second transformation. Every move we make and every outside stimulus triggers a reaction through the skin, bones, organs, muscles and cells. We breathe, on average, 700 million breaths in a lifetime; an adult skeleton is replaced every seven to 10 years; we shed as many as 30,000 dead skin cells every minute; and the food we eat travels 30 feet (9 meters) on its journey through our bodies. Now, the National Geographic Channel (NGC) takes you beneath the skin to reveal how our bodies evolve from birth to old age, and the amazing biological systems we need to thrive.
From the producers of NGC’s critically acclaimed In the Womb series, Inside the Living Body traces one “everywoman’s story”, using milestones to examine the everyday workings of a living, functioning body in ways not seen on television until now. Cutting-edge miniature endoscopic HD cameras delve deep inside the mouth, throat, heart, lungs, digestive tract, brain and reproductive organs to shed new light on how and why our bodies do what they do. Stunning photography in this two-hour special reveals universal moments in human development at the most minute level, providing insight into both our own individual metamorphosis and our shared human experiences.

(the bold is my part!)

The Show airs September 16th on the National Geographic Channel (and the NG HD channel!) at 8PM.

Share

National Geographic’s The Living Body: DITM Featured in World’s First HDTV Broadcast of Surgical Procedure

ng

I’ve mentioned the National Geographic Special “The Living Body” and wanted to fill you in on why this is such an exciting project for me.  The show follows a woman from birth through life and death and traces the function of all of her bodily systems.  It will feature my surgical laparoscopy footage as the world’s first broadcast of surgery in HDTV.  To produce this I used a protype laparoscopy system that visualizes the highest resolution images ever seen of the human body. If you watch this show you’ll see endoscopic images on your living room HDTV set better than almost any surgeon has seen in the OR! 

I became involved when I received a call from the NG people and ther production team out of London.  They had heard of my work in developing HDTV endoscopic surgery and that I had performed the world’s first HDTV laparoscopy back in 2000.  This show was being produced in HDTV for braodcast in HD on the National Geographic HD channel (then downconverted to standard definition-SD for traditional broadcast and DVDs).  They were looking for some HD footage of internal organs. 

The original HD projects I did back in 2000 used a prototype 4-chip HD from JVC camera modified from a microscope camera for use in laparoscopic surgery.  At that time we had to use a w-vhs recorder as this was the only way to record the 1080i signal in HD. 

I became very excited at the prospect of helping them with this project since I had been testing a new endoscopic system that was unique in having the world’s highest reolution ever as well as the ability to record in full lossless HD using a new type of blu-ray HD DVD based recording system.

I recorded a series of shots for them of all the internal pelvic and abdominal organs and am delighted it made the final edit of the show.  You’ll see an egg developing inside an ovarian follicle, the bowel, liver and gall bladder, fallopian tubes, cervix and uterus.

My next post will review the technolgy between the HDTV system I used and some images from it.

Share

Embryo Adoption, Stem Cell Research, Partial Birth Abortion Oh My: Breaking News From DITM

embryo-brochure.jpg timefetus.jpg

When does human life begin and what is a human?  Fertility specialists wrestle with this question every day as embryos are created, frozen, thawed, implanted, and discarded.  Occasionally an embryo is even “adopted”.  Today I received the draft results of a US government Health and Human Services Research Project that I participated in on the potential for embryo adoption in the US.

In 2002, the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption.   Today I received the research report of the commission’s results:

Between April 4, 2005 and July 27, 2005, the Social Science Research Center (SSRC) at California State University Fullerton contacted 481 Assisted Reproductive Technology (ART) Centers in the United States, including yours, soliciting participation in a survey study. Attached to this message, please find a copy of the final report based on the 254 ART clinics that participated in this study.  This document is being distributed in response to interest in the results of the study expressed by many ART clinics.

The report begins 

Embryo adoption is a relatively new process in which individuals who have their own frozen embryos agree to release them to a recipient couple. The intent is to transfer into the womb of the recipient mother the donated embryos so that she and her partner may bear a child and  be that child’s parents. The number of embryos currently in storage in the Untied States was estimated at approximately 400,000. Of this number 88% are still being used by the creating families for their own family building efforts. Still, the remaining 12% or 48,000 embryos cannot be overlooked. Assuming an embryo transfer success rate of 30%, these 48,000 embryos could result in the birth of more than 14,000 children to infertile couples.

Under Public Law 107-116 (the Fiscal Year 2002 Department of Labor, Health and  Human Services, Education and Related Agencies Appropriations Act), the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption.

There are 126,160 Human Embryos In Storage In the USA:  The  mean number of embryos stored across the centers is 1,208.89, and the median is 531. Overall, 126,160 embryos were being stored.

How Common is Embryo Adoption in US IVF/ART Programs:   43% of the programs indicate that their fertility center had a functioning embryo donation/adoption program during the previous year. 44% report that their fertility center currently had such a program.  Considering clinics with a current embryo donation/ adoption program and those reporting plans to implement such a program, almost 60% of the ART centers in the survey sample are likely to sponsor a program by this time.

How is Embryo Adoption Done in the US Now?:  75.1% of  fertility centers refer patients to outside sources for information regarding embryo donation/ adoption. Centers that do not currently have embryo donation/ adoption programs are more likely to refer their patients to outside sources for information on this topic than centers that do. Even among fertility clinics that do currently have embryo donation/adoption programs, however, the proportion who make outside referrals is still substantial (64.5%).  The largest proportion (59.7%) of clinic managers who refer patients to outside sources, refer their patients to the Snowflakes program. 7.9% refer their patients to embryoadoption.org; and 5.4% each to the National Embryo Adoption Center and to the Cooper Clinic. Less than 1% refer to “Embryos Alive.

Don’t Call it Adoption: Preferences for naming the transfer of embryos between couples were

    1. Embryo Donation (65.6%)
    2. Embryo Adoption (24.9%)
    3. Some Other Term (9.5%)       obviously the term adoption is value laden to equate an embryo with a living child

Where Are The Embryos Stored?:  The majority of center staff report that their fertility centers store their patients’ frozen embryos at their clinic location, while nearly 10% report subcontracting for embryo storage.

Most Clinics Don’t Know How Many Embryos They Have!  Of the center staff indicating that their fertility center tracks the number of embryos it has stored, an astonishing majority (63.4%) indicate that they don’t know how many frozen embryos are currently stored, and another nine refused to answer this question.

When Do the Clinics Belive Human Life Begins?  “How do you characterize your fertility center’s general approach or philosophy with regard to the point at which embryos are thought of as human lives?” Ninety-six (37.8%) centers replied, “Don’t Know” in response to this question, and 37 (14.6%) refused to answer, illustrating the highly sensitive nature of this issue. Of those who did respond, the largest proportion (39.8%) say that “Embryos are considered human lives at conception,” followed by 33.9% that report, “Embryos are considered to be human lives after viability of pregnancy” and 15.3% that answered, “Embryos are considered human lives after implantation into the uterine lining”

Chipping Away at Roe v Wade:  Lost Embryo is Wrongful Death.  An Illinois appellate court ruled that a couple could sue their fertility center for wrongful death when the fertility center inadvertently discarded the couple’s frozen embryos. many clinics expressed concern or policy changes as a result.

The Relation To Stem Cells and Partial Birth Abortion:  The Stem cell connection is clear with so many groups arguing for the use of these embryos in storage to create stem cells.  The recent partial birth abortion ban announcement is another step to equate the fetus with human life and rights.  It will be interesting to follow how the classification and rights of these embryos evolves and see how that plays into the political debate on when life begins.  The Bush administration is very clear in its drive to push embryo adoption.

My Perspective as a Fertility Doctor:  My personal experience is that almost no patients ever request that their spare embryos be donated to other couples.  The vast majority simply prefer to leave them in frozen limbo in storage indefinitely – avoiding having to make a final decision of what to do with them.  As a result of the enormous expense and liability this poses to the clinics, private companies are forming to store the embryos off-site.  Many also choose to thaw them and discard them letting them die in the laboratory dish.  Occasionally a couple will choose to donate the embryo to research.  Why don’t more couples choose to donate to other couples?  I believe it’s a mixture of fear of the unknown (who the parents will be, would they ever run into their donated child?)  and lack of information regarding the process.  The problem will only grow as more embryos are frozen and success rates increase (limiting the need to use the frozen embryos). 

European Disasters From Limiting Embryo Freezing Legislation: 

  • Italy passed the Medically Assisted Reproduction Law in March 2004, which prohibits the destruction of embryos created outside the body. This means that all embryos created during IVF (to a legal maximum of three) must be transferred to the woman’s womb- and within months infertile women were becomming pregnant with triplets despite the unwanted risks.
  • In Spain, it is legal to put embryos in frozen storage, but it is illegal to destroy embryos or to donate them to research, despite the fact that 74 per cent of Spanish patients with spare embryos in storage would like to donate them to research. Because most couples would prefer not to donate their embryos to other patients, there are currently 50,000 embryos sitting unused in frozen storage in Spain
  • The Embryo Protection Act of 1990 in Germany states that no more than three eggs can be collected from a patient for fertilization in vitro. After that, all embryos created must be transferred to the patient in order to avoid any embryo freezing or destruction. The result has been lower pregnancy rates and higher multiple pregnancy rate
Share

Babies Without Men: Creating Sperm From A Woman’s Bone Marrow

wonderwoman.jpg

NOTE TO READERS: this post is a copy of the full article and discussion which can be found here- please click for the many many comments

Scientists report today on the ability to create sperm from bone marrow cells.  Initially performed in men, the technique could potentially be performed in women and lead to a sperm cell made from a woman’s body.  You got it right- that cell could then fertilize an egg leading to the first female-female conception in human history.

As a fertility specialist I couldn’t resist this story and wanted to share the reality and the hype.  Prof. Karim Nayernia, Professor of Stem Cell Biology at the Instatute of Human Genetics at the Univeristy of Mewcastle on Tyne led the project reported in Biology of Reproduction.  A summary of the study was released in the Independent today.

The researchers said they had already produced early sperm cells from bone-marrow tissue taken from men. They believe the findings show that it may be possible to restore fertility to men who cannot naturally produce their own sperm.

But the results also raise the prospect of being able to take bone-marrow tissue from women and coaxing the stem cells within the female tissue to develop into sperm cells, said Professor Karim Nayernia of the University of Newcastle upon Tyne.

The report suggests that “Scientists are seeking ethical permission to produce synthetic sperm cells from a woman’s bone marrow tissue after showing that it possible to produce rudimentary sperm cells from male bone-marrow tissue.”

The Two Mommy- No Daddy Baby Making Research Plan:

“Theoretically is it possible,” Professor Nayernia said. “The problem is whether the sperm cells are functional or not. I don’t think there is an ethical barrier, so long as it’s safe. We are in the process of applying for ethical approval. We are preparing now to apply to use the existing bone marrow stem cell bank here in Newcastle. We need permission from the patient who supplied the bone marrow, the ethics committee and the hospital itself.”

If sperm cells can be developed from female bone-marrow tissue they will be matured in the laboratory and tested for their ability to penetrate the outer “shell” of a hamster’s egg – a standard fertility test for sperm.

“We want to test the functionality of any male and female sperm that is made by this way,” Professor Nayernia said. But he said there was no intention at this stage to produce female sperm that would be used to fertilise a human egg, a move that would require the approval of the Human Fertilisation and Embryology Authority.

This same group reported last year that they created artifical sperm from embryonic sperm cells in mice. 

(They) isolated stem cells from blastocysts, which are early-stage embryos only a few days old.  From these cells were extracted those that would go on to form sperm, known as spermatogonial stem cells (SSCs). The SSCs were then cultured in the laboratory, and when some developed into sperm, they were injected into female mouse eggs and grown into early-stage embryos. The embryos were transplanted into the wombs of surrogate mothers.

The Genetic Disaster That Could Result: Faulty Imprinting.  There is a huge genetic time-bomb here.  The genetic phenomenon called imprinting.  This describes the situation where a particular gene is marked or imprinted with a tag that says if it came from the mother or father- and more importantly only one of the other is active.  For example for a particular gene it’s possible that only the maternal copy gene could be active and the copy that comes from the mother could be switched off.  If this process goes wrong (mom and dad copy mistakes) then severe genetic diseases can result. 

A description of imprinting follows and a detailed description is here and here

However, it is now known that the expression of a small number of the 30,000 or so genes in the cells depends on whether the gene copy was passed down from the father or the mother. This process, whereby the expression of a gene copy is altered depending upon whether it was passed to the baby through the egg or the sperm, is called imprinting.

The term “imprinting” refers to the fact that some chromosomes, segments of chromosomes, or some genes, are stamped with a “memory” of the parent from whom it came: in the cells of a child it is possible to tell which chromosome copy came from the mother (maternal chromosome) and which copy was inherited from the father (paternal chromosome). This expression of the gene is called a “parent of origin effect” .

Share

Carnivals Galore: Grand Rounds x 2 and GeneGenie

I wanted to catch up with the recent carnivals and thank them for including docinthemachine’s posts. First was keagirl a great medblogger who writes at urostreamThis grand rounds was straight to the point and a cavalcade of posts.  Thanks for including my post on technology: is it god evil or neutral?

Dr Palter from Doc in the Machine (a blog aiming at transforming medicine with tomorrow’s technology) discusses “Evil Tech“, about how some people believe that some technologies are inherently good or evil – especially developments in medicine and the military.

Next came the always fun Dr.Dork (how can you not love someone who blogs about himself in the third person?) – along with some of the funniest grand rounds photos ever.

My post on genetic screening for STD’s added to pap smears was added to the research section

Docinthemachine blogs on new developments in genetic pap smears which could lead us one step closer to eradicating some common STDs.

Last but not least was my first submission to gene genie.  I submitted at the request of Bertalan Meskó from Science roll- the master of medical web 2.0 and genetics on the web. He writes gene genie is:

a new blog carnival on genes and gene-related diseases. Our plan is to cover the whole genome before 2082 (it means 14-15 genes every two weeks). But we also accept articles on the news of genomics and genetics.

Gene Genie this week was hosted over at Sandwalk. Thanks to Larry Mogan, a professor of biochemistry at Toronto and also a genetic blogger.  He added my post on preimplantation genetic screening for patients with Huntington’s Chorea- and hiding the results from them.

Steven F. Palter posts on a very sensitive topic—whether a patient wants to know if they carry a possibly lethal genetic mutation. For example, what if you are at risk for Huntington’s disease and you simply do not want to know whether you will die in your 40′s or not? That’s fine as long as you don’t have children but do you want to pass the defective gene to your children if you carry it? How can you have children without risk if you don’t want to know whether you are a carrier or not? It turns out there’s a way and Steven Palter explains how in Beyond Genetic & Prenatal Testing- Pre-embryo Testing – Hiding the Results From the Patient.

I enjoyed these three blogs so much aI added them all to my blogroll!

Share

DITM at Podcamp NYC

podcamp-nyc-logo-png.png

In preparation for my two new podcast projects I spent the day at Podcamp NYC- the “unconference” of podcasters.  THe idea of an unconference is that the participants script the events – or more accurately – they occur spontaneously.  There is not spposed to be formal invitees or corporate ownership but rather the players and audience are one.  All can speak and the event informally spills into the space.  Once they signed up 1000 people the tides turned a bit as a formal schedule got written and corporate aponsors jumped aboard.  I didn’t care.  It was well organized and a wonderful mix of podcasters and vbloggers from around the globe.  I met so many great people and got a chance to pick their brains and share ideas.  The concept of the meeting worked!

I especially enjoyed meeting and speaking with the leaders of blip.tv about how far vblogging and I-TV can go, podcasting guru Jason Van Ordern on marketing and promotion, podandgo and rawvoice on networks of podcasters, and countless widget app vendors – not to mentionall the people in the halls trading technical audio and video tips.

Share