Do Cells Have an IP Address Yet?

Ali-Ansary_12

In the future, implanted chips will have the ability to stop food absorption when caloric intake reaches 2200. Cells in our forearm will be able to monitor our glucose levels and adjust our insulin appropriately. These implantable cells or “chips” have their own IP address with their own circuitry that is connected to a network 24/7. Through this network, cells communicate with real-time super computers to synthesize the next step for an individual’s body. If Dr. Anthony Atala can utilize 3D printers to create a new kidney, then it is only a matter of time before we can incorporate the circuitry within an organ necessary to monitor its function wirelessly.

This was the future I was challenged to paint in my talk at TEDMED 2012 at the Kennedy Center for the Performing Arts in Washington, DC. As TEDMED 2013 commences, I ask myself, where are we one year later?

A caveat: The following are simple overviews on novel technologies I had been tracking over the past year and does no justice to the many amazing leaps we have made in innovative science and medicine during this time.

Implantable Sensors
Thomas Goetz beautifully discusses in The Atlantic that diabetics, although “loath” it, have been self-monitoring for years. Goetz goes on to say that the“….distaste falls into three categories: self monitoring for diabetes is an unremitting and unforgiving labor; the tools themselves are awkward and sterile; and the combination of these creates a constant sense of anxiety and failure.”

However, what if we had an implantable sensor that simply monitors an individual’s glucose? In 2010, Dr. David Gough from the University of California, San Diego demonstrated that you could potentially monitor an individual’s glucose by wireless telemetry. A patient can be in San Francisco with his or her physician having access to the data in Los Angeles.

And what if the immune system renders the chip incapable of functioning? Dr. Melissa Grunlan at the University of Texas A&M has been working to develop a self cleaning mechanism that prevents implantable glucose sensors from being “shielded” by the body’s immune system.

Dr. Giovanni de Micheli and Dr. Sandro Carrara at the École polytechnique fédérale de Lausanne in Switzerland have developed a 1.4 cm implantable device that can measure proteins and organic acids in real time. Imagine a signal being sent to your cell phone, and your doctor’s phone, indicating an increase in cardiac enzymes- potentially a heart attack. This device functions on a battery-less system that connects to a patch resting on the surface of the skin.

Natural anatomy acts as a barrier to implantable batteries. Yet, as Dr. Ada Poon and her team at Stanford University have developed a medical device that can be powered wirelessly using electromagnetic radio waves. Now, the tiny devices we envisioned can circulate into the depths of our vascular system without fear of losing power. Reminds me of “The Magic School Bus” episode when Ms. Frizzle takes her class on a field trip through the human body.

A personal favorite of mine: At the Massachusetts Institute of Technology, Dr. Konstantina Stankovic has demonstrated the ability to use the natural electric potential from electrolytes in the inner ear to power devices that can monitor biological activity in people with auditory and balance issues.

Early detection is fundamental in many of these devices, especially for cancer patients who have aggressive diseases prone to metastasis. Take, for example patients with malignant melanoma, one of the deadliest cancers and one that has seen little progress in its treatment. Dr. Shuang Hou and his team at UCLA have demonstrated a proof of concept of a “nanovelcro” chip that can capture highly specific and isolated circulating tumor cells.

And what about regulating food intake and nutrient absorption? Intrapace has created Abiliti, an implantable gastric stimulator and food detection system that is implanted into the stomach. As soon as food is detected, it stimulates the stomach to create a sense of fullness. I can see eventually a system that can monitor an individual’s caloric input over, say, 24 hours. This would allow us to eat normally without overindulging.
Wearable Sensors
A quick mention on a hot topic. As popular discussions emphasize trends like the Nike+ FuelBand, one step closer to wearable sensors are what Dr. John Rogers at the University of Illinois at Urbana-Champaign has developed: An electronic sensor that can be directly printed onto your skin using a rubber stamp and last for up to two weeks as highlighted in MIT’s Technology Review. The potential for this goes beyond saying.

The Fine Line
This is just a short list of exciting new innovations. Of course many people may be taken aback by such technologies, which is fine. The purpose of my talk was to create discussion while painting a potential future that may be upon us soon. It is important for all of us to be active in our own healthcare. If we aren’t, then someone else will be.

Knowledge about our glucose or hemoglobin and hematocrit in our time is just as important as knowing whether or not to fuel our cars with unleaded or diesel. But we still need an expert mechanic’s help. Let me explain. I do believe that growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the empowered and informed patient, but also via healthcare providers.

Old mechanics would drive a problematic car themselves to assess damage. Simple things such as hearing a funny sound or seeing the car pull to the left would give them enough information to diagnose the problem. Today the engineering of a car is so sophisticated that sensors continuously monitoring the “health” of the engine alert the driver when something is wrong. That unwelcome signal – a picture of a wrench, perhaps, or a flat tire – notifies the driver and the mechanic what part has gone wrong, what’s wrong with it, and what needs to be done.

So the mechanic had to evolve the way he (or she) fixed a car. The physician today is much like that mechanic. While the human body is far more sophisticated than even a brand new Mercedes Benz, newly trained physicians need to adjust how they care for their patients’ health.

Growth in this field, like anything else in medicine in the 21st century, will need to be not only through adoption by the e-patient, but also via tech-savvy healthcare providers.

Original presentation at TEDMED 2012

This piece also appears on the The Huffington Post, TEDMED.com, and The Health Care Blog.

| if I knew all the words I would write myself out of here. |

 

 

America’s Healthcare Crisis: A Prescription for Breaking the Cycle

Originally published in the Huffington Post.

By Jacob Scott MD, Sandeep Kishore PhD, Ali Ansary

At the turn of the 20th century, we built a healthcare system on responding to acute, curative, episodic issues. This system saw the eradication of many diseases and the advent of vaccinations and new treatments. The model was truly developed to be a “sickcare system,” which was what we needed at the time, and saw huge successes.

Fast forward 100 years and Americans are sicker than ever — but with different illnesses. What’s more, there is finally a national consensus that our healthcare system is broken. With increasingly tragic consequences, the reactionary medical paradigm has not provided the preventive care or chronic illness management that our culture needs. Healthcare spending currently consumes 17 percent of our GDP and without a radical shift in thinking, this number may grow even higher.

Sadly, patients are not the only ones suffering. The status quo is breeding a morale crisis among our nation’s doctors. If you asked one of the many thousands of medical students who are just beginning their fall semester why they chose medicine, many of them would give you confused, anxious responses about the field they are entering. This does not bode well for the health of future generations.

Last Spring, we met at TEDMED, an annual “grand gathering” in Washington, DC where forward thinkers from all sectors explore the promise of technology and the potential of human achievement as it pertains to health and medicine. Here, we presented our respective positions. One of us, Ali, argued that new technologies will actively change our health behavior. Another, Sunny, argued that we needed systems thinking in public health, focusing on the causes of the causes. Yet another, Jacob, argued for stopping the “imaginectomies” and fostering creativity in medical training by rethinking selection criteria and curricula for entrance to medical school.

This led to conversations across the country — with trainees and senior leaders — with all trying to imagine (and reimagine) what would be different for this generation, the generation of millennials (and beyond). What are the expectations that we, and our patients, have about how we practice medicine in the 21st century?

The short answer is we don’t know yet — but the conversation has begun.

On Sept. 10, an intimate discussion was co-sponsored by the Institute for Healthcare Improvement (IHI) and the Young Professionals Chronic Disease Network in Boston on medical education in the 21st century. Here we began to define four questions:

1. What should be the image of the 21st century physician?
There is no doubt that health and medicine attract the most dynamic thinkers in the world, many of whom come with a love of science and art, a yearning to improve health and well-being and an appreciation for thinking differently. To us, the creative enterprise of imagining what could be is a central competency of the 21st century physician. It provides a new platform, value and principle that allows us to unlock gains in technology, in public health, in discovery and in mapping new connections to the full gamut of knowledge that can help help our species not just to survive, but to thrive. We think it should be someone who is, above all, creative, imaginative and compassionate.

2. What should be the new quality standards for training?
We think they should be the ability to work on a team (to put collective rather than individual interests first) and to always focus on the needs of the patient. We believe that protected time for exploring creative endeavours in medical school, graduate medical education and in practice, is essential for transforming our health. Taking a cue from Google’s successful policy, we recommend that medical schools create the space for students to spend at least 20 percent of their time exploring. And for those who doubt that we can spare 20 percent of the time during the medical school curriculum, we suggest that at least this much of the curriculum is now no longer worth committing to memory, in our new world defined by information at our finger tips.

3. What are the models?
The traditional classroom model where one professor lectures to a room of over 100 students is changing. We think that providing didactic lectures online would allow students to maintain focus on their core medical education while freeing up time to discuss relevant topics not always covered in their textbooks. Take, for example, longitudinal ‘concentrations’ such as the Yale System where there are no required exams, no mandatory courses, a pass-fail curriculum and a requirement for a thesis. At Duke, the second year of medical school focuses on core clinical competencies while the third and fourth years allow students to explore clinical investigations and complete elective rotations. We think these models begin to provide the requisite space for creativity.

4. What does the disruptive innovation look like?
With viral movements via Youtube, the ability for students to create their own content and mentor each other online, and new platforms like TEDMED, which challenge medical standards, we have a new way of sharing information — of creating a vision and executing it together. Students themselves could create curricular content — they could become each others’ teachers in partnership with physician educators.

Conversations like this must continue — not only at places like TEDMED or the IHI, but inside classrooms and teaching hospitals, between mentors and students, and between patients and physicians.

As we adopt a 21st century vision of where we are headed, we must adapt and adjust our training so that it meets the challenges facing the patients of tomorrow. Creativity — the spark behind imagining the structure of DNA, in vitro fertilization, the pacemaker — must be valued to unlock major health gains. It will be these new innovations and new models of healthcare and delivery that will continue to push medicine forward.

Even as physicians reimagine the practice of medicine, we must adhere to the same principles that we swore an oath to — to practice medicine ethically and honestly, and to serve humanity. And unless we, as healthcare professionals, take the time to do this reimagining, it will be done by those who have not taken the same oath, and whose approach to reimagining medicine is driven by other motivating factors.

We submit that the best source to imagine the new mental model is from within medical education and it must be accompanied by forward thinking changes in practice and delivery. We need to stop the “imaginectomies” and help, collectively, step by step, to make creativity, imagination and compassion the 21st century standards of medical education.

This century, your future and your health may just depend on it.

Share with us your vision of a 21st century doctor at
www.tomorrowsdoctor.org.

Dr. Jacob Scott is a research fellow at the H. Lee Moffitt Cancer Center and Oxford University Centre for Mathematical Biology. Sandeep Kishore is an MD/PhD student at Weill Cornell Medical College/Rockefeller University/Sloan Kettering Institute. Ali Ansary is a medical student at Rocky Vista University.

Innovative Technologies that Address Global Health Concerns…

There was a recent call by the World Health Organization for innovative technologies that address global health concerns. The enteries were reviewed by an expert panel and narrowed down to a handful that met the criteria for the call. Applicants were graded on the type of device, health concern, developmental stage, whether or not the product can be commercialized, the purpose of the technology, where it can be used (i.e. users or health centers) and the list continues…

All of the following address major health concerns, yet I believe it would have been great to see technologies that address the issue of clean water, containment of TB from becoming drug resistant, and even remote disease management (aside from SMS to prevent smoking).
My personal favorites include: the isothermal nucleic acid amplification system for TB diagnosis, the decision support system for paediatrics HIV and the transcutanous  anaemia monitoring system.

enjoy!


Selected technology category 1: commercialized/-isable stage

1.1 Stool sample collection and preparation kit
The intended purpose* of the stool sample collection and preparation kit is to simplify faecal examination by reducing the number of consumables and steps required for the procedure. The kit could therefore facilitate the diagnosis of parasitological diseases. Additionally, the kit does not appear to require water or electricity, and is claimed to prevent recontamination of the environment.

1.2 LED phototherapy unit
The intended purpose* of the LED phototherapy unit is to treat hyperbilirubinaemia in newborn infants by phototherapy. The unit could increase the safety of the procedure by using a radiation source that produces blue light and minimizes the exposure to harmful ultraviolet radiation. Further potential advantages are that the unit measures the actual output of light at the useful wavelengths and is claimed to have lower energy consumption than previous designs.

1.3 System for on-site production of wound irrigation solution
The intended purpose* of the system for on-site production of wound irrigation solution is to produce aqueous solutions for the topical treatment of wounds and infections using a power source, demineralised water and salt. Solutions produced by the system could be used to treat a host of conditions including traumatic injuries, post-natal infections and neglected tropical diseases that cause ulcerations and infections.

her potential advantages are that the unit measures the actual output of light at the useful wavelengths and is claimed to have lower energy consumption than previous designs.

1.4 SMS smoking cessation system
The intended purpose* of the SMS smoking cessation system is to provide tailored SMS-based smoking cessation support to its users. According to preliminary research submitted, the system facilitates self-management of smoking cessation and increases the likelihood of user adherence to smoking cessation programs. The interactive system claims to be capable of answering messages about craving to support the user.

1.5 Reusable neonatal suction system
The intended purpose* of the reusable neonatal suction system is to remove obstructive mucus from the air passages in newborn infants to reduce the risk of asphyxia and to support neonatal resuscitation. The device is claimed to be reusable and capable of being cleaned and boiled between uses. The device is claimed to be made of durable silicone and not to require electric power.

1.6 Fluorescence visualization system for cancer screening
The intended purpose* of the fluorescence visualization system for cancer screening is to use the natural fluorescence of mucosal tissues when excited by a violet/blue light, to inform clinicians about the presence of abnormalities in the mucosa in the oral cavity. This system could aid in the early detection of oral/oropharyngeal cancers and thereby reduce morbidity and mortality associated with these diseases.

1.7 Transcutaneous bilirubin measurement system
The intended purpose* of the transcutaneous bilirubin measurement system is to provide an alternative to blood sample analysis for the diagnosis of hyperbilirubinaemia in newborn infants. The system uses spectral analysis of light reflected from the patient’s vascular bed to determine levels of bilirubin in the blood. The device is claimed to be non-invasive and to rapidly give a read-out.

1.8 Isothermal nucleic acid amplification system for tuberculosis diagnosis
The intended purpose* of the isothermal nucleic acid amplification system for tuberculosis diagnosis is to offer a point-of-care alternative to sputum smear microscopy for the diagnosis of tuberculosis. The technology is claimed not to require any additional equipment and to yield a rapid visual read out of the diagnostic result.

Selected technolgies category 2: non-commercialized/-isable stage

2.1 Simplified anaesthesia unit
The intended purpose* of the simplified anaesthesia unit is to function as an anaesthesia machine for surgical use in low resources settings. The device features an innovative valve system with reduced technical complexity compared to traditional devices. The device is claimed to function with oxygen from different sources, including ambient air and therefore would not require compressed oxygen.

2.2 Single use assistive vaginal delivery system
The intended purpose* of the single use assistive vaginal delivery system is to assist fetus extraction in cases of prolonged second stages of labour without having to use forceps, to use a vacuum extractor or to resort to caesarean sectioning. The lack of rigid instruments in the system is claimed to reduce the risk of injury to both mother and child.

2.3 Portable on site cell sorter and counter for HIV and malaria diagnosis
The intended purpose* of the portable on site cell sorter and counter for HIV and malaria diagnosis, a lab-on-a-chip device, is to monitor AIDS in HIV-infected people as well as blood cell alterations indicating malaria. The system appears to be a small and portable device that would allow for rapid automated screening of a blood sample for indicators of AIDS and/or malaria.

2.4 Decision support system for paediatrics HIV
The intended purpose* of the decision support system for paediatrics HIV is to move away from paper-based medical records while ensuring easy and reliable access to patient-centred information. This electronic health records system is targeted at paediatric HIV cases and is intended to aid clinical decision-making processes such as weight-based dosing support for antiretroviral drugs.

2.5 Transcutaneous anaemia monitoring system
The intended purpose* of the transcutaneous anaemia monitoring system is to screen populations for insufficient levels of haemoglobin in the blood and to carry out diagnosis of severe anaemia. The system is claimed to be based on spectrophotometric analysis. The device appears to be portable, non-invasive and is claimed to give a read-out in less than a minute.

2.6 Solar-powered autoclave
The intended purpose* of the solar-powered autoclave, is to sterilize medical instruments. It is claimed to run solely on solar power. This technology could allow sterilization of medical instruments in remote rural areas with no access to electricity and hence reduce the risk of infections associated with carrying out medical interventions with dirty equipment.

2.7 Portable infant warmer
The intended purpose* of the portable infant warmer is to improve the care of premature and low-birth-weight babies by providing heat at a constant temperature in order to prevent hypothermia. This portable device is claimed not to require electricity and would allow for close mother-to-baby contact. The product is targeted for use in urban and rural healthcare settings, and in home settings.

| if I knew all the words I would write myself out of here. |

The Dangerous of Melanoma and How to Early Detect…

For the past few years I have become more and more convinced that the burden of many diseases can decrease simply through prevention and early detection. This came through my involvement in UC Irvine’s Spot a Spot program, which is the main educational component of the National Melanoma Awareness Project. At its inception in 2003, this project was known as the Joel Myers Awareness Project in memory of young UC Irvine medical student who died from melanoma. Since that time, the “Spot a Spot.  Save a life” curriculum has been extended to across the country and taught 14,695 students from 2009-2010, which adds to nearly 50,000 students taught since 2003.

Some of the projects have included teaching middle school and high school students, junior life guards, and my personal favorite, going to Paul Mitchell School of Hair Design to teach young hair stylists how to spot a melanoma on their clients’ heads. The truth is when was the last time we checked our head for a melanoma?

Malignant melanoma is the second most common cancer seen in the adolescent and young adult population in the United States and accounts for 11% of all malignant cancers seen in this age group (age 15-39).  I will not go through all the statistics, just check out the Skin Cancer Foundation for solid facts.

What I do what to stress is that earlier detection, combined with improved treatment options, results in greatly improved survival outcomes. In fact, melanoma in 10- to 39-year olds is highly curable with 5-year survival rates exceeding 90%.

My motivation to write a quick blog post on this subject came as a result of an article in Vanity Fair on the Environmental Working Group’s recent study on sunscreen. The article quotes  “almost half of the 500 most popular sunscreen products may actually increase the speed at which malignant cells develop and spread skin cancer because they contain vitamin A or its derivatives.”

To add fuel to the fire, researchers from the University of Minnesota’s School of Public Health and Masonic Cancer Center claim that there is a link between use of indoor tanning devices to increased risk of melanoma, the most serious form of skin cancer. However, the data is now being challenged by the Sunbed Association which outlines their claims in a recent press release.
Yet through all this controversy, there are two simple ways which you can early detect melanoma: the ABCDEs of Melanoma and the Ugly Duckling.

ABCDEs of Melanoma

Consult your dermatologist immediately if any of your moles or pigmented spots exhibit:

One half is unlike the other half.
An irregular, scalloped, or poorly defined border.
Is varied from one area to another; has shades of tan, brown, or black; is sometimes white, red, or blue.

Melanomas usually are greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.

A mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

(American Academy of Dermatology)

Ugly Duckling


I personally think both methods are great tools for early detecting melanoma. However, to the untrained eye, the Ugly Duckling method has been tested  to have been a useful tool as a sign for melanoma screening (Arch Dermatol. 2008;144(1):58-64).

As much as we are told to stay out of the sun, wear protective clothing, or even use sun screen, your biggest tool in the fight against cancer is to early detecting melanoma by “knowing your skin.” (Dr. Leonard Sender)

*tshirt designed by Marc Jacobs to raise awareness about the deadly skin cancer and benefit melanoma research at the NYU Cancer Institute at NYU Langone Medical Center.

| if I knew all the words I would write myself out of here. |

The Khan Academy…

UPDATE (Oct 2010): Congrats to the Khan Academy and winning Google’s Project 10 to the 100!

First place = $2m

http://www.project10tothe100.com/

Today you can almost get a free education (minus the degree) by podcasting or webcasting some of the best lectures from MIT, Berkeley and Harvard. However, without prior knowledge, it can be difficult to watch/listen to a lecture and understand what is going on at these high level academic institutions.

The Khan Academy is a true revolution in the way we understand academia. I can attest to it as all my younger cousins have used it as an excellent reference to supplement their classroom learning. Actually, it has been such an amazing resource that they claim that these lectures are even better than what their teachers teach them. The Khan Academy is a not-for-profit organization with the mission of providing a high quality education to anyone, anywhere.

Yet, what makes The Khan Academy any different from other online lectures? The fundamental level of communication- using Paint Brush.

With over 1000+ videos on YouTube, and some videos having up to 200,000 hits and lasting up to 10 minutes per lecture, Salman Khan (not the Indian actor)has been able to create a true “open education system.” Originally the videos were put up for Mr. Khan to tutor his younger cousin who lived across the country, but little by little the videos began to pick up.

Subjects range from the Math (Calculus, Arithmetic, Trigonometry, Linear Algebra, Differential Equations, etc) to Biology, Chemistry, Banking, Finance, and Economics. Everything is literally covered and subjects are growing everyday.

Here, for example, is an excellent lecture on one of my favorite subjects that I constantly help my cousins with: Trigonometric Identities.

I’ve definitely become a big fan of The Khan Academy. Along with excellent efforts by Teach for America and AmeriCorps, the Khan Academy is an invaluable asset to the academic environment. This project is exciting because it simply reaffirms my belief that human nature is naturally altruistic. Finally, I am a massive proponent on free education and it being held to the highest standard.  Investment into the education and health of this country need to be two of the most fundamental concepts supported by our legislators and leaders.

| if I knew all the words I would write myself out of here. |

Why Medical Schools are Four Years Long?…

Why Medical Schools are Four Years Long?

Ever since I can remember, medicine and access to healthcare has played a central theme in many of the things I have been involved with. Yet, how was it that medical education in America grew to provide such an elite education and train many of the world’s top health professionals?

If we look at the history of medicine it has certainly come a long way, and how physicians are trained has changed even more.  Historical figures such as Hippocrates, Pedanius Dioscorides, ibn Zakariya al-Razi, Ibn al-Nafis, and Ibn Sīnā are not only known for their influence on medicine, but also for being botanists, philosophers, geologists, poets – the list goes on.

Indeed medicine has changed. Over 200 years ago physicians employed bloodletting to treat our first president, George Washington, a giant man at 6’3, to treat of signs of a cold which later proved to be fatal. It wasn’t the cold that had killed him though. Washington had been drained of half his blood in less than a day. Today, however, as physicians continue their interdisciplinary practices, their education has become standardized.

Continue reading

Mind the Gap: Cancer in Adolescents and Young Adults (Part II)…

Today, there are over 70,000 adolescents and young adults diagnosed with cancer per year in the US alone. For over two decades there has been little or no improvement in survival in cancer patients between the ages of 15-39, as defined by the US National Cancer Institute. Cancer is the most common fatal disease in adolescents and young adults.

Traditionally, cancer has had two schools of thought: paediatric oncology and adult oncology. Today, however, oncology (the study and treatment of cancer) can be thought to consist of four distinct divisions: paediatric, adolescent and young adult, adult, and geriatric cancer. What makes adolescent and young adult cancer patients different are the unique diseases that affect this age group. Paediatrics suffers from cancers such as leukaemia, and adults suffer from diseases  such as lung, prostate, gastrointestinal tract, and urinary system cancer, which are identified as older people’s diseases. Comparatively, almost 90% of all invasive cancers in the adolescent and young adult group are accounted for by ten groups. [See box]

Box [2]:
1.    Breast cancer
2.    Lymphomas
3.    Melanoma
4.    Female genital tract tumours (ovary and uterine cervix)
5.    Thyroid carcinoma
6.    Sarcomas
7.    Testicular cancer
8.    Colorectal carcinoma
9.    Leukaemias
10.    Brain tumours

Picture 4

[5]

Being an adolescent or young adult is the biggest risk factor for delayed treatment, even though there is some overlap in diseases between the different age groups, . Moreover, in the US, young adults have the highest percentage of uninsured or under-insured individuals of any age group. In 2004, 13.7 million young adults aged 19 to 29 lacked coverage, an increase of 2.5 million since 2000 [1].

People in the age range 15–39 have different risk factors for cancer. Cervical cancer occurs most frequently in females infected with human papillomavirus. Risk factors for Hodgkin’s lymphoma (cancer originating from a white blood cell) include a history of autoimmune disorder, a family history of malignancy or hematopoietic disorder (abnormal formation of blood cells), and being of Jewish descent [3]. Skin cancer risk factors can be contributed to a combination of events such as high UV exposure, having a mole and a history of skin cancer in the family [3]. Melanoma (a type of skin cancer) is the most common cancer in women ages 20-29, and the biggest cause of cancer deaths in women ages 25-30 [3]. Ironically, more than 9,500 cases of malignant melanoma were diagnosed in the UK in 2005, and while Australia may have a high rate of melanoma (9,722 new cases in 2004), the death rate is lower because of early detection (1,600 deaths in 2005 compared to 1,852 deaths in the UK in 2006) [4,12,].

Adolescents and young adults have different physiology (e.g. hormones) and pharmacology (e.g. drug clearance, side effects) to other age groups with respect to cancer susceptibility and treatment [7]. To fully comprehend these differences, scientists need more people of this age range to participate in medical trials. In addition to adolescents and young adults being under represented, there are far fewer men than women who have participated in clinical trials between the ages of 20 and 40 [2]. Poor clinical trial participation is one reason why there is a lack of progress on cancer treatment for young adults and older adolescents.

Today, cancer survival in paediatric and older adult age groups continue to improve, all while progress on treatment of adolescents and young adults remains lagging behind. That is why there are organisations that are creating a community for this age group through health education, survivorship events, conferences and policy making; as well as providing psychosocial support through support groups, social networks and blogs.

Organisations, such as the Teenage Cancer Trust (TCT) in the UK, are building units in NHS hospitals specifically for teenagers with cancer. The newest one is opening at the Addenbrooke’s Hospital in Cambridge at the end of 2009. In the US, organizations such as I’m Too Young For This! Cancer Foundation (i[2]y) and Planet Cancer have created grassroots movements to raise awareness and improve young patients’ prospects. ‘Spot a Spot’ is an educational outreach program in the US that is educating more than 10,000 students every year on the key risk factors for skin cancer using their “Spot a Spot. Save a Life” campaign. Finally, SeventyK is an adolescent and young adult advocacy organization that has proposed a new patient’s bill of rights specifically for young cancer patients, which has over 7,000 signature supporters globally. They have teamed up with other international organizations to help create a international charter that will set the precedence for treatment of adolescent and young adult cancer patients throughout the world.

Long-term survival and health is also important for young cancer survivors, which is why many organisations are emphasizing psychosocial support, as well as addressing other issues such as fertility[1,8]. Going through, for example, a round of radiation or chemotherapy increases an individual’s risk of infertility and of developing secondary cancers later on. The primary concern when dealing with cancer is survivorship as well as secondary concerns such as fertility treatment. Yet, a GP’s level of knowledge about preserving fertility, their attitude and their comfort level with the topic can vary [6].  That is why it is important for GPs to be up to date with the fertility options available, and to offer sperm banking and ovarian cryopreservation (freezing of parts of the ovary containing immature eggs) to adolescents and young adults; who may have not been given clear explanations of long-term side effects of their cancer treatment [9,10].

In order to increase survivorship for a generation who have fallen through the gaps of medical practise, there needs to be stronger science, improvement in the way psychosocial issues are addressed, and self-empowerment. The medical community needs to increase their understanding of the adolescent and young adult age group and their high risk factors for cancer. Along with continued education, clinical and epidemiological research needs to improve in order for the medical community to understand what makes this age group so unique.

A healthcare provider’s responsibilities need to go beyond the clinic and they should help to develop age appropriate programmes in order to ensure the survival of cancer patients from paediatrics to adolescents and through to young adults. Finally, there needs to be a sense of ownership from adolescent and young adult cancer patients, so that their voice is not blurred by misdiagnosis or delayed treatment. Ownership beginning with patients taking control of their health and supporting policy initiatives introduced by advocacy groups such as SeventyK [11] . It is important for young people to know as much as they can about their cancer and its effects; enabling them to make sure they receive the correct treatment and seek out the appropriate and specific help and care they deserve.

I originally had this essay printed in The Triple Helix. Special thank you to Dr. Leonard Sender & the SeventyK team.

| if I knew all the words I would write myself out of here. |


References:
1.    Adolescent and Young Adult Oncology Progress Review Group. Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, and the LiveStrong Young Adult Alliance.
2.    Bleyer, A., et al. (2008) The distinctive biology of cancer in adolescents and young adults, Nature Reviews Cancer, April, vol. 8, pp. 288-298.
3.    Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000. National Cancer Institute, NIH Pub. No. 06-5767. Bethesda, MD 2006.
4.    Skin Cancer. Cancer Research UK. http://info.cancerresearchuk.org
5.    Bleyer A. (2007) Young Adult Oncology: The Patients and Their Survival Challenges, CA Cancer J Clin, vol. 57, pp. 242-255.
6.    Quinn, G., et al. (2008) Patient–physician communication barriers regarding fertility preservation among newly diagnosed cancer patients, Social Science & Medicine, pp. 784–789.
7.    Wu, X., et al. (2005) Cancer incidence patterns among adolescents and young adults in the United States, Cancer Causes and Control, vol 16, pp. 309–320.
8.    Schover, L, et al. (2002) Knowledge and Experience Regarding Cancer, Infertility, and Sperm Banking in Younger Male Survivors. Journal of Clinical Oncology, April vol 20, 1880-1880.
9.    Soliman, H. and Agresta, S. (2008) Current Issues in Adolescent and Young Adult Cancer Survivorship, Cancer Control, Vol 15, pp 55-62.
10.     Jeruss, J. and Woodruff, T. (2009) Preservation of Fertility in Patients with Cancer, N Engl J Med 2009, vol: 360, pp. 902-911.
11.    SeventyK [homepage on the Internet]. [(www.SeventyK.org)
12.    Australian Government. Department of Health and Aging. Skin Cancer. http://www.skincancer.gov.au/

Mind the Gap: Cancer in Adolescents and Young Adults (Part I)…

mindthegap

It was all coming too fast. Three weeks ago J had gone to her GP (General Practitioner) to complain about the swelling of her arm that had not subsided. She had recently graduated from Yale—at the top of her class—and was preparing to go to Harvard Law School. She was home for the summer living with her parents in New York. J had two younger brothers and a young sister in London. The only thing that mattered to her was her post-graduation trip to sunny California. It was when J had been packing and had gone to reach for her shirt on the top of the dresser that the chair she was standing on lost its grip and J fell a couple feet to the ground, landing on her arm. As she only had some swelling and slight pain, her GP simply recommended to ice it and she would be fine.

When as young adults we complain of a problem to a GP we are not always taken seriously, which can result in late diagnosis or misdiagnosis. In fact, there are many explanations for late diagnosis and according to Dr. Archie Bleyer, these include delaying to seek medical care and obtaining a correct diagnosis, lack of routine medical care, poor training or an unwillingness to care for young adults among GPs, under-recognition by medical professionals of certain diseases or its symptoms and signs in J’s age group, and lack of health insurance (US).

J’s persistence to meet with her GP and to tell him that her swelling and pain around her right arm was not a result of her fall saved her life. J actually had osteosarcoma, one of the most common bone cancers in adolescents and young adults. The treatment for it calls for a combination of chemotherapy followed up with a surgery to remove the tumour and follow up chemotherapy to improve any chances for removing the cancer cells. Generally, radiation is only used when surgery is impossible. If J had waited any longer, the chances of metastasis of the tumour would have increased, most likely going to her lungs. Although the causes are unknown, the symptoms of osteosarcoma include tenderness, swelling and pain when lifting. All these are common symptoms usually also experienced after a fall so it can be seen how J’s GP could have overlooked a serious bone cancer for just a slight irritation. Yet, are GPs doing everything they can? to be continued

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A swallowed denture…

I am not going to lie, this is pretty amazing. A 56-year-old woman.

dentures4

The Lancet, Volume 373, Issue 9678, Page 1890, 30 May 2009

The plain abdominal radiograph (A) showed the denture within the small intestine, with no sign of bowel obstruction or perforation. Plain radiographs (B) showed the denture within the caecum, within the splenic flexure (C), within the descending colon (D), and within the rectal ampulla (E). Unremarkable plain radiograph obtained after the dentures had been removed (F).

Normal digestive pathway:

digestive-system

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DuVanity (Part II)…

burj-al-arab

van⋅i⋅ty
/ˈvænɪti/ Show Spelled Pronunciation [van-i-tee]
–noun
excessive pride in one’s appearance, qualities, abilities, achievements, etc.

This evening I went for a run on the beach. As I ran, kicking the sand in the air, trying to keep my balance, I could feel the heat insulated by the sand begin to rise. I then thought to myself about the project that is planning to place a cooling system below the sand so people don’t burn their feet while on the beach.

dubai-desert

The city known as Dubai continues to catch me off guard with something new and amusing. From the thrills of eating dinner above the city to the desert safaris, there is pretty much something here for anyone. However, what I have come to realize over my time spent in the city is that for the first time I am able to see how the rich spend their money. What is clearly noticeable here in newer developments of Dubai is that if you just got the new Nissan GTR, then the person next to you has the new Audi R8. These of course fall into the shadows of every single model of Ferrari you can think of. Lamborghinis roar through the Jumeriah Beach Residence over the soft luxury engines of a Mercedes, BMW, or Range Rover. Of course you can find a huge diversity of cars, however, there is such a large concentration of luxury cars that all the rest just fall into the background of the city. And if you think you have the best model, well let’s just hope your license plate number is two digits (1 digit will cost you $14.3 m).

lambo-dubai

I am not going to lie- the buildings are amazing. These buildings will continue to bring in people throughout the world to this city. Many have said how the financial crisis may be bringing this city to an end. As one construction developer who I spoke said, “Dubai’s construction isn’t slowing down, it is just stabilizing and going to normal growth.” The city has been growing faster than people are coming and slowly the government has been able to refocus its strategy and invest into more than just construction, for example the opening of DuBiotech. There still is development and hotels continue to open up and each one offering something more than the other. From Michelin star rated restaurants to extensive ornate networks of traditional souks (open air markets), hotels are making sure that they are the hottest things to come to Dubai. What took many cities to be built over centuries, Dubai did in a few decades. Still criticisms exist, “you’re building a city in the desert, this is impossible.” The desert did not stop Las Vegas from being built nor did it stop 20 million residents from living in Los Angeles- with an annual rainfall of only 15 inches (38 cm). Give it time, and Dubai will continue to grow.

madinat-jumeirah

Malls confirm every rumor that have reached the west coast. Dubai Mall offers an in door ice skating rink, giant 4 story waterfalls, and a massive aquarium. Emirates mall stands out with its massive ski slope and all malls are able to offer some of the finest clothing and brands available in the world. Even the local gold souks attract many of the world’s buyers.

dubai-mall

Restaurants, no matter where you are (or at least where I have been), serve with respect and quality. I must also give a shout out to the Mexican restaurants here. I have had more Mexican food in my time spent in Dubai than I have the entire past 6 months in the UK. A nice horchata and I would possibly have no reason to ever go to another restaurant.

dubaimarket

I have seen minimal police, and the few that I have enjoy their BMWs. This might be a non-American thing, however, in the US the most luxury a policy officer gets is a Crown Vic or a Camaro. There is no visible poverty and you see no homeless people on the street. Occasionally you may find a piece of liter on the floor, but that would be a rare occasion as well.

Fashion also plays an important role like any other place where you find beautiful people.  You will find Russians, Europeans, some Americans and some from Down Under. Some people come out in their brands, others come in their $500 torn t-shirts. Emirati’s of course are visible, even with some of the world’s most stylist Abayas. Everyone looks good no matter what age or after how many kids. The preface here is that fashion goes beyond expectations and sometimes extends to the overwhelming range, but it makes great for people watching.

burjdubai

My point for these random thoughts isn’t necessarily to say that this life style doesn’t exist anywhere else, because I am sure that it does. Rather, it is to show how concentrated this life style is to one area. Dubai has been able to become a center hub for the Middle East and Euroasian continent and has welcomed all individuals to come. However, I have also noticed that some expatriates are more welcomed than others and I have begun to see that Dubai is more than just one dimensional… to be continued

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Management by Email…

It is about 9:00 am, you just have arrived to work and the first thing you realize is that your email inbox has overwhelmingly tripled from 25 new emails to 75 new emails…OVERNIGHT! Okay, so one-third of the emails are Facebook messages/comments, Twitter updates, or news feeds. A small percent go straight to the trash, and the remaining emails all need to be replied to. Well, technically this isn’t true because simply picking up the phone and making a call to that individual can resolve a majority of the emails. However, you innately refuse to call and would rather email someone back and forth to set up a meeting, plan a lunch, or schedule a conference call and unfortunately somewhere in those gaps, the message is lost, misinterpreted or not even received!

This is what has become the normal behavior for individuals whose work revolves around a computer. Now I am not arguing whether or not the Internet has made my life easier or not. If that was the case I sure can say it has. However, what happens is that emails go back and forth weeks on end and topics are discussed, times are scheduled all of which could have been simply taken care of by a few simple phone calls. We lose millions of dollars due to inefficiencies and miscommunication. This comes from an observation I had from working in a hospital.

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On a side note: Interestingly though, email may not be the main resource any longer. Former COO of Paypal (before eBay) and producer of Thank You For Smoking, released his Web 2.0 company- Yammer. Similar to Twitter, it allows users to post updates of their activities and follow other’s activities. Unlike Twitter, Yammer is focused on businesses, and only individuals with the same corporate email address can join a given network. Very clever and useful tool. Management by email will soon become management by Yammer.

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If you want to discuss inefficiencies in today’s society, we should look at the American healthcare system. There is a reason today’s medical healthcare system is failing. There is no clear communication and money is simply burned as a result. We live in one of the wealthiest countries in the world and yet we cannot provide the basic health necessities to our citizens. This is a country where the Fathers of Our Country emphasized that liberty is to the collective body, as health is to every individual body. Without health man can taste no pleasure; without liberty, no happiness can be enjoyed by society.

In the state of California the real problem occurs for my friends who are older then 21 and younger than 62. Up until the age of 21, the State Children’s Health Insurance Program (SCHIP) covers for liability and for individual older than 62, there is at least the option of Medicaid. However, what does it mean when a 24 year old cancer patient goes to the clinic, finds our he will be infertile after his bone marrow transplant and cannot sperm bank because he cannot afford it.

As I reflect, I believe that change is in the foreseeable future. I close with one of my favorite quotes by Thomas Jefferson who observed that “without health there is no happiness, and called for the government to give highest priority to the health of citizenry.”

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If you win their hearts, you win the War…

This last Sunday I attended a demonstration in front of the Los Angeles Federal Building in Westwood. This was a peaceful rally in response to the escalation in the number of innocent civilian deaths in Afghanistan. Although the war in Afghanistan would be a great write, it would also be a long (maybe a book :-) ). However, I wanted to share some pictures and thoughts that crossed my mind on Sunday.

On August 22, the US-Coalition led forces killed 76 Afghan civilians in the village of Azizabad, a Heart province located in the western region of Afghanistan. As reported by the Interior Ministry in the Guardian, a majority of these deaths were women and children.

The problem here is that, according to the CIA World Factbook, almost 50% of the country’s population is under the age of 14. That means children who were born after the invasion of the Soviet Union and during the Taliban are now seeing an increase in innocent civilian deaths resulting in continued warfare and deaths. These children have seen nothing but war, death, and suffering so the issue of Afghanistan is not going to be solved next year, or the following year. It is an issue that will be part of the American history as it helps rebuild the country. From the Lost Boy of Sudan to the displaced children during the Bosnia conflict, studies have long suggested post traumatic stress disorder as one of the main problems that arise in adolescents from war torn countries (Goldstein et al 1997). This situation in Afghanistan should not be taken lightly and will take patience and time.

“Ignorance, isolation, illness, violence, and social upheaval have produced a “lost generation”; failure to provide long term support for Afghanistan risks losing another,” is how Professor Zulfiqar Ahmed Bhutta describes the conflict in Afghanistan. Since health care has been such an important aspect of my life, on February 2002 the British Medical Journal published possibly one of the most over looked pieces of work in the 21st century. The article, Children of war: the real causalities of the Afghan conflict stresses the importance of women and children being the prime focus of attention in rebuilding Afghanistan. This includes through sustained efforts at improving health, nutrition, and education, not reckless bombings.

Kathy Ganon, award winning Associated Press writer in Afghanistan for nearly 20 years, was interviewed by  on Democracy Now where she explains the situation quit clearly-

“People are—people today, even though they don’t want the international forces to go, because they’re afraid of what’s going to be left behind, because it’s such a mess—not just Taliban, but corruption, the lawlessness, the warlords, that has grown out of proportion or grown so greatly since 2001. So they’re afraid of what is left. But that’s why they don’t want them to go. And at the same time, they’re afraid now of the international forces. It used to be—really it used to be, five, six, seven years ago, they looked at the international forces with hope. Today they’re afraid.”

I would like to end on a point that was made strongly by two young college Afghan students. In every war you face collateral damage. Professor Marc Herold wrote, “the U.S. bombing campaign which began on the evening of October 7th, has been a war upon the people, the homes, the farms and the villages of Afghanistan, as well as upon the Taliban and Al Qaeda.”

Thus, if you invade our land, in the name of peace, and the war must continue, be humane at least.

As the world moves forward, Afghanistan is one of few countries that is going backwards. The photo below is from my family album taken prior to the invasion of the Soviet Union in 1978. The heart and beauty in this magnificent culture is on a delicate beam, balancing between preserving what has not been lost and an occupancy that has brought continued difficult times.

If you would like to know how to help, please contact me, ali@aliansary.com .

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Orange County Great Park, A New Kind of Park…

I went to a park on Sunday that is still in developments and won’t be complete anytime soon. However, what has been done thus far is mind blowing and what is coming in the up coming years will define a 21st century park. On an old marine base on the boarder of Irvine and El Toro exists a huge orange helium balloon that goes as high as 400 ft (FAA regulations set balloon max height t 500 ft). As I pulled into the parking lot that was built from old high ways and I neared the entrance of the Great Park I felt not only like a child who finds an open swing, but also knew how it feels to live in the eco-conscious environment of the 21st century. The balloon flys Thursdays-Sundays mornings and evenings…FOR FREE!!! Yes, you read correctly, you get to not only enjoy one of the most non-natural sustainable parks in the world, but also hop into a helium air balloon!

The Great Park was designed by Ken Smith (designer of the Third Street Light Rail Project in San Francisco) after he won the design competition. The Great Park was created in an effort to provide the 21st century a self-sustaining park that would span from walking through canyons, lakes and a cultural terrace. Here also will exist Orange County’s largest Sports Complex, botanical gardens, and restoration and management of the habitat home to everything from the Kangaroo Rat, to Buckwheat, to the California Quail, to the Bobcat.

All this fun, but how is it paid for? Well aside from funding from the Lennar Corporation, there is also fees totaling no more than 1% of property value which is added to base of the property tax resulting in $201 million for infrastructure and park development in addition to funds for ongoing maintenance. I guess price comes with a cost, but we are talking about a place which brings the community together on so many different levels: Personal health, Regional Health, Global Health which encompases Energy, Nature, Materials, People and Water.

Okay, now you ask how does such a wonderful park get started? It began with a donation from Lennar Corporation who purchased a large sum (4,700 acres to be exact) of land from the Navy for $649 million in Feburary 2005. Then the Lennar Corporation donated 1,347 acres to the City of Irvine for the Orange County Great Park and agreed to pay an additional $200 million for future development and maintenance of the Park.

Some things are too good to be true. If you look at the land that surrounds the Great Park, it is all open. In less than 10 years from now homes will be built like legos, on all 3,700 acres of it. What has been done is a clever move from the Lennar Corporation which has been building homes since the 1950s. The thought here is build one of the worlds largest and sustainable parks of the 21st century, get people to come to it, ride the balloon for free, increase the value of the property and there you have it= beautiful over priced California homes.

Yet, I still cannot discredit what the Great Park stands for. Green. Sustainable. Renewable. This is one sphere where political constituencies did not  trump public open space. This is a place for our families. I certainly echo Los Angeles Times’ architecture critic Christopher Hawthorne when he named the Great Park as one of his best picks.

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Mouse Party…

Mouse Party

I remember when I was in college I knew a guy who always complained of a tooth ache. Weeks went by and he would never eat anything because of his tooth. One day I bumped into him on in front of Sproul Hall and I asked him how is tooth was. He said it was fine. I was glad to hear that he finally saw a dentist, but when I he told me that he hadn’t I asked how he solved his problem. He was quick to answer: cocaine.

Of COURSE! Cocaine is sometimes used as a topical (applied to the surface layer) anesthetic.

Heroin, Ecstasy, Marijuana, Methamphetamine, Alcohol, Cocaine, and LSD…all drugs that of us are familiar with. One is legal in the US of A, a handful are gate way drugs used by many high schoolers and college students. Now, the University of Utah has developed a clever way to teach their students of how these drugs affect the chemistry of the brain. At the Genetics Learning Center at the University of Utah, professors are using a unique way to teach how drugs alter the brain’s reward pathway.

Mouse Party1

For example, here you are told that alcohol particularly effects areas of the brain involved in memory function, decision making and impulse control. Then you are taken into the brain of a mouse.

Just a fun thing I thought I share. You can play with it here:

The New Science of Addiction : Mouse Party

P.S. For some of you non-science people, Dopamine, Serotonin, GABA are different types of neurotransmitters, which are chemicals that relay, amplify and modulate signals.

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