Monthly Archives: February 2012

The Patient of the Future

Technology Review

Back in 2000, when Larry Smarr left his job as head of a celebrated supercomputer center in Illinois to start a new institute at the University of California, San Diego, and the University of California, Irvine, he rarely paid attention to his bathroom scale. He regularly drank Coke, added sugar to his coffee, and enjoyed Big Mac Combo Meals with his kids at McDonald’s. Exercise consisted of an occasional hike or a ride on a stationary bike. “In Illinois they said, ‘We know what’s going to happen when you go out to California. You’re going to start eating organic food and get a blonde trainer and get a hot tub,’ ” recalls Smarr, who laughed off the predictions. “Of course, I did all three.”

Smarr, who directs the California Institute for Telecommunications and Information Technology in La Jolla, dropped from 205 to 184 pounds and is now a fit 63-year-old. But his transformation transcends his regular exercise program and carefully managed diet: he has become a poster man for the medical strategy of the future. Over the past decade, he has gathered as much data as he can about his body and then used that information to improve his health. And he has accomplished something that few people at the forefront of the “quantified self” movement have had the opportunity to do: he helped diagnose the emergence of a chronic disease in his body.

Like many “self-quanters,” Smarr wears a Fitbit to count his every step, a Zeo to track his sleep patterns, and a Polar WearLink that lets him regulate his maximum heart rate during exercise. He paid 23andMe to analyze his DNA for disease susceptibility. He regularly uses a service provided by Your Future Health to have blood and stool samples analyzed for biochemicals that most interest him. But a critical skill separates Smarr from the growing pack of digitized patients who show up at the doctor’s office with megabytes of their own biofluctuations: he has an extraordinary ability to fish signal from noise in complex data sets.

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Seeking Clues to Heart Risk in a Patient’s Family Tree

The Wall Street Journal

Doctors often gloss over a key question for assessing a person’s risk for coronary heart disease, according to a new study: What is the patient’s family history of cardiovascular illness?

The study suggests some doctors may not be capturing the full extent of many patients’ chances of developing heart disease. Detailed family information could help doctors better predict who is at risk and more accurately target patients for preventive care that may help avert the disease altogether, according to the study, due to be published Tuesday in the Annals of Internal Medicine. Routinely tracking family history sharply boosted the number of people in the study considered at high risk for heart disease.

A widely used scorecard for measuring heart risk, the Framingham Risk Score, fails to take family history directly into account. And while many doctors currently collect some information about the health of their patients’ families, the data often lack the detail to be clinically useful for assessing risk and prescribing care.

“Family history remains one of the most important predictors of an event for an individual,” says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and president-elect of the American Heart Association. Still, “most of the family history that we’re collecting is just the presence or the absence of heart disease, not the age of onset or the type of disease,” says Dr. Arnett, who wasn’t involved in the latest research.

Guidelines for heart-risk screening, issued by the heart association in late 2010, encouraged doctors to take family histories into account. Doctors sometimes make judgment calls to treat people as high risk because of family history, even if it isn’t part of the patient’s risk score.

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Oncolytic Virus Extends Survival In Medulloblastoma Model

Captured by Darrell Ward

  • Medulloblastoma is the most common malignant brain tumor in children.
  • Disseminated medulloblastoma is particularly lethal and requires extensive radiation therapy to the brain, which can cause brain damage.
  • An oncolytic measles virus has shown effectiveness in a new model of disseminated human medulloblastoma.

COLUMBUS, Ohio – A strain of measles virus engineered to kill cancer cells prolongs survival in a model of medulloblastoma that is disseminated in the fluid around the brain, according to a new study by researchers at the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and the Mayo Clinic.

Treatment with the oncolytic virus called MV-GFP extended survival of animals with disseminated human medulloblastoma up to 122 percent, with treated animals surviving 82 days on average versus 37 days for controls. Two of the eight treated animals were left cancer-free.

The findings, published online in the journal Neuro-Oncology, could lead to a safer, more effective therapy for medulloblastoma, and particularly for disseminated medulloblastoma, the researchers say.

Medulloblastoma accounts for 15 to 20 percent of all childhood brain tumors, with 350 to 400 new cases diagnosed annually in the United States.

Untreated, medulloblastoma is fatal. Current therapy for the disease involves surgery, multidrug chemotherapy and radiation therapy to the entire brain. Five-year survival is about 60 percent, but the extensive radiation therapy often leads to decreased intelligence.

Furthermore, in about 20 percent of newly diagnosed patients and 75 percent of patients with recurrent disease, the tumor has disseminated into the cerebrospinal fluid. Five-year survival for these children is less than 20 percent.

“Patients whose tumor has spread into the fluid around the brain and spinal cord have an especially grim prognosis,” says principal investigator Dr. Cory Raffel, professor and vice-chair of neurological surgery.

“Because dissemination of tumor carries a grave prognosis, any treatment that can effectively treat this condition while avoiding radiation therapy could potentially improve survival in these patients and quality of life for survivors.”

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Vitamin E Tocotrienol Supplement Delays Progression of Advanced Liver Disease

Captured by Sherri Kirk

COLUMBUS, Ohio – New research conducted at The Ohio State University’s Wexner Medical Center suggests an alternate form of natural vitamin E delays the progression of disease in patients awaiting liver transplantation, the only definitive therapy that reduces a patient’s morbidity, mortality and improves their quality of life. The study shows, for the first time, successful delivery of the vitamin – administered orally – to vital human organs such as the brain, heart, liver, skin and fatty tissue.

Researchers at Ohio State’s Wexner Medical Center initially sought to measure levels of vitamin E tocopherol (TCP) and vitamin E tocotrienol (TE) in tissue and vital organs of patients with end stage liver disease. The data displayed a significant increase in TE levels in the bloodstream and tissue of study participants who received daily oral supplements of TE.

“This work is the first to show oral supplements of tocotrienol are being transported to the vital organs of patients,” says Chandan K. Sen, associate dean for translational and applied research in The Ohio State University College of Medicine. “This is exciting evidence for patients at high risk for stroke because our previous work identified low levels of TE to be protective against stroke-induced damage to the brain. Findings of this current research are equally excited for patients on the liver transplant list as it increases their chances of receiving a new liver, and therefore survival.”

Earlier research published by Dr. Sen and colleagues at Ohio State’s Medical Center proved tocotrienol a safe and neuroprotective nutrient, which minimizes stroke-related damage to the brain. “We also showed in previous studies that TE can be part of a regular diet and keeps the brain enriched and better prepared to defend itself,” added Sen, also vice chair for research in Ohio State’s Department of Surgery.

For this recent study, published in the February issue of Journal of Nutrition, researchers studied blood and tissue samples from 80 participants. One cohort involved healthy patients who received oral TE or TCP supplements. Vitamin E levels found in tissue were measured in healthy participants after 12 weeks of receiving oral supplementation. Healthy adult participants were selected for this study because they could receive oral supplements for a designated period of time, whereas the other cohort was bound by surgery schedules.

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Beyond the $1,000 Genome

Captured by Forbes

The cost of mapping an individual human genome may break the $1,000 barrier by the end of the year, thanks to Life Technologies, Jonathan Rothberg and the Ion Proton Sequencer. This achievement, more than a decade in the making, will help to usher in a new era of personalized medicine – an era in which individuals’ genetic information will help guide diagnosis, treatment and prevention.

Larger availability of complete genomic data will have a profound near-term impact on cancer research. The ability to rapidly and economically sequence individual patient tumors will help us to better understand the biological mechanisms of cancer and will facilitate data-driven patient stratification. This, in turn, will facilitate more effective clinical trials and speed the development of new therapies.

The significant near-term growth of rich genomic data will impact the patient care side too. Companies like Foundation Medicine use this data to perform molecular analysis of tumors that will assist in pinpointing the optimal treatment strategies for individuals with cancer.

Genomic data alone is not a silver bullet. Rather, it is just one of multitude of data sources that will help us unravel the still largely mysterious workings of the human body and make the leap from genotype to phenotype. The true power of genomic data becomes unlocked when it is integrated with other data types, including other molecular data, imaging and laboratory results, data from apps and mobile devices, and Real World data such as electronic medical records and medical claims. These integrated data sets then need to be paired with analytical methods that can extract actionable knowledge from the data, and do it at scale.

Genomic data is big, but it’s not nearly as big as the data sets that are being routinely analyzed in the context of ecommerce today, data sets like those used by Amazon’s recommendation engine. The infrastructure that will allow us to analyze $1,000 genomes is already in place.

Eric Green, director of the NHGRI, told the Wall Street Journal that “we can sequence the genome for dirt cheap, but we don’t know how to deal with the data.” I disagree – we absolutely know what to do with the data. We now know how to combine genetic data with data from other modalities to discover what works in healthcare and for whom. Scientists, mathematicians, and computer engineers during the last couple of decades have developed new analytic tools that go beyond traditional statistics — tools that can extract knowledge at scale and make novel predictions based on data.

GNS Healthcare is part of a group of stakeholders patiently waiting for the data to become widely available. This group includes industry thought leaders Eric Schadt, Director of the Institute for Genomics and Multi-scale Biology at the Mount Sinai School of Medicine, Stephen Friend of Sage Bionetworks and Daphne Koller of the Stanford AI Lab.

The infrastructure is already in place. The analytical tools have been developed. We are ready to go.

‘Do Your Best’ Not a Good Enough Goal to Improve Diabetes Diet

Captured by Emily Caldwell

A specific goal to eat a set number of daily servings of  low-glycemic-index foods can improve dietary habits of people with Type 2 diabetes, according to new research.

Study participants were given a goal to eat either six or eight daily servings of foods with a low glycemic index – carbohydrates that are digested slowly and are less likely to spike blood-sugar levels than would carbohydrates with a high glycemic index.

Overall, most participants reached the eight-serving goal, partly because researchers discovered that many people were already consuming about six servings of low-glycemic-index foods each day.

The participants also ate about 500 fewer daily calories and added vegetables, fruits and nuts and seeds to their diet – all foods that are on the low end of the glycemic index.

Participants’ confidence about being able to meet these dietary recommendations was key to their ability to reach the goal. People who had more confidence about the goal were more committed, and higher commitment levels led to a better likelihood that they would reach the goal.

Goal-setting theories are applied widely in the workplace and in sports management, but little research has examined the effectiveness of setting goals in a clinical setting to improve health – even though goal-setting is a common technique used by health-care providers.

“We ask people to set goals because they motivate action,” said Carla Miller, associate professor of human nutrition at Ohio State University and lead author of the study. “Telling people to ‘go out and do your best’ is not effective. It’s not specific enough, or targeted enough, or timely.

Click here to read the full article.

OSU Researchers Design Self-Test for Memory Disorders

WYTV-TV (ABC-Youngstown)

Testing for Alzheimer’s Disease can often be costly and include tests such as an MRI and spinal tap. Researchers at The Ohio State University Medical Center have created a test called SAGE, Self-Administered Gerocognitive Examination, which takes 15 minutes to administer in the doctor’s office and costs only pennies. The examination tests memory and cognitive ability and is an early, cheap predictor of the potential for Alzheimer’s Disease. Dr. Douglas Scharre was interviewed.

This coverage resulted from a multimedia release distributed by OSU Medical Center Public Affairs and Media Relations, available online at: