Clinica Editors' Blog

Figuring out the tipping point

2008-08-27T17:57:00.013+01:00

The Clinica scoop finally made it to the front page of The Guardian several weeks after the news was first published in the newsletter

News – and gossip – work a bit like a virus, Malcolm Gladwell observes in his book, The Tipping Point. They’re contagious. And they spread.

But for a piece of news to spread like an epidemic pretty much depends on the kind of carrier or connector it has (ie the right person, or the right thing), and the context of the message.

In June this year, our deputy editor uncovered a big story about the high level of asbestos exposure at the Palace of Westminster, which was largely ignored by the authority. We made noises, and we even published a press release about it, but except for the usual news aggregators, wire services and one or two US-based news websites, it didn’t resonate with any of the major UK broadsheets.

We were sure the context of the message was right. But the agent wasn’t.

Gladwell identifies three types of people he feels are responsible for disseminating information efficiently, and quickly: the connector, the maven and the salesman.

You can learn more about the effects of asbestos and the nature of the lung diseases associated with it in our sister publication, Critical Reviews in Toxicology

In our case, we had the salesman (the PR team that distributed the press release) and the maven (Bernard Murphy, the investigative journalist). But the connector, ideally a highly networked and much-trusted messenger – was missing.

On June 18th, a few days before I was about to attend an equality conference at Church House, next to the Palace of Westminster, I told a colleague, a very respected equality officer, that I felt a bit spooked about the asbestos thing. She reassured me that we will be fine. And then she said: “I'll pass the info on to interested parties!”

I am not sure if this was the tipping point, as it took another month before the news finally made it to the front page of the Guardian (Asbestos scare at Houses of Parliament, 17th June 2008).

By 18th June 2008, the news was hotly discussed over morning coffee by delegates at the summer school I attended.

The Center of Investigative Journalism (CIJ) Summer School is no ordinary summer school. Held every summer at City University, London, it brings together some of the best and most popular investigative journalists and authors in the English-speaking world.

Listen to our Toxicast

Aspartame: A Safety Evaluation
Interview with Dr Bernadene Magnuson
Aspartame has recently been the subject of controversy due to alleged health concerns, with studies linking it to causing everything from headaches to brain tumors Listen

A Small Dose of Toxicology
Interview with Dr Steven Gilbert
How does the science of toxicology touch our lives every day? Dr Gilbert's book, A Small Dose of Toxicology, sets out to answer these questions by setting toxicology in a human context and focusing on the health effects of common toxic agents in the home and the environment Listen

A Peer-Reviewed Research Journal
Interview with Dr Michael McGuigan
Dr Michael McGuigan discusses topics covered in Informa Healthcare’s leading clinical research journal on medical toxicology Listen

Environmental issues are always big at such an event. So, to have your story mentioned at an event attended by Mark Schapiro, John Pilger and Nick Davies was quite something.

It taught me a valuable lesson about ‘viral’ campaigns, something that I thought I’d figured out ages ago, being a web editor and all. No matter how great a piece of information is, and how organised it is communicated from the top down, if the connector does not have a bond of trust with the intended audience, the audience will not bite.

Think of the number of useful leads we had in the past that our mainstream counterparts might have missed, simply because we have no ideal platform for the conversation to take place between us. And because we don’t go out enough to see our colleagues in the mainstream media.

Hopefully, the new Clinica website, soon to be launched, will realise its 2.0 potentials. But for now, we will make do with this blog.

If you are interested to learn more about the effects of asbestos and the nature of the lung diseases associated with it, you might want to check out the latest papers published by our sister publication, Critical Reviews in Toxicology:

To hear our toxicology podcasts, visit http://www.toxicast.com/

Patient "elated" with retinal transplant

2008-08-13T16:17:00.008+01:00

"I saw nothing but shadow."
Podcast (0:22 min)
Photo: Rakesh Ahuja

Following recent positive results with an experimental retinal transplant using cells taken from aborted foetuses, Madeleine Armstrong spoke to Elizabeth Bryant, one of the patients who received the treatment.

Ms Bryant suffers from retinitis pigmentosa, a genetic eye condition which leads to progressive loss of vision and, eventually, blindness.

"No complications whatsoever."
Podcast (0:46 min)
Photo: Lasik Eye Correction

The phase II trial found that seven out of 10 patients with either retinitis pigmentosa or age-related macular degeneration had improved vision, although their eyesight was still short of normal. The lead investigator, Dr Norman Radtke of the University of Louisville, Kentucky, warned against over-hyping the transplant, but it was clear that Ms Bryant was very happy with the results of her operation. Dr Radtke described her as the biggest success story of the trial.

"Before the transplant…I saw nothing but shadow. Now I see objects," she said.

"I'm back."
Podcast (0:29 min)
Photo: Eyebank Kerala

When asked if she was glad that she had the transplant, Ms Bryant exclaimed: "Oh my gosh, yes." She said that she would think about having the transplant in her other eye, adding, "I haven't had any type of complication with it whatsoever."

Activities she can now carry out that she was unable to do before the transplant include writing cheques, sewing, crocheting and reading. Ms Bryant explained that before the transplant, she had problems recognising people, including her husband, but this was no longer a problem. "I'm back now doing the things that I used to do," she said.

"If I had to do it over, I'd do it again."
Podcast (0:28 min)
Photo: kentuckylasik

She continued: "I'm just elated. If I had to do it over, I'd do it again, and I would definitely have the other one done." She concluded: "I just feel like God has blessed me."

For the full story, please see Clinica No 1317, p 17.

Sausage dog blindness gene could help human research

2008-08-12T09:58:00.003+01:00

Photo: Dr Frode Lingaas, Norwegian School of Veterinary Science, Oslo, Norway

Researchers have found a genetic mutation that causes blindness in daschunds that could be used for research into inherited human forms of the disorder.

The mutation, in the NPHP4 gene, could be a candidate for human patients with eye diseases like cone-rod dystrophies. These disorders are caused by progressive loss of cells in the retina, and early symptoms often include "day blindness", or sensitivity to bright lights. Later, full vision loss can occur.

Daschunds are particularly prone to similar conditions, and inherited vision disorders are more common in dogs in general. The scientists, led by Dr Frode Lingaas of the Norwegian School of Veterinary Science in Oslo, found that a portion of the gene was deleted in affected daschunds.

The findings could help scientists understand cone-rod dystrophies better, and even lead to new treatments, including gene therapy.

The NPHP4 gene has previously been associated with a combination of kidney and eye disease in humans. The newly-discovered mutation only affects the eyes, so could be present in humans who only have eye disease.

"Hands off" approach for neurosurgery imaging

2008-08-11T10:46:00.002+01:00

Researchers developed a system that recognises hand gestures rather than keyboard or mouse commands. The technology, called Gestix, has been tested by neurosurgeons and could enable them to remain sterile during an operation.

Neurosurgeons use MRI or CT images during craniotomies, operations where part of the skull is removed to access the brain. Sometimes they need to use a different sequence or series of images, but changing these on a computer means they need to go through the time-consuming process of getting scrubbed again afterwards.

The tests show that using Gestix saved around 35-40 minutes, which is almost half the time needed for the total procedure. This could be reduced even more once a surgeon gets used to the system.

Gestix was developed by the Washington Hospital Center in the US and Ben-Gurion University of the Nege in Be'er Sheva, Israel. The system is designed to respond to natural, intuitive gestures like a rotational movement (like turning a knob) or left/right/up/down gestures like turning pages in a book.

Siemens' colourful mammography system

2008-07-28T14:39:00.004+01:00

The Dali Universe on London's Southbank was certainly an impressive setting for Siemens Healthcare's latest UK launches.

Outlines of the new ultrasound, the Acuson S2000, and Mammomat Inspiration mammography system, hulking under dark shrouds, didn't look out of place among Salvador's surreal sculptures, sketches and paintings.

As their coverings were whipped off to reveal the machines underneath, visitors crowded around for a close-up look. The company's spokespeople were keen to talk up their benefits, such as the Inspiration's speed and low radiation dose, which can be adjusted according to breast size and tissue type.

However, the most immediately striking thing about the Inspiration was the hypnotic light display at the back of the system, which Siemens calls MoodLight. It changed through a whole spectrum of colours, but apparently mammographers can choose different tones or just one colour.

Siemens said it had added this feature after talking to practitioners, and that the coloured light was designed to provide a more comfortable screening environment for patients and promote relaxation. But it begs the question: is this just a gimmick? Or is it something that patients really will find valuable?

Remote-controlled mannequin to aid healthcare training

2008-07-22T14:02:00.003+01:00

Healthcare training has been taken to a new level with the introduction of iStan, a wireless, portable mannequin designed to talk, sweat, bleed, vomit and have a heart attack. The product, which costs around £40,000 ($80,000), is the world’s first wireless patient simulator, according to its creators at the University of Portsmouth in the UK.

The product is a distant relative of the training mannequin Resus Annie and of similar technology that was used on the TV programme ER. It has been designed “inside out” so that it resembles a human skeleton and mimics all of its anatomical characteristics. It can be remote-controlled from up to 50 feet, allowing it to be taken to large teaching area for demonstrations.

Despite being named after “standard man”, iStan can in fact be a pregnant female or a child. Other features of the technology include:

* blood and body fluids pre-filled
* realistic skin for sweat and goosebumps effect
* eyes are designed to blink, dilate and cry
* lungs can collapse
* blood pressure can fall

And to cap it off, suppliers of iStan have an online recipe book for customers to brew up their own realistic bodily fluids.

Cook's modular AAA graft an "engineering achievement"

2008-07-18T16:45:00.011+01:00

An updated modular stent graft for the treatment of abdominal aortic aneurysms is to be launched in Europe by Cook Medical. The graft incorporates "legs" – shorter stents that unite with the main graft and seal the device below the aortic bifurcation.

The Zenith AAA Flex Legs are additional devices designed to be implanted along with Cook's main Zenith AAA graft. John Foster, product manager for Flex Legs, told Clinica: "These legs are used in conjunction with the Zenith triple-A device; it’s a modular system. There are three pieces that are used with the Zenith main body...which is an existing product. We add on two legs to complete the device."

The firm said that the device "represents the highest order of engineering achievement in the pursuit of improved outcomes for patients."

Mr Foster explained that design of the legs has recently been improved. "One, it’s a change to the delivery system that's used, which we're now calling the Z-track delivery system," he said. "We're also changing a little bit of the geometry of the legs, to increase or improve the flexibility of the device, which allows it to better accommodate more tortuous vessels."

US launch "this fall"

He added: "The change to the legs was really pretty simple, but it's amazing how much difference it makes. We've shortened the stents by about 2mm, and that increases the gap between each stent, giving the overall device much more flexibility."

Like the Zenith Flex main body, the legs are made of polyester graft material supported by stainless steel Z-stent bodies. Bloomington, Indiana-based Cook said that it expects to trial "an even more advanced leg system" for minimally-invasive endovascular aneurysm repair (EVAR) "in the near future".

The product was CE marked for sale in Europe on May 19 2008, and is set to hit the European market by the end of this month. In relation to US marketing efforts for Zenith Flex Legs, Mr Foster said Cook expects to make an announcement about FDA approval "relatively soon", adding that "the intent is to launch it [in the US] this fall."

Genetic link: Africa and HIV

2008-07-18T12:31:00.011+01:00

A genetic variant that is common in African people has been shown to increase vulnerability to HIV by 40%.

The variation was in the Duffy antigen receptor for chemokines (DARC) gene. The receptor is expressed on red blood cells, as well as vascular endothelial and neuronal cells, and influences levels of chemokines, which are involved in inflammation and the immune response. DARC could therefore modulate levels of HIV-suppressive chemokines and inflammation seen during HIV.

A study published in Cell Host and Microbe found that DARC-negative African-Americans had a 40% increase in the odds of acquiring HIV-1. The variation is found in around 60-70% of African-Americans, and around 90% of Africans.

It also confers resistance to Plasmodium vivax malaria, which could explain why there are such high levels of the variant in Africa.

It is not known whether the variation also increases the risk of HIV infection in African people, but the researchers think this is likely. They extrapolated their findings to estimate that approximately 11% of the HIV-1 burden in Africa may be linked to the polymorphism.

Perhaps strangely, the variant also slowed the progression of HIV – people who carried it survived an average of two years longer than those without it.

The reasons for these results are unclear, but the researchers believe that there is likely to be a complex relationship between DARC, chemokine and virus levels.

This could help explain why HIV and AIDS are so prevalent in sub-Saharan Africa. Although it is often assumed that the high incidence is down to promiscuity or differences in sexual behaviour, the new research suggests this might not be the whole story.

Tomatoes as a medical device?

2008-07-10T13:04:00.005+01:00

You say tomato, I say medical device

When is a tomato a medical device? When it is acting as a delivery mechanism for an oral Alzheimer's disease vaccine.

That is the hope of Korean researchers, who have tried out the technology in mice. They inserted the beta-amyloid gene into the tomato genome, and gave the mice the transgenic tomatoes once a week for three weeks, with a booster seven weeks after the first dose. They then measured the immune response.

The investigators, from the Korean Research Institute of Bioscience and Biotechnology, Korean firm Digital Biotech and Wonkwang University, Iksan, South Korea said that blood analyses showed a strong immune response and production of antibodies to the foreign protein. However, there was no reduction of existing amyloid plaques. The team still believe it could be a unique approach to producing a vaccine, and are currently working on increasing its potency.

Beta-amyloid accumulates in amyloid plaques in Alzheimer's patients' brains, and are thought to contribute to the disease. Many experimental therapies aim to decrease the amount of beta-amyloid, which it is hoped will address the underlying causes of the disorder. However, they have not enjoyed much success so far.

The researchers chose tomatoes as they can be eaten without heat treatment, which could destroy the immune effects of the foreign protein.

Healthcare outsourcing - a cure for all ills?

2008-07-07T16:15:00.004+01:00

UK resident Mohammad Zamir, a £50,000-a-year interpreter, has decided to fly abroad for treatment of a prolapsed disc and plans to claim compensation for loss of earnings due to delayed treatment from the NHS. Should this be taken as a warning of things to come unless the NHS gets its act together on innovation funding and management?

Mr Zamir has been out of work for six months and is suffering debilitating side-effects from the course of 28 drugs to manage his painful condition. Although his NHS surgeon promised an epidural and pain management programme "as soon as possible", newspaper reports claim that he has heard nothing on this promise for over a month.

Outsourcing makes sense on many levels
By opting to go abroad for care, Mr Zamir is tapping into a solution – healthcare outsourcing - that has been gaining mainstream popularity among opinion leaders in Europe and the US.

More popularly known as "medical tourism" - because treatment packages include holiday-type tours of the host country - the opportunities are already being exploited by thousands of patients worldwide, particularly in the cosmetic surgery segment.

Backers of the concept say it makes sense at several levels, including: low cost (treatments at destinations such as India, Thailand and Korea cost a fraction of what they cost in Europe or the US); relief for overburdened developed country healthcare systems; end of "brain drain" of medical professionals from developing countries; and investment into the healthcare systems of developing economies.

Loss of wellbeing also costly
Healthcare outsourcing would also reduce the economic consequences of psychological ill-health. The UK is already facing a significant burden of people with mental health issues that are keeping them out of work and on incapacity benefits. Patients awaiting medical treatment and suffering debilitating physical conditions will swell this group. Patients' isolation from the outside world and anxiety about their future and that of their families make this a highly probable scenario.

Could suicidality test eventually be used outside drug trials?

2008-06-30T09:11:00.002+01:00

The news that eResearch Technology has launched its EXPeRT ePRO Suicidality Monitoring System (SMS) for use in clinical drug trials begs the question of whether this is the sort of device that could one day have more general use.

It seems clear that such a test is needed for new drugs, with a growing number of them being linked with suicidality – suicidal thinking or behaviour. These include anti-epileptics, antipsychotics, antidepressants (with GlaxoSmithKline's Paxil and Pfizer's Zoloft high-profile cases), Merck & Co's asthma medication Singulair, Pfizer's smoking cessation therapy Chantix, and Sanofi-Aventis's anti-obesity drug rimonabant.

eResearch said its test improved the quality of suicidality assessments compared with those performed by physicians alone, as patients are more likely to disclose sensitive information to a computer rather than another person.

The SMS also "comprehensively and consistently covers every relevant topic while efficiently branching around irrelevant questions", the company said. It believes that its use will become an integral part of the drug development process, just as ECGs to assess cardiac safety have become essential in drug trials.

But could it also be used to assess suicide risk in the general population?

With suicide ranked by the World Health Organization as the 12th leading cause of death worldwide, and with global annual suicides predicted to rise to 1.5m by 2020, maybe the idea isn't so far fetched not so far-fetched.

UK focus: On the vultures and ostriches of the new NHS

2008-06-23T15:05:00.013+01:00

As the reforms of the NHS are about to be unveiled, our lead story this week conceals a timely lesson.

The reason for reporting what has transpired in the Palace of Westminster in London is not what has happened, but what has not – and what is yet to come in terms of healthcare needs.

It is not about what we know in terms of the presence of asbestos over long periods at the Palace, but what we cannot be sure of yet, in terms of scale and response; not about what we can and should address right now, but about what cannot yet be quantified.

Yet, in the UK's new NHS, the current restructuring of services into neat packages – contracts for medical imaging, pathology, minor surgery and so on – needs some time to be put to the test, also to better quantify the demand.

But what of the long-known UK service needs that are not being met, despite the best-practice evidence and national service frameworks (NSFs) to address them? Clinica regularly bangs the drum over regulatory and service-related omissions. But the question remains: Why the delays in adopting best practice?

I recently put that question to UK health secretary Alan Johnson, citing the delay in screening for colorectal cancer and for abdominal aortic aneurysm. He retorted that I should see the glass as being "three-quarters full, instead of three-quarters empty"; that the UK will be a world pioneer with its bowel cancer programme – once the pilots help establish it.

That's all very well. But in the meantime, more than 2,000 (16%) of the 16,000 people who die every year in the UK from bowel cancer could be saved by screening for the disease. That's not Clinica saying it: it is what NHS Cancer Screening Programmes concluded in 2001 after two years of pilots that, already then, were deemed to demonstrate clinical and cost-effectiveness.

Earlier this year, health minister Lord Darzi suggested to me that the delay was due to problems of low and patchy uptake. In that case, is not a need to drive public awareness the answer?

A few years ago, at a time of heightened financial pressure across the NHS, Clinica was given a different reason: that the NHS needed to have the appropriate follow-up diagnostic capacity in place (primarily colonoscopy for confirmatory diagnosis). At the time, the programme was said to need a £25m annual investment.

But now, with the announcement this month that the NHS has a surplus of £1.66bn ($3.25bn) – artificially reduced by a late surge in spending – budgetary pressures should no longer justify any cost-cutting that is at the expense of healthcare need.

Which leaves the question: Why are the strategies that are being lined up for the new NHS taking so long to define – let alone deliver? Is it to court the private sector? Are these services awaiting the establishment of "marketised" service commissioning contracts, which in turn depend on earmarked funding or book-balancing guarantees, as well as an estimation of clinical need to set throughput targets, and so on?

It seems to be the only logical answer. If so, we can only hope that the new players – vultures and ostriches among them – of this new panorama all recognise the complex and evolving demands that will be made of this packaged NHS, and just how important the role of medtech is in meeting them.

The masthead of the UK Guardian newspaper's June 18 supplement on the "new directions for the NHS" featured a PCT chairwoman beaming at the prospect of having a "health service that is the best in the world, as well as being perceived as such".

And there is the point: it's all about perception. Individuals and patients are aware of the services they do have, even if they cannot be sure of the best access to them.

But healthcare needs a culture of awareness of the best technologies and policies. In turn, that awareness, with a gentle nudge from the media, drives the political will – and funding – needed to implement them.

Clinica's lead story is not a finger-pointing exercise, but an insight into just how the demands on the NHS could well change over the coming decades, and why they must be addressed – if there is awareness of the universal benefits of doing so.

(This editorial was published in the June 20 issue of Clinica, in relation to the story "UK asbestos case resets lung diseases screening time bomb")

A victory for device and man

2008-06-11T09:40:00.005+01:00

Our congratulations are due to double amputee and South African athlete Oscar Pistorius who appealed against a ruling that could have prevented him competing in the Beijing Olympic Games.

For those of you who have not followed the story, Oscar Pistorius was told in January 2008 that his Cheetah Flex-Foot prosthetic legs, manufactured by Reykjavik, Iceland-based Ossur, were a “technical device” that gave him an advantage over other athletes not using such a device. Consequently, the International Association of Athletics Federations (IAAF) said that he did not comply with conditions required to participate in the competitions held under IAAF rules.

On appeal, the Court of Arbitration for Sport said that the IAAF did not have sufficient evidence to show that Mr Pistorius did, in fact, have any metabolic advantage. The court’s panel noted that the Cheetah Flex-Foot prothesis has been in use for a decade, and yet no other runner using them, either a single amputee or a double amputee, has run times fast enough to compete effectively against able-bodied runners until Mr Pistorius had done so.

“In effect, these prior performances by other runners using the prothesis act as a control study of the benefits of the prosthesis and demonstrate that even if the prothesis provided an advantage…it may be quite limited,” the court said.

As well as Mr Pistorius, Ossur was delighted too. Jon Sigurdsson, president and CEO, said: “All the obstacles in his path have been swept away, and we will again have an opportunity to watch as this extraordinary young man changes how we perceive sport.”

New noninvasive gene test shows if you're a "lark" or an "owl"

2008-06-09T14:20:00.006+01:00

Late for work again? Now you can blame your genes.

Researchers at Swansea University, UK, have developed a noninvasive test which measures the activity of genes involved in circadian rhythms – the sleep-wake cycle. It does this by measuring RNA levels associated with these genes.

Swabs are taken from the inside of the cheek – previously blood samples were needed. The university is discussing developing an over-the-counter version of the test with pharmacy chain Boots.

The genes measured include Per2, which peaks at around 4am and is associated with sleep; and REV-ERB, which is associated with wakefulness and is highest at around 4pm. People who have peak REV-ERB activity earlier than 4pm are described by sleep scientists as "larks", while those with a peak after this time are classed as "owls". Similarly, those with a Per2 peak after 4am could find it more difficult getting out of bed in the morning.

Work is being done to see if the activity of these genes can be permanently altered by unnatural sleep patterns, such as in shift workers.

Other applications for the test include studying jet lag "cures" such as melatonin tablets, and attention-deficit hyperactivity disorder (ADHD), as differences in circadian rhythms have been associated with the disease. It could also be used in patients receiving chemotherapy, which might be more effective if given at certain times of day.

Pacemaker patients could be victims of a hack attack

2008-06-06T11:44:00.000+01:00

A Harvard cardiologist and a team of researchers at the University of Massachusetts have sent the heart rate of pacemaker patients racing, after they successfully hacked into an implantable defibrillator last month.

Dr William Maisel and the research team confirmed concerns in the US that devices such as ICDs, neurostimulators and drug pumps, are susceptible to attack from criminals.

Outside intrusion into the device could give a patient irregular shocks. However, Dr Maisel told US newspaper Baltimore Sun: “This is not an important risk for patients right now. We just want the industry to be thoughtful about where we as a society are going with these devices.”

These words may be little comfort to the thousands of people with pacemakers, who must still be nervous after a study in Michigan last year found that iPods could also interfere with the devices and cause malfunction.

Squeaky hip implants haunting Stryker?

2008-05-30T14:52:00.003+01:00

In January, Clinica reported that orthopaedic implant specialist Stryker had recalled its Trident PSL and hemispherical acetabular hip implants after reports of “squeaking” coming from the products.

Claims of dubious noises ranging from “squeaking” to “grinding, crunching and screeching” led to US FDA scrutiny and, in turn, an internal investigation by Stryker (see Clinica No 1291, p 10).

That was January, but now Stryker’s problem has reared its head again in the shape of an article in the New York Times titled “That must be Bob. I hear his new hip squeaking”. This, combined with the fact unhappy customers are posting videos on YouTube displaying the offending hips, shows that problems with the implants have not gone away.

Stryker’s share price has dropped by around 17% from $74.53 at the beginning of 2008 to $62.12 at the close of markets on May 23.

Earlier this month, Stryker cut its revenue forecast for 2008 after reporting that it was expecting a lower volume of hip replacement procedures this year than previously forecast. The company said that it would not be ordering any Cormet hip resurfacing implants from its UK partner Corin until December.

Corin blamed delays in surgeon training during Q1 2008, however, the squeaky hip implants will not have helped Kalamazoo, Michigan-based Stryker.

Could imaging via mobile phones increase access in the developing world?

2008-05-21T09:55:00.008+01:00

Researchers have developed a way of processing images via mobile phones, which they say could reduce costs and increase access, especially in the developing world.

They point out that in developing countries the use of imaging systems is limited by their high cost and the need for experienced users to operate and maintain them. However, mobile phone use in these countries is high, "because so little infrastructure is required to maintain wireless networks". In fact, it is estimated that over 60% of mobile phone usage is in developing countries.

The scientists, from the Hebrew University of Jerusalem and the University of California, Berkeley, used electrical impedance tomography (EIT) to image a simulated breast tumour (a gel-filled container). The raw data were collected at the patient site, and the measurements uploaded to a mobile phone and sent to a central facility for processing. The resulting image of the simulated tumour could be viewed on a mobile phone.

The group said that the system should work with any mobile phone capable of sending and receiving multimedia messages. The tool used to collect the data was made from off-the-shelf components and the researchers said it could be operated by someone with basic technical training.

Prof Boris Rubinsky, the lead investigator, believes the concept could also be valuable for developed nations. "It could be worthwhile to consider this as a way of reducing the cost of medical imaging," he said.

The "Booty Buster"

2008-05-20T15:56:00.006+01:00

While we'd all like rock-hard abs, the enduring popularity of those belts that electronically stimulate your abdominal muscles proves that we're not so keen on the rigorous exercise regimens needed to achieve them.

A new device invented by two Hampshire, UK sisters and developed with help from the University of Portsmouth could provide a new approach. The "Booty Buster" is shaped like a wok, with an unstable base that forces you to work your stomach muscles as you sit on it. It also massages the bottom and thighs to target cellulite.

The sports scientists at the university tested it using electromyography, using small electrodes on the skin which pick up the electrical activity of the muscle underneath. Apparently, it showed more muscle activity than other devices on the market for exercising core stability.

While not exactly a medical device, anything that could help combat the oncoming "obesity epidemic" can't be bad.

MRI detects source of "booze rage"

2008-05-06T12:12:00.002+01:00

Trouble brewing: Alcohol might encourage Dutch courage by damping down the regions of the brain that detect threatening stimuli
Photo: Lukas Zeman

Ever wondered why people get more aggressive after a few pints? It turns out that alcohol damps down the regions of the brain that detect threatening stimuli.

This lack of anxiety means that people are more likely to make risky decisions, and could fail to avoid an argument or a fight. On a more positive note, it could make us less worried about chatting to new people.

Scientists at the National Institute on Alcohol Abuse and Alcoholism in Maryland gave 12 volunteers either alcohol or placebo over two 45-minute periods. They showed them photos of people with frightened facial expressions, and measured their brain activity using MRI.

Patients receiving placebo had increased activity in the amygdala, insula and parahippocampal gyrus when they saw the photos, but those receiving alcohol did now show much enhanced activity. These areas have previously been identified as important in fear.

The investigators also found that alcohol stimulated striatal areas of the brain, which are involved in feeling rewarded.

So, next time you're in the pub and someone tries to pick a fight with you, you'll know why … you might not want to point that out to them, though.

Brittle ortho shares set for big surge?

2008-04-30T15:19:00.011+01:00

So far, it seems as if 2008 might be a difficult year for publicly-listed orthopaedic firms. Since the beginning of this year, orthopaedic specialists such as Orthofix, Orthovita and OrthoLogix have all seen their shares fall in value considerably, while the larger companies have also struggled.

The stock value of Orthofix has almost halved - it began 2008 at $58 per share and now resides at around $30. Orthovita and OrthoLogix’s shares have dropped ominously low, $2.33 and $0.97 respectively (at the close of markets on April 28).

The big players in the market have not fared spectacularly either. While Smith & Nephew and Zimmer performed admirably, Stryker, Wright Medical and Corin were unable to match their rivals. Shares in Corin have tumbled 19% during 2008 to 459.50p on the LSE, Stryker has dipped 16% to $64.30 on the Nasdaq, while Wright Medical managed to lose $5 off its share price before recovering to a 1% loss at $28.81 per share. Although Medtronic witnessed a small gain in its share price this year, this came after it navigated a substantial dip in its value.

However, if the Financial Times is anything to go by, the orthopaedic companies are set for a bright future and it would be worthwhile for investors in this space to hold on to their shares. An editorial in a recent issue stated that “the huge baby boom generation is developing creaky joints and new products aimed at early intervention could expand the customer base”.

The FT points out that the orthopaedic market had $32bn in sales during 2007, and is expected to grow by 10% annually over the next three years - suggesting that the recent performance by ortho firms is merely a trough before a more considerable high.

Medical miracles?

2008-04-25T15:53:00.008+01:00

Here’s a faith-restoring story. Keith White, a churchgoer at Immaculate Heart of Mary Church in Cincinnati, Ohio was dancing with his wife at the 60th anniversary celebrations of the parish when he suffered a cardiac arrest. The other parishioners quickly gathered around him, and their actions saved his life. Was this a case of miracle healing? Maybe, maybe not. Mr White’s life was saved by parishioners using Defibtech’s Automated External Defibrillator (AED), mentioned in a previous blog, that the parish had at its disposal. Surely, then, one would see this as a clear case of medical rather than divine intervention - until we learn that the AED had been donated to the church anonymously, just ten days earlier.

Churches have been the scenes of numerous defibrillator life-saves in the US and their installations do not appear to be ruffling the feathers of worshippers who believe in the power of spiritual healing. Pope Benedict XVI, no less, personally accepted the gift of a Defibtech AED at the Vatican on April 17. "He was genuinely interested and immediately grasped how a defibrillator can save lives," said Defibtech’s president Gintaras Vaisnys, who presented the pontiff with the device.

First implantation of a "bionic" eye

2008-04-25T14:51:00.010+01:00

News of the first implantation of a "bionic" eye that allows retinal disease patients to see again hit the headlines this week. Tina Tan, business editor of Clinica, was interviewed by Sky News and commented on the driving forces behind technological advances in medical devices and how healthcare providers respond to these innovations.

Diagnostics key to the "nichebuster" era

2008-04-22T17:13:00.002+01:00

The era of the blockbuster drug could soon be over.

"People are already talking about nichebusters," said Hans-Juergen Arens of Abbott at last week's Imaging in Oncology conference in London.

Diagnostics will be vital in the "nichebuster" era. "For targeted therapies, you need targeted diagnostics," Dr Arens added in his talk about "theranostics", which he described as "the marriage of drug therapy and diagnostics". He said that its goal was to be able to perform a diagnostic test that aids in the selection of patients and can monitor the biological effects of a drug therapy.

Although targeted therapies only account for a small share of the current oncology market, they make up two thirds of compounds in clinical development. The proportion in preclinical studies is even higher.

A reason for this could be that current, "traditional" therapies using a "one size fits all" approach are not very effective - as low as 25% in oncology, while other areas such as Alzheimer's disease and asthma also have lower rates than you might expect.

Also, being able to use biomarkers to test the efficacy of drugs earlier in clinical trials could cut down the time and money wasted continuing the development of duds. 70% of all drug development projects are discontinued because of low efficacy or tolerability, Dr Arens said, adding that a 10% improvement in predicting phase III failures could lead to savings of $112 million.

Several cancer therapies already use the theranostic approach, including Roche/Genentech's Herceptin (trastuzumab) and GlaxoSmithKline's Tykerb (lapatinib). Both target HER-2-overexpressing breast cancer, and Tykerb also inhibits the epidermal growth factor receptor (EGFR). HER-2 status is measured using immunohistochemistry (ICH) or fluorescence in situ hybridisation (FISH). However, problems can arise when patients are diagnosed as HER-2-positive when they are in fact negative, or vice versa. False negatives can deny patients life-extending treatment while false positives can give them false hope and also lead to patients receiving an expensive drug without any benefit, said Dr Arens, emphasising how important it is that diagnostic techniques are properly applied.

Theranostics are also used in HIV therapy, for example Pfizer's CCR5 inhibitor maraviroc (Selzentry/Celsentri), which employs Monogram Biosciences' Trofile assay to identify patients with CCR5-tropic HIV-1, who are likely to respond to the drug. GSK's antiretroviral Ziagen (abacavir) causes a hypersensitivity reaction in HLA-B*5701-positive patients (5-9% of people receiving the drug), so they have to be tested for this first. It is also possible to test treatment-naive HIV patients for resistance to antiretroviral therapy - the prevalence of resistance in these patients in the US and Europe has been estimated at around 10%.

"Prevention and managing disease will truly become a topic of the future," says Dr Arens. Here, the medical devices and diagnostic industry clearly has a large role to play.

Spain's vCJD medtech policy - neglectful or measured?

2008-04-21T15:48:00.005+01:00

How effective can Spain's surgery instrument reuse and blood screening policies be in terms of protecting from the risk of prion protein transmission?

Following the announcement of two new cases of variant Creutzfeldt-Jakob disease (vCJD), the health ministry says it has "exhaustive measures" in place to ensure the public is protected.

But, given that the controls are related only to animal feed and human foodstuffs, backed by low-key assurances that regional encephalopathy monitoring activities are adequate (and that transmission in the latest cases must have predated the control measures), the question is inevitable.

The government says it has worked with the UK in establishing these measures. But in the UK, device reuse and screening policies surrounding the highest-risk surgical procedures and blood transfusion remain as high a priority as they have ever been in allowing for any level of latent encephalopathy infectivity among the population.

The difference in official case numbers – 163 in the UK, versus three in Spain (the first was in 2005) – does not appear to justify the difference in perspective.

"Cakehole surgery" removes man's appendix

2008-04-17T11:12:00.006+01:00

You've heard of keyhole surgery, now there's "cakehole surgery"; American Jeff Scholz has just had his appendix removed via his mouth. Doctors say that the new procedure, although still in its early days, could cut recovery time, reduce scarring and pain, and decrease the risk of infections like MRSA. It could also expand the market for devices normally used for keyhole procedures.

Surgeons threaded instruments down Mr Scholz's throat, emptied his stomach and cut into its lining to remove the appendix, which was placed in a bag and pulled back up through his throat.

According to reports, the patient was discharged from hospital after only 17 hours and claimed to be back at work the next day.

Keyhole surgery, also known as laparoscopic surgery, involves smaller incisions than normal operations - for example, a patient's gallbladder can be removed through a 1cm incision at the navel. However, four incisions are needed in total for this procedure and patients usually have to stay in hospital for two to three days.

Most appendix removals are now carried out laparoscopically, but this still requires three incisions through the abdomen wall, whereas the latest operation just needed one incision in the belly button to insert a camera, according to lead surgeon Professor Santiago Horgan.

The group at the University of California, San Diego, plans to carry out one more "cakehole" procedure before starting a pilot study. Diseased gallbladders have also been removed in a similar way via the mouth or vagina.

The main concern with the new technique is that stomach juices could leak out if the hole is not properly closed, which could lead to life-threatening complications. This aside, it could be a safer and less painful procedure than other surgeries. Mr Scholz described his operation as a "cakewalk".