Pioneering Ideas

The Rise of Community Acquired MRSA

Yesterday the Journal of Emerging Infectious Diseases published a study detailing a rising health threat from of both types of drug-resistant staph inside U.S. hospitals.

 

Part of a project to fight antibiotic resistance called Extending the Cure, and funded by the Pioneer Portfolio, the study found a seven-fold increase in the proportion of "community-associated" strains of MRSA in outpatient hospital units between 1999 and 2006. "This emerging epidemic of community-associated MRSA strains appears to add to the already high MRSA burden in hospitals," said Ramanan Laxminarayan, Principal Investigator for Extending the Cure.

 

This study, which will help prompt researchers to find new ways to quickly test for various strains of MRSA and treat accordingly, has been getting a lot of press attention -- which is a good thing. We encourage you to check out the article and coverage at NPR’s Health Blog and let us know what you think about the study findings.   

 

If you are interested in seeing what else Extending the Cure is working on, make sure to check out their blog and twitter account.   

 

Dr. David Eddy’s Vision for the Future of Medicine

“Whether Eddy will get a Nobel Prize, I’m not sure. But he’s certainly changing how we think about health care.” – Dr. Lynn Etheredge, Director of Health Insurance Reform Project at George Washington University and Pioneer grantee, on Dr. David Eddy

 

We encourage you to read “Modeling Human Drug Trials – Without the Human,” a profile of Pioneer grantee Dr. David Eddy and Archimedes, his mathematical model of human physiology, diseases, interventions and health care systems. Featured in the December issue of Wired and authored by Jennifer Kahn, the article explains that Archimedes is part of Eddy’s “vision for the future of medicine: faster, cheaper, broader, clinical trials — all happening inside a machine.” While clinical trials are still required to test the safety and effectiveness of new medications, Archimedes — which Eddy has spent more than a decade developing — recreates aspects of diseases not readily measurable by researchers and turns out results at a much faster rate, and for far less money.

Pioneer is currently supporting Dr. Eddy to develop and launch ARCHeS, a powerful Web-based interface that gets a brief mention in the article. As Kahn writes, ARCHeS “will allow doctors, policymakers and researchers to access Archimedes and design their own trials.” By doing so, Pioneer aims to ensure that health officials can attain a better understanding of the implications of their decisions before making recommendations for patient care, not only advancing disease treatments but also curbing unnecessary health care costs for patients. ARCHeS will not be a database of answers, but an evidence-based tool that can be used to find answers.

Dr. Eddy will be visiting with us at the Robert Wood Johnson Foundation in early December to share a beta version of ARCHeS and we’ll, in turn, share highlights from his presentation via the Pioneer Twitter account. We hope you’ll follow.

In the meantime, tell us what you think of the article. We’ll be monitoring blogs and tweets that write about the piece and sharing them here later in the week.

Time for New Behavior Change Models and All Things Neuro

We had a really interesting meeting.  It was provocative and wide-ranging; I can’t begin to do it justice in the format of a blog.  Look for a more thoughtful and informative report in the weeks to come.  Also, we’ll work to set up an on-line space where people who are interested in these questions can come together.  In the meantime, here are just a few ideas and thoughts to come out of the meeting:

 

Do we need a next-generation model for behavior change?  The models we have for behavior change have enabled impressive gains and powerful programs, but they were largely developed 20 years ago when our ability to understand what is going on inside someone’s brain was much less developed.  Technology that didn’t exist 20 years ago provides a much more detailed picture of what influences decision and behavior, enough of a new picture that it may be time to re-evaluate our current models of behavior change.

 

Watch for increased use of the prefix “neuro.”  There’s neurotech, neuroplasticity, neuromodulation.  There’s neuroimaging, neuro-oncology, neurogenetics. and neurofeedback.  But when you seek to understand an experience at the neurological level—and you have the technology to do it—you can go anywhere: neuroaesthetics takes a scientific approach to understand perceptions of art and music.  At the other end, look for increased use of the suffix “ceuticals.”  We heard about the possibility of cognoceuticals that improve people’s capacity to learn (This has been happening for years, caffeine and nicotine, for example.  For five or six years now, there’s been the occasional story about use of Ritalin and Adderall as study aids.); emotoceuticals that could in a much more targeted way address emotional disorders or enhance certain emotional states; and, sense-ceuticals that could improve your sense of smell, touch, hearing.

Finally, monitoring your brain’s wellness could become a new responsibility for primary care providers.

What We Are Reading: Flu Season and Antibiotic Overprescription

In the past we’ve talked about the work Extending the Cure, a Pioneer grantee, has done on hospital-acquired infections and antibiotic resistance. However, with the flu, in particular H1N1, on everyone’s mind right now – ETC’s recent brief on the link between flu and antibiotic prescriptions couldn’t be timelier.

 

According to ETC, “from 1995 through 2002, 26 percent of patients—just over one-quarter of them—who were diagnosed with flu were prescribed antibiotics… simple math translates that into 500,000 to 1 million antibiotic prescriptions every year with no possible benefit to patients.”  It leaves us wondering what role antibiotic resistance may play in this year’s flu season. Check out the brief and then come back here and let us know what you think.  

 

If you are interested in reading more from Extending the Cure, check out their blog and twitter.

Darwin Labarthe Lecture: Cardiovascular Disease Prevention

Next up from the Penn Positive Health Lecture Series is a talk by Dr. Darwin Labarthe on cardiovascular disease prevention. As part of his lecture, Dr. Labarthe will explore the contributions that new prevention strategies, social determinants of health and positive health may play in cardiovascular disease prevention.

Dr. Labarthe is the Director of the Division for Heart Disease and Stroke Prevention in the National Center for Chronic Disease Prevention and Health Promotion at the CDC. The second edition of is text, Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge, will be released in March 2010.

The lecture series is part of the Positive Health project which is funded by the Pioneer Portfolio and led by Dr. Martin Seligman of the Positive Psychology Center at the University of Pennsylvania.

If you have the opportunity to attend we'd love for you to share your thoughts.

Here are the details

Date - Wednesday, November 11, 2009

Time - 12:00 - 1:00 p.m.

Location - Dunlop Auditorium, which is in Stemmler Hall at the University of Pennsylvania School of Medicine, Philadelphia

Free and Open to the Public

TEDMED, 23andMe and Kaiser Permanente's RPGEH

Excitement about the power of genomics was palpable at TEDMED this year as some attendees lined up to spit in DNA vials and send it off to 23andME. Unfortunately, many may be disappointed to find out how little our genomes can tell us without research that a large population-based research program, such as we are helping to build at Kaiser Permanente, can provide. Ann Wojcicki, CEO and founder of 23andMe, stated from TEDMED stage that Kaiser Permanente plans to genotype the DNA of 100K members but does not plan to provide that information to the individuals who donated their DNA, implying that valuable information was being withheld.

We asked Cathy Schaefer, executive director of the Kaiser Permanente Research Program on Genes, Environment and Health (RPGEH), to respond.

The RPGEH is designed to conduct research on populations to improve health and medical care. The information collected, including the genotyping of 100,000 individuals for our NIH-funded grant, will enable researchers to conduct population-based research that may help them understand the genetic and environmental basis of disease, treatment response, and health.

We inform all participants about the purpose of collecting genetic and other information, and they volunteer to participate — at no cost to them — to facilitate this research, knowing their individual results will not be returned to them and that all data about them will be "de-identified." We also inform participants that if we discover something in their data or samples that may be important to their health, we will contact them to learn if they want to have the information. 

Why doesn't the RPGEH restructure so that it can return results to individuals? Because genetic information obtained through today's genome-wide studies has not been designed to be useful to individuals; it is designed for use in research. In most cases, it isn’t known whether the variants tested for are actually implicated in a disease process, or are markers for variants that play a role in disease, and results from these tests are rarely actionable.

Ann Wojcicki from 23andMe misspoke at last week’s TEDMED gathering when she said that Kaiser Permanente does not return genetic results. Kaiser Permanente Health Plan members have access to genetic testing as part of their Health Plan membership and through their physicians. Kaiser Permanente physicians order genetic testing and return genetic results to thousands of patients, for numerous conditions, when information that testing will provide could help to inform the patient’s health care, disease prevention, or future childbearing. For example, members with some cancers or HIV may have genetic testing to determine the most effective treatment. Couples considering pregnancy may also be tested to determine family histories for certain diseases that may be passed on to their children.  

Individuals who have questions about their genetic risks for various health conditions should talk to their physicians, who can provide useful information about risks and options for testing.

Health IT: What’s the Future?

I’ve just come back from the "Discovery and Innovation in Health IT" workshop. You can find more on the workshop’s web site.  You can also follow the twitter stream by using the #dihit hash tag.  This workshop pulled together about 100 people – mostly researchers from academia, government and corporate labs – to lay out the key health IT research challenges going forward.  I’ve attempted to summarize some of the key themes and points that were raised, but I’ve by no means captured it comprehensively and I’m certain that I’ve taken a lot of license in my interpretation – so please add your voices – I’d love to get other perspectives.

The workshop started with some tone-setting presentations that illustrated the gap between the potential of health IT and where we are now.  Zak Kohane, in a brief introduction, noted that back when he was a grad student (more than a few years ago), clinical decision support was said to be right around the corner and while it’s still not reached its promise, Apple’s managed to generate 86,000 apps in its app store, many of which focus on health, in less than a year.  “Why?” he asked.  Bill Stead, recapping the work he led for the National Research Council’s report on Computational Technology for Effective Health Care, laid out the challenge starkly, saying (and I’m paraphrasing) that the path we’re on with health IT will not solve the problems in our system and could even make them worse.  Most hospitals have implemented IT in ways that rate a 5 on a scale of 100, where 100 is ideal and the best are at 15-20, he went on.  Today’s health IT systems “chain us” to the realm of transactions not decisions and often focus on post-hoc documentation.  “Would you ever get into an airplane where the pilots go through the checklist after they’ve taken off?” he quipped.  He focused a lot on the need for cognitive support, showing a hockey stick graph of the number of facts that will be relevant to a given clinical decision over time (this theme reappeared several times over the two days).  The number is expected to reach 1000 by 2020, while the number of facts that a human can contemplate while making a decision remains stuck at um, five.

 

Other presentations, notably from Dietrich Stephan of Navigenics and Craig Feied from Microsoft, extrapolated from recent progress in genomics, proteomics and systems biology to sketch out a future of increasing precision in our understanding of diseases (hence the hockey stick of medical knowledge).  In these visions, the increasingly ability to subclassify diseases at the molecular level, to understand the biological processes that cause them and to design laser-like therapies to target them, leads to precision diagnoses, early detection and better understanding of which therapies will work and which won’t.

TEDMED 2009 = Innovation, Technology & Inspiring Stories

I really liked TEDMED. There was lots of wiz-bang new technology stuff – genetics, organ regeneration, ways to slow the aging process, wearable sensors that can monitor and wirelessly transmit data that traditionally required a person to be in a controlled environment with leads connected to multiple body locations. It’s really exciting to see what may be possible in a few short years. Of course, no one really talks about how long it will take, how real people will be able to use these gadgets and how they’ll be paid for.

 

There are also great stories of human accomplishments – either overcoming tremendous adversities to triumph or innovative and caring ways to help others. Every one of the presentations is worthy of commentary. In addition, it’s amazing to realize the number of incredibly smart people that were there. Not only are they smart but each has accomplished more than one might expect, even given their brain power. And many of them are truly nice and approachable.

 

For me the highlight of the event was Jamie Heywood talking about the Patients Like Me site. The reason for this is less that they are using some pretty impressive analyses but more that you have a platform where ordinary people can record their experiences with their conditions and treatments in a way that contributes to a shared and actionable understanding, without expert clinical intervention. The reality is that right now this helps each participant deal with her or his condition. In addition, it is beginning to yield data that can expand clinical knowledge faster and more broadly than traditional methods. Whether the scientific community can learn how to make use of that data seems to me a question of how open the professionals are to exploring nontraditional sources. I certainly hope they are.