ELISA test beaten by STEM high-schooler: when experience is overrated

Great story. High school freshman, Jack Andraka, develops a paper sensor for detection of blood proteins signaling some early stage cancers. Certain proteins get over-expressed in the blood for different cancers at early stages.  Tests categorized as ELISA (enzyme-linked immunosorbent assay) are part protocol for early cancer diagnostics. Jack’s discovery—now with the patent lawyers and Johns Hopkins—seems factors more efficient and accurate than ELISAs, the first of which was invented over 40 years ago.  For perspective, here’s how ELISA was celebrated only in 2006.

I note:

• Jack attends a public high school.
• Like the rest of us he was also “home-schooled”, i.e, he learned stuff at home.
• Jack did research outside the advantages, constraints, accoutrements and professional politics of a conventional research grant-based environment.
• Jack had supportive parents and teachers.
• He had fun.
• Jack seems personable, well-mannered, cordially and easily conversant with a balance of complexity and simplicity, and people seem to want to work with him. (TRANSLATION: Jack’s emotional IQ doesn’t appear inversely proportional to his conventional IQ.)
• Jack focused on a little part of a really big something.
• Jack is 15.

Much cancer work is on treatment. In conventional medicine—whose professional impulses in the grimmest cast mimic complacency if not a more honorable abject surrender—cancer is a given.  Oncology’s whole start. And in truth there are problems about which we know little to do and cancer’s surely among them. Viruses too. They stump us for similar reasons and it’s no coincidence we’ve cured neither.

But this  freshman is focusing on a small part of the story—proteomics and detection— upstream. Less of treatment and more of time. Because everything is a rate. And he’s  valuing the simple proposition of earlier diagnostics—plus better ones—as, yes, a prelude to earlier treatment.

Thinking about big problems can be daunting.  Cancer is big.  But the ability to focus on a little important piece is key.  It’s all science is.  But research tradition—even in the fine exploratory arena of a progressive Johns Hopkins lab—can sometimes obscure how legitimate little pieces look.  Some fruit, I fear, hangeth too low for view by the fanciest eyes.

A Yale management professor said it takes 10 years of doing something to become an expert—there are studies. Yes. It takes volume. And volume takes time. But that’s not the story, increasingly. First, whole industries now rise and die in 10 years. You won’t get that window to “master” in.  Secondly, you’re due to know something after 10 years, but a remaining question is whether it’s optimum. Lastly, even if you get to master something, your frequency of innovation over the course—e.g., Jack-style—is something else. And that’s business’ whole deal.

Quite opposite dismissing children because of youth or no volume, I particularly attend. I follow them on twitter. In science great questions and discovery, as Jack teaches, not only can come early before you’re a conventional expert and often seem to come in part because you’re not, but increasingly in a competitive world, they must.

Diddy’s Ciroc Vodka and the disproportionate marketing influence of African Americans

“My brand is rocket fuel. It would take this brand 10 years to get to where I can take it in one year.” –Sean “Diddy” Combs

Diddy signed a 2007 deal with Diageo PLC entitling him to a 50% stake in Ciroc Vodka.  Here’s how business has done since he signed, and for simple comparison, how the Air Jordan sneaker business did for the same period after Michael Jordan signed his famously successful shoe contract with Nike.  It’s a succinct graph but in both categories sales were either flat or growing unremarkably up to the contract:

It’s one of many new deals between the alcoholic beverage industry and proven influential lifestyle brands in industry moguls and icons.

In the March 2011 Forbes column “Why Diddy Will Be Hip-Hop’s First Billionaire” , Forbes staff noted:

“…Executives at Diageo could never have expected just how much Diddy’s presence would boost sales. In 2007 sleepy Ciroc was moving cases at a rate of 60,000 per six months, or 120,000 per year. In 2009 Diddy’s second year with the brand, Ciroc moved 400,000 cases. This year Ciroc is on pace to sell more than 1 million cases. The boom was fueled in large part by Diddy’s diligent shilling—on billboards, in lyrics, on Twitter and even through a self-proclaimed nickname, “Ciroc Obama.”

Diageo management framed Ciroc’s success after the Combs partnership:

“Only twice in my career have I seen an immediate response in our brand tracking”…“We saw it really take off in the African-American community, and it has started to broaden its appeal. Throughout the entire economic recession, it was one of the few brands that never slowed down.”… “As a community, African-Americans are leaders in terms of style, fashion and image,”…“They can take brands and make them very big themselves.”–Jim Mosely, Diageo Senior Vice-president for consumer planning 

Other examples of non-textbook breakthrough African American marketing influence can be found in industries of fashion and accessories, food and non-alcoholic beverages, fragrances, electronics, automobiles, and even travel.

Doctors abandoning evidence-based medicine. Again.

The New York Times reported today that a little medical device company, Biotronik, with 5% market share in pacemakers and defibrillators, is Big Daddy in one certain medical center (some of whose doctors it hired) with 95% market share.  And it got there in 3 years from 0% market share. Technically, that’s a growth rate of infinity. Many a firm is emboldened by 10%. This is a quick change of heart—devices. Plus clinical trial (all expenses paid).

Casualities in this story—at least 3:

• evidence-based medicine
• competition
• ethics

Health Reform Hits Main Street–KFF cool cartoon gives low-down

Narrated by Cokie Roberts and recommended by Risa Lavizzo-Mourey (current President of the Robert Wood Johnson Foundation, the nation’s largest healthcare philanthropy), this Kaiser Family Foundation animation aims to give a summary low-down on health reform.

following Illinois, tort reformers lose big in Georgia

The state Supreme Court of Georgia has unanimously ruled that a 2005 tort reform law imposing a $350,000 cap upon noneconomic damage awards—damages including a plaintiff’s pain and suffering—in medical malpractice cases is unconstitutional. The cap was framed as the “cornerstone of the state’s sweeping 2005 tort reform law.”

A court that is hardly deemed liberal upheld only last week in a 4-3 decision, another key provision of the Georgia 2005 law that makes it virtually impossible for patients to recover damages in malpractice cases connected to emergency room care. But the court determined that the cap violated a plaintiff’s right to a jury trial and its main function in the finding of facts, a right pre-dating the Georgia 1798 state constitution.

“The very existence of the caps, in any amount, is violative of the right to trial by jury.”—Chief Justice Carol Hunstein

Translation:

It opposes the very function of the litigation to—via a cap—pre-determine the maximum damage outcome independent of the facts of the case, alongside a supposedly deliberating jury whose very function is to fact find and assess the damages.

As always the case upon which the court’s decision is based is a horrendous one, and one that already met the high and onerous plaintiff burden of proof and threshold of negligence under our existing body of tort-deterring medical malpractice law. The $350,000 figure is arbitrary, has no economic relevance to the facts of the case, to the damage recovery by the plaintiff or to the broader legal concern in the procured health product in the incentivised practice of medicine.

House historic vote on health care reform

Via a process akin to this,

we’ve come from Teddy Roosevelt ‘s desire for universal health care here on this interactive timeline,

to here,

to  here:

Once the bill passes, there will come however anemically in legal substance, challenges to undo the bill, for example challenges over an alleged lacking in The Constitutionality of the Individual Mandate for Health Insurance . Such challenges are not particularly among lawmakers’ longterm concerns, and for compelling legal reason. Otherwise, there is no unsmelling of the coffee at this juncture.

On to the next.

tort reformers lose big in Illinois—and rightly

Earlier this month the Illinois Supreme Court delivered this blow to tort reformers. I say well done Illinois Supreme Court. I’ve previously detailed my position here. I would have this view even without a familial history like the plaintiffs here with a negligently botched delivery directly leading to cerebral palsy, and an indeterminable cost upon the direct victim and family at all levels. What is unfortunate is that individual opinions—as represented here in some comments—change with personal tragic experience. It’s inexcusable—and inhuman. No particular personal tragedy should be required to actually befall one before he or she grasps the necessity of holding health care practitioners accountable for negligence in the delivery of care. Doctors already have medical malpractice law to shield them. Neither they nor patients need quotable caps to negate all risk and responsibility.

Protected: childhood obesity and why Michelle Obama will be the best thing yet to happen to it

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retirement is overrated

It is. In general, I think working—barring extreme risks or health impairing taxation—is healthy. Stress, like that induced from meeting a daily schedule, punching a clock, showing up, getting in and out of traffic, greeting and interacting with people and negotiating relationships—all of it calls upon your faculties and senses in a way that is stimulatory and life enhancing.

I see it in my elderly relatives.  Those in their 80′s who still work are perfectly engaged.  They’re a part of things. Those who are not aren’t.  When life doesn’t demand that you delineate time and attention, it’s a challenge to do anything constructive with either. During a discussion about a classic car I wanted that had been sitting, a mechanic said correctly, “Cars want to be driven.” A sitting car is in worse shape than a driven one.  Same for minds. People are their minds.  They want to be engaged, useful and a part of something. In so many ways, simple routinized work offers just that.

Protected: epigenetics: “Why Genes Aren’t Destiny” + the Haiti factor

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new disease among HIV-infected gay men

A Taiwanese researcher has received a doctorate from the University of Antwerp and the Institute of Tropical Medicine Antwerp for scientifically linking episodes of the rare disease Amebiasis, an infection with the single-celled amoeba Entamoebia histolytica, with incidents of male homosexual (oral-anal) contact. An earlier association was discussed as far back as 1979.

A rare parasitic disease, which normally only is transmitted by contaminated water, has been shown to be transmitted by gay sex between hiv-positive men. In the industrial world the disease is virtually absent, but that could change.

Compelling about the methodology is how researcher Chieng-Ching Hung was not only able to isolate the amoeba as a culprit in illness, but able to show genetically how closely related different amoebas from disparately located indviduals were, thus implicating the genetic dispersement of the parasite as a subfeature of some essential social or behavioral link between the infected.

Globally, amebiasis is said to take some 70,000 lives annually.

some mythology of tort reform and medical malpractice insurance premiums

What many who favor tort reform as a means of reducing healthcare costs don’t know about medical malpractice law (medmal) is that substantively, it is already “tort reform”. More precisely, it is front-end, built-in tort retardation.

Its invention within the body of tort law is singularly purposed on the shielding of doctors from litigation, even in the case of factual medical error. The centuries-old sufficient elements of tort—duty, breach and injury—are not even a starting point for medmal.  Indeed, even in general torts, injury, error and even death alone are hardly sufficient grounds for bringing any negligence suit against a non-doctor-—under an infinity of scenarios, one can drive into a school bus and cause the death of forty people thereon and not be liable for a penny. But upon shifting into medical malpractice law, liability is even lower, as the plaintiff’s burden of proof is by law higher.

Medmal’s effect on the profession of medicine is mechanically parallel to the effect of the New York Times vs. Sullivan Supreme Court decision on the practice of journalism. It frees up professionals to exercise their crafts with sufficient room to make genuine error without disarming fear of legal liability. What is being protected is of course different—on the one hand, the constitutional mandate of a free and robustly inquiring press functioning as chief watchdog for the republic’s electorate, and on the other, the professional practice margin of doctors negotiating, even imperfectly, the improved health status of patients.

Medmal is specially contextualized tort law designed outright to raise the burden of proof for prospective plaintiffs, thereby greatly reducing winnable legal claims against doctors. The minimum standards by which a plaintiff could successfully sue a corporation for injury resulting from a defective product, for example, are insufficient to give rise to a legal claim against a doctor, even if a patient suffers death and the defective product claimant only suffered nonlethal injury.

two zero-cost and widely ignored ways to quickly reduce medmal litigation:

1. Actually reduce medical error.
   Given so high a burden of proof borne by the plaintiff, a direct course of action to prevent litigation is to simply reduce the very legally cognizable medical error on which it can ever be based. Yet this point of focus is entirely absent from all reformers’ discourse. No, medmal isn’t a big enough hindrance–instead, the patient must be additionally walled off from any legal claim whatever by static damage award caps that represent nothing truly deterrent or economic but an actuarial convenience for insurers and practitioners. How much sense can a static damage cap of X dollars make when the costs of healthcare are dynamic and themselves rising faster than inflation? Where does X come from? It has no relationship to the injury or to deterrence. It is a calculation disconnected from all economic relevance and proper—market based, even—reality. It begs the question: X will simply be factored into actuarial pricing, thereby raising the underwriting cost and returning the patient class to the same risk exposure it enjoyed originally, but now with less coverage and the very thing the claim associated with the cap was supposed to deter—if not worse.
2. When there is medical error, learn as practitioners how to talk about it to patients.
   Political ideology aside, litigation is apparently not even truly a function of injury or of clear practitioner negligence alone, but rather of practitioners’ communication about it, as cited in this New England Journal of Medicine article in 2006, when they were respectively Senators Obama and Clinton:

“Studies show that the most important factor in people’s decisions to file lawsuits is not negligence, but ineffective communication between patients and providers. Malpractice suits often result when an unexpected adverse outcome is met with a lack of empathy from physicians and a perceived or actual withholding of essential information. “.—Senators Obama and Clinton

Indeed here is the difference such improved disclosure and communication made—greater than 50% in all cases—in the University of Michigan Health System:

Results of Medical Error Disclosure Program at the University of Michigan Health System

Yet little energy on the part of the AMA or practitioner community seems aimed at this free—value additive–and immediately available corrective.

Again, the emphasis remains squarely on shutting down all plaintiff courses of legal redress.

Suing a doctor is hard. It’s really hard. When next in a crowded place, take a poll of how many in your midst have successfully sued a doctor or even personally know of one who has. Having legal standing is hard, never mind actually winning a case. And when you sue, juries frequently enough award modest amounts by most standards perhaps out of longstanding reverence for doctors.

Atop the higher burden of proof, due to the unparalleled asymmetry of information between doctor and patient and the patient’s family, far greater medical errors are quietly buried—literally and figuratively—than are ever even medically understood by would-be plaintiffs, let alone those who can meet the plaintiff’s burden. These facts support litigation’s demonstrable infrequency. It is much less common than recent political discourse suggests.

Points and citings too infrequently made in the current discourse are these:

Stability, Not Crisis: Medical Malpractice Claim Outcomes In Texas, 1988-2002 : Famous study citing non-positive relationship between lawsuits and medical malpractice premiums (excellent sample pool of Texas state). There are 100s of thousands of likely litigable healthcare cases that go unlitigated—medical malpractice cases appear “under-filed”. No positive correlation exists between medical malpractice litigation and the raising of doctors’ insurance premiums by insurance companies in one of the best population samples currently available.

To Err Is Human: Building a Safer Health System : Most famous study citing avoidable medical error in U.S. history (often referred to as “the IOM (Institute of Medicine) study”). Considerable doctor and hospital staff error contribute to not just injury, but a high death statistic exceeding certain “epidemic” disease statistics:

“As many as 98,000 people die each year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents [43,458], breast cancer [42,297] and AIDS [16,516]—making medical errors the fifth leading cause of death in this country.”

Deaths from avoidable medical error more than double in past decade, investigation shows: Study showing how avoidable error is worsening, not getting better.

Harvard School of Public Health Study : Casts doubt on claims that medmal system is plagued by frivolous lawsuits.

Updates: latest from Health Affairs: Hospital Error May Be Ten Times Greater Than Previously Measured

nanotechnology sensor can “smell” lung cancer in exhaled breath

Cancer has a smell—at least, non-small-cell carcinoma lung cancer does, and it’s one which recent nanotechnological research has rendered identifiable using the now standard research fare gold nanoparticles and in part the simple techniques of gas chromatography and mass spectrometry. The good news concerns how these smells, termed “volatile organic compounds” (VOCs), can be relatively inexpensively and noninvasively detected at a primary cancer stage, marking a potentially new and more widely accessible diagnostic opportunity.

“A multidisciplinary research team at Technion – Israel Institute of Technology have now demonstrated a highly sensitive, stable, relatively inexpensive, and fast-response nine-sensor array that consists of gold nanoparticles functionalized with different organic groups that respond to various VOCs that are relevant to lung cancer.”

I expect that small-cell carcinoma—-a more aggressive lung cancer—will be found to be similarly detectable, as has chronic kidney disease (CKD) by the same research group. According to the World Health Organization, lung cancer is the leading cancer-related cause of death accounting for 7.4 million deaths globally in 2004, with significant increases in mortality anticipated:

“The number of global cancer deaths is projected to increase 45% from 2007 to 2030 (from 7.9 million to 11.5 million deaths), influenced in part by an increasing and aging global population.” —World Health Organization