When The Vegetative Patient May Be Able To Communicate

By Judy Foreman
Guest Contributor

One of the most vexing emotional and ethical issues in all of medicine is the decision by family members to “pull the plug,” that is, to take a severely ill, non-communicate relative off of the life-support systems keeping him or her alive.

What makes this decision so hard, of course, is, absent a really clear statement ahead of time from the patient about end-of-life wishes, family members basically have to guess. But there may be – not yet, but someday – a way to make this agonizing guesswork a bit easier, thanks to a stunning series of recent experiments by Adrian Owen, who holds the prestigious Canada Excellence Research Chair in cognitive neuroscience and neuroimaging at the University of Western Ontario.

(Digital Shotgun/flickr)

The recent work by Owen, and others, using fMRI brain scanning technology shows that some patients diagnosed as being in a persistent vegetative state may actually have some degree of consciousness and be able to communicate, that is, by sheer thinking, be capable of answering comparatively simple questions such as “are you in pain?” (Obviously, that’s a much simpler question than “do you want to die?”)

The particular patient generating the latest excitement is 39-year old Scott Routley who, 12 years ago, had a car accident that left him with a severe brain injury. By standard tests, doctors thought he was in a persistent vegetative state, or PVS. Continue reading

Reuters: Controversial GMO Measure May Be Killed By Big Food

A controversial question on the California ballot may have a major impact on the foods you eat — no matter what state you live in. The question, known as Proposition 37, is whether labeling should be required on foods that have been genetically modified.

While the measure appeared to have solid support as recently as last month, opposition by big food companies may kill the proposal, Reuters reports. If passed, it would be the first such law in the nation.

(Timothy Valentine/flickr)

Still, as goes California, so goes the nation so it’s worth considering:

Major food and seed companies appear to be on the verge of defeating a California ballot initiative that, if passed on Tuesday, would create the first labeling requirement for genetically modified foods in the United States.

In a campaign reminiscent of this summer’s successful fight against a proposed tobacco tax in California, opposition funded by Monsanto Co, DuPont, PepsiCo Inc and others unleashed waves of TV and radio advertisements against Proposition 37 and managed to turn the tide of public opinion. Continue reading

Painless, Quick-Release Medical Tape Reduces Infant Skin Injuries

Pain-free bandages? I’ll take ’em.

Researchers from Brigham and Women’s Hospital and MIT report today that they’ve invented a quick-release medical tape that will minimize injuries for delicately-skinned newborns.

Here’s the Brigham news release:

Commercial medical tapes on the market today are great at keeping medical devices attached to the skin, but often can do damage—such as skin tissue tearing—once it’s time to remove them.

A research team from Brigham and Women’s Hospital has invented a quick-release tape that has the strong adhesion properties of commercial medical tape, but without the ouch factor upon removal.

The team was led by Jeffrey Karp, PhD, BWH Division of Biomedical Engineering, Department of Medicine, senior study author in collaboration with The Institute for Pediatric Innovation which defined the need and requirements for a new neonatal adhesive based on national surveys of neonatal clinicians.

The study detailing the tape design will be electronically published on October 29 in the Proceedings of the National Academy of Sciences. The research was conducted in collaboration with Robert Langer, PhD at the Massachusetts Institute of Technology.

The tape which achieves strong adhesion when securing medical devices to skin, but could also easily peel off safely, utilizes a three-layer design approach that sets a new paradigm for quick-release medical tapes. Continue reading

Toward A More Emotionally Astute Machine

Read this great story in The New York Times today by CommonHealth contributor Karen Weintraub on the future of affective programming, or teaching machines to read facial expressions and emotions. Here’s the lede:

In a Cairo school basement, two dozen women analyze facial expressions on laptops, training the computers to recognize anger, sadness and frustration.

At Cambridge University, an eerily realistic robotic head named Charles sits in a driving simulator, furrowing its brows, looking interested or confused.

And in a handful of American middle school classrooms this fall, computers will monitor students’ emotions in an effort to track when they are losing interest and when they are getting excited about lessons.

All three are examples of an emerging approach to technology called affective computing, which aims to give computers the ability to read users’ emotions, or “affect.”

People are good at understanding one another’s emotions. We realize quickly that now is not a good time to approach the boss or that a loved one is having a lousy day. These skills are so essential that those without them are considered disabled.

Yet until recently, our machines could not identify even seemingly simple emotions, like anger or frustration. The GPS device chirps happily even when the driver is ready to hurl it out the window. The online class keeps going even when half the students are lost in confusion. The airport security system can’t tell whether someone is behaving as if he were concealing something or is just anxious about flying.

The piece details work by Rosalind Picard, founder and director of the Affective Computing Research Group at MIT’s Media Lab. Picard and her colleagues are developing technology to measure emotional arousal through skin sensors, something that might ultimately provide a kind of lifeline for people with autism or similar disorders who have difficulty making social connections and communicating emotions: Continue reading

Amanda Palmer, Tweeting On Health Insurance, Hits A Nerve

Hat tip to Martha Bebinger who writes on her Healthcare Savvy blog about musician/performer/social media phenomenon Amanda Palmer’s new fascination with health insurance.

Amanda Palmer tweets on health insurance and her ever-reliable fans respond. (Photo:

Here’s the story behind Palmer’s #InsurancePoll:

It all started when Palmer, casually reading The Sunday Times and tweeting on the train, came across Nick Kristof’s heartbreaking column this weekend about his old friend and college roommate dying of prostate cancer in large part because he had no health insurance (and as a result, continuously delayed medical care until he was diagnosed with late-stage cancer). Palmer writes on her blog that the column moved her deeply:

it hit a nerve with me, and i sent a few musing tweets about my own experiences with insurance…

most small-to-mid-level musicians i know don’t have health insurance. some musicians find tricky ways, some pay, most take the risk & pray.

when i was in my early twenties, buying my own insurance would have been equal half my rent. it just didn’t seem like an option. (cont…)

my parents had just watched the death of my step-brother (uninsured when stricken with a disease) almost destroy the family bank…(cont).

…and so they DEMANDED i get insurance. we fought. they offered to pay half. i agreed. i was lucky. many aren’t. think about it. #AndVote.

…and then people starting musing back at me, in their own tweets, about their own experiences with insurance. i could tell i’d hit somewhat of a nerve with THEM, and then it occurred to me that’d it’d probably lead to a fascinating cross-section of
information if i asked everybody on my feed what their current situation was…

So Palmer decide to conduct a little survey and almost immediately, her 698K Twitter followers began to respond:

quick twitter poll. 1) COUNTRY?! 2) profession? 3) insured? 4) if not, why not, if so, at what cost per month (or covered by job)?

…and my feed EXPLODED. EXPLODED. i found out that twitter has a twitter LIMIT (you can’t tweet more than 100 tweets/RTs in an hour – which is probably to prevent actual pornbots and such) and i went to “twitter jail” twice. but the force of what people wanted to share was unstoppable. i think i probably got more than 2k responses to the question. i only wish that i could have shared every single response, because the story it’s all telling is huge. deep. painful. crazy.

Now, she’s heard from teachers and nurses, a British doctor with free NHS care, “thank goodness” and a U.S. writer who lost her coverage when she left an abusive spouse and now can’t afford insurance at all. Two breast cancer survivors tweeted that they couldn’t get coverage because they are deemed “high-risk.” The response was so overwhelming that Palmer recruited a volunteer to help tally the data: Continue reading

Desperately Seeking A Tampon? There’s An App For That

For 18-year-old Olenka Polak, the eureka moment came in a Harvard bathroom.

While at the college’s innovation lab attending a recent “start-up scramble” aimed at helping young entrepreneurs develop new ideas, Olenka, a sopohmore, went to the women’s restroom and was pleasantly surprised by a basket full of free tampons. How cool, she thought. But then she wondered: What if there were no free tampons and the vending machine was out of order and you were just plain stuck in “a periodic emergency?”

That’s when Olenka had the flash: “Wouldn’t it be cool to have this community of women on a mobile platform and have this kind of tampon hand-off where you could earn points for donating a tampon to a fellow sister in need?”

With this vision of girl-power camraderie dancing in her head, Olenka returned to the event, raised her hand and pitched her idea: There, Code Red, the mobile tampon app, was born.

The mobile app would allow users to send out a “red alert” if they were stuck in an emergency without a tampon.

A Code Red team including Olenka and two other women — Isha Agarwal and Yogeeta Manglani, both 24-year-old graduate students in global health at Harvard’s School of Public Health — quickly coalesced and started brainstorming. They came up with a simple prototype: a mobile app that would allow women in need to send out a “red alert” that would ping other nearby users who could rush over and delivery a tampon or sanitary pad or share information on where the nearest working tampon vending machine might be. (The machines are usually out of order and in some buildings simply non-existent, said Agarwal, who is also a student at Harvard Medical School.)

The interface the team has developed asks whether a pad or tampon is preferred; respondents can send back a yes or no answer about whether help is on the way. They can also initiate a chat, to say, for example, “class is just wrapping up, I’ll be there in 10 minutes.” The mockup also includes “health bytes,” a running ticker of women’s health stories to read while you’re waiting. The mapping system would track and update users’ GPS locations with each ping.

Security is clearly an issue and the team has proposed an initial launch within the Harvard community to enable a verification system using Harvard ID numbers.

But beyond tampon distribution, the Code Red team hopes to broaden its reach and become a platform for other types of women’s health needs.

For example, the app might include an automatic phone reminder for women to change their tampons in order to cut their risk of toxic shock syndrome. Continue reading

Questioning The True Cost-Savings Of Digitized Health Care Records

(MC4 Army/flickr)

In an opinion piece today in The Wall Street Journal, Harvard professor Stephen Soumarai argues that the savings promised from electronic health records is little more than hype.

Soumerai, a professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, writing with Ross Koppel, a professor of sociology and medicine at the University of Pennsylvania, suggests that the IT guys selling this stuff are promising huge savings that “turn out to be chimerical:”

Since 2009, almost a third of health providers, a group that ranges from small private practices to huge hospitals—have installed at least some “health IT” technology. It wasn’t cheap. For a major hospital, a full suite of technology products can cost $150 million to $200 million. Implementation—linking and integrating systems, training, data entry and the like—can raise the total bill to $1 billion.

But the software—sold by hundreds of health IT firms—is generally clunky, frustrating, user-unfriendly and inefficient. For instance, a doctor looking for a patient’s current medications might have to click and scroll through many different screens to find that essential information. Depending on where and when information on a patient’s prescriptions were entered, the complete list of medications may only be found across five different screens.

Now, a comprehensive evaluation of the scientific literature has confirmed what many researchers suspected: The savings claimed by government agencies and vendors of health IT are little more than hype. Continue reading

It’s The Driver, Stupid: So Don’t Blame The Cell Phone

(Marilyn M./flickr)

Bad news for those comforted by laws that restrict cell phone use while driving: it’s not the technology causing the problems, it’s the aggressive, bad drivers, a new report from MIT suggests.

The Boston Globe reports:

People who chat behind the wheel often drive more aggressively even after they hang up, according to a study from the Massachusetts Institute of Technology,

“The people who are more willing to frequently engage in cellphone use are higher-risk drivers, independent of the phone,” Continue reading

State Wins $17M To Build New Health Care Portal A La Online Banking

Dr. JudyAnn Bigby, Mass. Secretary of Health and Human Services

WBUR’s Martha Bebinger reports that Massachusetts has secured $17 million to begin building the country’s first health care portal that will work much like online banking.

The new Health Information Exchange is a program through which doctors, hospitals and labs can log in from any location to share notes, converse and post patient records. Health and Human Services Secretary JudyAnn Bigby says connecting a patients providers will save money and improve care.

“Providers could have access to the same information at the same time so that there’s no delay in developing a coordinated plan for someone who has a major illness,” Bigby sayd.

The network will encrypt information to ensure safety and require patient consent. Patients will be able to log on in later phases of the project.

Here’s the full news release, from the Patrick Administration, with more details:

The Patrick-Murray Administration today announced that Massachusetts is moving forward with its statewide Health Information Exchange, which will create a health care information highway, paving the way forward for integrated care and cost containment efforts. The Obama Administration approved $16.9 million for the project, which will allow providers, hospitals and others involved in patient care to exchange clinical data via a secure statewide network.

“When fully implemented, this technology will support our goals of providing high quality care while slowing the growth of costs,” said Governor Deval Patrick. “The health care industry is a vital part of the Massachusetts economy, and I thank the Obama Administration for the continued support.”

The federal Centers for Medicare and Medicaid Services (CMS) approved Massachusetts’ request for $16.9 million in funding, which is a combination of American Recovery and Reinvestment Act (ARRA) grant funding and Medicaid funds. Following a competitive bid process, the Patrick-Murray Administration entered into a contract with Orion Health to advance Phase 1 of this three phase program.

Massachusetts was the first state in the nation to receive federal funding participation approval through CMS to create a Health Information Exchange. This new funding will complement additional efforts underway to support Health Information Technology advances in the Commonwealth.

“This exchange will serve as a statewide health care information highway, that will connect every payer, provider, and patient to a single technology backbone,” said Secretary of Health and Human Services Dr. JudyAnn Bigby. “This will create the infrastructure providers and hospitals need to move towards a more integrated, global model of care.”

The funding announced today will support Phase 1 of the Health Information Exchange and will allow the Commonwealth to put in place a strong project management team, governance structure and operations staff to develop the HIE’s technical infrastructure. Phase 1 of the project is targeted to go live later this year.

“Massachusetts has always paved the way when it comes to health care and this is another example,” said U.S. Senator John Kerry. “Investing in health information technology is a smart way to create jobs, improve care, and reduce costs. This investment will create the infrastructure that doctors, insurers and patients across the state need to share information electronically in a secure environment.”

“This Recovery Act funding will help move Massachusetts¹ health care system from the age of the black bag to the age of the BlackBerry,” said Congressman Edward J. Markey. “By creating a secure flow of information between health care providers, we can ensure that the care patients receive is appropriate and well-coordinated. When individuals such as those with Alzheimer’s or other dementias show up at an emergency room, it is vital for the doctor on-call to have that patient’s medical history on-hand to ensure the patient receives the appropriate care.”

“The use of this technology will improve patient safety and increase quality of care while reducing administrative costs. This investment, coupled with the benefits of the federal Affordable Care Act, will go a long way in controlling health care costs,” said Congressman John Olver. “I am pleased that these ARRA funds have been put to such good use.”
“The use of this technology will improve patient safety and increase quality of care while reducing administrative costs. This investment, coupled with the benefits of the federal Affordable Care Act, will go a long way in controlling health care costs,” said Congressman John Olver. “I am pleased that these ARRA funds have been put to such good use.”

“Better coordinated care between patients, doctors, and hospitals is key to our efforts to reduce health care costs and improve patient care,” said Congresswoman Niki Tsongas. “With this health information exchange, Massachusetts is again leading the way when it comes to improving our health care system.”

“We need to bring our health care services into the 21st century, and this announcement marks a concrete step towards that goal,” said Congressman Bill Keating. “With the Health Information Exchange, we are trading inefficient paper records for at-your-fingertips information available across the board to a patient’s health care providers. This will cut down on duplicative diagnostic tests, unnecessary and sometimes life-threatening delays, and costs for the patient and our system.”

“Orion Health has provided comprehensive yet easy-to-use integration solutions to innovative health information exchanges across the country and around the globe,” said Paul Viskovich, president, Orion Health North America. “Our technology will now support the statewide HIE in Massachusetts, providing us with a unique opportunity to work with the most healthcare-centric state in the nation.”

“Connecting payers, providers, and patients will improve quality, safety, and efficiency of health care throughout the Commonwealth,” said Dr. John Halamka, Chairman of the New England Healthcare Exchange Network and Co-Chair of the HIT Standards Committee.

“Building the health information exchange brings Massachusetts one step closer to fully connected and secure patient health records,” said Pamela Goldberg, CEO of the Massachusetts Technology Collaborative. “Our e-Health Institute’s efforts to connect providers to this exchange will help ensure patients and providers can access and use health records in a meaningful way.”

The health information technology initiative is part of the Patrick-Murray Administration’s comprehensive efforts to promote quality health care through the use of technology.

These measures, together with market innovations in integrated care, new cost-sharing models enabled by the federal Affordable Care Act and renegotiated contracts between some insurers and providers, have helped Massachusetts make significant progress in controlling health care costs. Governor Patrick is working with the Legislature to bring a final cost-containment bill to his desk that will give the industry more tools to continue moving toward the kind of integrated care that improves health care quality and lowers total cost by rewarding the quality of care, not the quantity.

Report: ‘Sexting’ Among Teens More Common Than Previously Thought

Here’s another reason to put a lock on your teenager’s computer: a new report by public health researchers in Texas found that teens are sexting — sending nude pictures of themselves by email or text — even more than we imagined. Nearly 30 percent of teens send these nude pictures, the report says, despite being ‘bothered’ by such requests.

Here’s the news release:

In the first study of the public health impact of teen sexting, researchers found that close to 30 percent are engaging in the practice of sending nude pictures of themselves via email or text. Further, the practice is indicative of teens’ sexual behavior overall and, particularly, girls’ participation in risky sexual behaviors.

These findings, from a University of Texas Medical Branch at Galveston study that is the first to explore the public health impact of sexting, are published in the July 2 issue of Archives of Pediatrics and Adolescent Medicine.

Researchers surveying nearly 1,000 students at seven public high schools in southeast Texas found that 28 percent of adolescents have sent a nude pictures of themselves through electronic means; more than half (57 percent) have been asked to send a nude picture; and about one-third (31 percent) have asked for a nude picture to be sent to them.

These rates are at the higher end of other estimates generated from available online research and polls and substantially higher than recently published peer-reviewed data suggesting that only a little more than one percent of teens had sent naked pictures. The authors note that the current findings, based on a much larger and more diverse sample than those used in previous research, provide a more accurate depiction of U.S. adolescents’ sexting behaviors.

“It appears that sexting is a modern version of ‘show me yours and I’ll show you mine,’ Continue reading