Studying How Body Rhythms Can Help Diagnose Diseases

Studying How Body Rhythms Can Help Diagnose Diseases 

Excerpts from the 3 July 2012 Wall Street Journal article

In an effort to develop new ways of diagnosing and treating diseases, scientists are increasingly tracking the various patterns by which the body senses and reacts to stimuli.

Such patterns, commonly referred to as body rhythms, are a constant dynamic. A foot senses a crack in the sidewalk and the brain instructs the muscles to compensate so the person doesn’t fall down. Within the body, when cells detect too much carbon dioxide, the lungs respond by taking a breath. To get the right response, neurons, or nerve cells, communicate by emitting electrical impulses that are picked up by other neurons.

Researchers are finding that measuring these electrical impulses can reveal the presence of disease. Recent studies have shown that children with autism have significantly different brain-wave patterns than children without the disorder. Other studies have found that brain waves in people with epilepsy behave differently shortly before a seizure.

James Collins, a researcher at Harvard University’s Wyss Institute for Biologically Inspired Engineering, in Boston, has been investigating what he calls balance-control rhythms to understand why people are less steady on their feet as they get older and what can be done to correct that.

 

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Point-of-Care Diagnostics for the Developing World

This hour long video talk is from the University of Washington.

 

(The Molecular Medicine Program at the University of Washington also provides additional webcasts from their public lectures, seminars and special courses at http://depts.washington.edu/molmed/webcasts/index.html)

From the Web site

People living in the developing world suffer greatly from many illnesses, many of them caused by infectious agents. These people usually do not have access to stable power or clean water, let alone the best diagnostic tools. What can we do to bring the high-tech diagnostic methods used in the developed world to those with fewer resources? Dr. Paul Yager, Professor and Acting Chair in the Department of Bioengineering, explains how microfluidics, a new technology for manipulating small volumes of fluids, is enabling the development of a small portable and inexpensive system for detecting pathogens far from the centralized laboratory. This system could soon have an impact on global health.

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The impact of unnecessary testing and treatment on patients

Image via Wikipedia

From an October 2011 article at KevinMD.com

Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments.  Turns out their doctor may secretly disagree.  That’s the conclusion of a new study. The implications are more than a bit disturbing.

Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care – meaning that the doctor was ordering too many blood tests and x-rays and prescribing too many treatments.  Only six percent said they were receiving too little. The study was published recently in the Archives of Internal Medicine.
Read the rest of The impact of unnecessary testing and treatment on patients on KevinMD.com.

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Is Preventive Medicine Really Overtreatment?

Is Preventive Medicine Really Overtreatment?

From the NPR Health News item

In Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch argues that modern medicine is looking too closely for disease, and that unnecessary screenings, MRIs and CT scans turn healthy people into diseased patients, by revealing often harmless abnormalities….

….

But overtreatment isn’t just a problem for patients diagnosed with cancer. It could sometimes be a problem for healthy people, as my next guest writes in his book “Overdiagnosed: Making People Sick in the Pursuit of Health,” because even healthy people are subject to more and more tests every time they visit the doctor.

Think about it, what do you do? You get the normal tests. You get your cholesterol level, maybe your liver test if you’re doing statins, you have a PSA, you have a body scan, tests that are often they often result in treatment. And because the traditional dogma is, as my next guest writes, more early diagnosis means better medical care, which means more treatment; and more treatment means better health.

But is that traditional view true? Is it accurate? Should we still be thinking about it that way? Are all these tests and treatments actually improving our health or are we looking too hard for disease?….

…

FLATOW: Why is it because doctors can do all these diagnoses, all these tests that they do, do them?

Dr. WELCH: Well, certainly, part of it is what’s possible, and what’s possible is, of course, changed dramatically over the last year. But it’s also part of our ethos, if you will, that it’s always a good thing to look for early forms of disease. And, of course, that message just been sent out to the public through the media and other sources that, of course, the thing you want to do is look for early forms of disease.

But the truth is there are really two sides to the story. I think patients are used to thinking of treatments as having side effects, but so does testing. And the side effect of looking for early forms of disease is that we find, virtually, all of us have some. That’s because we all harbor some abnormalities. And we never know which patients are those that have abnormalities that are going to cause problems in the future. So we tend to treat everybody we find with an abnormality and that means we’re just treating some patients who can’t benefit from our treatment because they were never going to develop the problem at hand if they’re overdiagnosed.

FLATOW: But how do you say to the person, you know, that maybe in the minority, as you say, that you may have saved that person’s life by overdiagnosing them? Is that worth of maybe one in a hundred cases?

Dr. WELCH: Well, I think that’s the question we all need to face. And, you know, sort of, traditionally, doctors have focused on the one out of a thousand we might help by looking for early forms of disease. But we haven’t really asked the question, what happens to the other 999? And this problem was really demonstrated to us in prostate cancer screening, which is really a poster child for the problem of overdiagnosis.

20 years ago, a simple blood test was introduced. And 20 years later, over one million Americans have been treated for a cancer that was never going to bother them. That test was the PSA, or prostate specific antigen. And it turned out an awful lot of men had abnormal PSAs. Many were found to have microscopic cancers far more than whatever suffer from prostate cancer.

Now, you might say, does it matter? Yeah, sure it matters because most of these men were treated with either radical surgery or radiation. And roughly a third suffered side effects of treatment generally related to bowel, bladder or sexual function. Even a few have died from it.

So this is a problem. It’s a matter of finding the balance between the question of just how hard we should be looking for problems in well patients……

Related Articles

• Prostate cancer from a patient perspective (kevinmd.com)
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• Cancer breakthrough — or nightmare? (cnn.com)
• Overdiagnosed: Making People Sick in the Pursuit of Health (beaconbroadside.com)
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Most consumers want predictive tests to learn if a disease is in their future

Most consumers want predictive tests to learn if a disease is in their future

Largest study of its kind demonstrates the ‘value of knowing’ may be underrecognized by conventional cost-effectiveness analyses

From a January 7, 2011 Eureka news alert

BOSTON, Mass.––Consumers may place a high value on information to predict their future health, and may be willing to pay out of pocket to get it. In a national survey conducted by researchers at Tufts Medical Center, roughly 76% of people indicated that they would take a hypothetical predictive test to find out if they will later develop Alzheimer’s disease, breast or prostate cancer, or arthritis. On average, respondents were willing to pay $300 to $600, depending on the specific disease and the accuracy of the test.

Published online in the journal Health Economics, the study examined individuals’ willingness to take and pay for hypothetical predictive laboratory tests in which there would be no direct treatment consequences. Overall, researchers found that in most situations, people were willing to pay for this ‘value of knowing’—even if the tests were not perfectly accurate.

Responses to the survey varied according to information provided about the disease risk profile and the accuracy of the hypothetical test. Of the 1463 respondents, willingness to be tested was greatest for prostate cancer (87% of respondents), followed by breast cancer (81%), arthritis (79%), and Alzheimer’s disease (72%). Average willingness to pay varied from roughly $300 for an arthritis test to $600 for a prostate cancer test.

“This study brings us a step closer to understanding people’s preferences and motivations for wanting a diagnostic test, even if it has no bearing on subsequent medical treatment,” says lead author Peter J. Neumann, ScD, director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center. “While we have to proceed cautiously in this area, given that tests have costs and risks as well as benefits, our study suggests that many people value information—both for its own sake and because they will adjust lifestyle and behavior choices accordingly.”

The randomized, population-based internet survey presented participants with the option to take a hypothetical predictive blood test for one of the four diseases, understanding that the test would not be covered by insurance. Participants were asked how much they would be willing to pay for a test that could predict their disease. Some respondents were asked about a ‘perfectly accurate’ test, and others about an ‘imperfect’ one. They were also queried about their socioeconomic information, health status, risk attitudes and behaviors, and likely actions after receiving a positive test result.

The advancing field of in vitro diagnostics (IVDs) includes an increasing number of clinical laboratory tests that offer the hope of personalized screening to assess an individual’s risk of developing certain diseases based on genetic markers found in blood or tissue samples.

According to Neumann, the growing use of predictive testing worldwide has resulted in increasing demands for evidence that demonstrates the value of such tests. Health technology assessment groups typically measure the utility of diagnostic tests in terms such as increased accuracy of test results, cost-effectiveness, or improved health outcomes for patients. But assessing the value of predictive testing may also require the use of new or different measures. In the Tufts Medical Center study, the researchers also found:

• Income and disease type impact willingness to pay. The amount of money patients were willing to pay out of pocket for tests increased with income levels, and was significantly higher for breast and prostate cancer and Alzheimer’s disease than for arthritis.
• Gender, age, and education influence test participation. About 24% of individuals sampled elected not to take the predictive test. Generally, older respondents, women, those with a bachelor’s or higher degree, and those with healthier behaviors were less inclined to undergo testing, even if it were free. Among those not wanting the test, major concerns expressed included the cost of the test, living with the knowledge of one’s disease risk, and the lack of preventive measures.
• Test results may alter future behavior. When faced with positive test results, individuals indicated they would change certain aspects of their lives, such as spending more time with loved ones (51%), putting their finances in order (48%), or traveling more (31%).

“By taking into account all implications of these tests— including the risks, costs, potential cost offsets, and the value they have outside of medical outcomes—we can build better policies and make better decisions about coverage and reimbursement, so that we may more accurately reflect patient preferences and appropriate uses of societal resources,” says Neumann.

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The study, “Willingness to Pay for Predictive Diagnostic Information with No Immediate Treatment: A Survey of U.S. Residents,” (Health Economics, published online before print, 28 December 2010: doi: 10.1002/hec.1704) was supported by a grant from the Institute for Health Technology Studies (InHealth). Coauthors of the study are Joshua T. Cohen, James K. Hammitt, Thomas W. Concannon, Hannah R. Auerbach, ChiHui Fang, and David M. Kent.