Bad behavior for Navigenics and 23andMe according to government report - San Jose Mercury News

Navigenics, 23andMe slammed in government report - San Jose Mercury News

First let me say that I am not opposed to genetic testing, and to the use of the resulting data to target medicines for better outcomes and fewer side effects. I'm also not opposed to using genetic data as a reason to modify one's behavior if, for example, genes were found to indicate a particular risk of heart disease. A better diet and a little more exercise wouldn't be such a bad thing. However, one bad outcome of personal genetic testing is that the consumer who pays for, and receives, genetic data, is mislead into thinking their genes are predictive for a disease when there is little or no data to support it.  This is especially troublesome when the disease in question cannot be prevented by known means, and is currently incurable; Alzheimer's disease for example.  If the company goes further to offer them additional products that can help them stave off the said disease, then in my view, this is unethical and possibly dangerous. I have heard of this anecdotally from an employer of a local health food shop. This lady paid for her profile and then was sold an additional package of supplements and dietary aids intended to reduce her risk for a variety of diseases that her genes were supposedly pointing her towards.  To me, this is free-market opportunism at its most insidious.

In the news story above, a couple of personal gene testing companies are in trouble with the government because of their interpretations of the gene patterns to the customer.  Few genes can be definitively associated with disease risk and with the current state of knowledge regarding prevention of disease, there is little to be done with the genetic information.  The most useful application is to let patients know whether they will respond to a particular medicine, or be at risk of a certain side effect.  Genetic ancestry is also a popular use of genetic tests at present but this also carries ethical implications if misinterpreted.

By misleading the public into thinking the data mean more than they, do, Navigenics and 23andMe are doing a disservice not only to the consumer, but to their industry.  The government is already considering regulations for direct-to-consumer gene tests and hopefully these will be sensible and not too restrictive.  Research needs to continue on the meaning of genetic information and when the data is clear on a particular finding, patients and physicians should have access to tests. But companies must act responsibly with the data and the information they pass back to the consumer.  Genetic information must be accompanied with the caveat that the implications of the data are not well understood and that association of a gene with a disease does not imply causation. Systems biology scientists are working on algorithms that can take into account environmental factors and the influences of genes on genes, but we have a very long way to go before we can say a gene or genetic pattern actually increases risk in a definitive way. 

Honey as an antibiotic: Scientists identify a secret ingredient in honey that kills bacteria

Honey as an antibiotic: Scientists identify a secret ingredient in honey that kills bacteria

Scraped knees and elbows is a common hazard of the young and I was no exception. I liked to ride my bike fast, and scooter my scooter faster. I was always in some state of injury and my dad was always there with the honey. A small scoop of granulated, crunchy honey placed on a would and covered with a band- aid was always sure to bring rapid relief and healing. I hated that it was sticky and was often irritated at the inevitability of the solution but it always worked. Finally science has caught up with my dad. The protein responsible is defensin-1 that prevents the bacteria taking hold at an infection site by working with the body's own defenses. The method is particularly appropriate for resistant bacteria which is important; the more antibiotics we use, the more bacteria develop resistance against them as a rule. There are cases now, where patients are dying because they have resistance infections that cannot be treated with known antibiotics. The researchers used medical grade honey which differs from food grade honey a little in that the medical grade contains less bacteria. Table grade seems to possess fewer antibacterial qualities according to research but the rough honey of my youth seemed to do the trick.
For minor scrapes, maybe a little honey rather than neomycin, might be the way to go?

Reference:
P. H. S. Kwakman, A. A. te Velde, L. de Boer, D. Speijer, C. M. J. E. Vandenbroucke-Grauls, S. A. J. Zaat. How honey kills bacteria. The FASEB Journal, 2010; DOI: 10.1096/fj.09-150789.
Cooper et al, 2009: http://www.woundsresearch.com/content/a-comparison-between-medical-grade-honey-and-table-honeys-relation-antimicrobial-efficacy

Loneliness, poor health appear to be linked

University of Arizona (2010, June 21). Loneliness, poor health appear to be linked. ScienceDaily. Retrieved June 23, 2010, from Science Daily. Two studies have found that hoarding friends doesn't necessarily diminish forlorn feelings and that loneliness is a matter of perception. Superficial relationships, researchers say, can not only result in feelings of detachment, but also contribute to certain health-related problems.

Remember Robert Putnam's book several years ago, Bowling Alone.  He made a startling statement in that book, the lack of social connectedness was worse for your life expectancy than smoking.  If he was correct, and the current studies from the University of Arizona support his hypothesis, then what is to become of all the folks who sit at home alone playing computer games?  Do on-line social networks count?  I'd be interested to see what the researchers think about that.  As more of us develop our virtual friendships, how does the quality of those connections compare with real-life?  The Arizona studies found that quality of relationships was more important than quantity.

I like my social networks and find them comforting.  It's validating to put thoughts out there and have folks comment on them, whether the comments are for or against.  I find other humans fascinating so I like it when I see some posts that people are doing their laundry, preparing to paint the living room, or returning from vacation. I even like reading what people eat.  Personally, I love the virtual world but I wouldn't swap it for real life friends.

Living with all life's joys and burdens is a pleasure for sure. Without someone to share it all, it loses its flavor.  It's easy to see why daily stresses can build over time and threaten a person's well-being.  Too much adrenaline suppresses the immune system.  The effect is so pronounced that certain military units have had to curb the the rigors of their training, because soldiers were becoming sick with opportunistic infections.  Adrenaline is also given to patients whose immune system is over-reacting in the acute and serious allergic reaction known as anaphylaxis.  Consider a person who is lonely and stressed and whose adrenaline perhaps never gets a break.  It is easy to see how chronic feelings of isolation might suppress our immune systems and make us sick over time.

Loneliness is a terrible thing and it seems our bodies don't like it any more than our minds.

McDonald's faces lawsuit over Happy Meals - latimes.com

McDonald's faces lawsuit over Happy Meals - latimes.com
This article suggests McDonald's is negligent for attracting young and impressionable toddlers with a cute toy in their Happy Meal. Since when does the toddler in the house make the decisions about what he or she will eat? I understand the wailing kid in the back seat blubbering that everyone else has that toy except him and now he'll be left out... blah, blah. I went through this with my kids. They can be VERY persuasive but at the end of the day, parents are the ones who should be saying no if they don't like the idea of the Happy Meal.

McDonald's built a business on fast, unhealthy food that sells to millions and millions. We all know the deal. Perhaps the problem with McDonald's is not the enticing Happy Meal toys, but rather the disgracefully cheap dollar deals that let you feed a family of five for about ten bucks. This seems to be a more criminal aspect in my view. Try driving around with a car full of hungry teens and a meager $20 left in your pocket to feed them. The dollar menu calls. It's fast, easy and filling but of course lacking in significant nutrient value.

Should we picket Micky D's to take away the dollar menu, withdraw the Happy Meal toys, or better still, shut their doors altogether? In my opinion it is none of these. Fast fat food is everywhere. It's just cheaper at Micky D's and the like. A walk around the supermarket will tell you that our whole diet has degenerated into an artificial, sugary mess. Even yogurts are stuffed full of sugar and we tend to put those in the health category. The latest Dannon yogurt I ate had 23 grams of sugar!!

So, let McDonald's advertise the toys. And parents out there... teach your children to resist early. It doesn't get any easier as we get older. As big business continues to push the calories, it is up to us to say no and the earlier we learn that life skill the better. No-one will do it for us.

Now what did I do with that Twinkie.....

Hospital acquired infections

On a trip to England last year, I saw hand washing stations outside each hospital ward, and surprisingly, most people were using them before they visited their loved ones. I remember, more than 20 years ago, the hoopla about MRSA in the hospital I worked in in London. We practiced barrier methods to keep the bugs from spreading and washed our hands relentlessly. People generally came to hospital to get rid of their infections, not pick them up. That’s how I remember it anyway.
Today, the chances of getting an infection while in hospital appears to be staggeringly high. The World Health Association estimates that any any given time, 1.4 million people worldwide are suffering from infections they got while in a healthcare establishment. Healthcare- associated infections (HAI) costs the US alone almost $7 billion each year. What is worse, some of these infections can be quite difficult to treat. The levels of antibiotic resistance is increasing and along with it our chances of having to take a more risky antibiotic to treat our infections. Unbelievable as it sounds in this day and age, people can and do die of infections that cannot be treated with known antibiotics. Antibiotic resistance makes hospital visits that much more scary. Imagine you go in for a life-saving procedure, for a burst appendix perhaps, and come out without your appendix but with a HAI that takes you weeks to recover from. Or imagine that you go in for a little liposuction and endure months of prolonged pain as a result of something you became infected with while in the hospital. These scenarios are becoming more common and with it, an increased reticence about going in for that operation in the first place.

Hospital acquired infections would be much less worrisome if many of them were not drug resistant. There are many efforts across the globe to better understand antibiotic resistance and to ensure we have drugs available for emerging resistance strains. Some bugs of concern, so-called Gram negatives, including the particularly nasty Acinetobacter are difficult to treat to begin with. WIth resistance accelerating to even newer antibiotics, there are few drugs in the pharmaceutical pipeline to keep up with resistance. MRSA still remains a problem even though it tends to stay out of the headlines these days. Once a hospital-acquired infection, MRSA is now just as likely to be contracted in the community. Infection control for some microorganisms has been improved in many hospitals. However, some centers still have a way to go. Just this week the Journal of the American Medical Association (JAMA) published an article that suggests lax infection practices may plague the nation's more than 5,000 outpatient centers. Patients coming in for day surgeries are leaving with more than they signed up for in more and more hospitals. U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement that her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers.
Reporting infections is important and in general, is on the increase although some doctors still fail to report incidences at their hospital.

In the future it is conceivable that minor operations may not be widely accessible due t the high risks of acquired infections in the hospital. Patients may have to think twice about procedures we now take for granted such as C-sections, joint replacement surgeries and cosmetic procedures for example. With the risk of HAI growing, the future of medicine may see a very limited list of surgical options for patients in non-life-threatening situations.

For people interested in learning more about HAIs, there are a couple of places to go. The first is a website put together by Kimberly-Clark at www.haiwatch.com. Folks can sign up for newsletter and browse around for general information particularly on two of the most common HAIs; ventilator- associated pneumonia and surgical skin infections (SSI). The CDC also provides more information at http://www.cdc.gov/ncidod/dhqp/healthDis.html

TED video on a new way to get around the web: MUST SEE

Pretty cool way to explore the web

Scheduling babies

News reported in the New York Times today says Caesarian births (C-sections) are at an all time high in the US and now comprise the most common surgical procedure over here.  I read the headline and had three questions on why this might be: 1) Are US pregnant mothers less healthy than other country counterparts (maybe due to lack of good healthcare?); 2) Do US mothers choose C-sections more often as elective surgeries?; 3) How does this affect the health of the baby?
The article answered these questions reasonably well and also gave me some surprises.  It seems that C-sections are going up in all countries but the US and China appear to be among the biggest fans. China's rate is approaching 50% (!) and there is a suggestion that a major driver is increased income for doctors who perform the surgeries. Here in the US it seems the causes of C-sections are many-fold. The main reasons however, appear to be elective procedures called for in the name of convenience, and fear of liability issues on the part of the doctors.  Caesarians are about twice as expensive as normal deliveries and, unless there is a specific risk to the mother and/or child, the babies are not healthier.  In addition the risks of the surgery include abnormalities of the placenta and as with any surgical procedure, the risk of infection.  The latter may be of particular concern as hospital acquired infections that are resistant to antibiotics seems to be on the rise too.
In other news it appears the trying to get weight under control in school aged children may be too late to off-set the increased risk of obesity later on.  Chubby babies may be cute, but so-called baby fat may not be as innocuous as once thought, leading to obesity in adults and increased incidence of type 2 diabetes.   An additional report from the LA Times suggests that women can prevent the normal 1-2lbs of body weight gain that occurs per year between the ages of 25 and 50 by simply exercising for 1 hour per day.  Sounds delightful--but who has time?  I think we probably all do if we prioritize the activity but then again....Those are also the child-bearing years and this factors in in more ways than one.  Pregnancy related weight gain and the the complete lack of time for anything but baby and work for working moms makes a whole 60 mins of me-time out of the question for most.  Still, its a nice ideal and something to aspire to.

Three snippets:
Cool position advertised:
Head of McGovern Family Center for Venture at Cornell.  Wish I loved closer to Ithaca, NY.

Cool organization found:
Bravewell consortium for integration medicine I would love to work with these guys somehow.

It's World Water Week!
Unicef's tapproject.org

Eyes, brains and sea squirts

In 2005 scientists discovered a way to predict who is at risk of Alzheimer's by looking at the lens inside their eye.  As we age our lenses get cloudy over time leading to the formation of cataracts which we can replace with an artificial lens when things get too murky.  There is another type of cloudiness, however, that is caused by the deposition of the same proteins that are believed to play a major role in the development of Alzheimer's disease (AZ). A special ophthalmoscope is needed to identify the amyloid deposits.  Yet another way to get a hint of the pain to come but what of potential new treatments?

Firstly, the humble sea squirt (Ciona intestinalis) offers a possible model for screening new compounds that might inhibit the formation of plaques and tangles that characterize AZ as we know it.  The marine creatures are likely our closest non-vertebrate relatives and share 80% of our genes  (don't get too excited - we share about 98% with chimps). Sea squirt tadpoles share all the known genes for the formation of plaques and tangles and can be stimulated, with the introduction of a mutant protein, to form not only plaques and tangles in one day, but also behavioral defects that can be reversed with an experimental anti-plaque forming drug.  This novel method, development by Bob Zeller and Mike Verata at the San Diego State University, is one of the most interesting and promising steps forward in the quest for AZ drugs.  I wonder if the little guys (the sea squirt tadpoles that is), can help model Lewy Body Disease too?

In other news, a potential new treatment for Alzheimer's made by Pfizer was nixed today by the FDA. The drug, Dimebon (that sounds  a bit like time-bomb if I am pronouncing it correctly) did not show improved cognition or overall functioning in early- to mid-stage AZ patients.  Analysts had been mixed on their expectations, with The Day article citing anticipated ROI ranging from $1.5 billion to zero. Pfizer was disappointed with the results but not as disappointed as all those folks with the inappropriately cloudy lenses that are now anxiously awaiting news of a cure for their impending AZ...

Technology and medicine- future directions?

I couldn't pass up an opportunity to comment on a recent article in the latest issues of the Economist.  Basically there is a 3-D bio printer machine on the horizon that can be programmed to create cell lines and eventually whole organs.  Researchers are starting simply with skin, muscle and blood vasculature but hope to progress to larger patches of cells that are grown on artificial scaffolds in the shape of particular organs.  Researchers have created ex vivo bladders this way but not using a machine approach. My feeling is that a bladder is one thing, but a functioning organ such as a kidney will be a great deal more complex. Human biology being what it is, I think it unlikely that a machine primed with recipes for 'baking body parts' will become a reality any time soon, if ever.  I do applaud the effort however.  There is certainly no progress in any field without imagination.

It's obvious that our current healthcare system is unsustainable and this piece from the New York Times sums it up nicely. In addition to speculating on the future collapse of the system he talks about his son's recent wrestling injury which I must admit distracted me from the meat of the message, having a young wrestler myself (see pic).  Regardless, if you are thinking healthcare reform is unnecessary, you should take a look at what he has to say.  We spend the most but are way down the list when it comes to outcomes such as life expectancy and infant mortality.  For those worried about tax increases to pay for universal access, would you rather pay a few hundred more each month for health insurance with higher deductibles and more procedures not covered, or a bit more tax for higher coverage for all.  The the country as a whole, the latter makes so much more sense.

I don't hear much about this yet but it's eye opening how much 'high-tech' doctors are earning these days.  Even taking into consideration their malpractice insurance, these salaries are likely to come under scrutiny as health reform progresses (yes, it is progressing, albeit very slowly).   When physicians earn up to half a million per year and patients are going bankrupt to afford the services, something is out of balance.  Even for those who are adequately insured (a rapidly decreasing segment of the US population), increases in insurance premiums and decreases in covered services will bring the actual costs of medicine and everything it encompasses further under the microscope.  It's hard to figure how this will re-balance, given the costs of med school and malpractice, but re-balance it must.

This posts brings up a related question: High tech means high cost; how much technology in medicine is too much? And who makes that determination?  Ultimately, it must be you and I, the consumer.  Are we prepared?

Bedtime browsing to start the day

I turned on the TV this morning and saw some old news. Senator Chris Dodd is retiring. To NBC this was 'Breaking News' and yes, he only announced it early this morning, but to me it was old news. You see, I get all the stuff that I need to know before I get out of bed. My iPhone alarm sounds and I reach for the phone to turn it to snooze. After one or two snooze cycles, I click the AP news button, and a quick glance tells me the major news, some saucy snippets from Hollywood and what I can expect from the weather today (COLD!). From my early morning bedtime browsing, I also know that England was blanketed in snow last night, that UK talk show host, Jonathan Ross (or Wossy to his Tweeter-buds) couldn't start his car today and fed the birds in his yard before taking a taxi to work, that there is a nasty virus attached to a particular Facebook group and that I had no urgent e-mails to worry me. All this took about 5 minutes, maybe less, and provided me with a working view of my environment for the day, whether it will really affect me or not.
So, do we need NBC? or CBS, or any TV news station, any more? I do like the recipe sections on the morning editions, and the interviews are interesting at times. For news, however, they have to offer something spectacular for me to be able to watch. There has to be something I couldn't find in a headline on my iPhone. US news channels use a rapid fire approach so that all the major news is over within the first 3 minutes. To survive, maybe US news should take a cue from the BBC. Each item gets thorough coverage with news and in-depth contextual background. WE can get a taste of it with BBC America over here. When I first came to the States I was shocked at the almost dismissive nature of the 5 o'clock news. Now I am used to it but find there are better ways to get 3 minutes of whiz bang breaking news--on my iPhone before I even get up.
There are elements of my environment that my iPhone cannot tell me about. There is the mood of my family members first thing in the morning (dubious at best) but then again, if one should ever get up before me, they would likely post their status on FB and so I would have that too. Imagine if I could get a read out of how I am doing healthwise. I see a future where we have a tiny implanted chip that records what we eat during the day, and how our bodies respond to it. Maybe one morning, I will add to my browsing list, the details of my previous day's health status. Maybe it will say something that might translate to this, 'take it steady today, you ate twice as many calories as you need and went way overboard on the fat with that giant bag of potato chips. Oh, and your serotonin is a little low so be on the lookout for depressive thoughts, and try to walk a bit more, lardy.' We could get used to our personal baselines, and then bit by bit, try to do better each day until we are making a real impact on our longer term outcomes. Maybe it would help us learn to connect our lifestyle choices more closely with the health impacts. Just thinking about it makes me want to eat an apple. See, it's working already.
PS: the picture is of a couple of puff pastry mince pies- just one of the items my in situ health monitoring chip would tell me to avoid like the plague...

The sad state of health insurance in the US

Today a report announced that about 20% of Americans went without health insurance for some or all of last year. By contrast, in almost every other developed nation in the world, 0% went without health insurance in the same time period.
The report suggests, not surprisingly, that lack of insurance was more common amongst the unemployed. I have found myself in this situation recently, having lost a job unexpectedly and being unable to afford the premiums for a private plan once my corporate benefits ended. Most plans cost in excess of $1000 per month for a family of 4, and still have deductibles that run into the thousands. For those without regular income, this is laughable, and insurance of any kind only becomes more thinkable if one's family income is at poverty levels so you can at least get the kids signed up with Husky. Husky appears to be a comprehensive and admirable way to spend our tax dollars. Almost 40%of our children are covered with a Husky plan according to today's report with only 8% left without insurance at all. Personally, I had no idea so many children were taking advantage of government health insurance. I find it reassuring that the program is there.
For parents, life without a job is difficult. Life without health insurance, is terrifying. That's why we need health reform. Bring it on.

Eye news

http://www.sciencedaily.com/videos/2005/1210-detecting_alzheimers_early.htm
Similarities between amyloid beta deposition in the lens of the eye, and the brain-clogging features of Alzheimer's Disease point to an early detection method for the brain disease using a special florescence test to identify a telltale pattern of lens cloudiness that is different from that found in normal cataracts that are an inevitable consequence of growing old. Dr Goldstein from Brigham Young Hospital in Boston uses an internal ophthalmoscope to detect early protein deposits before any cataract has formed, and then follows up with the fluorescence test to determine whether the deposits are indeed the type associated with Alzheimer's. He figures early detection could lead to better chance of treatment but...who would want to know though? That's always been my question. Since there are no known paths to prevention or cure, knowing you have the disease at a very early stage would be worrying to say the least, if not downright disabling.
http://bit.ly/7NNIoT
In a second eye story, a new genetic eye disease has been discovered that affects the macular and causes central vision loss similar to that seen in macular degeneration. It is surprisingly infrequent that a new genetic disease is discovered. In this case, relatives of sufferers may have other eye problems such as poor alignment of the eyes rather than the macular degeneration which has made the link more difficult to pin down. This macular disease appears to occur much earlier than age-related macular degeneration but it appears to be potentially treatable with the same drugs, VEGF-inhibitors, injected directly into the eye.
It is likely that the eyes will come under more intense focus (no pun intended, oh alright maybe it was intended) as the population ages. Still, though, there is no good way to prevent age related eye diseases that we know of. The only advice we have to live by is, wear sunglasses, eat a balanced diet, watch your blood sugar if you are diabetic, and get your eyes checked regularly. Maybe genetic testing will be added to that list. Eventually.

News on personalized medicine

http://www.technologyreview.com/biomedicine/23620/ Craig Venter underscores the caution needed when interpreting genetic tests. While variance is almost non-existant for the number and constituency of the base pairs detected, differences in the patterns of gene expression that are used for analysis give rise to significant differences in intepretation of data. Venter finds the data encouraging for the future of personalized medicine but cautions about inappropriate conclusions to be drawn from data in these early stages of personal genome analysis.
http://www.technologyreview.com/business/23997/page1/A new company, Generation Health attempts to decipher genetic test results to put risk and benefit into perspective for the patient, the doctor, and the pharmacist. This comes hot on the heels of CVS announcement that they will partner with this company to define the most useful tests that may then become available through CVS pharmacies. However, the main target for Generation Health's research is the health insurance industry. The company hopes to create the compelling evidence that will encourage insurers to get behind genetic testing as a way to target medications, for better health outcomes and to reduce costs. A trick to making sense of genomic/genetic/phenotypic information is going to be the application of a robust data analysis system. News on this seems to have been a bit quiet lately so I'm off on a search to see what's going on...

Niacin scores

A couple of newsy bits today...the drug Zetia appears to be no better than niacin at reducing cardiovascular events in patient with high cholesterol and may even be worse at protecting against plaque build up. Although the small study conducted by Abbott (who make the version of niacin used in the study) cannot be considered definitive, it does create more uncertainty about the use of Zetia and the related drug Vytorin. Despite the news, Merck's shares are on the rise, partly because analysts has expected even worse news with the study, and partly because the NEJM has said the study was flawed. http://bit.ly/FyXSD. If it was me, I would probably opt for the niacin anyway.
Scientists are hoping to improve the body's ability to take up curcumin, the yellow ingredient in curry that has shown potential to fight several diseases including Alzheimer's, cancer and psoriasis, http://bit.ly/44I3nc. A recent report shows that encapsulation of the curcumin into liposomes protects the chemical from breakdown during digestion and increases their anti-oxidant activity in rats. Several of my Indian friends swear by the healing actions of turmeric, the bright yellow powder used in curries that is is rich in curcumin. Time will tell whether the rat results translate to humans, but I'm upping my curry intake anyway (any excuse...).
As drug makers put up the price of brand name drugs today, some of these more natural options are looking more and more appealing.

Guy goes to Africa

I learned today that my friend and colleage, Guy St Clair is in Nairobi on a knowledge strategizing mission. I must admit, I was a tad envious when I heard the news. I have been a little out of the knowledge loop since my foray into medical education (I know, one would not think medical education would be out of the knowledge loop, but in my experience, strangely, it was) and am anxious to return with renewed vigor and fresh insight. Guy has begun a blog on his adventure, that you can find here: Guy's Thoughts - Sharing my Journey
I am looking forward to following his take on the African experience and also to how the knowledge effort progresses. He inspires me to do more with what I know of this space as I think about where to go next in my career. Over a week ago, I lost my job and have a little time to reflect on where I really need to be making a difference these days. Not that this reflection can take long, mortgage due and all. Nor should it though. I've been thinking about where I really fit for a really long time. The answer has always been there, but not always obvious to me. Where I fit, is the very place there is usually no spot for; ie, in the space between. I love to bridge gaps, reach across disciplines, discover the assumptions that underpin the stories we well ourselves. I suspect for most of us who try to make our place sorting out the knowledge flows that circulate around problem solving and strategy development, there is no clear place to rest our hats in most organizations. Variously, we are placed under strategy, innovation, organizational design, information sciences, libraries, informatics, or even HR. But no matter which part of the organization we work from, we always end up doing the same thing; try to establish the real problem(s) to be solved, determine the necessary understandings to be made, and then set about connecting all the key players that need to know, understand, and eventually do, what needs to be done. It's a fascinating process and I love every bit of it. While knowledge management may have become unfashionable as a term, the concept is needed more that ever as the volume of data increases and the need to translate to usable knowledge becomes more critical. Maybe we need to come up with a new term, one without the baggage that KM drags around. Whatever its name, wherever I end up fitting in an organization, I look forward to helping this field evolve, adapt and continue to make a difference. Now, I just need to find a place to do it....

Back to to the Future--2012

Image courtesy of NASA.

The movie 2010 opens today in theaters across America. For the impressive trailer click here. For a scathing review from a scientific perspective, click here.

I like the trailer, I like John Cusack, I like disaster movies in general so I'm hopeful I'll enjoy this one. I don't expect a whole lot of scientific accuracy however. And why should I? It's a movie. Sure, I will poke fun at the technical impossibilities and the scientific improbabilities just like anyone else with a science background. I will also drive my children crazy, pointing out every continuity error in a movie because that's the kind of thing I notice. I hope there is a good story with a long build-up to death and destruction; there is nothing worse than a too-soon disaster in a disaster movie. I like to see normal life going on with subtle hints of problems that we would normally explain away. Like the cold tap water being slightly warmer than usual, or the occasional clock stopping due to blips in the magnetic field for example. I like to see some people dismiss these initial signs with a genuine head-in-the-sand mentality, while others see dreadful portents in the slightest (and ideally insignificant in a red herring sort of way) happenings. Still others, recognize there is something unusual going on, and quietly prepare themselves for the unknown. In other words, a disaster movie for me, is not about the accuracy of the science (although, the more accurate, the better), but rather about the portrayal of the human reactions. 2010 in itself is hardly based on science. I just picked up a book that I that I can't wait to dig into: The 2010 Story: The Myths, Fallacies, and Truth behind the Most Intriguing Date in History. I'll report back on what I find in a later blog.

Healthcare hysteria in the USA

I'm in the middle of it and it's ugly. Obama is doing the rounds with his naughty national healthcare talk (well, almost), and folks are going quite batty with fear. First there is the ceremonial euthanasia, remisicent of Logan's Run, except the talk is that they will let us live until we are 75 rather than knock us off at 30. Second is the notion that we will be forced to see second rate doctors, and never, ever, ever, get to see our favorite family physician again (this might be true, but for different reasons; most family docs are having a hard time making it because of outrageous overheads caused by the inefficiencies in the current hopeless system. With national healthcare, we might see more of that family doc..), third is the notion that we have to wait for years to get treatment and when we finally get there, they only give us generics that don't work (partly true; the UK goes for good of the many versus good of the few, a notion worth serious contemplation as there are solid arguments for and against), fourth is simply that well, if you get really sick, then you will just be left to die (Sarah Lyall, in the New York Times last Sunday pointed out that someone had said Stephan Hawking himself would never have survived so long had he been imprisoned in the UK National Health Service. Stephan Hawking responded that, as he actually lives in the UK, the protraction of his life under such challenging circumstances was indeed due, in large part, to the UK National Health Service). A fifth topic of hysteria is the idea that once we have a National Health System (if we ever do), then we will all be forced to use it. Massachusetts didn't do us any favors here with its compulsory healthcare plan punishable by a fine if you don't buy in and get insured. In the UK, the NHS is the default. You can get any care at no cost save for the small amount of 'National Insurance' you pay each month into the big Health Care Kitty. Its taken automatically as part of taxes so no-one misses it and probably half the population don't even know they pay it. For those so inclined, there is always a private option. Most companies offer private insurance and most employees take advantage of it if only as a back up to the NHS when the waiting line is too long.
Of all the aspects of the UK that I miss the most, the NHS is probably the thing I took most for granted and now wish I had. I know people who skip physicals because they can't afford the co-pay, I know people who have lost their houses to pay for the medical expense of a serious illness. Others I know will be in debt for the rest of their lives because after a nasty car accident the insurance ran out after the first year of re-hab. There is good medicine practiced here, and there are pockets of goodness on the system, but overall, give me the NHS anyday, long waits and all.

CP Snow and such

What a to do recently in the science mags about the 50th anniversary of CP Snow's lecture on the "Two Cultures" in 1957 at the University of Cambridge in the UK. With the the advantage of hindsight we can critique his brave stance while agreeing or not with his contention that the failure of art and science to communicate was disastrous for society. I like to think his lecture pointed more to a lack of appreciation of the connection between the two, rather than the explicit lack of shared understanding of the complexities of each. In Nature (vol 459, 7th May 09) there are a couple of essays celebrating the anniversary and offering up the equivalent challenges of the current day. Martin Kemp believes specialization in all disciplines to be the primary hinderance to undestanding between the humanities and science (I happen to agree with him-strongly), while Georgina Ferry asserts it is the push and pull between the optimists and the pessimists that stands in the way of some common ground. My view is that true pessimism is relatively rare where either science or literature is concerned, and that science and literature are inescapably joined at the hip on account of the arguable absence of absolute truth in either. At best, all we have are beliefs at a moment in time. If we kid ourselves for one moment that we have the answers, then science has failed. The true division in this day and age, in my opinion, is the one between those that believe they know it, and those who recognize that they don't. The pessimists may be re-christened skeptics in this scenario. In our information-heavy environment it is easy to think scientists have all the answers; there is so much out there to be found. However, what we lack is a clear consensus on what the real questions should be these days. As we become more specialized we can find more solutions to those may parts that make up the whole. But is the whole any better off? How would we ever know? Our specialized systems don't allow us to easily address the question about the health of the whole. We look to the skeptics to force us to reconsider our assumptions and re-shape the terrain of scientific inquiry.

According to Ferry's article, the literary giant (and one of my favorite authors), Ian McKewan says you can't be curious and depressed. It's hard to argue with that, but the exptrapolation of optimism to hope in the essay is troubling to me. I don't see hope having much of a place is science. In the arts, yes. At the bedside, for sure. But in science, isn't hope the one aspect we systematically try to keep out of the picture? Hope is passive, surely. Science requires that we move beyond hope, and beyond current belief, to a future where something is different. Science suggest forward motion, that replaces hope with meaurable outcomes that we can believe in. At least for a while...

At the heart of CP Snow's teachings is the notion of keeping an open mind and being relevant and responsible in scienc. With the Internet, global warming, corporate greed, and the tremendous gulf between the rich and the poor, I wonder what he would think of our world today?

The relevance of genomic information

I don't know about you but I am overwhelmed and energized by the recent explosion in interest in the relevance of gene knowledge to human difference. For several years we have been sequencing and profiling genes looking for aberrant genes and SNPs in the hope of identifying critical variants that explain disease risk, behavior, physical looks and so on. Only recently have we reached the point of understanding where can begin to realize the enormity of the task ahead in personalized meedicine. Recent papers in Nature have told us that the one-gene one-product hypothesis is only true for about 6% of our 20,000 or so genes. This is comforting given that our absolute gene number seems to equate with a mere nematode worm. The worm's genes can't seem to multi-task as well as ours do so it seems we are more evolved after all. Phew. This multi-tasking nature of most of our genes arises because a particular gene is separated along the DNA by areas of non-relevant DNA (to that gene at least) which means the gene can be read in a number of ways depending on the physical configuration of the DNA and possibly according to the influence of regulatory genes. This leads to 'alternative splicing' which results in different proteins being produced by a given gene. This finding is fascinating. No wonder SNP research has yielded so little in terms of identifying disease causing genes. The SNP is such a minoscule part of the altnertive splicing universe. Every issue of Science and Nature lately seems to have a plethora of articles and editorials on gene findings and their relevance to humans. I sense we are on the verge of a tipping point that will lead to novel hypotheses about the degree of determinisim we can reasonably expect from our genes. I'm excited about what we will come up with but hesitant because I know how long it can take to shift a paradigm. I hope we do not continue with more of the same and hope for some different conclusions. The alternative splicing effect should give us pause for thought; a reason to step back and question our assumptions about the role of genes and what we can expect from personalized medicine research in the future. What a fortunate time to be a biologist after all those years of sequencing and collecting the data--we can now begin to really look for the story our genes seem ready to tell.

Google Genes

"Analysts said they did not believe that the news about Mr. Brin would have a negative impact on Google’s shares", from the New York Time this morning after the co-founder of Google revealed he has a gene that may predispose him to Parkinson's Disease. This in itself, is not particularly alarming, since most people who have the gene do not develop the disease, as far as we know. Phenotypic expression of most genes require other factors such as other genes, or environmental triggers to ever see the light of day. What is rather alarming, in my opinion, is that last sentence in the NYT piece about even a hint of effect of this revelation on the company's shares. Why should it affect shares of the company? He is very young, and even if he is to get the disease eventually, it won't be for 20 years or more. The larger question is this- if the CEO or any other highly influentional person in a business decides to get his genes profiled for disease risk, should it be public knowledge? And if it does become public knowledge, how should the public think about it in terms of their investments? It's one thing to consider company value when the CEO is actually sick, as has been the case with the media and Steve Jobs of Apple, but to even speculate that the stock would respond to the news of a company's co-founder having a gene that may or may not result in a disease in 20-30 years time, is a bit over the top in my opinion. I say, leave genes out of it, at least until we know more about the real risks that they confer. If we have to consider the genetypes of CEOs with all that's going on in the Market at the moment, then our heads will all implode and we may well all end up being swallowed by the resulting black hole.