Dith Pran, a farewell

For many of us who were too young at the time to fully grasp the human atrocities suffered by the people of Cambodia during the regime of the Khmer Rouge, The Killing Fields was the very powerful movie in the 1980s that showed us an overflowing album of the saddest pictures in that part of the world. I have watched that year’s Oscars that awarded the late physician and actor Dr. Haing S. Ngor (1940-1996) for his soulful portrayal of the translator and photojournalist Mr. Dith Pran. But I have seen the film in full only in 2004.

 

The New York Times announced yesterday the passing away of Mr. Pran, losing to his pancreatic cancer.

Dith Pran, a photojournalist for The New York Times whose gruesome ordeal in the killing fields of Cambodia was re-created in a 1984 movie that gave him an eminence he tenaciously used to press for his people’s rights, died on Sunday at a hospital in New Brunswick, N.J. He was 65 and lived in Woodbridge, N.J.

 

He had been a journalistic partner of Mr. Schanberg, a Times correspondent assigned to Southeast Asia. He translated, took notes and pictures, and helped Mr. Schanberg maneuver in a fast-changing milieu. With the fall of Phnom Penh in 1975, Mr. Schanberg was forced from the country, and Mr. Dith became a prisoner of the Khmer Rouge, the Cambodian Communists.

 

Mr. Schanberg wrote about Mr. Dith in newspaper articles and in The New York Times Magazine, in a 1980 cover article titled “The Death and Life of Dith Pran.” (A book by the same title appeared in 1985.)

The story became the basis of the movie “The Killing Fields.”

 

The film, directed by Roland Joffé, showed Mr. Schanberg, played by Sam Waterston, arranging for Mr. Dith’s wife and children to be evacuated from Phnom Penh as danger mounted. Mr. Dith, portrayed by Dr. Haing S. Ngor (who won an Academy Award as best supporting actor), insisted on staying in Cambodia with Mr. Schanberg to keep reporting the news. He believed that his country could be saved only if other countries grasped the gathering tragedy and responded.

The full article which may be read here, contains a brief and beautiful account on Mr. Pran’s space in history including a video which was to be his last message to the world.

Top 3 Thoughtful Reads Today plus an Overdue Rant

1. Panda Bear, M.D.’s Defending the Pie. An emergency physician’s opinion on medical quackery, “dis-ease”, and what one should be conscious of as a potential patient.

Sure, anybody can see somebody with a cold or some other minor complaint and the odds are good that nothing they do, provided they don’t get too jiggy with it, will do much harm. But let’s suppose that you have never rotated on a medical service or done your share of critical care. Suppose you have never worked in an emergency department or spent a few sloppy months on the labor and delivery floor. Imagine, if you can, seeing a provider for your family’s medical care who is treating your kids but has never had a lick of formal pediatric training or so little that she has never seen the really bad pediatric diseases that look like a little bit of nothing when they first present. Does your chiropractor, for example, know the odds that a fever in a neonate is some flavor of bacteremia that needs aggressive treatment?. Let us further suppose that while your chiropractor has spent hundreds of hours learning how a little normal misallignment in the spine can cause “dis-ease,” he has never had to recognize appendicitis, pancreatitis, or the first subtle hints of colon cancer. In short, while a lot of primary care is routine stuff, little potatoes that the school nurse would have to work at to screw up, not all of it is and if all you’re barely qualified for is to pass sick patients to somebody else as some kind of completely redundant middleman, maybe you should stick to the entertainment business and leave medicine to those with training.

Update (3-28-2008): This post has very intelligently proven its point. And I very much agree with most of its reasons. However, I personally believe that the complementary benefits of the ancient forms of healing should be explored and given its place. Nothing should be unknown to us. We should not block knowledge or even theories from disciplines outside of our hard-wired structures—modern structures at that. While I am totally for research and evidence based principles of care, I think western medicine has no monopoly of truth. Neither does eastern medicine. While there should be some form of check and balance as to proven fact and false claims, integration of these methods of care, especially when of great advantage to the patients, should be given a chance. Integrate the positive practices of these so called alternative principles (I speak mostly about activities like yoga, meditation, art therapy, etc.) as a complementary and gentle arm to patients’ ways to recovery with the current chemotherapy for example, but not cancel chemotherapy all together. As sometimes, some patients (and so do all of us) need positive reminders at the very least. I liken some complementary processes to the process of writing. Many times, it is not what we actually write but the process itself makes us learn and thus evoke self evolution.

2. New York Times’ Mixed Messenger by Peggy Orenstein. A realistic word on reality that has been existing for so long and many preferred to deny, ignore, or pretend otherwise. It is a sincere and sensible essay that I resonate with personally.

A few weeks ago, while stuck at the Chicago airport with my 4-year-old daughter, I struck up a conversation with a woman sitting in the gate area. After a time, she looked at my girl — who resembles my Japanese-American husband — commented on her height and asked, “Do you know if her birth parents were tall?

Most Americans watching Barack Obama’s campaign, even those who don’t support him, appreciate the historic significance of an African-American president. But for parents like me, Obama, as the first biracial candidate, symbolizes something else too: the future of race in this country, the paradigm and paradox of its simultaneous intransigence and disappearance.

I am myself biracial—East Indian and Filipino. In my own high school (a private Chinese school, with a small minority being Filipino — go figure!) in my home country, I experienced being teased for my “different” race. It came in the form of childish or thoughtless (though rarely cruel) comments about my ethnically distinct features and darker complexion—which now is simply seen as an exotic tan. But the reality is, these judgments or stereotyping coming at you in whatever form still speak of the reality that these biases and disrespect are passed on and learned, especially as a child.

This particular life experience along with my other social exposures has led me to further explore through the rest of my curiosity about other races and cultures. It led me to develop an awareness of the existence of the international community. It led me to celebrate my own diverse background. It led me to develop respect towards other people different from myself. This consciousness, sensitivity, and respect should be shared and brought to surface.

3. Dr. Val and the Voice of Reason’s Young Doctors are Easy Targets for Marketing Messages. This post points out the strong need for a more balanced solution to residents’ salary issue in urban areas.

Some attending physicians are understandably annoyed when residents don’t pay close attention to their carefully prepared lectures. Dr. Wes describes his frustration when his young protégés seem more interested in filling their bellies (with pharmaceutical sponsored luncheon fare) than their minds with his years of wisdom. Although I am absolutely sympathetic to Dr. Wes - and always tried hard to be attentive and respectful to my mentors - I wanted to point out that there is an underlying educational crisis at work in urban centers where some residents train. Here’s one NYC resident’s experience:

After taxes, my annual resident salary was about $39K/year. I worked at a hospital in New York City where rent for a small one-bedroom apartment was about $29K/year (which is now closer to $48K). Living on $10K/year in New York City is next to impossible (as you can imagine) and so my survival required undignified behaviors such as crashing “drug rep dinners,” working second jobs on post-call days, and living in crime infested places with lower rents. I got a job as a bartender at a fancy restaurant so that I could get a free meal and some survival cash now and then, and also worked an IT job from home.

This picture is not so different in the Philippines either. It so much is a reminder of accounts of low resident salaries there.

My question is, aren’t the medical associations or some other body supposed to ensure that resident physicians get compensated fairly?

It does not help that he/she is made to work more than 40 hours a week. Medical schooling and training has explained to us in some way or another why these traditional work hours are kept. I personally do not mind the required hours as long as the educational return would be worth the while. But that is another story. Medical schooling have at some point trained us not to complain about unfair returns in work situations. Or we simply do not have the energy left after all the toil required.

—

Here is the part where I rant at last.

When I was a senior clerk rotating in a tertiary hospital in the Philippines, I shared the most unnecessary experience with my classmates at its obstetrics and gynecology department. Sadly, a big part of that rotation was spent trying to survive the attitude problems and work ethic of the residents. There was absolutely some line crossing—I’ve felt we had been disrespected as medical students in being used as personal errand runners. I mean, I have no qualms about helping out. Someone has to do the scut work and all that relates to hospital work. But this is absolutely not about that. This is about the absence of teaching, especially in comparison to the other departments we rotated through. We sat through their Grand Rounds but no further resident-mentor roles were assumed except when attendings were present. They just went about their work and treated us like nuisances or like we owed them our lives.

Some examples I can remember of the day to day… It was lunch time and the important ward work was done for the moment. The residents paged one clerk to the office, and I reported right away, as the page was a stat. Once there, I found these residents having lunch and taking their time (which I would fairly recognize as their right but excludes the right to usurp my time). A resident told me in a condescending tone to go a few blocks off the hospital to the copy service, as she needed it for her personal presentation to an attending. Another time, they placed the same stat page during lunch time and told one of us to deliver invitation letters to various clinics around town for an upcoming department affair. When a group mate of mine was made to do this task, there was no regard for transportation expenses (in a place where very few students had their own cars, we had to take cab rides or less convenient jeepney rides to get around). He had to spend for his trip around town to deliver invitation letters because the resident running the department was too cheap to buy stamps! Another student recounted being called in from the clerk’s quarters to go to the department office at lunch —just to purchase a bottle of soda! And the page was stat!

Truthfully, these unpleasant experiences would have been easily forgotten had there been some effort to mentor. But there was none. Or at the very least, maintaining ethical behavior. (I am glad to have realized at the time that it was unwise to go head-on with the immaturity in front of me. So, my group mates and I took the rather hard but honorable route of just woefully taking it—though honestly, this was a case of just avoiding fuss to survive the rotation and moving on.) In fairness, there was one resident who broke free from the gang mentality and taught us some at least as she should, while maintaining appropriate boundaries between her professional requests and her personal wishes.

I was so terribly disappointed at my rotation that I decided to do my required post-graduate year at another hospital in a different city—one of the best decisions I have made in my medical life! (Perhaps I will write about this much better experience here someday.) I expressed my thoughts (albeit distilled to “I did not have a very good experience as a clerk here. I am applying elsewhere for internship.”) to the attending who sat as chair of the program in a casual encounter when I was about to graduate and submit an application for the post-grad match.

Fortunately, we later had another rotation in a maternity and puericulture center, where we received a fair and most educational obstetrics experience. I am very thankful for that chance sans the nightmare bunch who were supposedly our mentors.

It is a sad recollection for me. It is the first time I have written about it. It mainly remained as an interns’ quarters chat. I hope the situation subsequently evolved, and that later batches have had a more rewarding experience.

Having recounted my stories, I still keep in mind and heart my appreciation and enormous respect for the better role models (including those in obstetrics) whom I have met before and afterwards.

That said, let me end my noise now.

Can Our Art and Science Keep Pace with Technological Evolution?

It should. As we all know, technological advancement is currently evolving faster than one can wholly observe. In blogs and table-talks alone, we rejoice over these advancements. I do. Truly, it is a gift of our time.

But just for a second, let us step back and check on the point of why we are in these endeavors. Why do we keep abreast of technological primes? Why do we check out these tools and get excited when it adds to our medical gadgetry?

Because we must all know the bottom line—that it could potentially complement our beloved art and science, the practice of medicine. That in its ideal form, we are able to reach newer heights, we are able to accomplish beyond a dream—better quality of life, better approach to problems of chronic diseases and achieving better outcomes, better management protocols towards these diseases that too often take over lives, better understanding and interpretation of research results, better ethics and compassion towards another life. And what of this science? What of this art? The human factor, the providers skillfully delivering care to patients and the patients themselves, are the life blood of all these work. Arguably, no technology can suffice for the lack of humanity in all of these. In the practice of medicine, in the aim to heal, success lies in how we effectively transmit our best knowledge with the use of the best tools available and with the most underrated factor of all, our selves—our evolved selves.

Here are two examples of those humans today, If I may. Dean Kamen and Ray Kurzweil.

Here is Dean Kamen and his solutions at DEKA Research.

Dean Kamen is an inventor, an entrepreneur and a tireless advocate for science and technology. His roles as inventor and advocate are intertwined — his own passion for technology and its practical uses has driven his personal determination to spread the word about technology’s virtues and by so doing to change the culture of the United States. His vast knowledge of the physical sciences, combined with his ability to integrate the fundamental laws of physics with the most modern technologies, has led to the development of breakthrough processes and products.

At DEKA, we focus on technologies that enhance quality of life. In many cases that means developing medical devices and products that aid the people who need it most. Some of these allow healthcare professionals to deliver better care, while some enable people to live better lives, with more mobility, more freedom, and less discomfort. Some of these products are used for surgical procedures and the administration of medicines, while some are designed for people to use themselves, freeing them from the constraints of hospitals. All have one thing in common–making life better.

Watch Dean Kamen on TED—Technology, Entertainment, Design by clicking on the screen shot below.

However, I could not go on after sharing about Mr. Kamen here without a bit of a personal anecdote. When my husband and I first carried a conversation over the phone, he babbled about him for an hour and a half. We were just getting to know each other then. Perhaps half floating in the air myself at that moment while listening and dancing along to this particular courtship song, I could remember nothing much from that conversation but the Segway man whom he photographed while being interviewed by his friend for the magazine, Make. After that conversation, I affirmed myself once more as a geek having been immensely attracted to the person who burnt my ears with his bit of adventure to Segway-land—Manchester, New Hampshire. Apparently, it worked as I am now married to this good man.

Back to business and on to Ray Kurzweil, another great inventor and futurist who is best known for his theories and writings on Singularity.

At the onset of the twenty-first century, humanity stands on the verge of the most transforming and the most thrilling period in its history. It will be an era in which the very nature of what it means to be human will be both enriched and challenged, as our species breaks the shackles of its genetic legacy and achieves inconceivable heights of intelligence, material progress, and longevity.

For over three decades, the great inventor and futurist Ray Kurzweil has been one of the most respected and provocative advocates of the role of technology in our future. In his classic The Age of Spiritual Machines, he presented the daring argument that with the ever-accelerating rate of technological change, computers would rival the full range of human intelligence at its best. Now, in The Singularity Is Near, he examines the next step in this inexorable evolutionary process: the union of human and machine, in which the knowledge and skills embedded in our brains will be combined with the vastly greater capacity, speed, and knowledge-sharing ability of our own creations.

Watch Ray Kurzweil on TED by clicking on the screen shot below.

There is a lot going on in his equally busy web site, though truly a fun and a leaping-ly educational way to spend some of your time in.

Then of course comes the iPhone’s firmware Version 2.0, superbly titled in Wired as The Tech Rx for Doctors: The iPhone. This article explores further its possible medical use.

The arrival this June of an enterprise-friendly iPhone is exciting to more than just business users. Doctors, too, are eyeing Apple’s handheld and wondering if it could kill off the old-fashioned clipboard and X-ray light box once and for all.

“If you could use the gesture-based way of manipulating images on the iPhone and actually manipulate a stack of X-rays or CT scans, that would be a huge selling point,” says Adam Flanders, director of informatics at Thomas Jefferson University and an expert in medical imaging.

To date, such a feature has remained a pipe dream due to most smartphones’ inability to handle the sophisticated compression techniques used on large medical images. Also, most phones lack the requisite memory and image-processing capabilities.

And, adding to this remarkable reality, of course, is the health care picture—the whole picture. The following article tells us that there is a need to keep pace. Jim Yong Kim, former director of the World Health Organization’s HIV/AIDS program, was noted by Wired as the Doctor (who) Urges Creation of “Science of Healthcare Delivery.”

While treatments have multiplied, the operations and processes for delivering those medicines haven’t kept pace, slowing health improvement in developing and developed countries.

“There is an implementation bottleneck,” said Jim Yong Kim, a Harvard Medical School professor and former director of the World Health Organization’s HIV/AIDS program said. “We know how to do so many things already, but we’re not delivering them.”

Kim urged the creation of a new science of healthcare delivery that would systematically evaluate which techniques worked and which didn’t.

There is more to this interesting discussion accounted by Wired. You may read the rest of the article here.

Unlike biological evolution, there is no missing link here. At present, we are more aware of our potential than previous generations, especially our creative potential as human beings willing to learn more and live more. However, a very tricky resource allocation issue and a multitude of complex factors (realities of the great digital divide for one) lie before humanity in this particular challenge to use the best of (medical) technology as effective tools. Addressing the great need in developing nations (as well as in the developed nations) is another addition to this challenge. Humans need to evolve as well in bettering themselves individually and collectively as vessels for these efforts in technology to be worth the while. We, as humans, as physicians and health care professionals, need to not only hold these gadgets in our hands, we must understand their greatest value is in the uplift of human life. The examples above help me believe we are definitely getting there.

If only we can develop our selves as fast as we can create our technology.

Happy Easter!

Upcoming Conferences: International Medicine and Medicine 2.0

Wonderful news! Two of my favorite topics and explorations, International Medicine and Medicine 2.0 are currently accepting registrations for their respective conferences.

 

On May 30th to 31st 2008, the Institute for International Medicine would be hosting the 3rd Exploring Medical Missions Conference at the University Center on the Main Campus of the University of Missouri-Kansas City, Kansas City, MO.

Most health professionals contemplate international service and are inspired by the prospects. Yet few are confident about where to begin.

This event is co hosted by the St. Luke’s System, Healthy Mothers-Healthy Babies, Research Medical Center, University of Kansas School of Medicine Department of Infectious Diseases, and the University of Missouri School of Medicine International Medicine Program.

 

Medical missions are closest to the heart for me, be it rural areas or urban neighborhoods. The human experience is just invaluable. The strength and insight one can gain from various medical missions experiences will be truly the most treasured learnings in the practice of medicine. This endeavor addresses many dimensions of our lives—personal, the society that we see and observe, the people we visit with—those we touch, those who touch us, those we work with, and many many others whom we are blessed to meet along the way.

—

On September 4th till 5th 2008, the Journal of Medical Internet Research, the International Medical Informatics Association, the Centre for Global eHealth Innovation, CHIRAD, and other organizations will be sponsoring the Medicine 2.0 Conference: Web 2.0 in Health and Medicine at the MaRs Center in Toronto, Ontario in Canada.

For those who are curious or currently exploring and enjoying the possibilities of Medicine 2.0, this conference is going to be very interesting, if not exciting.

Who should attend?

    * Academics (health professionals, social scientists, computer scientists, engineers)

    * Software and Web 2.0 application developers

    * Consultants, vendors, venture capitalists, business leaders, CIOs

    * End-users (health professionals, consumers, payors)

 You may go to the above websites for more conference details.

Media in Medicine: Bertalan Mesko’s Scienceroll and More Medicine 2.0, an Interview

I am very excited as I type this. I will be deferring the supposed post for today, Media In Medicine: Sprinkle Some Imagination, for later. Alternately in some of the days to come, I will be posting about some interesting proponents of media in medicine. I have written about them here at some point. This time, I will be trying to interview some of them via e. Ah, happy day!

In May of 2007, I wrote a post about Medicine 2.0. It dealt with my own exploration and understanding of the interesting place of medical and health care professionals, medical students, academics, researchers, medical leaders and learners, and patients along the arteries and veins of Web 2.0. I then proceeded with exploring further focusing more on its soul—media (focusing on the gifts of the new media) than its intimidating surname—2.0. However, I do not dislike the geeky appeal of the numeric assignment. It has a been a wonderful ride since—one of very open learning avenues and exchanging thoughts with so many interesting folks behind the writings and blogs. I am delighted to have expressed my humble voice this way about a discipline that is a lifetime endeavor. Though 2.0 is just one amongst its expansive collaterals, I speak and write proudly and with ever more curiosity about this revolutionary means of communicating and sharing medical knowledge.

Please welcome, one of my favorite reads on the medical web, Bertalan Mesko. He is a medical student at the University of Debrecen in Hungary. He is one of the active proponents in educating the rest of us about the endless possibilities of Medicine 2.0 among many other interesting things that he shares about in his blog, Scienceroll. Recently, he travelled from Debrecen to Los Angeles, New Haven, and New York and gave a presentation in a conference called Medicine Meets Virtual Reality and another one at Yale University. I am honored to share about this interview here today.

1. How did you get started with your takes on Web 2.0 in Medicine?

In January, 2007, I came across the online presentation of Vesselin Dimov who is a physician in Cleveland. I think he is the first person to write about this subject on his blog in the blogosphere and that presentation opened my mind. I knew these tools, services and websites provided by the realm of web 2.0 could change the way medicine is practised, so I started to write about this special field of medicine and launched a blog carnival under the name of Medicine 2.0 later in 2007.

2. Who coined the term Medicine 2.0? Do you consider yourself one of its pioneers?

I have no idea who used this term for the first time. Anyway, it’s a hard question. I consider myself as a member of the „second generation”, because it wouldn’t be fair to call myself a pioneer. If someone has mentors, he obviously cannot be a pioneer and I do have mentors like Ves Dimov, Attila Csordas, Scott Shreeve and Bob Coffield.

3. You recently presented at the Medicine Meets Virtual Reality Conference, would you care to share that experience from a professional, cultural, and general standpoint?

Wow, it should be quite a long answer. From a professional standpoint, it was good to see physicians and scientists are really open to these new opportunities of web 2.0. They tend to create a new form of medical practises (e.g. Jay Parkinson), they know how much these tools can ease their own job. And that’s why they liked my presentation and the live Second Life simulation. From a cultural standpoint, that is a different world. The system of health care or medical education is totally different from ours. Your medical education is based more on clinical practise. And generally, the main difference, according to my experience, between the USA and our region is that if you have new ideas, you can go further more easily than your competitors.

4. How was the Yale University presentation experience? Can you share with us a sample question raised by your audience there?

I’m humbled to spend some days around Yale and to give a presentation at the School of Medicine of Yale was probably the best thing I’ve ever done. Sometimes everything works. I think I gave my best slideshow ever at Yale. The questions raised by the audience were focused on search engines. A major concern of the residents was that it’s quite hard to find relevant and useful information in Pubmed in seconds. And when they have a patient and have to make a decision fast, they need to have a great tool with which they can get the right information in time because getting tens of thousands of results after making a search for a medical condition cannot be efficient. That’s why we’re currently working on a personalized medical search engine for medical professionals which I will present soon on Scienceroll.

5. What difficult issues (if any) have you encountered in developing your Second Life in terms of sharing medical information?

The medical exercises organized in Second Life by the Ann Myers Medical Center will never be as realistic as real medical education. But educating or learning without geographical borders is just fantastic. I especially enjoyed learning from US physicians and discussing medical cases with Brazilian, German or English medical students. In this virtual world, we have all the tools to educate interactively (descriptions, animations, simulations anbd reliable websites). The only concern I still have is about credibility. We have to ensure all of the visitors that we’re real physicians and medical students. That’s why I will construct soon a page for listing our credentials and any kind of data regarding our professional life.

6. In your opinion, does SL have an imminent future as a tool or even a venue for medical education?

Second Life was centered around casinos and entertainment in the past. But as casinos were forbidden, we have now the space and opportunity to focus on education. I think the virtual world has an educational golden age nowadays. So yes, even if most of people think it has no future, I’m absolutely sure about it’s future role in medical education.

7. Do you have anything to say about the tide of social media (networking sites like within3, iMedix) in relation to medicine? Can you share a personal thought or two regarding the role of this new media (digital, web, internet) in medicine at present? And your thoughts about the future?

I’m pretty sure this new kind of media will play a major role in the future of medicine. With these community sites, not just the physician-physician interaction becomes easier (e.g. Sermo.com), but doctors can communicate with their patients in a more efficient way. It’s not about making a diagnosis on-line, but making contact faster with patients. I plan to work as a geneticist probably in a personalized genetic company and I hope I will not only be able to tell my patient about their own genetic background but to show them some reliable and useful resources where they could find even more information. Web can be the best friend of a physician if used in the right way for the right purpose.

8. What do you hope to achieve in the long run or advocate for with your work at Scienceroll?

It was only a blog with 20 readers, now it has more then 1500 readers a day. My aim is to become one of the most reliable resources of web 2.0 and medicine. I would like to present my slideshow at more and more conferences to show physicians this new world of web. That’s why I have already given slideshows at several local clinics and departments and I took a journey to the US. I also would like to be a good genetic blogger to become a good geneticist. I have a more than normal passion for personalized genetics and I’m pretty sure my future will totally be dedicated to this field of medicine. So blogging or writing about web 2.0 and medicine is just my hobby.

10. How do you balance your time as a medical student and as a successful medical blogger?

First, I’m not a good sleeper, second I’m enthusiastic about my blog. I just love blogging and informing my readers about the most recent improvements of web 2.0 and medicine or genetics. I also like interacting people from around the world and getting many e-mails, suggestions and tips. Blogging can totally change your career. I feel lucky and try to encourage others to start their own blogs. So back to the question, during the day I’m a medical student and this is my top priority, of course. But during the night, I browse the net, organize my web projects, etc. Writing blog posts became one of the most important tasks in my daily routine.

Wonderful!

Here is his most recent slideshow presentation. In a few clicks, you will be provided with awareness and some brilliant synthesis of knowledge snippets from many roads, scattered points, nooks, and crannies.

Thank you very much, Berci, for your time and generous attention to this interview. All the best in your endeavors!

Media in Medicine: Collaborative Aim and Reach of JovE, WorldVistA, PLoS Medicine

Not a long time ago, open source advocates were pushing a little farther to forward and expand their cause. We have been witnesses and fortunate end-users to this web evolutionary development. From our street corners, we have observed a waterfall of resource and journal sites free of charge open shop like market day. As I started exploring Medicine 2.0, I blogged about 2 sources, WorldVista and PLoS Biology. Let me share more about them here again in a short while.

First, here is something close to the heart, an open journal site that presents experiments in video format. JoVE.

Journal of Visualized Experiments (JoVE) is a peer reviewed, open access, online journal devoted to the publication of biological research in a video format.

For a sample, view this experiment on “A Craniotomy Surgery Procedure for the Chronic Imaging of the Brain” by clicking on the screen shot below. Have I mentioned that I love film? Woot! Have fun!

Thanks, Gaurav Parikh for sharing this site.

WorldVistA is an open source, low cost software that handles electronic health records. It was originally created by the U.S. Department of Veterans Affairs for use in their hospitals and facilities. Now, the rest of the world can use it too.

WorldVistA’s mission is to improve healthcare worldwide by making medical information technology better and universally affordable.

WorldVistA seeks to help those who choose to adopt the VistA system to successfully master, install, and maintain the software for their own use. WorldVistA will strive to guide VistA adopters and programmers towards developing a community based on principles of open, collaborative, peer review software development and dissemination.

Here are excerpts of Thomas Goetz article on the New York Times, “Physician, Upgrade Thyself,” when this software was first introduced to the public.

Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.

—

Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.

WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.

But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care.

I end today’s post with another personal favorite, PLoS Medicine or the Public Library of Science Medicine.

PLoS Medicine believes that medical research is an international public resource. The journal provides an open-access venue for important, peer-reviewed advances in all disciplines. With the ultimate aim of improving human health, we encourage research and comment that address the global burden of disease.

PLoS Medicine…is an open-access, peer-reviewed medical journal published monthly online by the Public Library of Science (PLoS), a nonprofit organization.

Here is a message from the PLoS founders,”A Medical Journal for the Internet Age.”

The Internet is awash with medical information. Eight hundred million people have direct access to the Internet [1], and in the United States over 60% have searched for health or medical information on the Web [2]. Go to any search engine and type in the name of a disease or drug, and you will be directed to hundreds of sites, ranging from the sound and useful to the quackish and dangerous. Google “medical” and you get 85 million pages, “drug,” 40 million, and “health,” 230 million.

But something is conspicuously missing. The most reliable medical information on the Internet—the contents of peer-reviewed medical journals—is hidden from the public and most of the world’s physicians. Although most medical journals are available online, their publishers limit access to those who choose, and can afford, to pay for access. This should not, and need not, be so.

I agree!

Grand Rounds 4.22 is now up at Scienceroll!

For the general reader:

What are Grand Rounds?

…are a ritual of medical education, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents, and medical students. The patient is usually present for the presentation and may answer questions. Grand rounds have evolved considerably over the years, with most current sessions rarely having a patient present and being more akin to lectures.

In the medical blogosphere, the tradition of Grand Rounds continues. The virtual Grand Rounds were brilliantly founded by Nicholas Genes in 2004. This “weekly compilation of the best medical blogs” is “hosted by a different blogger each week.” The first Grand Rounds subsequently debuted at his medical blog, Blogborygmi.

Today, Grand Rounds Volume 4 No. 22 is up. This week’s showcase of the best of the medical blogosphere is hosted by Berci Mesko at Scienceroll. It wonderfully highlights The Future of Medicine!

The number of submissions, the learning value, and the diverse content are truly worth the while. It shows the many many interests and issues of medicine. Truly a ton of somethings for the curious or the voracious.

The Story of Healing’s post, Media In Medicine: More Than Mending The Broken, is featured as one of the editor’s choices.

Media in Medicine: The Big Guns Are On It

Before I share the main course for today, let me first touch base with the chosen labels for our endless babble involving technology’s role in potentially enhancing or carrying medicine and health care to the next better level—Media, Medicine 2.0 and Health 2.0. I initially have veered away from the latter term in my previous posts as I would like to apply my time more on Media (being mostly new media) and Medicine 2.0. These are more tangible to my focus at this point. I wanted to alleviate the great confusion these digital surnames bring us all. Though further on, I also realized that I too have to be educated on what these terms entail. The differences in detail between the two are also important. We could all learn something new everyday. That said, what is Medicine 2.0 and Health 2.0? Ms. Frankie Dolan, creator of MedWorm shares her understanding with us in her blog, Frankie Speaking Frankly.

…Health 2.0 is the application of Web 2.0 technologies in the area of health, whilst Medicine 2.0 is the use of Web 2.0 technologies in the area of medicine. Some examples can be seen in the Medical 2.0 Directory. I have come to think of Health 2.0 websites as being those that provide services geared towards the consumer, and Medicine 2.0 those geared towards services for the medical professional…

Now that that is in place, on to our dish.

It seems like big web corporations such as Google, Microsoft and AOL are all on board the Health 2.0 caravan in pitching in their share of the possible solutions (or possible market share) in the seeming broad revamp, evolution, and even revolution of health care. This could begin an effective model in technologically advanced societies that have an electronic medical system of some sort in place or that are actively transitioning (or have transitioned) their medical records to e— such as the U.S. This could eventually spread across the globe.

Let us begin with Google. According to CNN,

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools.

Here is a screen shot cropped from the Liquidmatrix Security Digest.

The original beta page itself has apparently been taken down. Google has not officially announced this new venture. This project, code named “Weaver” according to Mashable, is evidently made possible with the participation of the non-profit hospital, Cleveland Clinic, which by the way publishes medical e-books that are available free to download in some e-book sites such as Wowio. From the same article in CNN.com,

Contacted Wednesday, a Google spokesman declined to elaborate on its plans. The Associated Press learned about the pilot project from the Cleveland Clinic, a not-for-profit medical center founded 87 years ago.

From a technology and development standpoint, it is exciting. However, I have questions of my own regarding assurance of privacy. Communicating medical and health information on the web is helpful in many ways in streamlining the jungle we call health care. However, the world wide web containing detailed medical information about patients, about us, about you, raises the big security question. Currently, our records are stored in computers in hospital networks and clinic systems. HIPAA issues, anyone? Here is more from CNN,

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

Prodded by the criticism, Google last year introduced a new system that purges people’s search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department’s demand to examine millions of its users’ search requests in a court battle two years ago.

The Mountain View, California-based company hasn’t specified a timetable for unveiling the health service, which has been the source of much speculation for the past two years. Marissa Mayer, the Google executive overseeing the health project, has previously said the service would debut in 2008.

Either way, this is something to look forward to. Hopefully the security bases are, in fact, securely covered.

The other 2 big leaguers who are having their own new hits are Microsoft and AOL.

Here is Microsoft’s Health Vault.

According to Mashable,

HealthVault is a web-based personal health record tracking data such as blood pressure, cholesterol levels, surgical procedures, etc. Centralizing medical data for physician access alleviates problems in both personalized care and also insurance.

Microsoft does not expect a flood of users to immediately populate the site and is instead looking to existing healthcare institutions for help. Ideally patients will permit hospitals, doctors, and clinics to insert information into their HealthVault records. Early partners of HealthVault include the American Heart Association, Johnson & Johnson, the Mayo Clinic, and seven hospitals throughout the Baltimore-Washington metropolitan area.

Last but not the least for today is AOL’s Revolution Health and Health Talk.

 

Here is a report from CNet News.

AOL co-founder Steve Case announced Wednesday his online health and wellness company, Revolution Health Group, has acquired HealthTalk, pushing his company into the ranks of the second-largest health information site on the Net.

HealthTalk will operate as a site within the Revolution Health Network, which includes CarePages.com and RevolutionHealth.com. The Revolution Network is also affiliated with drugstore.com and SparkPeople.com.

More and more examples add to our pages as we continue to explore the important role of media in medicine. The more we know about what is out there and which way we are heading, the more we empower ourselves to participate in our very own process and quality of health care as patients. Thus, we might improve our choices and strengthen our voices about what really matters to us in maintaining our health. As doctors, including other medical professionals, who are abreast with technology can also broaden our reach in terms of understanding, communicating, and ensuring the quality of care we are giving. The important bottom line, as we have emphasized again and again, is the need for effective communication among us all.

Media in Medicine: the Reality of the Digital Divide

Two quick reads to munch on tonight about the imbalance in the accessibility to health information created by economic disparities and lack of infrastructure, among other reasons, in developing countries.

Allen Cheng of The Next Generation shares his point with us.

An established information infrastructure in the developed world has made accessing health information a facile task. In a span of minutes a patient may coddle his curiosity by self-diagnosing an illness, investigating the origin of the disease, reading on different treatment options, and checking the background of relevant doctors and hospitals, all tasks simplified by the wide availability of the internet. Recent medical information and research journals can be disseminated to doctors, describing current trends in disease or new treatment methods. Colleagues can consult each other across the country instantaneously, ensuring the best treatments for their patients. Electronic medical record systems allow seamless sharing of patient data among different clinics, documenting histories, drug regimens, referrals, and existing conditions. These capabilities save time and reduce mistakes.

In contrast, health workers in impoverished countries are starved of the relevant information typically accessible to their colleagues in other places. Hospitals in remote areas with virtually no roads, electricity, or basic communication means often have to function almost autonomously without access to medical information or colleague support. In turn, the hospitals are difficult to monitor, making assessment of healthcare standards difficult. While improving conditions in a developing country will eventually spill into its healthcare sector, a host of obstacles currently hinders physicians who desire the best for their patients.

Finish this important and insightful article here. Apparently, according to the same article, some solutions implemented have failed and may have wasted valuable resources in these countries. The above perspective was published just a couple of months ago.

We go back to an article about 7 years back by the Bristish Medical Journal similarly wailing on this seeming great divide.

Information and communication technologies have not been harnessed systematically to improve the health of populations in developing countries.

These technologies empower those who use information by providing them with a choice of information to be accessed in their own time and by allowing them to put their own information on the web.

The current digital divide is more dramatic than any other inequity in health or income .

The quality of health information available on the web is inconsistent, and the visibility of research from developing countries is limited.

The way forward is to exploit the full interactivity of the internet, which allows rapid feedback and change to continuously mould information into useful knowledge.

I may have a very simplistic notion of this problem. I do recognize the enormity and the complexity of these issues once in the field. But my take is this, start small. Perhaps if we aim to start implementing solutions at a more manageable and affordable level, with strong measures of sustainability and maintenance in place, we might just move a step forward. As with many solutions offered, many intents would be noble. But there is a difference between intents and carrying through. One way to ensure this is to see it in as many possible dimensions and angles as possible, looking closely or moving far from it, including even the simple intent and theory. And the working button for this might I suppose could mean in the same spirit, boldness, and starting cost as those of the green, small, and handy?

Media in Medicine: I Love Film

This New England Journal of Medicine article is another one worth sharing about the use of media in medicine. Today’s plate is film. This medium of communication is a personal favorite of mine. It is also my favorite learning tool.

It is not uncommon to use video as a medium to communicate medicine, to educate, to share knowledge, to present theories, report breakthroughs. Though most commonly, the point of view is that of the professional, student, or authority on health issues. But this time Dr. Gretchen Berland of the Yale University School of Medicine aptly rotated the camera sharing with all of us a stark portrait, “The View from the Other Side—Patients, Doctors, and the Power of a Camera.”

As an internist, I was disturbed by the contrast between those two scenes, the second revealing the depth of Buckwalter’s concerns and fears, none of which were apparent during the conversation with his doctor. In the later tape, Buckwalter’s struggle is palpable. If such stark contrasts are common, how much do I really know about my own patients? Probably far less than I care to admit.

I learned that participants generally need more than a few days or weeks with a video camera to record their experiences adequately; the unfurling of one’s life requires time.

…film is a medium conducive to exploring the smallest details that make up a life. These details are often overlooked, or missed, in clinical research conducted in more traditional ways. As nuances of a patient’s experience are compressed into standardized responses, statistical power is achieved, but depth is lost.

Perhaps a first-person perspective, recorded from the wheelchair, would reveal a world rarely seen by most nondisabled persons. Buckwalter had been the first to volunteer for the project, followed by Vicki Elman and Ernie Wallengren. All lived in the Los Angeles area and had heard about the project through the UCLA medical community. Buckwalter used a wheelchair as a result of a cervical spinal cord injury, Elman because of multiple sclerosis, and Wallengren because of amyotrophic lateral sclerosis.

You may click on the following screen captures, on the left to view the video and on the right to listen to the interviews done on Dr. Berland, the researcher and Dr. Buckwater, one of the volunteer participants in this study.

This again is one other example of the use of media in medical advancement, an important one at that. Here it was used as a witness and reminder to be vigilant in improving the quality of patient care. It promotes awareness in many respects about the daily struggles, both inward and outward, of patients and people with disabilities having to deal with those who are supposed to help them and work with them but end up adding to their unrelieved suffering.

I love film.

Related—Media In Medicine: Dr. Stark, ZocDoc, iMedix

—Media In Medicine: What of the Insurance Companies and Other Issues?

—“How Web 2.0 is Changing Medicine”, an addendum

—Media In Medicine: More Than Mending The Broken

—2.0 in Medicine and Definitely Beyond

Upcoming—Media In Medicine: Sprinkle Some Imagination