In 1928, Alexander Fleming discovered penicillin through an equal mix of scientific rigor and serendipity.  Still, doctors spent the better part of the 1930’s one step behind infections that had no regard for human life.   Penicillin was simply too expensive and difficult to produce in large quantities, and the drug was tucked away on a laboratory shelf until the outbreak of WWII in 1939.

The US government used the need to treat battlefield infections to seize control of penicillin production, along with the intellectual property and patents behind the drug.  But Uncle Sam’s questionable tactics paid off: from 1939 to 1944, penicillin went from an expensive laboratory experiment to a battlefield staple in every soldier’s medic kit.

Having lost their patents and potential financial gain to the government, drug companies began the quest to develop other types of drugs that were similar to penicillin, thereby launching a billion dollar antibiotic development industry.

NPR had a segment on ‘All Things Considered’ this week discussing the full story of bringing penicillin to market, which appears in a new book, ‘A Fierce Radiance’, by Lauren Belfer.

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ScienceBlogs.com — one of the most well-known and highly-cited blog sites — caused quite the hullabaloo on Twitter and the blogosphere today when they announced their newest contributor: PepsiCo.

For quite some time, SEED Media (the parent company behind ScienceBlogs.com) has sold advertising space on contributors’ sites.  But as PalMD describes in his post, the center panel of each site is always under the direct control of the author.  With the launch of the PepsiCo blog, SEED Media is in grave danger of blurring the line between advertising and content.

I don’t think there is anything inherently wrong with selling ad space on the periphery of popular blog platforms.  Everyone has to pay the bills, and SEED Media needs a revenue stream to distribute and market its content.  But I’m not exactly sure how PepsiCo will use its newly launched blog, now that it has control of that valuable “center panel”.  Only time will tell whether the PepsiCo blog will become a PR platform for the food conglomerate, or whether they’ll actually contribute to scientific discourse.

Whether we like it or not, the prepared food industry will be a major player in our food supply in the near future.  We need to find novel ways to engage these companies to improve health and nutrition in society.  Hopefully, PepsiCo takes this opportunity to contribute in the exchange of scientific information, and doesn’t just focus on improving sales.

I’ll be watching this site very closely over the next few months, and I’ll report on what I find.

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I was fairly quiet on the blogs and Twitter the latter part of last week, because I spent Thursday and Friday at the Health Horizons Conference, sponsored by the Institute for the Future (IFTF). I’ll post some reflections soon, but first I want to comment on an interesting discussion that was brewing last week. Read more…

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In these days before the book comes out – tomorrow! – there have been some wonderful write-ups about the book. Just thought I should note them here.

Kent Bottles wrote a piece titled “Check Lists and Decision Trees” that mulled whether structures like a decision tree can help people negotiate the huge information dumps that come with data-driven medicine. Besides the flattering proximity to Atul Gawande’s book, Bottles was generous in grasping the fact that I’m not claiming a decision-tree paradigm depends solely on rational decision making (which is inevitably unrealistic) but that I’m trying to find a way to bring our rational capacity together with our emotional needs – and therein lies better healthcare.

Brian Ahier wrote a terrific post on O’Reilly Radar, largely about the book. Riffing off one of my set phrases – it’s data, not drugs – Brian – who’s not only a health IT expert and blogger but also a member of his city council – nailed the promise and riddle of turning to a data-intensive model for healthcare. As he puts it, “Putting the patient at the center of healthcare and creating a strategy to process all of health data available today is a great start towards meaningful healthcare reform.” I was especially glad that Brian recognized the flexibility of my three principles for patient-centric health: Early is better than late; Let data do the work; and Openness is a powerful thing.

And Susannah Fox of the Pew Center lobbed a characteristically provocative take recently on e-patients.net. Her take: that the book could be retitled What to Expect When Your Expecting a Long Life. (Fine with me; those What to Expect books are huge!). In addition to the flattering notion that the Decision Tree compelled Susannah – a longtime health expert – to rethink her own health decisions, she astutely recognizes that I’m not just calling for self-tracking gadgets and gizmos – I’m really arguing that we should use whatever tools we have, including messaging from the FDA and other official bodies – to make health information clearer and more personalized.

It’s very heartening to me that three people who constitute experts in the field all seem to think the book is in tune with their own knowledge – that the notes are right, and that the composition is in the right key. My hope, of course, is that the book will also find a larger, less-expert audience, but my hunch is that unless I convince the experts, the lay audience won’t be there. If these three are any indication, I’m on the right track.

Lastly, I want to address some Twitter kibbitzing that these ideas are simplistic, naive, or somehow dangerous. I take some assurance that so far, this chatter comes from people who haven’t read the book – because the book itself goes to great lengths to explore both the promise as well as the perils and challenges of engaging in patient-centric healthcare (challenging both for the patient and the system). There is ample evidence presented in the book; the bibliography alone runs to 15 pages. Of course, I’ll answer this head-on when I have the chance. But broadly, I’ll offer this:

There is hope in the book, yes; there is a simplicity to the idea, indeed – but naive or simplistic it is not.

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Japan’s population is about to tank, and with it, will fall the world’s second largest economy. In roughly 100 years, the country’s population will decrease from 127 million to 44 million. The outlook is bleak, as birth rates are at an all-time low, and the country maintains the highest proportion of senior citizens in the world. By 2050, the Japanese workforce could decrease by as much as 70%. An entertaining segment on Current TV explored both the cause of, and a possible solution to, Japan’s population catastrophe.

Japanese couples are not having babies. As more and more Japanese women and men prioritized their career ambitions over starting families, the national birth rates plummeted. Inadequate child care and employer discrimination of working mothers further discouraged working couples from having children. Swallowed up in the “work hard, play hard” pace of big cities like Tokyo (not to mention all the pretty faces at the local Host/Hostess Clubs), the Japanese 30-somethings claim they’re now too set in their ways to consider having kids.

Read more…

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In a recent post, I talked about the dangers of celebrities promoting pseudoscience.  Well, maybe the celebrities have redeemed themselves.  GQ featured a pictorial of scientists kicking it with rock stars such as Joe Perry and Sheryl Crow, aimed to raise public awareness of important medical and scientific research.

Not since will.i.am of the Black Eyed Peas appeared via hologram (seriously) to talk to CNN’s Anderson Cooper during the 2008 Presidential Election, has the rock & roll establishment nerded-out so much.  But I applaud this effort to break down the stereotypes of scientists.  Despite common misconceptions, we too have a sense of humor and can have fun.  Enjoy.

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Two recent blogosphere topics revolve around celebrities handing out scientific advice.  I want to be clear in this post, I’m a huge fan of citizen science, where the public invokes the scientific method to run their own series of experiments, and answer scientific questions for themselves.  After all, science is not meant to be stuffed away in a lab, only attempted by rubber-gloved scientists in white lab coats.  Science needs to live and breathe on our streets, in our schools, and in our backyards.  But it bothers me when celebrities start dishing out anecdotal advice as “science-based”, when it’s simply based on isolated personal experiences.  Such advice is not citizen science, but rather a ploy to gain media attention, boost ratings, or sell products and books.  I want to highlight two excellent articles I came across — one that discusses the science that debunked the autism-vaccine controversy, the other on the danger of Oprah’s health advice.

Read more…

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Since the 1980′s, American soft drinks have been sweetened with high fructose corn syrup (HFCS), and it’s rapidly becoming the sweetener of choice in most processed foods.  Critics are quick to point a finger at this enigmatic sugar as the root of all evil, claiming its empty calories are contributing to the obesity epidemic, and the numerous chemical processes needed to make it are simply “unnatural”.  These accusations didn’t sit well with “King Corn”, and The Corn Refiners Association fired back with a series of TV commercials stating that HFCS was in fact natural, and completely safe in moderation.  Government officials have been talking out of both sides of their mouths on the issue, first allowing HFCS to be called natural, then recently proposing it be taxed, thereby equating it to other unhealthy items, such as cigarettes.  With all this conflicting information, what should the public think?  Should we avoid HFCS at all costs?  How does HFCS compare to other sugar sweeteners?
Read more…

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The New York Times had a story on Friday criticizing the National Cancer Institute for its new decision tool on colon and rectal cancers. The problem, the reporter says, is that the tool – an interactive questionaire that creates a risk estimate for developing colon cancer – only works for white people. African-Americans or Hispanics who try the tool get a message that says: “At this time the risk calculations and results provided by this tool are only accurate for non-Hispanic white men and women ages 50 to 85.”

It’s an odd story for a couple reasons. First, the reporter seems to have created the controversy on her own – she quotes only one critic of the tool, and that critic is described as reacting negatively “after being referred to the site by a reporter.” The same reporter, I assume, who’s writing the story. Hmm.

But the real problem with the critique is that it barely acknowledges the reason that the tool only works for whites: It’s because the data on risk for colon cancer that’s built into the site is based on research that only studied whites. In other words, the NCI used the existing epidemiology, the data that exists, which is based on a Caucasian population study. More research is being done on risks in other populations, but it’s not substantial enough to merit a valid decision tool.

I’m all for calling on the NCI to extend the tool and fund the science that will relate to more people. But this is the way of all research – you take certain populations, which correlate in various ways to larger populations, and try to ascertain risk. Rare is the study that’s so well funded and so well managed that it can handle the full spectrum of people in the US. So the science evolves slowly, piece by piece, and over time the broader population is covered. Yes, there is such a thing as disparities in health research – certain populations are regrettably understudied. But there’s no indication in the Times story that that’s the case with colon cancer.

So the Times story has the effect of criticizing the NCI for creating a tool because it’s incomplete, entirely missing the forest for the trees: The great thing here is that such a tool exists in the first place. This is the sort of thing we should be encouraging the NCI and other health entities to do – show us the science, and show us how it’s relevant, *as it emerges and as soon as it emerges*. These sorts of risk assessment tools are incredibly powerful ways for individuals to think about their health. They help us understand the great body of science in immediately personal terms, giving us perspective on how our decisions – in this case, how much exercise we get or how many vegetables we eat – affect our risk for developing cancer. This should be applauded and encouraged, not criticized for failing to emerge in an all-at-once exhaustive form.

Indeed, the one critique that I have about the NCI’s tool – which you can see here – is that it doesn’t make plain how your risk stands up against other people’s, nor does it make plain what sort of changes could reduce your risk. When I played around with a worst-case scenario for me – only some exercise and not many vegetables – it gave me a lifetime risk of about 6%. But without the context of a general population, I have no idea if that’s high or low. And when I fiddle with the numbers and say I take aspirin and eat lots of vegetables and get lots of exercise, my lifetime risk drops to 1.6%. Much better, but I had to guess at what variables to change – meaning I have to guess at what changes to make to my life to improve my odds. If the NCI automated these functions and let me know where I stood and what I might consider changing, the tool would be a lot more potent.

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