Drilling into the Head

Brain injuries and strokes can sometime require surgeons to relieve pressure on the brain by drilling burr holes through the skull using a trephine. The device is straight out of the good old days of medicine when surgical tools and torture implements were made by the same manufacturers. Yet, while even dentistry has moved on, performing burr hole craniotomies is still very much a manual cranking operation prone to causing injury and even leading to meningitis.

Researchers at Fraunhofer Institutes for Photonic Microsystems, Laser Technology, and Integrated Circuits have developed a new laser system that may soon replace the trusty trephine with a safer, more consistent option. The system uses advanced new mirrors and a femto-second laser to allow the surgeon to guide the cutting beam and penetrate the skull without causing injury.

Wireless Brain Trauma Diagnostics

Visualize brain hemorrhaging and trauma in real time! This radical new device itself uses low energy electromagnetic waves to image the head. This is in no way a replacement for a Computed Tomography (CT) scan, but unlike a CT it can provide continuous realtime data. I am not sure there are devices that can even compare to this working prototype. 

This device was envisioned by Professor Boris Rubinskya and his team at UC Berkeley to assess people in rural villages that do not have access to expensive scanning equipment. It was tested at a Mexican Army Hospital and demonstrated the following:

The results from the healthy participants were clearly distinguishable from the patients with brain damage, and data for bleeding was distinct from data for swelling.

The need to quickly treat an intracranial bleed is of the utmost importance, and time is the number one enemy. However, imagine medics were this device and could transmit the images enroute to a hospital, you know how much time that would save once the patient gets to the hospital? The device could be given to medical missionaries who travel abroad, and the images could be relayed back to a doctor miles away who could remotely diagnose patients and proper arrangements can be made for that patient. The possibilities are endless…

Bonuses for Doctors Pay Off for Patients

In this article, the proponents decided to allocate a finite budget towards compensating doctors and boosting productivity in a system that is not operating at its full potential, rather than improve infrastructure. Interesting concept, I’ll give them that. But is this the message we want to send future doctors: that monetary gains can dictate one’s productivity and adherence to medical standards? 

“For example, a provider receiving $.55 for four standard prenatal care visits received $1.47 for providing higher quality care such as administering tetanus and malaria vaccines or detecting a high-risk patient and referring her to a hospital.”

At the end of the day it has been working as there was 30% increase in clinical care guidelines and a 20% increase in productivity, but I am still torn as to what the right approach should be and how to implement it. Just because something works does not negate the possibility of a more efficient and ethical system.

Gene Patent

By now most of you heard of the Angelina Jolie double mastectomy case. There is a very important legal issue that arose from this case. 

The two genes that Angelina Jolie tested positive mutations for, Brca1 and Brca2, were discovered by the company Myriad Genetics. They have put copyright patents on this gene. So that means, to test for mutations in these genes, it will cost a patient up to $4000, due to the premium put on it by Myriad Genetics.

It is understandable that Myriad has poured in millions, if not billions of dollars to discovering this mutation, and that they have to be able to make up for it, but where is the right balance? What do you think?

Here is something old school, like 5th century BC old school. You need no introduction to Hippocrates, the father of Western medicine, but let us examine what he had accomplished with his classic oath and how it has changed to conform to current social values of healthcare. Check out the two short oaths below and see what differences you find:

Classical Hippocratic Oath

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

Modern Hippocratic Oath

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Interesting, right? So what changed? 

The classical oath binds medical practitioners to educate future healthcare professionals for free, shuns abortion, euthanasia, and surgery. It maintains patient confidentiality and prohibits sexual relations with patients and their families. 

The modern version has a different overall attitude, it no longer holds a doctor to be the pinnacle of knowledge, but rather one who must be humble enough to say “I know not.” The modern oath gives patients a humanity, by not merely referring to them as illnesses, but as patients, an ideal that has yet to be fully embraced in hospital settings. It talks about prevention and is no longer anti-euthanasia. And as my bioethics professor would say, “it does not set aside the need for moral and critical thinking.”

Might it finally be time for a Post-Modern revision? What do you think? And are there any differences I missed?

The Human Connectome Project

Stunning data has been released by the Human Connectome Project - Brain wide Axonal labelling which visualises the main connection pathways between brain areas. Data is mainly based on genetic twin studies as well as  high-angular diffusion and diffusion spectrum imaging of around 50 subjects (at the moment). The dataset presented here holds great potential value not only for neuroscience presentations but mostly as a reference work for (not exclusively) brain scanning techniques.

All a part of the national effort to unveil the mysteries of the human brain.

LONI! (laboratory of neuro imaging)

USC hired 110 new staff (from UCLA) to boost their neurology department! The research will be going towards the national effort of the human connectome project. This is so exciting!

With the kinds of funding that USC will be able to provide for these scientists and the new buildings and technology that the university has obtained, we will be that much closer to solving the mysteries that the brain has for us.

1000 surgeries in 10 days

In 1986, Dr. Ruit developed a strategy to use small-incision cataract surgery (SICS) in the developing world at the community level, through the use of a low-cost intraocular lens (IOL).

However, the high cost of IOLs placed them out of reach for many poor cataract patients, and Ruit started looking for alternatives to reduce the cost of IOLs. In 1995 he devised an international standard IOL that could be produced for far less than those manufactured in developed countries. The cost of IOLs that was around US$ 100, has now been reduced to US$ 3.5.

He used this technique in North Korea to perform a 1000 cataract surgeries within 10 days while teaching the North Korean surgeries the procedure. His heart and hard work is amazing. We often focus so much on the most rare diseases and high-tech devices that we forget the importance of basic life care.