Archive for February, 2010

Book Review: Googled-The End of the World as We Know It

February 27, 2010

I recently completed this book by Ken Auletta who promotes his unique access to the search engine giant. The books follow the history of Google from the earliest days of the founders at Stanford, to rocketing to fame, going public and then being labeled as the evil empire. More recently, he chronicles conflicts with the government, traditional media, traditional advertising, publishers and China. He leaves with Google at a crossroads of maturing founders which he suggests may be losing focus, competitors in social media, and ongoing challenges from Microsoft and others.

The book describes each new major app and the process and culture of building new tools and keeping them free. Only two pages are devoted to Google Health, however. Generally, the books focuses much more on the advertising business which has made lead to Google’s financial success sometimes overshadows description of apps and the engineering culture. Too many pages are devoted to the failing of traditional media and, of course, Google and the competition continue to evolve since the publication of the book.

The closing question in the book is: has Google become so big and entangled in conflict that it has lost its innovative edge? Recently the excitement over Google Wave and Buzz have met there match with Apple’s iPad. Yet the dominance of cloud computing and Google’s dominance in the cloud may continue to have more of a long term impact than the devices that connect to the cloud.

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Review of Chasing Medical Miracles

February 21, 2010

The subtitle of this 2009 book by Alex O’Meara is “The Promise and Perils of Clinical Trials.” O’Meara combines this personal experience of a clinical trial using stem cells for Type I Diabetes. He reviews the risky world of clinical trials beginning with large for-profit research centers who recruit healthy volunteers and stories of the volunteers who participate for a living or to supplement their income. Some questionable situations are noted including the recruitment of low income and alcoholic men in Indianapolis and elsewhere. He details some famous cases of unethical trials which landed in the courts including those involving genetics and conflicts of interest. Fortunately, some of these potential abuses are more carefully scrutinized. He spends two chapters on international clinical trials which have shifted much of the work to developing countries with a real focus on the issues in Uganda as case study. The fact that drug companies provide medical care in addition to clinical trials creates a dilemma for developing countries with small healthcare budgets.

One outstanding story related to a patient’s right to their own data is from a Hepatitis C trial in which the subjects were not allowed to receive information on their viral load during the study as a way of discouraging drop outs. However, this in itself seems unethical in that the patient would not know whether the treatment was effective or ineffective and whether their disease was progressing. I hope that Institutional Review Boards would not approve such a procedure for trials involving serious illness. Much of the book looks at the issues with placebo controlled studies and blinding – it raises many questions which are yet to be resolved by medical scientist and bioethicists.

I would recommend this book for anyone involved in clinical research, whether in Pharma, medicine or as a patient.

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Decision Tree and the Quantified Self

February 15, 2010

The article in Wired on Decision Trees and the new book also by Thomas Goetz has generated a greater interest in participatory medicine and quantifying one’s life and health.

The title of the first chapter says it all: Living by the Numbers – How alot of science and a little self awareness can give you control of your health.

Brian Ahier addresses these issues as well in his post on “Data Not Drugs: Taking Control of Your Health in the Age of Genetics.” While pointing out the host of tools available to manage your health, everything from WolframAlpha to GetUpAndMove, he discusses earlier adopters who will lead the way, knowing not only their genetic risk but also quantifiy their daily health status. He notes that with few blockbuster drugs in the pipeline, perhaps this is the future of healthcare.  Can the quantified self, enabled by health promotional tools which get easier to use each day, have a larger impact on health than the next lipitor?

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Medpedia adds Clinical Trials

February 3, 2010

Medpedia continues to add vetted health information. In addition to health topics in a Wikipedia style, they had added news and RSS feed from blogs (including this one). Now they have developed integration with ClinicalTrials.gov. The unique approach they are promoting is linking from articles to related clinical trials. I tried this for myself and was able to find that it worked particularly well for some terms like “diabetes.” Also, the search function has good features and the advanced search, called “Clinical” includes Study Type (Interventional, 

Medpedia, despite its growth, has some gaps. For instance, if you look for articles by the alpha index, like leukemia, you find none, but do a search and dozens of very specific articles appear (hairy cell leukemia).  Overall the number of articles, organization and layout of Medpedia continues to improve.  Try out the Clinical Trials search for yourself and see what you think.

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PHRs, EHRs and Social Media – Where are We Headed?

February 2, 2010

Two coincidental articles were published today. First, in iHealthBeat, John Moore and Matthew Holt talk about why ”Consumers Not Ready for Do-It-Yourself PHRs.” In response to the decision by Revolution Health to discontinue their PHR, the experts comment that “the direct-to-consumer market for PHRs just doesn’t work.” But they say that populated records are the future, those tethered to EHRs, like Kaiser’s and how Google Health and Microsoft HealthVault enable this kind of population of data from other sources. In the future, as it is now for some, the PHR will not be separate from the EHR, just the interface on the front of patient data. But this will mean patient entered data, like diaries of their conditions, and from home monitoring devices.

The second article appeared in JAMA, from the Centre for eHealth Innovation in Toronto, titled, “Electronic Health Records in the Age of Social Networks and Global Telecommunications.” Here the authors talk about the intersection of social media and EHRs. Specifically, the authors envision the future with open standards which can enhance interoperability and “natural language enrich by audio or video…Rich media has the potential to reduce ambiguity and enhance performance in complex tasks.”

So while the concept of PHRs may be on the decline, the future of patient empowerment through information has only begun. The convergence of personal health information, provider-based information and social and rich media will provide a basis for future health decisions on a very individual, personal level.

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