Improving CT Scans, Treating MS: Notes from an IR Conference

I am slightly obsessed with the topic of radiation exposure, since I have covered radiation overdoses from CT scans on this blog and written about radiation issues in post-earthquake Japan and treating radiation injuries for Medscape. So I was interested to learn about efforts to decrease radiation exposure in patients when I stopped by the Society of Interventional Radiology's annual meeting in San Francisco last week.

Interventional radiologists (IRs) perform many minimally-invasive procedures, such as placing stents in arteries to increase blood flow or delivering targeted chemotherapy to a tumor. These procedures can often replace more invasive and riskier open surgeries. But the flip side of this medical progress is that some of the imaging technologies used to guide these procedures, specifically CT scans and X-rays, expose patients to ionizing radiation, the type of radiation that can harm DNA. 

A poster at the session explained that CT scans are a key source of radiation exposure in the U.S. This exposure can be decreased by adjusting the CT scanner and basing the dose on the patient's BMI, explained author J. Collins et al. ("A Practical Guide to CT Dosimetry for the Interventional Radiologist").

Another intriguing development covered at the conference: the use of angioplasty (widening a narrowed blood vessel) to treat multiple sclerosis. Angioplasty can clear blockages in veins that might contribute to MS symptoms. Some patients who were studied reported that their symptoms improved after the procedure. The course of MS can be so fickle, though, that it's hard to tell whether symptoms improved or the disease simply relapsed for a while, reporter Laird Harrison explained in a WebMD article on the topic ("Treating Clogged Veins Improves MS, Study Says"). The press release about the procedure from the Society of Interventional Radiology is available online.

Lessons from female crash test dummies

The Washington Post had an interesting article yesterday about the use of female crash test dummies to test car safety in 2011 cars. These dummies, which are lighter and smaller than the male dummies used in the past, provide very different safety data than the male dummies. Some cars tested with the female dummies now have lower safety ratings than they had with male dummies ("Female dummy makes her mark on male-dominated crash tests").

Women drive less than men, but because they tend to be smaller than men they are more vulnerable to injury in car crashes, writer Katherine Shaver points out. They are also more likely to be in the passenger seat than in the driver's seat when traveling with others, which increases their risk for injury and death.

Despite these gender differences, the National Highway Traffic Safety Administration has used only male dummies to create crash test ratings for cars in the past. The story about the use of new female dummies in the 2011 ratings is worth reading to better understand the true risks of driving for women, which the auto industry can address with improved safety features.

How mobile phones improve public health

Smartphones and cell phones are increasingly playing a role in public health. Combine a smartphone with crowdsourcing and infectious diseases, for example, and you end up with a novel concept called participatory epidemiology. The Outbreaks Near Me app for iPhone and Android, for example, released during the swine flu epidemic in 2009, collects data from users and from the media to track the flu and other diseases in every part of the country. Install the app and you can see what disease might be tearing through your city right now (in my neck of the woods, it's the highly contagious Norovirus).

Mobile phones are also used to manage the response after disasters and disease outbreaks. In an interesting article about participatory epidemiology written by the creator of Outbreaks Near Me, the authors cite applications such as Ushahidi, used to manage the response after the Haitian earthquake in 2010, and GeoChat, used to track diseases in Southeast Asia (you can read about the pros and cons of participatory epidemiology in the article "Participatory Epidemiology: Use of Mobile Phones for Community-Based Health Reporting").

For health care providers in resource-poor countries, tracking data on a smartphone is actually easier than tracking it on paper, according to a study released by the CDC this week ("Smartphones more accurate, faster, cheaper for disease surveillance").  In the study, providers collected data for questionnaires about influenza in Kenya using either smartphones or paper forms. The smartphone data was more thorough and (since it was digital) quicker to access in a database than data recorded on paper. What's more, the 2-year cost of implementing smartphones to fill out these questionnaires was also lower than the cost of collecting the data on paper.

More widespread collection of health care data can serve the public good. Perhaps that's how health care data should be seen: as a public asset that we can all contribute to and that we all benefit from. As more health care data is digitized for easier access by public health officials and other entities, however, it becomes increasingly important to protect the privacy of each contributor.

Should you check your DNA?

In medicine, aggregated personal health data, including genetic information, is extremely valuable, even lifesaving. Researchers can analyze data from electronic medical records to find patterns of diseases, see how well treatments work across broad populations, and to pinpoint risk factors for a variety of ills (identifying details for each patient, such as name and address, are blocked to protect the patient's identity).

Some organizations also gather and analyze genetic information to combat specific diseases as a public service. One such organization is the bone marrow donation site DKMS Americas, which collects genetic information from volunteers to create a database of potential donors for cancer patients. This service has saved and improved many lives over the years.

But what happens when the analysis of genetic information becomes a consumer product? The testing company 23andMe, for example, collects a DNA sample from a you and analyzes it to tell you your genetic heritage and your risk for various diseases. The wellness company GeneMe collects DNA to create personalized supplements to improve your health. And the list goes on. These companies encourage customers to use their knowledge of disease risks to make healthy lifestyle choices that might reduce these risks.

In an "Ethicist" column in last Sunday's New York Times about DNA testing companies ("Sizing Up the Family Gene Pool"), however, Ariel Kaminer explains that consumers don't always have control over or knowledge about how their genetic information is used:

Many of these companies do use customers' data for medical research or commercial applications, or they sell it to third parties whose interests you might never know. Legally they can't do that without your consent, but the fine print on those consent forms goes by so quickly that it can be hard to follow.

Kaminer also points out another problem: the results of these tests can be wrong. "A Government Accountability Office investigation into so-called direct-to-consumer genetic testing found inaccurate results and exaggerated claims about how much those results could really tell you," she writes.

Your genetic information is legally protected by the Genetic Information Nondiscrimination Act of 2008 (GINA). The law prohibits discrimination against individuals by employers or health insurers based on the individual's genetic information, which includes genetic tests and genetic diseases in that person or their family members.

But consumer genetic testing is new territory. It's true that this genetic information might be useful to the consumer and the consumer is legally protected against discrimination. But what if the information is leaked or hacked, or the data is misused in unforeseen ways, or by new, yet-to-be-invented technologies? The recent furor over Google's privacy policy demonstrates that we don't always understand what we're giving up when we use new technologies.

Is Your Parents' Health Your Destiny?

I attended a health technology forum recently in Silicon Valley, and, not surprisingly, the issue of health care for Baby Boomers came up. A number of promising new technologies and services are being developed to keep Boomers healthier and help them avoid expensive hospital stays as they age.

The people who are watching Boomer health most carefully, however, are not those creating and funding these new technologies; they are the children of the Boomers. As some speakers noted at the forum, many children of aging parents want to take steps now to avoid developing the chronic illnesses that they see their parents struggle with.

I thought about children of the Boomers when I read the article "12 Ways to Live a Better Life" in the Washington Post this week, based on the book 30 Lessons for Living: Tried and True Advice from the Wisest Americans by gerontologist Karl A. Pillemer. The book compiles life advice from 1,000-plus elderly that Pillemer interviewed, including advice to make healthy changes early in life to help avoid the miseries of chronic disease later in life.

The Baby Boomers are certainly driving changes and innovation in health care. But their children, who are starting to see first-hand the effects of extending life without improving the quality of life, are the ones who will probably work hardest to decrease the high rate of chronic disease in the U.S.

Why Contagion Didn't Get an Oscar Nod

With the Academy Awards approaching, I'm wrapping up my yearly quest to see as many of the movies nominated for Best Picture as possible before the show. Working my way through the list of nominated movies, I enjoyed the clever film The Artist, even though I was initially loathe to watch a French silent film about actors set during the Depression.

But this year's Oscar nominations have been frustrating for me as well, because I thought that Contagion would be nominated for Best Picture or for another major Academy award. Hollywood politics no doubt played a part in the nominations. But I wonder whether the Academy's passover of Contagion comes from a more primal place.

Contagion, which I saw in the fall, was a very difficult movie to watch. Although the script sometimes veered into science lecture territory, in general the movie seemed realistic and frightening as it documented how quickly a lethal virus could spread worldwide.

For me, the movie brought up fresh memories of the 2009 swine flu (H1N1) pandemic. I had been concerned about swine flu, not panicked about it, and mostly allayed my fears by passing out bottles of hand sanitizer to family members.

Because my pediatrician did not have access to the new H1N1 vaccine, in the fall of 2009 I took the kids to a local clinic to get vaccinated, waiting in line with other families and seniors. As the line grew and wrapped around the block, a rumor spread that the clinic had run out of the vaccine.

Suddenly, the police showed up, as if they expected the parents and seniors to riot in the street (and do what? Toss sippy cups and canes at them?). Their presence did not calm people down. It just made all of us nervous: what was going on? As it turned out, the clinic did have enough vaccine, and after waiting several hours in line, the kids got their shots. But the edginess in the line, and in the city, was real.

Now, many of us don't think much about the possibility of another influenza pandemic, until a movie like Contagion is released. Or until researchers are asked to suspend their work on developing a flu strain that is considered a biosecurity threat, as happened earlier this year.

Everyone's a little jumpy these days. Maybe even Hollywood, whose idea of entertainment includes a mother in a coma (The Descendants) and an actor in a downward spiral (The Artist), finds a movie about a global pandemic a bit too disturbing.