Next steps...

It has been a long journey, but at last I've finished my PhD transfer thesis and successfully passed the transfer viva examination. This means that I have the official blessings of the department to continue my research before writing and submitting a final thesis and defending my work in yet another excruciating oral examination.

I think people who sign up to do PhD's must be complete masochists and crazy nutcases.

I've never written such a long document in my life (176 pages in total), nor has my work been placed under such scrutiny as it was in the viva. I am honored, pleased and relieved that I've passed this stage gate for the degree program, and I am anxious to get going with the new work I'll be doing to complete the research. There also appears to be the opportunity for a number of publications to come out of my work. Wish me luck!

With regards to new ideas and new paradigms for healthcare, I'm excited about the London Entrepreneurs' Challenge 2008/09 as a playground and testbed for fleshing out some ideas I have, and I recently attended the kick-off session and first workshop for the competition.

I asked the program organizer, Mr. Tim Barnes, about the viability of not-for-profit organizations in a competition such as this and he responded that there are many similarities in start up and operation of a for-profit company and a not-for-profit charity regardless of what the organization does with its "profits" at the end of the day.

The competition is the result of a colloboration between UCL and the London Business School, and I hope to meet business-minded folks who also share the passion to improve the access and quality of healthcare in the world.

Some initial ideas I have include:

• Open source medicine -
  Are there ways incorporate the spirit of the open source software movement to medical device, drug and procedure development?
  
• Public research -
  I've seen the escalation of the IP arms race with even universities participating in the whole "patent everything" hysteria. But I've also seen companies discard good ideas because they couldn't get "exclusive rights" to it. Could medical device "charities" be formed to sweep up and develop good ideas that corporations won't touch with a 10-foot (3 meter) pole? Could this help expand truly public research unemcumbered by IP restrictions?
  
• Economies of scale -
  Part of the reason why medical devices cost so much are because of the small volumes involved in their production. Could excess production capacity be used to produce devices sold near cost for charity to second and third-world nations where these companies don't have a commercial presence but desire to get a foothold into these nascent markets? Perhaps this could be a consultancy to help commercial companies establish a charity arm or explore and administer the charitable operations for them?
  
• C-to-C networks -
  There are a number of business-to-business networking services that oil the cogs for businesses to work together and colloborate. Are there similar services for charities?
  

I would love to hear your thoughts on this. Please leave me a comment here, or email me directly.

Cheers,
Ifung

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More linkies...

Yes, it's been a while, but here are a few more interesting articles that I've come across on the web.

Recently, I've been writing like a madman, slaving away feverishly on my transfer thesis for the upgrade from the MSc to the PhD, but I promise to write a proper post sometime soon.

Talk about maximally invasive surgery!!! Doctors remove six organs to cut out a tumor, and then put everything back!
http://www.nytimes.com/2008/03/25/health/25miami.html?_r=1&ref=us&oref=slogin

A possible new method to put a patient into suspended animation. Currently works on rats only. We seem to be really good at developing medical treatments that work only on rats! What about us humans?
http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-200804000-00018.htm;jsessionid=HqrbWWpfz1BPRS4sDzyvqJWVqvBkZQFZcflnlb1GZCm3HYw1bGWr!1675702673!181195628!8091!-1

Scientists discover a genetic basis for schizophrenia?
http://medheadlines.com/2008/03/29/could-schizophrenia-be-entirely-genetic/

The FDA investigates a potentially serious link between the asthma drug Singulair (montelukast) and increased risk of suicide.
http://medheadlines.com/2008/03/28/singulair-may-be-linked-to-increased-risk-of-suicide/

Merck's experimental weight loss drug taranabant may be linked to psychiatric side effects. The drug, which works by blocking the cannabinoid receptors in the brain (the receptors that make people feel hungry when smoking marijuana), may induce mood swings that might make patients more suicidal.
http://www.efluxmedia.com/news_Mercks_Taranabant_another_Obesity_Drug_with_Psychiatric_Side_Effects_12602.html

More bad news for Merck, as the American College of Cardiology recommended to doctors not to use Zetia (ezetimibe) and Vytorin (ezetimibe/simvastatin) until there is more science about how exactly ezetimibe works, if it works at all.
http://www.forbes.com/business/pharma/2008/03/31/crestor-astrazenica-schering-biz-healthcare-cx_mh_0331crestor.html

The whole Zetia / Vytorin debacle might be a lesson to over-aggressive drug-industry marketeers, who's marketing efforts oftentimes gets way out in front of the actual scientific proof.
http://www.businessweek.com/bwdaily/dnflash/content/mar2008/db20080331_704360.htm?chan=top+news_top+news+index_top+story

Merck was accused of hiring professional writers to author scientific papers that eventually are published under the names of reputable scientists and physicians in the medical community. The specific papers in question had to do with studies on the non-steroid anti-inflammatory drug Vioxx (rofecoxib).
http://medheadlines.com/2008/04/16/hired-writers-not-scientists-behind-mercks-vioxx-studies/

Finally, a study at the University of Minnesoty showed that health insurance costs in the US soared 30% from 2001 to 2005, increasing ten times faster than income increases during the same time period.
http://www.latimes.com/business/la-fi-insure30apr30,1,643844.story

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Changing the world with water purification.

This man, in one short TV appearance on the Colbert Report, has rejuvenated my belief that technology can be a great contributer to solving the world's problems.

Of course, great political and social will is still required and essential in the prudent and judicious acquisition and distribution of technology, but score one for scientists and engineers!

I need to find out more about how this device works (vapor compression distillation ?!?), but his accomplishments are an inspiration to me. I'm lucky and glad to have met Dean Kamen in my product design class at uni.

But Dean, give us our Sterling engine, puleeeeeeezzeee. (And throw in a Segway, while you're at it!)

UPDATE: Okay, I did some digging around after the initial enthusiasm had subsided. From a Google search, I've found many hits for "vapor compression distillation" which is an old technology for getting back some of the energy used to evaporate the water for distillation, and using it to evaporate more water. So if Kamen's device uses this process, I'm not sure what's so novel about it. Still, if he can increase the efficiency / reduce the price to levels affordable to the developing world, then bravo!

In the news.

I know, it's been many weeks since my last post. Here are a few things I've read in the news recently that hopefully will tide you over until next I can write.

CNN Money ran a nice article about Melinda Gates.
http://money.cnn.com/2008/01/04/news/newsmakers/gates.fortune/index.htm?postversion=2008010703

An article from ABC News about drug companies withholding clinical trial information when the results don't go quite their way.
http://abcnews.go.com/WN/story?id=4149594&page=1

An opinion on CNET News.com regarding Bill Gates' concept of "Creative Capitalism."
http://www.news.com/On-creative-capitalism%2C-Gates-gets-it/2010-1014_3-6227712.html

And a contrary opinion.
http://www.news.com/Gates-misses-the-point-on-creative-capitalism/2010-1014_3-6227726.html

A new study may show that some antidepressants are not much better than placebo, even though they come with pretty bad side-effects.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045&ct=1&SESSID=a6ba371990c03daf972702c4c5fadb9a

An article in the Washington Post predicting that US Health Care costs will double by 2017, "reaching $4.3 trillion and accounting for 19.5 percent of the nation's gross domestic product."
http://www.washingtonpost.com/wp-dyn/content/article/2008/02/26/AR2008022601380.html

Democrats in the US have been sweating the details over universal health insurance coverage, but what about the coming debate in the general election between liberals and conservatives over whether this even should be a national priority?
http://www.nytimes.com/2008/03/02/weekinreview/02sack.html?_r=1&oref=slogin

Bill Gates challenges world leaders at Davos to adopt "Creative Capitalism"

It's great to see the richest man in the world Bill Gates, at the World Economic Forum in Davos, Switzerland, talk about finding ways "to make the aspects of capitalism that serve wealthier people serve poorer people as well."

The Wall Street Journal has a good write-up of his speech here, and a video of the full speech is available here. I think Gates' idea of "creative capitalism" deserves a more in depth look, especially the thoughts about harnessing the best of business, government and charities to tackle the enormous problems of healthcare and poverty.

When so much of the news in healthcare these days is about corporate apathy and malfeasance, it is wonderful to hear someone who has been treated so well by capitalism speak up for people who have not.

It is also wonderful to see the Davos Question so popular on YouTube.

Here are some highlights from the Science forum at Davos.

An Intel Approach to Meds.

I came across this Newsweek article a little while ago and I thought I would share it with you along with my thoughts:
http://www.newsweek.com/id/68221

According to the article, former Intel CEO Andrew Grove commented that the pharmaceutical industry could learn a lot from the semiconductor industry. Please read the article for details.

While I agree with the spirit of some of what Mr. Grove is saying, I believe that the comparison between the medical device and pharmaceutical industries with the semiconductor industry is flawed and a bit unfair.

Besides, of course, the moral and ethical responsibility to ensure as best as possible that a medical product will not maim or kill the patient, the largest hurdle to getting a product onto the market is the lengthy and costly government approval process it has to undergo to be approved for legal human use.

Just a little background - in the United States, the approval process is regulated by the Food and Drug Administration (FDA). The FDA drug approval process is summarized here and the FDA medical device approval process is described here.

If all this sounds to you like huge amounts of work, it is. But remember that it is this way for good reason - to protect patients' health and public safety.

Even with the regulatory process as it is, things slip through, medical products are recalled and people still die. Remember the cox-2 inhibitor drugs like Celebrex and Vioxx that were recalled because some of the people who took this drug for arthritis were dying from myocardial infarction and stroke.

In the medical world, you don't get a second chance. If a product has hurt or killed someone, it is very hard to regain the trust of doctors to give it another go, even if it has been vastly improved by the developing company.

In some cases, the faulty device doesn't even have to come from your own company. One company I worked for was developing a staple for heart bypass surgery that had some great pre-clinical data. A smaller company that got to clinical trials faster ended up with dead patients, which put surgeons off of the entire class of device. Talk about poisoning the well.

Also, remember that large corporations stand to lose a lot due to product liability lawsuits if their product results in unexpected damage or death. So companies tend to be very thorough with their testing and approval submissions. And they tend to be very, very slow and conservative in nature.

I believe it also makes them inclined to bet on the "safe projects" that provide the best predicted return-on-investment rather than on products that potentially are the most efficacious, or the ones that might have the most impact on global health.

I'm not trying to defend these companies or justify the decisions they make. But I think it is important to understand the preconditions that might help to explain why the companies behave as they do. Things are always more complex than they at first seem.

I agree that things do happen too slowly, especially for those whose hopes for health and survival depend on breakthroughs that these companies promise to deliver.

Academia at times does seem too focused on obscure academic things, and corporations seem too focused on risk reduction and maximizing the bottom line. In the mean time, the public at large seems to be losing out. Big time.

So what do we do? Anyone have any thoughts?

Funny moments for doctors.

All right. Maybe I should continue to alternate between serious blog entries and more light-hearted goofy ones. Here is a list of funny medical moments submitted by doctors.

Now while I can't vouch for whether these are real submissions by real doctors, I can verify that they are all pretty funny. Remember to always consider your sources when reading something, but in this case, it doesn't really matter because, heck, this might actually make you crack a smile.

(MILD CAUTION: Some of these are of a mild sexual nature, so don't click on the link if that's not your cup of tea. But then again, if that's you, you probably shouldn't be surfing the internet anyway.)

Here it is:
http://www.bubblejive.com/funny-moments-for-doctors

How It All Ends.

While not about health care per se, I found this series of videos on Global Climate Change to be intelligent and fascinating. And if the worst case scenarios of GCC were to come to fruition (God forbid), we will have, amongst myriad other disasters, a health care crisis like none the world has ever known.

Definitely watch the first video "How It All Ends" and pick and choose others that you think you might like. I found "Nature of Science," "Risk Management," "Mechanics of GCC" and "Scare Tactics" to be particularly interesting.

In a show of utter procrastination, I watched all six hours of videos, but you don't have to do the same. Be aware though that the videos are addictive, and you may end up clicking on link after link until six hours have passed by, and then your wife or girlfriend turns to you and asks you what the heck you are watching on the internet at two in the morning.

Here it is -- the link to a website that has all the videos in sequence:
http://www.howitallends.org/

And here is the first video "How It All Ends" on YouTube:

Oh my!

And here you thought this was going to be a serious blog. No seriously.

This is the strangest Christmas present idea I've seen all year. Give the gift that keeps on giving - send your loved ones herpes (in plush toy form) here.

The website has an entire section on venereals (other choices include gonorrhea, chlamydia and syphilis), as well as calamities (such as ebola, typhoid and mad cow). Or how about sending your loved ones some staph, MRSA or toxic mold? Don't you wish all microbes were so cute and cuddly?

Happy New Year!

On this the first day of 2008, I wanted to wish everybody a Happy and Healthy New Year! Cheers from London! Be well and be safe.