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Stem Cells Might Speed Healing In Achilles Tendon Rupture

H/T to MedGadget who’s post introduced me to “bioactive sutures.”  What a great idea by the Johns Hopkins biomedical engineering students!

……have demonstrated a practical way to embed a patient’s own adult stem cells in the surgical thread that doctors use to repair serious orthopedic injuries such as ruptured tendons. The goal, the students said, is to enhance healing and reduce the likelihood of re-injury without changing the surgical procedure itself.

The project team of 10 undergraduates focused on Achilles tendon injuries which require repair in approximately 46,000 people in the United States every year.   The surgery may fail in as many as 20%.  Recovery can take up to a year even with successful surgery.  If this new suture speeds healing and lowers failure rates – what potential!

At the site of the injury, the stem cells are expected to reduce inflammation and release growth factor proteins that speed up the healing, enhancing the prospects for a full recovery and reducing the likelihood of re-injury. The team’s preliminary experiments in an animal model have yielded promising results, indicating that the stem cells attached to the sutures can survive the surgical process and retain the ability to turn into replacement tissue, such as tendon or cartilage……………

As envisioned by the company and the students, a doctor would withdraw bone marrow containing stem cells from a patient’s hip while the patient was under anesthesia. The stem cells would then be embedded in the novel suture through a quick and easily performed proprietary process. The surgeon would then stitch together the ruptured Achilles tendon or other injury in the conventional manner but using the sutures embedded with stem cells.

*This blog post was originally published at Suture for a Living*

Where Obama Is Right On Health Care Reform

Cost is the enemy here. via the WSJ blog

“If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket.

…if somebody told you that there is a plan out there that is guaranteed to double your health care costs over the next 10 years, that’s guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that.

Well, that’s status quo. That’s what we have right now.”

Proponents and supporters can argue forever about whether this is the fault of the free market or the fault of too much or too little government. I happen to believe that what we have today is nothing more than an expected result of the government regulations put in place. No matter how you try and structure regulation, capitalism will exploit it.
Every insurance I am involved with has a beginning and an end. If your house burns down, you get a defined compensation. If your spouse dies, their life insurance pays a defined compensation. If drive your car into a garbage can and dent the hood, your insurance pays a a beginning and an end.
With health care insurance, we haven’t defined an end point. With fee for service, the costs are unlimited, and therefore our health care inflation is unlimited.
With bundled care, the costs are limited, and there fore our health care inflation is limited as well. Some folks believe that you can’t estimate how much it will cost to take care of a patient with diabetes with complications, coronary disease and six other chronic medical diseases. I think we can. And I think we can do it much cheaper than we are doing it today.
The current model is not sustainable. In any third party model, whether it is the government through taxes, or private insurance through premiums, no one is accountable to cost. FREE=MORE makes providers do more. FREE=MORE makes patients do more. I have come to the conclusion you can’t have both fee for service and third party insurance AND not double our expenses in the next 10 years. I personally do not want to spend $25,000 on myself and Mrs Happy’s health insurance in ten years.
Obama is right. This is exactly where we are heading. Remember that $25,000 in health care insurance is $25,000 less in take home pay being withheld by your employer. As long as someone else is paying the bills, FREE=MORE will prevail and we are all screwed.
Either abandon health insurance all together, or abandon fee for service. We can’t have both and survive.

*This blog post was originally published at A Happy Hospitalist*

The Curious Case Of A Child With Half A Brain

media_125675_en.jpgThe scans presented here are of a ten year-old German girl who was discovered to be missing the right hemisphere of her brain. Incredibly, she is perfectly normal, except for a history of seizures and a slight weakness on her left side. Attending school with others of her age, it is reported that she is able to study and play sports, just like other kids around her. Of course, the mystery is how is this all possible? To answer the question, University of Glasgow scientists used an fMRI to see where the left eye’s vision is processed. Turns out that the brain’s visual area responsible for the right eye offered up some space for the left.

Normally, the left and right fields of vision are processed and mapped by opposite sides of the brain, but scans on the German girl showed that retinal nerve fibres that should go to the right hemisphere of the brain diverted to the left.

Further, the researchers found that within the visual cortex of the left hemisphere, which creates an internal map of the right field of vision, ‘islands’ had been formed within it to specifically deal with, and map out, the left visual field in the absence of the right hemisphere.

Dr Lars Muckli of the Centre for Cognitive Neuroimaging in the Department of Psychology, who led the study, said: “This study has revealed the surprising flexibility of the brain when it comes to self-organising mechanisms for forming visual maps.

“The brain has amazing plasticity but we were quite astonished to see just how well the single hemisphere of the brain in this girl has adapted to compensate for the missing half.

“Despite lacking one hemisphere, the girl has normal psychological function and is perfectly capable of living a normal and fulfilling life. She is witty, charming and intelligent.”

The girl’s underdeveloped brain was discovered when, aged three, she underwent an MRI scan after suffering seizures of brief involuntary twitching on her left side.

The scientists believe the right hemisphere of the girl’s brain stopped developing early in the womb and that when the developing optic nerves reached the optic chiasma, the chemical cues that would normally guide the left eye nasal retinal nerve to the right hemisphere were no longer present and so the nerve was drawn to the left.

This implies that there are no molecular repressors to prevent nasal retinal nerve fibres from entering the same hemisphere.

Dr Muckli added: “If we could understand the powerful algorithms the brain uses to rewire itself and extract those algorithms together with the general algorithms that the brain uses to process information, they could be applied to computers and could result in a huge advance in artificial intelligence.”

Press release: Scientists reveal secret of girl with ‘all seeing eye’…

*This blog post was originally published at Medgadget*

Video: Healthcare Reform: Putting Patients First

Better Health bloggers from across the country participated in a historic discussion about healthcare reform at the National Press Club on July 17th, 2009. I managed to condense a 3 hour event into a 4 minute video… for those of you who were unable to make it, here’s my highlight reel… Thanks to Freddie Dorn at Picture This Video for helping to create it! Factually Inaccurate, But Doing Some Good Nonetheless

Last week marked the 10th anniversary of a smoking cessation website called “”. Now those of you who know me, and know that website and its director, Mr John Polito, may wonder why I’m choosing to give it some free publicity. The website is strongly against the use of all pharmacological aids for smoking cessation, and some would argue that it does harm by misinforming smokers about the harms and benefits of these smoking cessation aids. However, although I certainly do agree that the site does misinform about pharmacological aids, it also has a number of positive qualities and presents a different perspective that may appeal to and help some smokers.

The site started 10 years ago primarily to tell the story of a few individuals who were killed very young by smoking caused diseases. The idea was to vividly tell their tragic stories and to inspire others to quit tobacco and so avoid the same. In 2000 Joel Spitzer, an experienced smoking cessation counselor and author joined whyquit and the site took on more of a role of advising smokers how to quit using a very clear philosophy based on the “cold turkey” method.

The site has a large amount of educational material, including free pdf copies of lengthy books by Polito and one by Spitzer. The descriptions of individual cases of tobacco-caused diseases are informative and will inspire some to avoid the same harrowing experience. The site also has a discussion forum called, “Freedom from nicotine.” But once again the fundamentalist opposition to the use of pharmacotherapy aids is evident in the rules for use of “Freedom from nicotine”. The site states that,

“A single-minded program, those applying for posting privileges must have quit all forms of nicotine delivery cold turkey within the past 30 days, without use of any products, pills or procedures, and remained 100% nicotine-free for at least 72 hours. A nicotine-free forum, any nicotine relapse – even one puff, dip or chew – permanently revokes posting privileges.”

This is a rather unusual requirement for people to use a quit smoking discussion site, and it seems rather odd to ban people “permanently” from using the discussion forum, because they had a puff or chewed a piece of nicotine gum.

The site contains a large number of factual inaccuracies, particularly when referring to research on the use of pharmacotherapy for smoking cessation and the evidence on it. There are too many examples to mention, but just to mention a few:

- the site states that nicotine withdrawal lasts 72 hours. Most studies of nicotine withdrawal symptoms find these to be significantly raised after the first week, and typically not returning to normal levels for 3 weeks.
- The site asserts that in “real life” studies nicotine replacement therapy doesn’t work and “cold turkey” always produces a higher quit rate. An example of a study refuting that claim is provided below (West and Zhou, 2007)
- The site asserts that placebo-controlled trials of pharmacological treatments are all severely flawed because participants can sometime guess better than chance (.e.g. because the medicines work so well at treating nicotine withdrawal that participants can tell what the got, so the study is not perfectly “double blind”). On this point the site is somewhat out on a limb as most scientific research bodies regard the randomized placebo-controlled trial as amongst the best ways to find out if a drug treatment works or not.
- The idea that the results are entirely due to participants’ awareness of whether or not they received the drug also doesn’t bare much scrutiny. For example, in dose-response studies or studies where there is also an “active” comparison, participants are less able to identify what treatment they received, but the higher dose typically does better than the lower dose, and both do better than placebo.
- The site is also highly critical of anyone who has been funded in any way by pharmaceutical companies, and implies that such a conflict of interest almost certainly causes those individuals (including myself) to lose all independent judgment. While I agree that researchers should declare their sources of funding and that readers should weigh that information when reading research reports, the idea that the whole field has been bought and sold to the pharmaceutical industry is blatantly false. It is not at all uncommon for researchers receiving pharma funds to publish studies with disappointing results for the pharma company, including reports of potentially serious side effects.
(e.g. Foulds, J., Stapleton, J., Hayward, M., Russell, M.A.H., Feyerabend, C., Fleming, T., and Costello, J. Transdermal nicotine patches with low- intensity support to aid smoking cessation in outpatients in a general hospital: a placebo-controlled trial. Arch Fam Med 1993; 2: 417-423.
Foulds, J. and Toone, B. A case of nicotine psychosis? Addiction 1995; 90: 435-437).

The reality is that for years academic researchers have been encouraged by our employers to build bridges with private industry in order to make scientific advances, and do so with their eyes open. Most acknowledge our funding as openly as possible without becoming very tedious (e.g. my funding sources are mentioned on my home page on healthline and also on my program website, rather than on every single blog post). Most of us draw the line at funding from the tobacco companies because they have such a clear and consistent history of distorting science and using primarily for PR purposes, and largely because their ultimate purpose is to sell a product that is extremely harmful to health, rather than products designed to improve health.

However, the point here is not to quibble with every single point or inaccuracy on the site. Rather readers should be aware that in among the inspirational stories and plenty of good advice on this site, there is an almost fundamentalist agenda that its just wrong to use medicines to help you quit smoking. If you agree with that, or are prepared to take it with a pinch of salt, then you may find other aspects of this “single minded program” to be helpful.

Here’s an example of a recent “real world” study finding that smokers using NRT have a higher quit rate

This post, Factually Inaccurate, But Doing Some Good Nonetheless, was originally published on by Jonathan Foulds, Ph.D..

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