E-Medicine - The Virtual Thing or the Real Thing?

What’s your opinion of “virtual” colonoscopies and virtually bronchoscopies?

Virtual advocates claim virtual techniques are just as good in spotting lesions as the real thing, and are safer, less invasive, and less traumatic. Critics claim virtual procedures cost more, expose patients to unnecessary ionizing radiation, and delay tissue biopsies which may require a "real" biopsy.

And you do you have any feelings about the flood of “virtual experiences” popping up on the Internet. These simulate health and disease situations in “astonishingly real” 3-dimensional color and sound. Patients can conceive of fighting disease, living with disabilities, or even recovering. Using the Internet, the old can experience being young, the paralyzed can walk, cancer victims can dream of cures, medical students can be trained.

Are these virtual realities a recipe for phony cures or false hopes? Are they a partial answer to the doctor shortage? Do they have therapeutic value? We may soon know. The CDC is testing a “virtual office”, the American Cancer Society if offering virtual lectures, March of Dimes is setting up a virtual neonatal ICU, National Library of Medicine is forming a virtual island of reliable information, University of California is simulating a virtual psyche ward to help understand schizophrenia, and Stanford is organizing virtual operating and ERs to train medical students.

What, in your opinion are practical things we can do and not do in the realm of virtual reality?

Physicians, academic - National Physician of the Year Awards

I serve on the Medical Advisory Board of the Castle Connolly America’s Top Doctors publication. Each year we publish a 1200-1300 page volume containing a list of more than 3000 of America’s top physicians. We select these physicians through a process of nomination by over 250,000 specialists and through periodic mail, telephone, and email surveys, interviews with leaders of various medical specialties, and leading physicians in medical centers. Finally, we ask our 12 member Medical Advisory Board to rate the candidates for the national physician of the year awards for clinical excellence and life time achievement.

This year the selections are:

For clinical excellence:

1) Delos, M. Cosgrove, MD, Chairman, Board of Governors, CEO, and President, The Cleveland Clinic – Dr. Cosgrove has performed over 20,000 surgical procedures and has become a world-renowned expert in the field of heart valve repair.

2) McCarthy, Joseph, G, MD, Professor of Plastic Surgery, the Institute of Reconstructive Plastic Surgery, NYU Medical Center. He has pioneered the concept of craniofacial distraction and introduced the concept of infant facial surgery to avoid psychosocial problems during childhood.

3) Patrick C. Walsh, MD, Director of Urology, the James Buchanan Brady Urological Institute, the Johns Hopkins Hospital. Brady has pioneered the development of “the anatomic approach to radical prostate" which involves nerve-sparing techniques reducing the possibility of impotence and incontinence.

Lifetime Achievement Awards

1) Maria Defivoria-Papadopoulos MD, Director, Neonatal Intensive Care Unit, St. Christopher’s Hospital for Children, Professor of Pediatrics, Physiology, and Obstetrics/Gynecology, In her 50 years of medical practice her steadfast dedication to at-risk newborns has earned her recognition as a leader in the field of neonatal and perinatal medicine.

2) Honorable Nancy G. Brinker, Founder of the Susan G. Koman for the Cure, former U.S. Ambassaror to Hungary, Baker has received numerous accolades for here work, including the Mary Woodard Lasker Award for Public Service, the Champions of Excellence Award presented by the Centers of Disease Control, and Ladies Home Journal 100 Most Important Women in the 20th Century.

Malpractice, tort reform - Effect of Lower Malpractice Rates and Caps: More Doctors

If you doubt how deeply steep malpractice premiums obsess doctors and drive them away, I invite you to read “More Doctors in Texas after Malpractice Caps.” (NYT, Oct. 5).

Four years after a constitutional amendment to limit awards to $250,000 for pain and suffering, doctors have flooded the Texas Medical Board with 2500 applications to practice there. Applications are up 30% over 2006. The increase in doctors - double the general population rate – has raised the state’s ranking in physicians per capita to 42nd in 2005 from 48th in 2001, and is certain to move up sharply in 2007. Average malpractice premiums dropped 21% last yeat.

Of doctors awaiting processing, after Texas, 145 come from New York, 118 from California, and 100 from Florida. They include 186 obstetricians, 146 orthopedic surgeons, and 26 neurosurgeons.

Says Dr. Donald Patrick – executive director of the medical board, neurosurgeon, and lawyer, “Doctors are coming to Texas because they sense a friendlier malpractice climate?

This tale’s moral? If you want more doctors in your state, lower your malpractice rates and caps.

Innovation, General, Innovation, academic - Cleveland Clinic’s Top Ten Innovations

These days it seems everybody is listing medicine’s top innovations. Now it’s the Cleveland Clinic’s turn. At its fifth annual innovation summit, the Clinic announced these top ten finalists.

1. Flexible intralumenal robotics: Catheters letting surgeons insert tiny tools in places where hands don't fit, such as inside the heart or other organs. The flexible robotic system can be used for urology, cardiology, cardiac surgery, and other specialty procedures.

2. Percutaneous aortic heart valves: Aortic heart valves delivered by catheters through a groin or small incisions in the chest wall and then expanded inside the heart. X-ray screening lets doctors monitor and position the valve.

3. RNA-based therapeutics: Gene-based therapies reducing a protein carrying bad cholesterol and triglycerides in the bloodstream to reduce heart disease.

4. Genome scanning and informatics to support clinical applications: Genetic testing producing personalized health risk assessments to head off future disease.

5. New drugs to prevent blood clots or bleeding: New anticoagulants, including low molecular weight heparins, to curb bleeding and thrombosis.

6. Nasal drops delivering flu vaccine to infants: Nasal drops containing live attenuated flu can be used as a vaccine instead of needles to protect from influenza in children as young as 6 months.

7. Image fusion for diagnostic and therapeutic use: Merging of different imaging technologies to better diagnose anatomic and physiologic problems and guide minimally invasive procedures.

8. Implanted devices to restore movement to the severely disabled: Neural control devices restoring movement of arms and legs to patients with spinal cord injuries, stroke, ALS, and other central nervous system injuries.

9. Engineered cartilage products for joint repair: Natural biomaterials to replace joint cartilage tissue damaged from injury or arthritis. The engineered cartilage is surgically implanted into the joint with the intent to avoid artificial joint replacement.

10. Dual energy source computed tomography imaging: Computed tomography (CT) scanners using two radiation sources and detectors, speeding medical imaging, and exposing patients to less radiation. It allos imaging of patients with high or irregular heart rates.

Please note. These innovations are all technological. Important innovations come in other forms, too. sites of practice: retail clinics and workplace clinics), types of practices (retainer and cash only), and social networking internet sites(sermo.com).

Innovation, general, innovation , academic - Four Centers of Medical Innovation

I’ve been invited to give a keynote address “The Rise of Innovation-Driven Health Care” at the University of Pittsburgh on November 9 at The Innovator’s Conference.
. The invitation got me to thinking: What does it take to launch an innovation revolution in medicine?

Basically three things:

1) Experienced entrepreneurs with ideas that make a difference, and a management team to take the idea to market.

2) Sources of venture capital to change ideas into reality.


3) Supportive urban supportive environments, homes of commercially successful enterprises, well-known medical institutions, and academic centers as sources of talent.

Four Centers for Innovation

Here are four medical innovation centers.


• Consider the entrepreneurial spin-offs from Healthcare Corporation of Amrica (HCA)in Nashville. Nashville now has over 300 for-profit innovative health care- related enterprises.

• Think of Boston’s Medical Industrial Complex with its nexus of academic medical centers and health fare firms sprouting around Route 128.

• Look at Minnesota’s Medical Alley stretching form from Rochester to the Twin Cities with the Mayo Clinic, Medtronic, St. Jude Medical Inc, United Healthcare Group, MinuteClinic, and 800 registered medical device manufacturers.

• View the University of Pittsburgh Medical Center which has pioneered organ transplant surgery, robotic surgery in the field of orthopedics, patient engagement before surgery by “prescribing” online interactive Internet programs telling patients exactly what to expect, and now an Innovation Center to bring new ideas, new technologies, new processes, and new ways of thinking to the attention of a wider world.

Physician business ideas - Practice Size and Physician Employment Trends

According to the Center of Studying Health System Change, a Washington, D.C. think tank, finances and a desire for balanced life styles and regular hours, are driving physicians out of solo practice, into single specialty groups, and into salaried settings. One surprise is that the number of physicians in multispecialty groups, said by some to be the basis for a more rational health system, has dropped from 30.9% to 27.5%, a 3.4% decline.

Here’s the Center’s data showing the trends from 1996-1997 to 2004-2005, the later being the latest data available.

Doctors in Different Practice Group Sizes and and Employment Settings

1-2 physicians, 40.7% to 32.5%, down 8.2%

3-5 physicians, 12.2% to 9.7%, down 3.5%

6-50 physicians, 15.9% to 21.8%, up 5.9%

Single specialty, 13.1% to 17.6%, up 4.5%

Multispecialty, 30.9% to 27.5%, down 3.4%

Other*, 31.2% to 36.0%, up 4.8%

*Other includes physicians employed by medical schools, HMOs, hospitals, community health centers, freestanding clinics and independent contractors.

Does this information surprise you? How do you interpret its meaning? Does it reflect inevitable trends?