This transcript has been edited for clarity.

Abraham Verghese, MD: Hello. This is Abraham Verghese. Welcome to a new episode of "Medicine and the Machine," which I have the great pleasure of cohosting with Eric Topol. Today we have a very special guest, a man I've looked up to pretty much all my career. Arthur Kleinman is a professor of psychiatry and medical anthropology at Harvard University. He carved out new territory early in his career by creating the field of social medicine and medical anthropology, literally putting it on the map and training several notable students, including Paul Farmer, who've gone on to do great things.

Arthur is the author of many influential books. One that truly informed my thinking was The Illness Narratives.[1] But he has a new book out called The Soul of Care,[2] which we'd like to talk about today. Arthur, welcome to this podcast. Thank you so much for spending time with us.

Arthur M. Kleinman, MD, MA: Thank you, Abraham, for having me. I'm delighted to be here.

Verghese: To begin, would you tell us how you got into this field of medical anthropology and social medicine? How did it evolve that your career began that way?

Kleinman: I was one of those strange types who, when he went to medical school, could have gone into something else. I could have gone to graduate programs in the arts and sciences. I was always very interested in history and in social theory, and after I had been in medical school and then at the National Institutes of Health, I was sent to Taiwan during the Vietnam War. As a US Public Health Service officer, I became very interested in the issue of how medicine was carried out in different cultures. I was from the United States, and I was in Taiwan and saw a radically different healthcare system and distinctive ways of caring for people. So, since my wife was a China scholar, and I knew the Chinese language, I thought I should attend to this culture in a deep sense and become an anthropologist. And that's what I did. I went from Taiwan to Harvard, studied social and cultural anthropology, and helped develop the field of medical anthropology. I guess the distinction I draw, Abraham, is that you are, in my view, a great writer as well as an outstanding physician. I see myself as a physician but not as a writer, even though I've written about 40 books.

Eric J. Topol, MD: Only 40? Wow.

Kleinman: I am a William Jamesian, almost a footnote to William James. Remember, William James said that everything comes out of experience. My great curiosity was about experience. How do people live with suffering? How do they respond to it? How do practitioners of very different kinds in different local worlds, worlds across the seas and worlds neighboring each other, how do they do things distinctively? So I had that sort of focus on experience. That sums up my interest, with one caveat: to use experience in order to help others.

Verghese: That brings us to your new book, which is a real departure in the sense that it's intensely personal. I'm sure you wished to never have to write a book like this, and yet, The Soul of Care is such a gift. Without giving too much away, in this book you talk about your transition from being an academic and physician to becoming a caregiver. I just want to quote from a passage you write in this book. "Care is also about the vital presence, the liveliness, and fullness of being; about the caregiver and the care recipient. Acts of caring call that presence out from within us. Care does not end with death, but involves actively caring for memories."

Tell us about the genesis of this book. Then I'd like to shift this discussion for a bit to talking about care, because it's a paradox. Healthcare is the business Eric and you and I are involved with. And yet care, especially the way you construct it, is almost tangential to the discussion of healthcare and healthcare reform. So tell us about this book and how it came about.

Kleinman: As you suggested, this was a painful book to write. For a little over a decade, I took care of my late wife, Joan Kleinman, who had early-onset Alzheimer's disease. And not only did she have Alzheimer's disease, but it was a particularly frustrating type, because it started in the occipital lobes of her brain, which are responsible for, among other things, the interpretation of images. So she was functionally blind as well as suffering from dementia. This was very cruel because she was a visual person, a fine painter and calligrapher in the Chinese tradition.

As this awful decade developed, it was as if a veil of ignorance was pulled away from my eyes and I was seeing caregiving from the inside as a family caregiver. And I realized that, with all these decades of experience I'd had doing research on healthcare and being an active clinician, I really had lost the sense of what caregiving is for a family member. This was so striking, and powerfully so to me, that I felt I wanted to write a book that was at once raw in its personal naturedeeply raw, I thinkbut also in which I could generalize from my individual example to care more generally.

So, the first thing was, what do I mean by care? How is it possible, for example, to have healthcare without care, which is where we fit in the crisis of healthcare right now. By care, I meant just the kinds of things you read. I meant, first of all, the nature of the relationship that caregivers have with each other, since I believe that's the most fundamental dimension of care. It's a relationship. And it's a relationship in which, once we focus on the care, it's easy to forget about the care recipientthat is, the patient or family member who needs care, but who is just as important, if not more important, than the caregiver.

And in this relationship, as I've experienced it and looked at it cross-culturally, there is a kind of gift exchange. It is an exchange of gifts in an anthropological sense in that the care recipient gives the gift of their vulnerability and their need to be helped, assisted; in turn, the caregiver gives the gift of their involvement and their attention, which is tied, I think, to their presence.

We're all familiar with the criticism of medicine, that frequently doctors are so absorbed by the screen on their computers that they have their backs turned to the patient and are not present. But when you look at family care, it involves a kind of a deep presence. It's that relationship that's begun long before and will end later. And it's not just a one-time shot but something of intimacy and tension, because even for the most loving and committed caregiver, care is tough work. It's hard physical work. It's tough emotional work. And it's moral work as well. So, besides presence, there's also the issue of enduring. You have a long illness experience of a disorder that cannot be cured but has to be managed. In that long illness experience, I really don't think any of us are truly resilient, where we're like rubber bands and we simply spring back to what we were before. This experience is so demanding, so difficult. The real issue, and it's one that we don't like to talk about in the United States because it doesn't have a kind of Hollywood ending, is enduring. How do we endure? That's what I felt throughout my 10 years of taking care of my wife. I was challenged to the core and wasn't sure I could endure. I felt at times that I was enduring the unendurable.

Clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays.

So, what is enduring about? How do we keep going? Because of my own experience, I looked at and spoke with many other family caregivers and was astonished by how many of them felt they came to a wall they couldn't get over, and yet because of their love and their concern for the person they were taking care of, they got over the wall; they made themselves get up, get over the wall, and keep going. I was impressed with how enduring is critical to care.

And then the last partit's surprising that I learned this from my personal experience; I should have known it from my professional experiencebut care does not end with the death of the person you're caring for. You're caring for memories after that. A clinician also cares for memories, remembering how to think about the care and how to perhaps use a particular case to improve care in the future. The family member, of course, is rebuilding a story about one's life and one's family. Central to that is the memory of the care you gave and what you've gone through. The attention to those memories, their ordering, the time we spend developing them becomes a very important part of our lives after the practical acts of care no longer need be given because the person has passed. Those are the kinds of things I was concerned with.

I came to realize two things: First, that care was disappearing from clinical medicine, that clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays. And second, there's some question as to whether in the future, even in families, we'll have care, given the limited time that family members have today, the fact that both husbands and wives workthis was women's work in the pastand men in our time, no matter how "woke" and liberated they claim to be, are not picking up the task of care.

Topol:The Soul of Care is an extraordinary book and, in many ways, a gut-wrenching story. You've defined care so elegantly. The other word, of course, is "soul." You captured this well in the recent Lancet piece you authored in August.[3] I want to read one sentence from it. It's about the soul of medicine, as you wrote in The Soul of Care. You wrote, "I find the expression 'soul-less' a resonant one to depict what is happening to caregiving in medicine in our times, where the health system's goals of efficiency and cost-effectiveness, new technological requirements that absorb the clinician's alertness and attention, and the sheer pressure of insufficient time to listen and explain have a dire effect on providing the best of care." Can you amplify on that?

Kleinman: I think that is, in fact, the case. My colleague, Atul Gawande, has written a terrific piece[4] that you probably read in The New Yorker about the Epic system, Harvard's electronic medical record system. It was developed without the idea of care in mind, and Atul pointed out that it is so complicated, so difficult to use, that the clinicians spend virtually all their time trying to make sense of it, and they use it to provide information about the patient that is critical to the treatment. So in a setting like that, the whole attention of the clinician is away from the patient.

The second thing that's happenedand Abraham, you may be the expert on this, but as a consultation psychiatrist, that is, a psychiatrist who works with people in internal medicine and surgery, I've been impressed by how internal medicine residents today seem to distrust their clinical skills of physical examination and want to jump right away to objective test results that come from the various machines we work with, which are more precise than we can be with auscultation and other acts of physical diagnosis. Yet, when physical diagnosis is done the way you do it, and the way I feel it should be done, it is a wonderful example of caregiving. It's the laying on of hands, the supporting of the person. It's the resonant sense that we're in this together, that I'm here with you. That's not the way I'm seeing the physical exam being carried out today. It's much more perfunctory. It's a sort of run-up to doing the tests that are more precise. The physical exam has lost its place as crucial to the actual caregiving through touching and connecting. That is a part of my concern.

Another part of my concern is that when you start a clinical interaction in medicine, bioethicists have clearly pointed out that the first actions are acknowledgement and affirmation. The doctor acknowledges and affirms the patient for being there legitimately with a problem that needs attention and affirms their suffering. And in turn, the patient affirms the doctor's right to explore their body and to ask questions. I think if you have your back turned to the patient, if you're focused on the technology of the computer, it's very difficult to establish this acknowledgement and affirmation of the humanness of the person. Hence, you begin the doctor-patient interview without that human connection being acknowledged and affirmed. Frankly, I think that's disastrous.

Verghese: I'd like to ask you about something I found to be extraordinary. If you plot the course of your wife's illness, the trajectory of it, medical diagnosis was a small element of it early on. But then if you look at the percentage of time of people who really mattered to you and your wife during this long course of illness, very few physicians are involved. Most of them have bit parts that are often detrimental to the care and not necessarily helpful. The most important individual you acknowledge again and again was the professional caregiver who worked with you. What are we going to do as a nation when we talk about healthcare reform, when we need much more, from the sounds of it, from the professional caregiver and much less from the high-tech stuff we spend a lot of time on?

Kleinman: It's a great question. I could not have taken care of my wife for 10 years, doing the things I had to do, if it weren't for the assistance of a terrific home health aide. This was a woman of Irish background who came from a family in which there were multiple generations of home health aides. She was just great with Joan. Not only was she great in helpingshe worked 5 days a week, 9 to 5but she pointed out to me that I worked 2 full days on the weekend and from 5 in the evening to 9 in the morning, 5 days a week. The respite she gave me, the chance to get away and do my work, made me a much more successful caregiver. In fact, I don't think I could have done it with without her. I lucked out.

The astonishing thing was that the medical specialty, neurology, which is responsible for patients with dementia, the neurodegenerative disorders, and stroke, is organized around diagnosis and a few medications, most of which are limited in their effectiveness. But the profession itself seems to have come to a conclusion that has nothing to do with aftercare. Some of the great neurologists in the country are at Harvard Medical School, and they made the diagnosis of Joan's Alzheimer's disease at least a year before it probably would have been made otherwise. They all wanted to help me; they knew me well and wanted to help me. Not one said anything about the care I would have to provide and what Joan would be going through. It astonished me. No one recommended a home health aide for me, which, as I just suggested, turned out to be absolutely crucial. And no one said anything about how I'd have to reconfigure the house so that Joan would be more comfortable there and I could take better care of her. No one mentioned anything about what the day-to-day living experience would be like, and where I would need assistance and how I could get it. And that was astonishing.

I went back to certain of my neurology colleagues and I realized that they just didn't see this as their purview, which is sad. Nor had they, as far as I could see, organized for Alzheimer's the kind of care team we take for granted in the area of oncology where, if the oncologist can't do it, there's a social worker, a physical therapist, or someone else who will step in to provide the kind of care that's needed. This is a huge problem for the neurodegenerative disorders. And I don't see an easy solution to it. In fact, I think it may get worse.

For example, who are the home health aides? By and large, they are poor women, often women of color, women who do not necessarily want to go into home healthcare but it's the only job open to them. This is certainly true of recent immigrants to the United States, who often dominate the field in Boston. It's primarily Asian immigrants who do this. And yet they do a remarkable job. Along the way, in both homecare and when Joan had to go into a cognitive care unit, her support from home health aides and from health aides in the clinic was just tremendous. They pick up where physicians fall off. But they're decreasing in number as people find that they can do other things, make more moneyit's so poorly paidhave more status, and so on. They're dropping out of home healthcare as soon as they can.

We're constantly talking about the quality of care, but we have no measures for quality of care. We don't measure relationships. We don't measure explanations. We don't measure listening.

And we don't even have good studies. As a researcher, I was astonished to discover that we have hardly any studies that tell us the content of the work that home health aides actually do, or how well they are prepared for it, and how well they deliver it. All of these things struck me as a sign that care is not in the minds of the people who organize the domain of healthcare for dementia and neurodegenerative diseases generally.

Here's another part of it that was astonishing to me, as I began to think this through. We're constantly talking about the quality of care, but we have no measures for quality of care. We don't measure relationships. We don't measure explanations. We don't measure listening. We don't measure skills in touching and supporting someone. We don't measure any of the things that are central to caregiving, and yet we claim quality care. So what do we mean when we say that? We're essentially substituting institutional measures of efficiency for measures of care. I think if more people were aware that we don't examine quality, they would be more concerned about this and what I see as a great crisis.

Verghese: I'm struck that in Eric's latest book, Deep Medicine, [5] he talks about how, in a way, machines have eclipsed us in terms of capability; at least theoretically, machines have gotten to that point. Yet, it indicates that this is the moment for us to get better at our humanness, so to speak. In a way, Eric, I think you were speaking very much to this new frontier we've managed to dodge because we've been so busy with our diagnostic instruments and therapies. But we have to come back to this kind of humanness because the machine can never do any of this for us.

Topol: That's right, Abraham. And that's why you grabbed me, Arthur, with the term "soul-less" and how medicine has moved in that direction. In fact, as you pointed out, we don't even talk about soul, no less think about it. Time is a big factor, the gift of time. You go back to the neurologist who didn't talk to you and your wife about what was ahead with her condition and your caregiving. A lot of this comes down to the reality that there's so little time to connect. The exam is another part of that, as you've mentioned; if we can restore that time, do you think we could get the soul back in medicine?

Kleinman: I believe so. First of all, you and Abraham are outstanding examples of the fact that we have practitioners who are able to bring the soul to bear or tend to it. But I think we have to try at many different levels, and to be honest about the lack of resources. I begin with families. Family members who provide care are providing it uncompensated. They need to be compensated. I think the country will come to this recognition laterally, after we begin to realize that if there were a 10% decrease in the number of families who care for people with dementia and neurodegenerative diseases, end-stage disorders of every kind, it would overwhelm all the hospitals, all the nursing homes, and all the facilities we have. So we must keep this going.

Second are the home health aides and long-term care insurance that goes with it. We don't provide those things. If we did, we would have a different family setting. They are provided in Japan and in Scandinavia. Then we think about medical school itself and the practice of medicine. In certain of the German medical schools and in a few of the Dutch medical schools, before the medical students start medical school, they spend a week or 10 days in the homes of families with patients who have serious end-stage disorders, very serious disabilities, and chronic conditions. They're expected to deliver care of a family kind. Now, these are medical students; they're just starting, and they're doing the cleaning, the washing, the bathing, the feeding, etc. I happened to have been a visiting professor at Leiden University in the Netherlands a few years ago, and I spoke to a number of their faculty who had gone through this program. They told me it was the single most important part of medical school.

We need that in the United States. It would remind doctors that it all begins by seeing the life-world in which illness is experienced. Recently, the National Academy of Medicine put out a report called "Families Caring for an Aging America."[6] It pointed out that it is commonplace for an elderly patient to have a surgical procedure and to return home after 2 or 3 days in the hospital with two tubes coming out of the abdomen, which no one has explained to the familywhat the tubes do and how you take care of them. And the family is petrified that they could infect the patient, that they could do something disastrous in the care of the patient, simply because no one explains the care to the family.

Right through the healthcare system, if the chair of an academic department of medicine or surgery or psychiatry demanded that the service chief in cardiology or nephrology demonstrate high-quality caregiving practices, then that will be modeled by the rest of the clinical team, down to the medical student. What is modeled in our time is the opposite of that.

We've basically turned over the clinical teaching of medical students to residents. The three of us were all residents. I remember my residency at Yale; when you're a resident, you're a survivor. You want to get out of the damn hospital. You're taking all the shortcuts in order to get out, and in so doing, you're giving a reverse message to the medical students. They've learned all of these things they should be doing, from taking a careful history to demonstrating empathy, and you're doing all the opposite things. So they come to see that if the resident is doing it, that's the way it is.

We have to change the way we teach medical students. For the past 5 years or so, I've been giving lectures at many medical schools across the United States, and I've been impressed with the fact that virtually every medical school is trying something new in regard to training medical students to be more human in their care. Of course, everyone is doing something different. But this is promising to me. There's an awareness that we can't go on like this. We have to return to certain core ideals of healthcare in which caregiving is crucial and in which doctors are able to participate.

I think we're not going to let doctors off the hook in the future. I was impressed by the experience with my wife, and by the number of family members I encountered who were taking care of their family member with Alzheimer's, all of whom felt frustrated and angryfrustrated by how difficult the care was, and angry about the fact that the professional medical side seemed cut off from what they were experiencing. That's the source of my optimism.

Verghese: Arthur, I think your book is going to be a siren call for change. You've been the frontrunner of new ways of thinking for so many years, but this may be your most important legacy.

I want to read the last sentence of the book, because it's so powerful. It's a bit about writing and it's a bit about you: "I am letting go of Joan by completing a long-drawn-out grieving process with this living testimonial. And in another, equally uncanny sense, the writing has enabled me to allow my old self to slip away, and to be replaced by the author of a book, this book, who is not only a carer of memories but decidedly a different human being."

You truly have captured this personal transformation, but I think it's going to help all of us to plot a new course, because you're rightwe definitely need a sea change in the way we give care.

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Abraham Verghese, MD, is a critically acclaimed best-selling author and a physician with an international reputation for his focus on healing in an era when technology often overwhelms the human side of medicine.

Arthur M. Kleinman, MD, MA, is a founder of the field of medical anthropology. He has written over 40 books, including The Illness Narratives: Suffering, Healing, and the Human Condition. His latest book is The Soul of Care: The Moral Education of a Husband and a Doctor.

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If the impeachment inquiry against President Trump moves to a trial in the Senate, Sen. Cory Booker (D-N.J.) told reporters this week, his role there must take precedence over his presidential campaign. "We are doing something that is with the gravity of removing the sitting president from office," Booker said. "I will be there. I will be focused. And I will do my work."

Insofar as any member of Congress deserves plaudits for promising to prioritize duly representing his constituents over seeking greater personal power, that's dandy. But Booker's framing of his work as remedying a crisis of presidential misconduct evinces a too-common misconstruction and one which helped us into this mess in the first place. It makes the legislature's restraint on executive power entirely ex post facto, letting lawmakers skip the more necessary work of trimming the imperial presidency back to its basic administrative roots.

Impeachment is necessary and sometimes unavoidable, but it is not prophylactic. Partisanship keeps it from functioning as a reliable protection against future wrongdoing, because even the worst presidents can expect near-lockstep support from their own party in Congress, and almost every president in the last half century has had at least a few years of a friendly majority in one house or both.

Divided government likewise offers no guarantee of accountability, as House Majority Leader Nancy Pelosi's foot-dragging on this very impeachment inquiry has revealed. Political considerations, chiefly alienating independent and swing voters, will often outweigh ethical concerns. "High crimes and misdemeanors" are significantly in the eye of the beholder, and the beholder is looking at the next election cycle.

That reality makes impeaching the president rather like a trip to the emergency room. Yes, it might save your life. It's also mostly unconnected to the day-to-day of responsible, healthy living except if it's your own fault that you're in the emergency room, in which case the visit should prompt some changes to whatever part of your lifestyle is the culprit.

The congressional Democrats spearheading this impeachment have no apparent intention of making such a change. They'll bandage a broken skull and send the patient right back to biking without a helmet. They'll try to oust this president and leave the very same tools of corruption and abuse for the next one. They'll let him claim, in deed if not in word, that he has the "right to do whatever he wants as president," armed with pen and phone.

This state of affairs can only be acceptable to the selfish or naive. It appeals to politicians and partisans because the power they persistently leave unchecked will sometimes fall to them. Why melt the crown if it may yet rest upon your head? And it appeals to those who retain a civics class credulity about American politics, clutching against all evidence to the belief that we may yet develop markedly better and broader electoral tastes. Unless Mr. Rogers rises from the grave with a hankering for the campaign trail, I wouldn't count on it.

The safer and more certain option is massive structural reform. Congress must put meaningful restrictions on the power of the presidency. The executive branch has for decades crept beyond its proper administrative function to usurp congressional authority, dictating the priorities of state well beyond the vague leeway of executive discretion.

Incidentally, it is this very pseudo-lawmaking which made Trump's alleged quid pro quo possible. Reform could indicate to foreign leaders that the president is an administrator with no power to refrain from disbursing funds Congress told him to disburse. It could place stricter limits on national emergency declarations, ensuring the president cannot unilaterally move money around in direct contravention of Congress. It could significantly curtail presidential immunity, making the president subject to indictment. Perhaps most importantly, it could limit the scope of executive orders, the favored method for presidents of both parties to exercise unconstitutional policy-setting authority.

This is a difficult and unlikely ask in that it requires sacrificing short-term partisan advantage for a long-term shot at more functional and congenial governance. I get the implausibility here.

Still I recommend it, and will continue to recommend it forever, because impeachment is confusing, uncertain, retroactive, narrowly targeted, and politically fraught. It may censure or remove a bad president, but it does so only in connection to a small selection of provable misdeeds and via a process that will always be subject to accusations of injustice. The best impeachment remains a contributor to political rancor and fails to stop further executive overreach. It's an ounce of cure when we need a pound of prevention.

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A new cancer treatment facility in Lancaster will be one of just two sites in Pennsylvania to offer proton therapy to cancer patients.

Penn Medicine broke ground Tuesday on the facility, an expansion of its Ann B. Barshinger Cancer Institute.

The 8,000-square-foot, four-story building will be the first proton therapy center in Central Pennsylvania. Construction is expected to be completed by the fall 2021.

The project represents a $48 million investment, according to Penn.

Proton therapy, a relatively new type of radiation therapy, often is used to treat cancers as well as benign tumors, according to the Mayo Clinic. Instead of using X-rays, which also touch non-cancer cells, proton beams enter the body at low doses of radiation that spare healthy tissue, according to Penn Medicine.

Clinical trials and studies suggest proton therapy causes fewer side effects than traditional radiation because it enables doctors to target more precise areas.

Proton therapy is an option for a number of cancer types, including brain cancer, spinal tumors, breast cancer, head and neck cancer, gastrointestinal cancers, gynecological cancers, kidney cancer, lung cancer, lymphoma, mesothelioma, oropharyngeal cancer, pediatric cancer, and prostate cancer, according to Penn.

Because it's relatively new, proton therapy availability is limited across the United States. There are currently just 28 active proton therapy centers, according to the National Association for Proton Therapy, with five more, including the Lancaster site, under construction or development.

The Roberts Proton Therapy Center at the University of Pennsylvania Health is the only proton therapy site in Pennsylvania.Since the center opened in Philadelphia in 2010, Penn radiation oncologists have treated more than 6,000 patients using proton therapy.

There are two other proton therapy facilities in New Jersey the ProCure Proton Treatment Center in Somerset and the Laurie Proton Therapy Center at RWJBarnabas Health in New Brunswick.

"Current patients who may benefit from proton therapy especially for hard-to-treat cancers can only receive this therapy at a handful of specialized centers across the country," Dr. James Metz, chair of radiation oncology at Penn Medicine, said in a release. "This project represents the next phase of proton therapy, further enhancing patients access."

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Penn Medicine breaks ground in Lancaster on Pa.'s second proton therapy site - PhillyVoice.com

Dr. Jim Adams, Chief Medical Officer and SVP of Northwestern Medicine joins The Roe Conn Show with Anna Davlantes to discuss why this flu season might be worse than last year. Also, Dr. Adams explains why owning a dog may lower your risk of death after a heart attack.http://serve.castfire.com/audio/3688822/3688822_2019-10-16-005222.64kmono.mp3

Better knowledge means better health for you and your family. Turn to Northwestern Medicine at nm.org/healthbeatnews for health tips, research and more.Follow your favorite Roe Conn Show characters on TwitterAnd be sure to follow Roe on Facebook!

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Northwestern Medicine's Dr. Jim Adams warns that other countries are having bad flu seasons and as it moves towards Chicago, it looks like it's going...

CAMBRIDGE, Mass. and RESEARCH TRIANGLE PARK, N.C., Oct. 15, 2019 (GLOBE NEWSWIRE) -- Editas Medicine, Inc. (Nasdaq: EDIT), a leading genome editing company, and Asklepios BioPharmaceutical, Inc.(AskBio), a fully integrated adeno-associated virus (AAV) gene therapy company, today announced the companies have entered a strategic research collaboration to explore in vivo delivery of genome editing medicines to treat neurological diseases. This collaboration brings together AskBios leading capsid development, clinical stage AAV vector delivery system, and manufacturing expertise with Editas Medicines leading genome editing technologies to potentially develop novel medicines for patients with high unmet need.

We are excited to collaborate with AskBio, a team with unparalleled experience in AAV technology and clinical-stage manufacturing. We believe that together we can deliver innovative genome editing medicines to the nervous system and rapidly advance medicines to treat neurological diseases and help patients in great need, said Charles Albright, Ph.D., Executive Vice President and Chief Scientific Officer, Editas Medicine.

The team at Editas Medicine has one of the most innovative technology platforms dedicated to finding solutions to severe diseases where there are few or no treatment options a mission consistent with AskBios, said Jude Samulski, Ph.D., Co-Founder, AskBio. With this shared goal in mind, we will combine our technologies to create an innovative approach to treating neurological diseases.

About Editas MedicineAs a leading genome editing company, Editas Medicine is focused on translating the power and potential of the CRISPR/Cas9 and CRISPR/Cpf1 (also known as Cas12a) genome editing systems into a robust pipeline of treatments for people living with serious diseases around the world. Editas Medicine aims to discover, develop, manufacture, and commercialize transformative, durable, precision genomic medicines for a broad class of diseases. For the latest information and scientific presentations, please visit http://www.editasmedicine.com.

About AskBioAsklepios BioPharmaceutical, Inc. (AskBio) is a privately held, clinical stage gene therapy platform company dedicated to improving the lives of children and adults with rare genetic disorders. AskBios gene therapy platform includes an industry-leading proprietary cell line manufacturing process known as Pro10 and an extensive AAV capsid library. The company has generated hundreds of proprietary third generation gene vectors, several of which have entered clinical testing. AskBio maintains a portfolio of clinical programs across a range of indications, including Pompe, Limb Girdle Muscular Dystrophy, Cystic Fibrosis, Myotonic Muscular Dystrophy, Huntingtons, Hemophilia (Chatham Therapeutic/Takeda) and Duchenne Muscular Dystrophy (Bamboo Therapeutics/Pfizer). For more information, visit http://www.askbio.com.

Editas Medicine Forward-Looking Statements This press release contains forward-looking statements and information within the meaning of The Private Securities Litigation Reform Act of 1995. The words anticipate, believe, continue, could, estimate, expect, intend, may, plan, potential, predict, project, target, should, would, and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Editas Medicine may not actually achieve the plans, intentions, or expectations disclosed in these forward-looking statements, and you should not place undue reliance on these forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations disclosed in these forward-looking statements as a result of various factors, including: uncertainties inherent in the initiation and completion of preclinical studies and clinical trials and clinical development of Editas Medicines product candidates; availability and timing of results from preclinical studies and clinical trials; whether interim results from a clinical trial will be predictive of the final results of the trial or the results of future trials; expectations for regulatory approvals to conduct trials or to market products and availability of funding sufficient for Editas Medicines foreseeable and unforeseeable operating expenses and capital expenditure requirements. These and other risks are described in greater detail under the caption Risk Factors included in Editas Medicines most recent Quarterly Report on Form 10-Q, which is on file with the Securities and Exchange Commission, and in other filings that Editas Medicine may make with the Securities and Exchange Commission in the future. Any forward-looking statements contained in this press release speak only as of the date hereof, and Editas Medicine expressly disclaims any obligation to update any forward-looking statements, whether because of new information, future events or otherwise.

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Editas Medicine and AskBio Enter Strategic Research Collaboration to Explore In Vivo Delivery of Genome Editing Medicines to Treat Neurological...

Nanotechnology is a growing sector of medical technology, and it encompasses everything from pill cameras to smart pills that detect and report on medication levels to even smart bandages that detect infection and release antibiotics. Many hail this technology as the future, but there are still concerns about privacy, cost effectiveness, and more as these technologies become more widely used and developed. But some day soon you may experience surgery with a nanobot or have your cancer fought with a tiny device that cuts off the cancer's blood flow. Learn more about the future of nanotechnology in medicine below!

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DISCLOSURE:I work for the infographic design agency that developed this graphic.

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Nanotechnology And The Future Of Medicine - Equities.com

Featured, Food & Agriculture, Global, Headlines, Health, TerraViva United Nations

Opinion

Credit: Busani Bafana/IPS

ILLINOIS, United States / ABUJA, Oct 16 2019 (IPS) - United Nations World Food Day is celebrated around the world on October 16 under the theme: Our Actions ARE Our Future. Healthy Diets for a Zero Hunger World.This theme is timely, especially, because across Africa and around the world, there has been a gradual rise in malnutrition and diet-related non communicable diseases, as highlighted inThe Lancetstudy and aUnited Nations Reportpublished earlier this year.

While45 percentof deaths in children are from nutrition-related causes, mainly malnutrition,diet-related non communicable diseaseslike obesity is a fast-growing problem across the world causing low- and middle-income countries to face adouble burden of malnutrition.

Globally, non-communicable diseases kill the most people every year. Based on2016 data, out of 56.9 million deaths, 40.5 million were due to non-communicable diseases (30.5 million were in developing countries). Diabetes, one of the complications of obesity led to 1.6 million deaths.

Researchin Ghana shows that children from poorer backgrounds are more vulnerable to food insecurity and narrow dietary diversity. In contrast, consumption of processed foods rich in sugar but poor in nutrients is common among all socioeconomic classes. Showing that obesity does not respect boundaries. InScotland, about 30% of adults and 13% of children are obese this is attributable to foods and drinks high in fat, sugar and salt.

It is said that; the youths are the future. However, if the present trends ofdiet-related non communicable diseaseslike obesity among youths fueled by unhealthy foods continue, the future would be unhealthy. This is how to make the future healthy.

First, focus on consumption of plant-based nutritious meals among women of child-bearing age. One way to achieve this is by civil society organisations working with government to identify locally available nutritious meals and training families on how best to prepare these meals.

Datashows that most important time for using nutrition to improve cognition and physical development of a child is the first 1000 days of life (from when the woman becomes pregnant, through-out pregnancy, birth and until the baby is 2 years old).

In addition to the woman eating nutritious meals, there are several nutritional interventions to achieving these, including exclusive breastfeeding within one hour after birth until the baby is 6 months old; introduction of nutritious complementary meals at 6 months and continuing of breastfeeding until the baby is 2 years old.

The good news is that, the African continent is endowed with indigenous vegetable plant varieties such as amaranth greens, African nightshade, Ethiopian mustard and fluted pumpkins that are affordable, and highly nutritious and dense in essential micronutrients that are lacking in many of the foods African.

In addition, many of these vegetable plants are highly adapted to the African climate and can endure drought and pests. Further, women that grow these crops for consumption can also earn income by selling the excess vegetables.

In Nigeria, for example,women farmersgrowing these indigenous highly nutritious indigenous African vegetable plant varieties arereaping several benefitsincluding earning income and boosting food security. Similar success stories are documented in severalAfrican countriessuch asKenyaandEthiopia.

Second, all nations should ban artificial trans-fat production and use. Globally, consumption of trans fat accounts for more than500,0000 deathsdue to heart disease every year, according to the World Health Organization.

Theharmful effectsof trans fat is by raising bad cholesterol and lower good cholesterol levels. Therefore, increasing risk of heart disease, stroke and insulin-dependent diabetes. Already there are lessons from countries that have policies on artificial trans fats.

For instance, South Africa limits industrially produced trans-fat in foods, fats and oils; and U.S. and Canada bans the source of industrially-produced trans-fat and require trans-fat to be labeled on packaged food.

Third, reduce daily consumption of salt to less than one teaspoonful a day because the sodium contained in salt increases blood pressure.

Hypertensionin turn, is implicated in 7.5 million deaths every year.According to the U.S. Centres for Disease control,more than 70%of the sodium Americans consume comes from processed and restaurant foods. There are severalwaysto reduce salt consumption such as public education, front-of-package labelling, promotion of salt substitutes, industry reformulation of packaged foods, and intervention for restaurants.

The United Kingdomsalt reduction programled to lower slat content in processed foods, resulting in a15% reductionin population salt intake.

Lastly, countries must come up with comprehensive policy approaches or revise already existing national nutrition policies to address this growing diet-related non communicable diseases. Once theyre set, governments must place high priority on them to ensure that nutrition policies are implemented and followed and that citizens are aware of them.

The complex, widespread and global rise of diet-related health diseases demand that we re-assess the foods we eat every day. Doing so will pave the way to a world where people are healthy.

Dr. Esther Ngumbi is an Assistant Professorat the Entomology Department, University of Illinois at Urbana Champaign.She isa Senior Food security fellow with the Aspen Institute andhaswritten opinion pieces forvarious outlets including NPR, CNN, Los Angeles Times, Aljazeera andNew York Times. You canfollowEsther on Twitter@EstherNgumbi.

Dr. Ifeanyi M. Nsofor, a medical doctor, the CEO ofEpiAFRICandDirector of Policy and Advocacy atNigeria Health Watch. I am a2019 Atlantic Fellow for Health Equity at George Washington University,aSenior New Voices Fellow at the Aspen Instituteand a 2006 International Ford Fellow.You can follow me on Twitter@ekemma.

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Let Plants be Thy Medicine You Are What You Eat - Inter Press Service

Ascension, for one, is reworking its linear reporting structure, said Trevor Walker, vice president of human resources organizational development and learning. Its testing out a model where interdisciplinary teams report to one leader, rather than their respective department heads.

To boost recruitment, Froedtert Health is reworking its tuition reimbursement program, said Holly Reilly, vice president of human resources operations. For growing needs like IT, four-year degrees arent necessary. But certifications dont fit into Froedterts tuition reimbursement program, she said.

Providence St. Joseph Health is investing in revenue streams related to organizations that build low-income housing, provide food and help meet other basic needs.

Ideally, those ventures can bolster its clinical care as well as rekindle its mission, said Darci Hall, chief learning officer at the Renton, Wash.-based system. Healthy communities start with a safe place to live and food to eat, she said.

But a more proactive, outcomes-oriented healthcare delivery system brings new data and responsibilities. Employers have to toe the delicate line between developing existing employees and hiring additional help.

Healthcare organizations are always looking for the next piece of technology that can facilitate this transition. But sometimes it can hurt more than help, said Heather Brace, senior vice president and chief people officer at Intermountain Healthcare.

Sometimes technology can be really distracting more than it can be helpful, she said. So we are finding ways to be better about discerning and learning which technologies are best to bring into our organization so they are not duplicative or creating more work.

Brigham Health has hired administrative support, community resource specialists, data-mining experts and additional help on the clinical side to facilitate more proactive care. It has also identified current workers who live in the community, know the cultural landscape and can help link individuals with local resources, said Dr. Jessica Dudley, chief medical officer at Brigham and Womens Physician Organization and vice president of care redesign at Brigham Health.

This new care paradigm requires, at times, ceding control. Providers also must get more comfortable in building teams outside of their respective organizations, said Dr. Adam Myers, chief of population health at Cleveland Clinic and director of Cleveland Clinic Community Care.

We are not afraid to work hard in medicine, but we want our work to be meaningful, we want the tools and resources to accomplish the tasks that are asked of us, and we want to have appropriate accountability. Those are the three things that lead to professional improvement, he said. We have meaningful work in healthcare, but the problem is we dilute that down with many nonmeaningful tasks. To the extent we can offload some of those to teams, the better.

At St. Jude Childrens Research Hospital, about 20% of patients will not overcome their cancer diagnoses. This creates a daunting challenge to keep clinicians and employees spirits up, said Dr. James Downing, St. Judes CEO.

Memphis, Tenn.-based St. Jude improved its employee recognition as well as its mentorship program. The organization asked its employees what brings them joy in their work. Staff wrote their answers on blocks of wood that were used to a build a sculpture featured on campus.

It is a place where 1 in 5 patients will die from their disease, but it is a place of hope, a place of joy, Downing said.

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Healthcare executives look to bring the joy back to medicine - ModernHealthcare.com

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We Americans tend to treat trade as a matter of purely economic exchanges. But we've recently learned that to become entangled with a country via trade almost inevitably invites broader entanglements as well of culture, ideology, and policy. After enmeshing ourselves in trade with China, for example, we've suddenly found China using that entanglement to silence criticism of China's crackdown on Hong Kong protesters. (Or its treatment of Tibet, or its massive surveillance state.) More perniciously, China's had American institutions and companies do the silencing and surveilling for it.

In other words, if the country we're entangled with has a lot of leverage, they can force us to behave in ways we otherwise might not, and would really prefer not to.

The thing is, if you're pretty much any country other than the United States especially a poorer or developing country you already knew this. Because for decades, the U.S. has been doing to the world what China is currently trying to do to us.

If you're a big country with lots of consumption spending and financial capital to throw around, other countries are going to want access to your domestic market. And that will give you leverage to condition that access on certain terms. While China's rise into the ranks of global economic behemoths happened in just the last two or three decades, the U.S. has been there since the end of World War II. Through institutions like the World Bank and the International Monetary Fund (IMF), the U.S. has used that leverage to build the global economic and trade order to its preferences.

In the initial post-war years, this setup worked out relatively well resuscitating the ravaged economies of Europe, and promising a prosperous new possible future for the global East and South. But then in the 1970s and 1980s, free market neoliberal ideology took over American policymaking and by extension took over the policies America was exporting to the globe. The U.S. started forcing countries to abandon capital controls and tariffs, thus allowing the free flow of both goods and financial capital across their borders. Industrial policy and state-ownership of enterprise was discouraged, privatization and free market solutions encouraged.

This model often turned out quite badly for developing countries in particular. The end of barriers to trade and financial flows left those countries vulnerable to rich western speculators who could boost their economy by rushing in, then collapse it by rushing out just as fast. When such crises left a country saddled with unsustainable levels of foreign-denominated debt, the solution imposed by America's neoliberal hegemony was austerity, which provided the surplus cash to pay off foreign creditors, but also crushed the country's domestic economy and the livelihoods of its own citizens in the process.

Indeed, the occasional country that did resist these demands wound up raising its wealth and living standards faster and there's no better example than China itself, which has used its own clout to pick and choose which parts of the neoliberal global trade order it does and doesn't want to cooperate with.

The modern era of big multilateral trade deals like NAFTA and the Trans-Pacific Partnership (TPP) came with a similar dynamic: America has used these deals to impose pro-corporate and anti-labor regulatory structures, outsized protections for wealthy investors, and draconian intellectual property laws on the rest of the world. (Ironically, now that President Trump has pulled the U.S. out of TPP negotiations, the deal's terms have become considerably less offensive.) Trump's current trade war with China is a similar effort to impose American policy preferences on China's domestic operations: It wants China to abide by those same intellectual property standards, and to soften the rules and terms for investors.

The point of these trade deals was to entangle countries in a set of rules and arrangements that would constrain their own domestic agendas "the creation of a set of property rights that, precisely because they span multiple sovereignties, cannot be touched by one government without inviting conflict with another," as economist J.W. Mason put it. Since the U.S. was the 800-pound gorilla in the room, no one wanted conflict with it. And thus the U.S. was able to impose its preference for neoliberalism on the world.

Now China has gotten big enough to throw its weight around as well. Of course, shutting up basketball stars and protesters and contest participants and corporate advertising campaigns that push positions China doesn't like is the imposition of political norms about acceptable discourse, as opposed to economic norms about acceptable policies. In terms of its economic relationships with the U.S., China has thus far been content to simply draw some bright lines with regard to freeing up trade and capital flows, and how much it's willing to adjust its own domestic policies to match U.S. preferences.

That particular mix of cooperation and opposition has mostly imposed its costs on the American working class, while turning out quite well for American elites. Which is why those elites only recently decided to pick a bigger fight with China and even now, Trump's trade war is far from universally endorsed among America's economic and political power brokers.

The more interesting question is how things might evolve in the future. The neoliberal global order is not in great shape these days, beset by multiple crises. And China has taken that opportunity to begin building something akin to its own global economic order. In multiple countries, China's been quietly investing in big infrastructure projects part of its Belt and Road initiative to firm up and support a global system of trade routes and exchange with China at its center.

It's presented as an economic project. But observers worry China is implicitly using jobs and development to buy good will in the international community. Should China and the U.S. come to geopolitical loggerheads over any number of issues future trade deals, the fate of political freedoms in Hong Kong, China's human rights abuses against Uighur muslims, or China's territorial claims to Tibet or the South China Sea the U.S. may discover that China has secured itself more friends and allies than we realized.

If there's a lesson here, it may be that you should be careful how far you go in imposing your own will on other countries when you're in power. Eventually, someone else will be in power, and what you once did will set the norms for what they can do now.

Want more essential commentary and analysis like this delivered straight to your inbox? Sign up for The Week's "Today's best articles" newsletter here.

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China is giving the U.S. a taste of its own medicine - The Week

It is projected to expand at a CAGR of 7. 4% during the forecast period. Rising geriatric population, in need of bioelectric medicine is the major factor expected to propel growth during the forecast period.

New York, Oct. 16, 2019 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Electroceuticals/Bioelectric Medicine Market Size, Share & Trends Analysis Report By Product, By Type, By Application, By End-Use And Segment Forecasts, 2019 - 2026" - https://www.reportlinker.com/p05822966/?utm_source=GNW Aging population is prone to medical disorders such as cardiac arrhythmias, Parkinsons disease, Alzheimers disease, epilepsy, and depression. Advanced electroceuticals including implantable cardioverter defibrillators, cochlear implants, cardiac pacemakers, and spinal cord stimulators, are used for the treatment of these conditions.

Increasing investment in the development of advanced bioelectric medicine is another major factor supporting the growth of the electroceuticals market. For instance, in FY 2016, Medtronic, invested around USD 2,224.0 million in R&D for the development of advanced products. According to, ElectroCore, almost 325,000 people in the U.S. experience cluster headache every year. The company, in an attempt to capitalize the untapped opportunity came up with a product which received FDA clearance in 2018 namely gammaCore, a noninvasive VNS therapy, helpful in managing painful headaches in adults.

Further Key Findings from the Report Suggest: Implantable cardioverter defibrillators segment was the largest revenue-generating segment of the electroceuticals market in 2018 owing to wider application of these products in the treatment of arrhythmia The implantable electroceuticals segment accounted for the largest revenue share in the bioelectric medicine market in 2018 owing to technological advancements In the application segment, the arrhythmia segment accounted for the largest share in 2018 and is expected to maintain its dominance throughout forecast period The hospitals dominated the electroceuticals end use market in terms of revenue in 2018 due to the escalating number of electroceutical devices implant procedures in hospitals The North America bioelectric medicine market is the leading regional sector and accounted for the largest revenue share in 2018 mainly due to the of large number of medical devices companies in this region The Asia Pacific region is expected to grow at a highest growth rate during the study period. The developing healthcare infrastructure and rising healthcare awareness in the Asian countries such as China and India is a major factor contributing to the growth of this region Some of the major players in the electroceuticals/bioelectric medicine market include Medtronic; St. Jude Medical; Boston Scientific Corporation; Cochlear Ltd.; Sonova; LivaNova PLC; Biotronik; Nevro Corp.; SECOND SIGHT; and electroCore LLC.Read the full report: https://www.reportlinker.com/p05822966/?utm_source=GNW

About ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.

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The global electroceuticals/bioelectric medicine market size is expected to reach USD 28.5 billion by 2026 - Yahoo Finance

Dr. Amit X. Garg, a professor of medicine at Western University in London, Ontario, knew about turmerics medicinal use because of his Indian heritage. He knew firsthand of its rich cultural significance too: On his wedding day, his relatives rubbed the spice all over him because it is believed to be cleansing.

After seeing the effectiveness of curcumin, in smaller studies, Dr. Garg and his colleagues decided to test it on a larger scale in hopes it would make elective aortic surgery safer by reducing the risk of complications, which include heart attacks, kidney injury and death. In the randomized clinical trial that followed, about half of the 606 patients were administered 2,000 milligrams of curcumin eight times over for four days, while the others were given a placebo. It was a bit disappointing, but we couldnt demonstrate any benefit used in this setting, Dr. Garg said of the study, published last year in the Canadian Medical Association Journal.

In fact, there is not enough reliable evidence in humans to recommend turmeric or curcumin for any condition, according to the National Center for Complementary and Integrative Health. Turmeric became a nutritional golden child partly because of its promise in laboratory studies cellular and animal. Some research indicates that both turmeric and curcumin, the active ingredient in turmeric supplements, have anti-inflammatory, antioxidant, antibacterial, antiviral and antiparasitic activity. But this has mostly been demonstrated in laboratory studies, and, in many cases, the benefits of preclinical research isnt observed in clinical trials.

According to Natural Medicines, a database that provides monographs for dietary supplements, herbal medicines, and complementary and integrative therapies, while some clinical evidence shows that curcumin might be beneficial for depression, hay fever, hyperlipidemia, ulcerative colitis, osteoarthritis and nonalcoholic fatty liver disease, its still too early to recommend the compound for any of these conditions.

And Natural Medicines has found there isnt enough good scientific evidence to rate turmeric or curcumins use for memory, diabetes, fatigue, rheumatoid arthritis, gingivitis, joint pain, PMS, eczema or hangovers.

Physicians say more research is needed. Dr. Gary W. Small, a professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at the University of California, Los Angeles, who studies curcumins effect on memory, sees a lot of therapeutic potential. He also states that existing research demonstrates curcumins biological effects.

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What Are the Benefits of Turmeric? - The New York Times

All students, faculty, and staff are needed for a study on campus health.

The Exercise is Medicine-On Campus study is now kicking off year two! The program isrecruiting University of Arkansasstudents, facultyand staff (age 18 or older) of all sizes, abilities and fitness levels. The study will include completing a new online survey with the option to also participate in an in-person health and fitness assessment.

Participants completing the survey will have the chance to win one of five $50 cash prizes. Additionally, participants whom choose to perform the in-person health and fitness assessment will visit the Exercise Science Research Center at the University of Arkansas. Participants completing the in-person health and fitness assessment will be eligible to win one of three $100 cash prizes.

Participants must be English speaking and should not have any limitations preventing them from attempting the in-person assessments including pregnancy.

If you would like to participate, or have any question or concerns, please contact: Bryce Daniels, bxd013@uark.edu, or Erin K. Howie, (479) 575-2910, ekhowie@uark.edu. If you are interested in completing the survey please click on the following link: https://uark.qualtrics.com/jfe/form/SV_74evJcczrLCLMIB. If you completed the Exercise is Medicine survey during the 2018-2019 academic year, you are welcome to complete it again and will be eligible for prizes.

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Exercise Is Medicine Now in Year Two - University of Arkansas Newswire

Photo by Vince Bucci

Ill admit it. Im a medical-TV junkie, addicted to 21st-century doctor and hospital dramas (most of which are now streaming on Netflix and other services).

Although some physicians are bothered by sensationalized depictions of their profession, I appreciate these shows for what they deliver: equal parts entertainment and insight. On the one hand, medical dramas are made for our amusement. Theyre theatrical escapes from reality, meant to be enjoyed from comforts of a cushiony sofa. On the other hand, we can learn a lot from these shows, especially when we compare depictions of doctors today vs. 20 years ago.

From House To Diagnosis

My love-affair with medical dramas began with House, M.D. (2004 to 2012), which centered on the eponymous antihero Dr. Gregory House, a grumpy diagnostic genius with a penchant for recreational Vicodin. Although he lies, manipulates others and breaks all the rules, his superior mind vindicates him in each episode, never failing to deliver a remarkable medical epiphany.

As CEO of The Permanente Medical Group, I sometimes thought about how I would have dealt with a brilliant but troubled physician like Dr. House. Of course, Id try to get him help, but its unlikely Id have any more success than the hospital leaders on the show. Ultimately, having been responsible for the medical care of more than 5 million Kaiser Permanente members, as well as for the livelihoods of 10,000 physicians and 36,000 staff, I would have had no choice but to fire him.

In addition to House, I enjoyed all 16 seasons of Greys Anatomy (2005 to present), a show in which the protagonists, Dr. Meredith Grey and colleagues, share much in common with Dr. House. They possess exceptional diagnostic prowess, remarkable technical skill and a whole host of psychological issues.

The physicians at the fictional Seattle Grace Hospital spend as much time carousing at the bar across the street as they do performing surgery in the operating room. Remarkably, these diversions never seem to inhibit their ability to resect an inoperable brain tumor or perform a death-defying cardiac procedure the next morning.

Together, these shows introduced 21st-century viewers to the on-screen motif of the doctor as an imperfect God, with exceptional characters capable of effecting miracles and imposing self-misery.

Then came the 2019 Netflix docuseries Diagnosis (fear not: no spoilers ahead).

The shows real-life protagonist, Dr. Lisa Sanders, is a Yale MD with a temperament more akin to Mr. Rogers than a misanthropic medic. The Diagnosis creator is best known for her popular New York Times Magazine column of same name.

Like its recent TV predecessors, Diagnosis obsesses over rare diseases and near-impossible cases. Unlike House and Greys, however, Diagnosis doesnt lean on the brilliance of a lone doctor for answers. Instead, Dr. Sanders uses her New York Times platform and corresponding online channels to open source possible diagnoses, inviting doctors and patients from all over the world to weigh in on complex medical cases.

The Doctor Is In(consequential)

The debut of Diagnosis signals how much our perceptions of doctors have transformed, right before our eyes. American society no longer sees physicians as God-like figures. Quite the opposite, in fact.With a nod to TVs latest medical offering, here are four insights into how our perceptions of the medical profession are changing:

A Quick Dose Of Reality

If youve ever watched one of those HGTV home-renovation shows, you understand that no one can flip a house in 60 minutes. But thats as much time as these shows have to entertain you, minus commercial breaks.

Doctor dramas are similar: What normally takes place over days, weeks or months, gets radically compressed (and dramatized) through the magic of television. The truth is, kidney failure with urine-flow cessation doesnt happen in a matter of minutes. The whites of a patients eyes dont suddenly turn yellow when the doctor walks in the room. Medical shows must walk a fine line between being outrageous enough to hold our attention (cue the Greys episode in which two train passengers get impaled by the same metal pole) and believable enough so that well care about the characters and outcomes.

Hollywood writers and producers go to great lengths to strike this balance. As a matter of fact, Dr. Lisa Sanders served as a technical adviser on House, M.D. long before she starred on Netflixs Diagnosis.

Ultimately, I believe theres truth and wisdom to be found in medical dramas and documentaries, alike. Brilliant physicians do, in fact, exist and they have the power to solve some of the planets most complex medical enigmas. At the same time, crowd-sourcing can also help us get to the bottom of perplexing symptoms and rare diseases. Patients, like doctors, can unravel clinical mysteries.

Though I truly enjoy the medical TV genre, theres one element I find both troubling and all-too frequent across these programs.

Hollywood promises us that every medical problem has a solution, if only patients can find the best doctor or consult with thousands of people via the web. This notion that everything is possible may attract viewers, but its misleading and potentially dangerous. False hope is what causes patients to chase miracle cures, deny reality and, occasionally, make the wrong decisions.Ive seen it happen too many times to too many innocent families.

The truth is, patient symptoms dont always have a clear basis and, even more frequently, there arent pills or procedures to make our problems go away.Unfortunately, admitting these truths wouldnt win you an Emmy.

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From House To Diagnosis: The Evolution of 21st-Century Medicine (As Seen On TV) - Forbes

Vall d'Hebrn Research Institute, Barcelona, Spain (J.O., X.V., C.S., J.C.)

Miguel Servet Hospital, Zaragoza, Spain (L.S., M.P.)

Bellvitge University Hospital-IDIBELL, Barcelona, Spain (A.R.)

Sant Joan de Reus University Hospital, Reus, Spain (A.C.)

Granollers University Hospital, Granollers, Spain (J.C., V.O.)

Matar Hospital, Matar, Spain (M.M.)

Note: The corresponding author had full access to all data and final responsibility for the decision to submit the manuscript for publication.

Acknowledgment: The authors thank the Catalan Lupus Foundation and all the patients who participated in the trial; the investigators who recruited patients to the study; and the research staff who assisted with patient recruitment, data collection, biomarker measurements, and data management.

Financial Support: From Bayer Hispania.

Disclosures: Drs. Ordi-Ros and Corts-Hernndez report institutional support from Bayer Hispania to conduct the study. Dr. Ortiz-Santamaria reports personal fees and nonfinancial support from Pfizer, Janssen, Lilly, GSK, Novartis, Roche, and Abbott outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at http://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0291.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.

Data Sharing Statement: The following data will be made available with publication: deidentified participant data (available from Dr. Josefina Corts-Hernndez; e-mail, fina.cortes@vhir.org). The following supporting documents will be made available with publication: informed consent form (available from Dr. Josefina Corts-Hernndez; e-mail, fina.cortes@vhir.org). These data will be made available to researchers whose proposed use of the data has been approved for a specified purpose, with investigator support, and with a signed data access agreement (no restrictions).

Corresponding Author: Josefina Corts-Hernndez, MD, PhD, Department of Internal Medicine, Rheumatology Research Group, Vall d'Hebrn University Hospital Research Institute, Passeig Vall d'Hebrn 119-129, 08035, Barcelona, Spain; e-mail, fina.cortes@vhir.org.

Current Author Addresses: Drs. Ordi-Ros, Vidal, and Sol: Vall d'Hebrn University Hospital Research Institute, Passeig Vall d'Hebrn 119-129, 08035, Barcelona, Spain.

Drs. Sez-Comet and Prez-Conesa: Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Paseo Isabel La Catlica 9, 50009, Zaragoza, Spain.

Dr. Riera-Mestre: Internal Medicine Department, L'Hospitalet de Llobrega, Feixa llarga s/n, 08907, Barcelona, Spain.

Dr. Castro-Salom: Internal Medicine Department, Sant Joan de Reus University Hospital, Sant Joaquim 42 1-3, 43204, Reus, Spain.

Drs. Cuquet-Pedragosa and Ortiz-Sanatmaria: Granollers University Hospital, Avinguda Francesc Ribas s/n, 08402, Granollers, Spain.

Dr. Mauri-Plana: Department of Internal Medicine, Mataro Hospital, Carrer de Cirera, 230, 08304, Matar, Spain.

Dr. Corts-Hernndez: Department of Internal Medicine, Rheumatology Research Group, Vall d'Hebrn University Hospital Research Institute, Passeig Vall d'Hebrn 119-129, 08035, Barcelona, Spain.

Author Contributions: Conception and design: J. Ordi-Ros, M. Prez-Conesa, X. Vidal, J. Corts-Hernndez.

Analysis and interpretation of the data: J. Ordi-Ros, X. Vidal, A. Castro-Salom, C. Sol, J. Corts-Hernndez.

Drafting of the article: J. Ordi-Ros, L. Sez-Comet, X. Vidal, A. Riera-Mestre, C. Sol, J. Corts-Hernndez.

Critical revision for important intellectual content: J. Ordi-Ros, L. Sez-Comet, X. Vidal, A. Castro-Salom, J. Cuquet-Pedragosa, C. Sol, J. Corts-Hernndez.

Final approval of the article: J. Ordi-Ros, L. Sez-Comet, M. Prez-Conesa, X. Vidal, A. Riera-Mestre, A. Castro-Salom, J. Cuquet-Pedragosa, V. Ortiz-Santamaria, M. Mauri-Plana, C. Sol, J. Corts-Hernndez.

Provision of study materials or patients: J. Ordi-Ros, L. Sez-Comet, M. Prez-Conesa, A. Castro-Salom, V. Ortiz-Santamaria, J. Corts-Hernndez.

Statistical expertise: X. Vidal.

Obtaining of funding: J. Ordi-Ros, J. Corts-Hernndez.

Administrative, technical, or logistic support: J. Ordi-Ros, L. Sez-Comet, J. Corts-Hernndez.

Collection and assembly of data: J. Ordi-Ros, L. Sez-Comet, M. Prez-Conesa, X. Vidal, A. Riera-Mestre, A. Castro-Salom, J. Cuquet-Pedragosa, M. Mauri-Plana, J. Corts-Hernndez.

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Rivaroxaban in Antiphospholipid Syndrome - Annals of Internal Medicine

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Newswise BOSTON (Oct. 16, 2019)Tufts University School of Medicine Dean Harris Berman will step down from his post at the end of the year. The managed-care pioneer and former chief executive of Tufts Health Plan will continue at the university on a part-time basis, fundraising for the medical school and university and training academic leadership in development.

In his time at the medical school, Berman has championed curriculum improvements, ushered in a new anatomy lab and other learning spaces, guided the development of a unique training program for rural doctors in Maine, and was actively involved in fundraising, which last year saw gifts of $37 million, the largest one-year total in the schools history.

While a search for a new dean is underway, Vice Dean Peter Bates will serve as interim dean. Before joining the Tufts School of Medicine this summer, Bates was senior vice president of academic affairs and chief academic officer at Maine Medical Center.

Bates and Berman worked together on one of Bermans proudest accomplishments at Tufts: launching the Maine Track Program. Berman recognized that rural areas in Maine have trouble attracting and retaining physicians, limiting patients access to care. So, in collaboration with Maine Medical Center, Berman led the development of a training track geared toward students interested in rural medicine with the goal of creating a pipeline of new physicians who would settle in Maine. Introduced in 2008, the program serves a part of New England that needed help, in a very innovative way, Berman said. It was a real turning point for Tufts.

Bates said the outgoing deans intelligence, judgement, and collaborative nature were instrumental to the initiatives success. He has accomplished so much in his career, yet is so humble, and is always focused on the goals of the school and its partners, Bates said.

Berman also oversaw the decommissioning of the old anatomy lab. Not only was it crowded, but there were air circulators that were so noisy, you could barely hear yourself think, Berman said. A new, state-of-the-art lab, made possible by a gift from the Jaharis Family Foundation, opened in 2017, doubling the space and incorporating cutting-edge technology that really transformed the way we teach anatomy, Berman said.

One of his cherished moments was watching the class who had taken the first half of their anatomy course in the old lab return from winter break to finish their course in the new space. They truly appreciated the change, he said.

Berman has held influential positions in his career, but his favorite job was his first one: a Peace Corps physician. It was there, coordinating the care for doctors throughout the corps network in India, that his outlook on medicine took shape.

When Berman expressed concern that India did not have the facilities for taking care of very ill patients, a local health official set him straight. He said, Look, young man, in America you have plenty of money to take care of patients. The few rupees we have to spend on health care we spend on prevention, Berman remembered. That conversation stuck with Berman. It was the best education I ever had on the importance of prevention and public health, he said.

Berman attended Harvard College and earned his M.D. from Columbia in 1964. After completing his internship and an infectious disease fellowship at Tufts Medical Center (then called Tufts-New England Medical Center), Berman and four other physicians decided to open a health clinic in Nashua, New Hampshire. Their approach was novel. They would charge their patients a flat fee each year, even if they had to see specialists. Although the term had yet to be coined, the model was essentially an HMO. They called it the Matthew Thornton Health Plan, after a New Hampshire doctor and politician who signed the Declaration of Independence. Specialists worked closely with internists, helping keep down costs.

We eventually convinced all the other multispecialty group practices in the state to join us, Berman said. We really did start a revolution.

When Berman left Matthew Thorton in 1986, it had 50,000 patients and was the second largest insurer in New Hampshire. From there, he joined Tufts Health Plan as its chief executive. He led the company for seventeen years, growing it from 60,000 members to more than one million.

Jon Kingsdale, then the senior vice president for planning at Tufts Health Plan, cited the way Berman decided which Medicare preferred plan for seniors the company should adopt. After six months of careful research, the staff had narrowed it to two choices, but could not decide between them. Well, its obvious, Berman said. This plan has integrity, and this one doesnt, so lets go with this one, Kingsdale remembered.

Integrity is central to every Berman decision, agreed James Roosevelt, who succeeded him as chief executive at Tufts Health Plan. The message that Harris always communicates, both in action and words, is do the right thing, Roosevelt said.

Massachusetts Governor Charlie Baker was the chief executive of Harvard Pilgrim Healthcare when Berman was at Tufts Health Plan. He called Berman a friendly rival, but also a mentor. Harris was an innovator and a leader in every way, Baker said.His leadership in every role he has ever had has been outstanding, and his commitment to improving health care for everyone has been long lasting and steadfast.

Berman was able to see medicines bigger picture and see it clearly. Atul Gawande, the surgeon and bestselling author who reports extensively on health care as a New Yorker staff writer, found a rare resource in Berman. He was one of the first people who ran an insurance company who could tell me what was wrong with the insurance system, Gawande said. When I was grappling with what is wrong with the way we train people to be physicians, he would be the first to acknowledge this isnt the way it should be.

After leaving the insurance industry, Berman joined the School of Medicine administration as chair of the Department of Public Health and Family Medicine in 2003. Then sixty-five years old, he planned to ease into retirement. It didnt turn out that way. He showed up every day for his part-time post and soon figured out that the department felt like a distant cousin to the rest of the medical school, which focused on training physicians.

I can fix it, Berman told the dean, Michael Rosenblatt, but I need to have the authority to be responsible for it. Thus Berman became the schools first dean of Public Health and Professional Degree Programs.

By better integrating public health into the rest of the school, we are sending a very clear message to our medical students and our public health students that youve got to work together, Berman said. Medical doctors need to understand public health diseases and get involved in their communities, and public health people need to be able to deal with doctors.

Berman continued toin his words"flunk retirement. He became vice dean of the medical school, and in 2009, when Rosenblatt left to take a job in industry, stepped in as interim dean. I had no idea I would be dean for ten years, Berman said.

As dean, he helped reinforce the bond between the school and Tufts Medical Center. Michael Wagner, the former chief executive at the hospital, said Berman was always available to talk. He has that physicians capability of being really thoughtful, of listening carefully, of caring, Wagner said. He would take those skills as a healer and apply them as a leader.

And it is the patience and trust he shows as a leader, his colleagues at the medical school say, that allowed them to flourish. He respects everyone on his team, said Naomi Rosenberg, dean emerita of the Sackler School of Graduate Biomedical Sciences at Tufts University. That is a pretty amazing thing, because Im not sure you can say that about many people and really mean it, she said. He might not always agree with you, but he always supported you. Thats true whether you were doing something easy or something that was incredibly hard. And we worked on both kinds of things.

No matter what Harris did, she said, he did it with the best interests of the school in mind.

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Health-care pioneer Harris Berman to retire as dean of Tufts University School of Medicine - Newswise

Penn Medicine Lancaster General Health is spending $48 million on a one-room proton therapy facility, with leaders saying they believe the cancer-fighting technology is worth the cost.

The new facility, to open in fall 2021, will have capacity for up to 30 patient visits a day.

Lancasters will be the second proton therapy center in Pennsylvania, working in partnership with Penns flagship center in Philadelphia that is described as the largest and most advanced in the world.

Work has just started on the facility here, which will be part of the Ann B. Barshinger Cancer Institute in East Hempfield Township.

Jan Bergen, president and CEO of LG Health, said the local center will allow area residents who have cancer to avoid trekking to Philadelphia for multiple days of treatment, which can be physically and emotionally exhausting.

Proton therapy is a form of radiation that can increase the dose to the tumor while decreasing the exposure of healthy surrounding tissue.

The center will measure about 8,000 square feet, with most of the space taken up by the massive proton therapy equipment and the concrete that will house it.

According to Dr. James Metz, chair of radiation oncology at Penn Medicine, proton therapy is most useful in combination with other treatments like chemotherapy and immunotherapy.

Dr. Randall A. Oyer, medical director of the Barshinger Institute, said adding proton therapy fits nicely with two other initiatives.

They are giving more Lancaster patients a chance to take part in clinical trials, and expanding use of precision medicine that is using increasingly targeted approaches.

There are more and more new drugs coming onto the market rapidly, Oyer said, and for the first time were seeing that patients who participate in clinical trials have better outcomes and live longer.

He noted that in some cases patients who participate in clinical trials get their medication free.

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Proton therapy is a relatively new technology and many insurers cover it on a limited basis or not at all, leading to financial difficulties at some of the existing centers.

Last summer, a Medicare Payment Advisory Commission report cited research that found proton therapy costs about twice as much as other types of radiation therapy and, noting a 2014 assessment, said use has grown despite a lack of evidence that it offers a clinical advantage over alternative treatments for certain types of cancer.

This summer, Medicare proposed a change that would limit proton therapy to roughly the same reimbursement as other types of radiation treatment.

Asked about those issues, Metz said insurance covers about 70% of patients getting proton therapy in Philadelphia, and its years of experience give the system confidence that the developing field of research shows improved outcomes for patients receiving the therapy.

Weve seen this coming, he said. Weve been doing this for a while.

He also noted that proton therapy is being refined as it comes into wider use and in some cases treatment can be much shorter than with traditional radiation and that cutting treatment times makes the therapy less expensive.

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Penn Medicine LG Health plans $48M proton therapy center that will be Pennsylvania's 2nd - LancasterOnline

By Katrina Martinez October 16, 2019

Graduate student of the Master of Athletic Training program Rachael Dickey operates the HIVAMAT device, which utilizes electrical stimulation to help ease pain for the student athlete. | Katrina Martinez/The Cougar

Brad Newton blindly chose the athletic training major in 2008 at Canisius College in Buffalo, New York when he noticed it on a list of potential career paths. There was no way he could predict that 11 years down the line he would find himself in Houston.

Newton, now one of 15 full-time athletic trainers, aids in servicing roughly 420 student athletes at UH. Houston athletic trainers do everything from first aid to stretching athletes to laser treatments and more.

They also treat around 150 to 200 athletes per day.

We work a lot of hours, you know, Newton, who is one of four football athletic trainers, said. Our typical work week is 80 to 100 hours year-round. Were always here.

Daniel Monreal, a fellow trainer but for track and field and cross country, has been with the staff since 2016. The Houston native, UH alumnus and former graduate student can relate to Newton.

The only rest time I have when Im usually not seeing athletes is from 6 to 7 in the morning whenever I come in to start getting paperwork done, he said.

The sports medicine facility on campus houses some of the best medical equipment available to college and professional sports teams alike, Newton said.

They have an onsite medical lab, which allows the sports medicine staff to run tests and produce diagnoses quickly. Student athletes can even have flu shots administered yearly at the facility and can see a physician during clinics held on campus four times a week.

In terms of capabilities within this room, its a fully operational healthcare facility, Newton said. So, similar to when you would go to a doctors office. Besides doing an X-ray and MRI, we could do just about anything else in-house.

The athletic trainers are first responders for all athletes. Whether they are injured during games and practices or just need help stretching before a workout, athletes have access to athletic trainers most of the time.

In terms of daily usage for student athletes, they all have our cell phone numbers, Newton said. So its 24/7 healthcare. They have the direct line to anything they might need at all times.

While managing this department may seem like a daunting task, sports medicine head Michael OShea is mostly unfazed.

First of all, youve got to love your job and love what youre doing, which Ive always done, OShea said. Youve got to have a lot of desire to work with athletes, young student athletes, not only to help them out on the playing fields, but in the classroom, too.

With all the treatment taking place, OShea said it is an all-day process that takes organizing to handle successfully.

The biggest thing you have to do is train your staff before the fact so they can handle the kids when they come in, OShea said. Its just a matter of organization and being able to organize the times. You cant have everyone coming in for treatment at 7 in the morning.

Much of the success of the sports medicine facility rests in the hands of students.

Undergraduates who are certified in CPR and first aid can work with the athletic trainers on a work-study or volunteer basis.

Additionally, 12 graduate students in the athletic training program work in the sports medicine facility, which helps ease the load for the full-time athletic trainers.

Without student help, our room doesnt run, Newton said. I would say thats probably true for a lot of college departments. The students are really what makes things tick around here.

The departments goal is to help students recover from injuries, and athletic trainers often see similar injuries over time.

For instance, football players commonly suffer knee and ankle injuries, but as a result of facility improvement, they have observed some major injuries decrease over the years.

Were very fortunate here, Newton said. We have a great weight room, so weve seen a very large down-tick in the last eight to 10 years in ACL injuries and those more severe injuries. Most of what were dealing with is sprains, strains and contusions.

For Monreal, he sees issues in the calves of distance runners, hamstrings of sprinters, knees of jumpers and wrists of pole vaulters and throwers.

With the growing support of UH Athletics around campus, the department is able to thrive and continues to play a key role in student athlete success from behind the scenes.

President (Renu) Khator herself has moved this University in such a great way that athletics here at the University of Houston, you take pride in it, Monreal said.

Monreal, who started working full-time at the sports medicine facility after graduating from the UH Master of Athletic Training program in 2018, doesnt mind the long hours. He is living his dream come true at UH, and he helps others succeed in the process.

In the end, I love what I do, and I love coming to work every day, Monreal said. I love this job. Its truly a dream job, and a lot of people cant say they get their dream job right after graduating.

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Tags: Athletic Trainers, Brad Newton, Daniel Monreal, Michael O'Shea, Sports Medicine, UH Athletics

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Sports medicine staff members are unsung heroes of UH Athletics - The Daily Cougar

Next-generation sequencing techniques to determine an individuals unique genetic code gave rise to personalized treatments. Single-cell sequencing is the next step towards making precision medicine more accurate.

Each cell in our body is unique. Even genetically identical cells can behave differently in response to a certain treatment. With next-generation sequencing, scientists can study how the average cell within a group behaves. However, this can lead to erroneous conclusions.

It is like population surveys which tell us the average American family has 1.2 children. Thats useless. Thats not helpful. Not a single family has 1.2 children, stated Christoph Lengauer, CEO of Celsius Therapeutics, in an interview with STAT News. His company has raised more than 60M to develop precision therapies using machine learning.

Single-cell sequencing, by contrast, can indicate which family has six children, and which has just one and a dog, Lengauer said. Its orders of magnitude more granular.

This is a huge paradigm shift. Single-cell sequencing was recognized as method of the year by Nature in 2013. Since then, the number of publications from both academia and the industry exploded.

In recent years, there has been a shift in the technology available to perform single-cell sequencing. Fluidigm used to hold the bulk of the market with products across the entire workflow but is currently suffering from poor sales due to new competitors.

At the forefront is US-based 10X Genomics, founded in 2012, which registered a 20-fold revenue increase between 2015 and 2017. Its sequencing platform allows large populations of cells to be separated and analyzed with high resolution. The company is also developing a technology to study how cells are positioned in 3D which could be used to see how tumors grow and expand.

Another contender is the alliance between two giants, Bio-Rad Laboratories and Illumina. They announced in January 2019 a joint single-cell sequencing solution that streamlines the whole workflow. Mission Bio, a spin-off from the University of California San Francisco is selling a single-cell sequencing platform that targets clinical applications with a lower price per run compared to its competitors.

Despite the rapid market growth, the use of single-cell sequencing is so far limited to a narrow circle of initiates. Over the past years, academic facilities have started providing single-cell sequencing services to researchers. For example, the technology is used at the Institut Curie in Paris to study cancer cells.

More recently, companies have started working in this area, often using technology initially developed in academia to identify new biomarkers and drug targets. All seem to have a common goal: personalized medicine.

Research on most diseases related to genetic or epigenetic mutations could benefit at some point from single-cell sequencing. There are already scientific publications applying this technology in microbiology, neurology, immunology, digestive and urinary conditions.

Among them, oncology is probably the most promising and mature application. Previously, bulk analysis of cells from a tumor biopsy only gave information on the predominant type of cells. In contrast, single-cell sequencing can provide information about other tumor cells, which might be resistant to a certain therapy and result in a relapse after the first line of treatment.

This technique is highly sensitive and is able to detect rare cell types from limited amounts of sample material. Combined with technology to isolate circulating tumor cells from a blood sample, single-cell sequencing can be used to select patients in personalized medicine trials.

IsoPlexis is one of the very few companies with an advanced program to apply single-cell sequencing to proteomic studies looking at the role of protein expression in cancer. The company is developing a technology to measure the levels of a dozen molecules secreted by immune cells that are primed to recognize and attack a tumor. Last year, this was used to predict, for the first time, the response that a person with blood cancer will have to CAR T-cell therapy. The company claims that it could also be applied to cancer patients treated with checkpoint inhibitor immunotherapy.

Single-cell sequencing can also be combined with CRISPR gene editing to make elaborated large-scale studies of how a genetic modification affects cell behavior. The Austrian company Aelian Biotechnology is combining both techniques to observe gene functions with single-cell resolution, establishing a new paradigm for next-generation CRISPR screening. This approach has broad applications, including identifying novel drug targets or studying unknown mechanisms of actions of drugs.

Either for research or clinical diagnostics, single-cell sequencing remains challenging and is far from being used routinely. One of the main reasons is that single-cell collection is tricky, as the amount of sample material used is low but the analysis still requires a sufficient amount of cells to make sure all cell types are represented. The time it currently takes to complete an experiment is another major concern. Companies developing single-cell sequencing technology need to work on creating streamlined and optimized workflows that limit these problems.

Although experimental methods for single-cell sequencing are increasingly accessible to laboratories, handling the data analysis remains challenging. There are currently limited guidelines as to how to define quality control metrics, the removal of technical artifacts, and the interpretation of the results. With larger experiments, the data analysis burden increases.

Single-cell data requires the analysis of millions of data points for a single tumor, said Andrei Zinovyev, who leads a machine learning project focusing on single-cell data analysis at the Institut Curie in Paris.

There are many software tools developed by academics, mostly available in open source. However, their use is limited to a small community of researchers that have been able to successfully combine advanced bioinformatics and statistical skills with in-depth knowledge of the biological systems they study. Companies such as 10X Genomics and Fluidigm also provide software tools, but this area remains in its infancy and gold-standard tools have yet to be developed.

For single-cell analysis to spread to a broader community, user-friendly analysis tools are needed. In this area, Swiss startup Scailyte is developing an AI-based solution to discover biomarkers from single-cell data, analyzing complex datasets in just a few hours. The US startup Cellarity is also working in this area, seeking to combine single-cell sequencing with artificial intelligence and CRISPR gene editing.

The use of single-cell sequencing is limited due in part to its high cost. Most of the instruments and reagents needed are costly. For someone looking to incorporate single-cell sequencing into their laboratory, 10X Genomics for example sells its instruments for about 70,000. A typical run, including cell isolation and sequencing, can cost anywhere between 3,000 and 10,000 per sample, depending on the number of cells.

Due to the high cost, it is becoming popular for laboratories with the equipment to offer single-cell sequencing and analysis as a service. The US company Mission Bio is tackling this issue, aiming to reduce the cost to between $1,000 and $2,000 for a typical run.

As is mostly the case in any area with a huge market potential, intellectual property can cause conflict, which can negatively impact the development of new technologies. For example, back in 2015, Bio-Rad sued 10X Genomics for patent infringement, and the jury determined it would have to pay 21M in damages. Furthermore, 10X Genomics could not sell their products to new customers, being therefore limited to servicing historical clients with all past and future sales subject to a 15% royalty.

Several months later, the US company Becton Dickinson also sued 10X Genomics. After that, the company decided to build a new piece of equipment to reinforce its intellectual property position. In September, 10X Genomics countersued Becton Dickinson.

The single-cell sequencing market experienced a growth spike between 2017 and 2018 due to several key stakeholders entering the market. But we are only at the beginning. According to most business reports, this market is expected to see a 300% growth, reaching a size of almost 1.4B by 2023.

Competitors are innovating at an insane rate to take the lead, but there is still a long way to go before single-cell sequencing can be widely used. A huge amount of investment would be needed to fully unlock its potential for research, drug discovery, and diagnostics. Nonetheless, the field has momentum and once it tackles the challenges, there is no doubt that single-cell sequencing will pave the way to breakthrough innovations in personalized medicine.

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Single-Cell Sequencing: Paving the Way for Precision... - Labiotech.eu

The Wayne State University School of Medicines new curriculum continues to build upon the schools promise for urban clinical excellence by bringing its matriculates inside the heart of its mission. Most recently, medical students met with several formerly homeless community members last month for a one-day series of panel discussions on The Care of the Homeless Patient.

The presentations on Sept. 26 followed a two-week unit of the schools Population, Patient, Physician and Professionalism course, or P4.

The P4 Care of the Homeless Patient represents a critical part of the unique education we receive as medical students at Wayne State University. We had an opportunity to learn from the first-hand experiences of homeless patients and physicians who work with the homeless population of Detroit and under-insured patients, said Class of 2022 student Arif Musa. I am greatly appreciative of the courage and willingness of the panelists to share their stories and answer our questions. Obtaining the views of providers and homeless patients allowed for students to gain a broad perspective.

The participants were individuals who the School of Medicine previously worked with through student organizations like Street Medicine Detroit and others.

This exposure in the first and second year of medical school is so important, and sets Wayne apart. Its a foundational professional skill, said Kelly Panoff, the P4 course coordinator.

The P4 course a Year 1 to Year 2 segment that emphasizes the evolving professional identity of a physician connected to patients and populations. The course exposes students to their roles as clinician, leader, interprofessional collaborator, scholar and systems analyst through large-group sessions, small-group sessions, online modules, self-directed reflective assignments and clinical opportunities in the community.

Its where a lot of discussion in medicine is going. It is critical to understand the social context of the patient before you can provide any hope of clinical care, said Assistant Professor of Internal Medicine Jarrett Weinberger, M.D., FACP.

Dr. Weinberger volunteered as one of four panel moderators at the presentation. He is director of the School of Medicines Internal Medicine residency program.

The panelists shared their personal stories of how they became homeless, from a heroin addiction to mental illness and suicide attempts, as well as their education and job history, what their childhood was like, their current living situation, their thoughts on the health care system, how they have been treated by health care providers, how they wish to be treated, and more.

Nothing tells a story like the patient. Nobody expresses the human psyche like the patient, he said. The students were really insightful about questions. They wanted to know about the underlying issues of homelessness.

Rafael Ramos was one of the nearly 300 students who attended.

Having the opportunity to hear the stories of the men and women who took it upon themselves to share their experiences with homelessness was a necessary and thought-provoking exercise to remind us that there are layers of social difficulty that a lot of us in medicine have not gone through, Ramos said. Living in an urban area like Detroit, this is a population we interact with colloquially in our everyday lives, and it was important to understand where our own prejudices and assumptions lie about people who fall under this umbrella. It is important to know this part of ourselves and carry these lessons as we continue our training as physicians.

The faculty physicians who participated shared the difficulties students may face within medicine to provide adequate care for those with unstable living conditions.

It is important to solidify that any free clinic work or volunteering that we may do in the wider community is part of a wider network of care. It was empowering to hear that some of the work we can do as students has a tangible effect in the lives of the people we work with and it's an enormous incentive to take our involvement in these activities seriously, Ramos said.

Like Ramos, Musa has seen what a student can do when given the opportunity.

Homeless patients often experience discrimination, prejudice, and sub-optimal care. The panelists were instrumental in teaching me about the unique circumstances faced by homeless patients that make it difficult or nearly impossible to adhere to the directions of providers. Not only is there a stigma surrounding homelessness, but health care providers may feel that homeless patients are only seeking shelter and a hot meal rather than having a genuine medical concern. Knowing this, I hope to treat homeless patients in the same way I would treat any other patients with respect, compassion and a genuine desire to improve their circumstances regardless of their background, Musa said.

Improving care for the homeless patient has been a mission of Musas since attending graduate school in the University of Southern California Keck School of Medicines Global Medicine Program, where he developed a business operations improvement project to streamline care to the homeless population at the John Welsey Community Health Center in Los Angeles.

After I came to Wayne State University, I learned how to communicate with patients to assess their living situation and access to basic needs with confidence, tact and evidence-based communication strategies, Musa said. My experiences at Keck School of Medicine and Wayne State University School of Medicine have allowed me to continue to develop the skills necessary to care for the homeless and under-insured patients that I will surely see in my training to become a physician, he said.

The P4 course for the Class of 2022 began in the summer of 2018 with a poverty simulation exercise. Since then, the students have attended presentations related to food insecurities, veterans health care, patients with development disabilities and more.

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'Nothing tells a story like the patient' - School of Medicine News - The South End

JANESVILLE, Wis.--(BUSINESS WIRE)--SHINE Medical Technologies, LLC today announced the creation of a new division of the company SHINE Therapeutics. The establishment of the division enhances the companys ability to focus on filling critical future needs in the rapidly growing therapeutic isotope market, while continuing to leverage its radioisotope production expertise.

The companys Therapeutics division will initially focus on the development and commercialization of lutetium177, or Lu177, a therapeutic isotope that is combined with a disease-specific targeting molecule to treat cancer. Targeting molecules deliver Lu177 atoms to cancer sites throughout the body, where they directly irradiate cancer cells.

The first Lu177-based targeted radiotherapy (for neuroendocrine tumors) reached the market in 2018. Many high-potential targeted molecules for the treatment of a range of other cancers with Lu-177 are currently under investigation. SHINE is also evaluating additional medical isotopes with therapeutic properties for future development.

Katrina Pitas, a 10-year veteran of SHINE who served most recently as the companys vice president of business development, has been appointed vice president and general manager of SHINE Therapeutics.

Targeted radiotherapy has the potential to fundamentally change the way cancer patients are treated, Ms. Pitas said. But a robust, reliable supply of therapeutic isotopes will be crucial as both the discipline and associated market continue to grow. Our Lu177 development program is well underway, and we look forward to bringing high-purity Lu177 to market.

In May, the company entered an agreement with the Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences (IOCB Prague) that provides SHINE with a global, exclusive license to a novel separation technology that it will use to separate lutetium from enriched ytterbium targets. The technology will enable SHINE to produce non-carrier-added, high-specific-activity Lu177.

We are excited to bring our core competencies and technology to serve the rapidly emerging therapeutic market, said Greg Piefer, SHINEs founder and CEO. This market is particularly exciting, as it offers very promising therapies for patients who before now had difficult or impossible to treat late stage cancers. The focus of our new division is to ensure cancer patients have a reliable supply chain of isotopes as new drugs are approved.

SHINE is continuing its efforts to bring molybdenum-99, or Mo99, to a global market experiencing shortages that directly affect patient care. Construction of the companys first-of-its-kind isotope production facility in Janesville, Wis., where it will produce Mo99 using the companys patented technology, is underway and progressing well.

European Association of Nuclear Medicine Annual Congress

SHINE will be exhibiting at the European Association of Nuclear Medicine (EANM) Annual Congress in Barcelona, Spain. The exhibit hall will be open Oct. 13-15. You can find SHINE at booth no. 23 near the center entrance to the exhibit hall.

About SHINE Medical Technologies LLC

Founded in 2010, SHINE is a development-stage company working to become a manufacturer of radioisotopes for nuclear medicine. The SHINE system uses a patented, proprietary manufacturing process that offers major advantages over existing and proposed production technologies. It does not require a nuclear reactor, uses less electricity, generates less waste and is compatible with the nations existing supply chain for Mo-99. In 2014, SHINE announced the execution of Mo-99 supply agreements with GE Healthcare and Lantheus Medical Imaging. In 2015, with the help of Argonne National Laboratory, GE Healthcare demonstrated that SHINE Mo-99 can act as a drop-in replacement for reactor-based Mo-99. In 2016, SHINE received regulatory approval from the Nuclear Regulatory Commission to construct its production facility. The company began construction of the facility in the spring of 2019. Learn more at https://shinemed.com.

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SHINE Creates Therapeutics Division, Will Attend 2019 European Association of Nuclear Medicine Conference - Business Wire