Renewing Partnerships

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NASA Administrator Charles Bolden and U.S. Environmental Protection Agency Administrator Lisa P. Jackson signed a Memorandum of Agreement today to promote and continue collaboration between the two agencies in environmental and Earth sciences and applications. The signing ceremony took place at the Howard University Middle School of Mathematics and Science (MS)² on the campus of Howard University in Washington. Following the ceremony, both administrators met with students to discuss the importance of science and engineering education.

"Our agencies have a remarkable opportunity to tackle a variety of environmental issues together," said Administrator Bolden. "Involving students in Earth science and climate research at an early age will encourage a stronger sense of stewardship toward our home planet."

The agreement renews a broad partnership to promote joint efforts to improve environmental and Earth science research, technology, environmental management, and the application of Earth science data, models and technology in environmental decision-making.

Video of the event can be seen on UStream

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‘Futurismi al confine orientale. Avanguardie di regime’ exhibit extended

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Futurismi al confine orientale. Avanguardie di regime

December 1, 2009 – February 21, 2010 May 2, 2010
Istituto Regionale per la Cultura Istriano-Fiumano-Dalmata | Trieste
Curated by Piero Delbello
Catalog

more info

In occasione del CENTENARIO del FUTURISMO (1909/2009), si propone in questa sede un’approfondita ricerca sulla grafica d’avanguardia al confine orientale che va a recuperare l’immagine applicata ad eventi, occasioni o alla propaganda delle diverse istituzioni e organismi in un arco di anni fra il 1920 e gli anni ‘40 (con un’appendice che supera il 1950) del secolo appena trascorso.

Trieste e la sua Provincia, l’area goriziana e il Friuli, ma anche l’Istria, Fiume e la Dalmazia, nonché la zona carsica sono i luoghi di questa indagine che, indubbiamente, andando al recupero soprattutto della grafica minore ed in qualche caso minima (e dei suoi autori) si presenta come totalmente innovativa e mai tentata in precedenza.

Sul futurismo, sui suoi artisti, molto si è scritto e si continua ad indagare. Nuovi approfondimenti emergono, frutto di studi monografici e indagini locali: sempre di più si completa il mosaico dell’iper-attività dei membri di un movimento che fu, nelle intenzioni, socialmente totalizzante investendo del suo impeto innovatore non solo ogni disciplina artistica “classica” (dalla pittura alla scultura, dalla letteratura alla rappresentazione scenica, alla musica) ma anche l’approccio al vivere quotidiano. La meno “classica” arte pubblicitaria, il design e il lettering di accompagnamento, la fotografia, la contaminazione di questi elementi, furono terreni di interessanti esperimenti e prove per il futurismo: ma furono anche il luogo dove una sterminata (e, spesso, sconosciuta) miriade di artisti (pittori, grafici, fotografi, ma anche architetti, scultori, decoratori), pur non rientrando ufficialmente nelle file del movimento, applicarono, in qualche modo, l’aria che il futurismo faceva respirare. Erano artisti minori, non era futurismo e non erano futuristi, ma seppero mediare e mediarsi, talvolta anche confondersi, fra futurismo, déco, cubismo, costruttivismo … Ne uscirono esiti vari, a volte straordinari, più spesso ingenui, ma erano la personificazione quotidiana di tanti “ismi”, di tanta volontà di innovare.

È per questo – sia concesso dai puristi – che si è inteso dare a questo lavoro il titolo di “futurismi”, nell’intenzione di riassumere l’atmosfera appena descritta, indagando “a lato” sia geograficamente (le terre giulie) che artisticamente.

La repertorializzazione di alcune centinaia di campioni grafici in argomento (gentilmente messi a disposizione dell’I.R.C.I. da fonti private) consentono di svelare un panorama sicuramente poco noto (addirittura, in molti casi, del tutto sconosciuto) delle nostre terre e, con la pubblicazione della catalogazione e della riproduzione del tutto, di proporre al pubblico degli esperti e degli storici dell’immagine, nonché a tutta l’opinione pubblica, uno strumento assolutamente nuovo e, appunto, inedito.

È questo il piccolo contributo che l’ Istituto Regionale per la Cultura Istriano-fiumano-dalmata, insieme con la Famiglia di Grisignana dell’Unione degli Istriani, vuole dare al centenario della nascita del futurismo: indubbiamente il momento culturale più dirompente che l’Italia abbia prodotto nel corso del Novecento e l’unico che abbia travalicato i confini nazionali ottenendo seguito e coinvolgimento in tutto il mondo.

EVAL, con uno schizzo che più infantile non si può, traccia la linea futurista di visione di Albona. Anzi: lo sguardo è dall’alto, dall’aeroplano, tanto che la sua opera, messa in cartolina, ha per titolo “Albona. Aeroschizzo della Piazza Vittorio Em. III”. La piazza ostenta negli edifici un’improbabile geometria, accentuata, nella visione di Eval, con linee tracciate sull’area aperta a tela di ragno, rombi, cerchi, stelle a otto (8) punte. Ma chi è EVAL? E cosa mai ha conosciuto Albona, la centro dell’Istria, di futurismo?

Nel percorso che stiamo compiendo vengono alla luce campioni di produzione di artisti poco noti e, talvolta, del tutto ignoti: Antonio Quaiatti, Umberto Ranzatto, Omero Valenti, Urbano Corva … sono solo alcuni dei nomi di cui si scoprono esiti impensabili.

Disegno e lettering vengono esaminati nelle loro esemplificazioni: scopriamo le inattese scelte giovanili di artisti come Mascherini (superomico) o Carà (cubo-futurista).

Si tratta a volte di un segno molto ardito, come nel caso di Ferenzi o di Marcello Claris, di una costruzione di chiara ispirazione futurista (architetti come Angheben) che diventa esempio anche per altri: in linea appaiono Urbano Corva (che, però, aveva indubbiamente occhieggiato Depero) oppure, ancora, le scelte che superano il déco (Gustavo Petronio), sfociano nel novecentismo (Guido Marussig) o ammiccano al cubismo (Orfeo Toppi, Pollione Sigon, ancora Ferenzi, Caucigh, Mitri). Fino ad arrivare all’estrema sintesi in una razionalissima semplificazione grafica che ha in Edoardo Ricci il suo campione.

Se tutto ciò, nella grafica applicata, trova una strada molto libera in ambito delle istituzioni del regime (Opera Balilla, Dopolavoro ma soprattutto GUF con i Littoriali), è innegabile che scelte stilistiche “ardite” le si ritrovino, pur con minore intensità, anche nella propaganda commerciale, industriale, turistica o del terziario.

Come è innegabile che lo sforzo grafico “insolito” superi il confine degli anni della guerra e si procrastini, spesso per opera degli stessi artisti (e il caso, p.e., di Omero Valenti), sino ai primi anni ’50. Magari per situazioni di “idea” diametralmente opposte: proprio Valenti che nel 1944 aveva disegnato la copertina dell’opuscolo “Nostro Socialismo”, per la Repubblica Sociale Italiana, comporrà il manifesto, con un bel gioco di inserti grafici e fotografici, per il “I° Maggio Socialista” del 1953.

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Pixels of Accuracy CHALENGE: Diagnostic Medical Imaging

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EXHIBIT A:

A typical example of a common medical diagnostic imaging artifact in the format as was submitted to a medical office this year. This image was used and is continued to be used make or not make critical medical diagnosis for patients and their families in the United States.

THE CHALLENGE:

Which pixel(s) in this actual patient medical record do or do not not meet FDA standards for accuracy and efficacy?

(please submit your response, your home address, and your wallet in x,y coordinates)

"Three Unique Medical Museums in Northern Italy," Lecture by Marie Dauenheimer, Observatory, Saturday May 1

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This Saturday night, Marie Dauenheimer--the curator of the "Anatomical Art: Dissection to Illustration" exhibition discussed in yesterday's post--will be on hand at Observatory to deliver an illustrated lecture that "will survey the collections of three unique and often over-looked anatomical museums in Northern Italy." One of the museums discussed will be The Museum of Human Anatomy in Bologna, which houses--among other works--an incredible wax self-portrait of Anna Morandi Manzolini dissecting a brain (c. 1760 ; see above). The other two musems she will discuss will be the fantastic and difficult-to-access University of Florence Museum of Pathological Anatomy and the University of Pavia Museum of Anatomy.

Marie--who also leads tours of medical museums for the Vesalius Trust (as discussed in this recent post)--is an excellent speaker; her lecture on Italian Wax Anatomical Models in European Collections, which she gave about a year ago, was beloved by all, and we are exceptionally pleased to be hosting her again!

Full details follow; hope very much to see you there!

Three Unique Medical Museums in Northern Italy
An illustrated presentation by Marie Dauenheimer of the Vesalius Trust
Date: May 1, 2010
Time: 8:00 P.M.
Admission: $5
Presented by Morbid Anatomy

Tonight’s visual presentation by Marie Dauenheimer will survey the collections of three unique and often over-looked anatomical museums in Northern Italy which Dauenheimer toured as part of last years Vesalius Trust “Art and Anatomy Tour.” First, the University of Florence Museum of Pathological Anatomy, famous for its collection of wax pathological models created in the 19th century, including an amazing life size leper; then The Museum of Human Anatomy in Bologna featuring the work of famed wax modeling team of Anna Morandi Manzolini and her husband Giovanni Manzolini, whose life size wax models inspired Clement Susini and the wax-modeling workshop in Florence (see image above); and lastly the fascinating University of Pavia Museum of Anatomy, which houses the beautiful 18th century frescoed dissection theater, where anatomist Antonio Scarpa. So join us tonight for wine, fellowship, and a virtual and very visual tour of some of the finest and most fascinating medical museums of Italy!

Marie Dauenheimer is a Board Certified Medical Illustrator working in the Washington, DC Metropolitan area. She specializes in creating medical illustrations and animations for educational materials, including posters, brochures, books, websites and interactive media. Since 1997 Marie has organized and led numerous “Art and Anatomy Tours” throughout Europe for the Vesalius Trust. Past tours have explored anatomical museums, rare book collections and dissection theatres in Italy, The Netherlands, Belgium, France, Scotland and England. In addition to illustrating Marie teaches drawing, life drawing and human and animal anatomy at the Art Institute of Washington. Part of Marie’s anatomy class involves study and drawing from cadavers in the Anatomy Lab at Howard University College of Medicine in Washington, DC (for more on that, see this recent post).

You can find out more about this presentation here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here. To learn more about Marie's "Anatomical Art: Dissection to Illustration" exhibition, click here. For more on the Vesalius Trust, click here.

Image: Self-portrait of wax modeller Anna Morandi Manzolini dissecting a human brain, Bologna, c. 1760; Via Scienza a Due Voci

Bogus Diagnostic Tests

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A few years ago a friend asked me to comment on advice given to her adult daughter by a psychiatrist whom she’d consulted for depression. The psychiatrist had recommended testing samples of saliva and urine for hormone and neurotransmitter levels, the results of which would likely indicate a need for supplements to correct deficiencies or imbalances. According to the psychiatrist, who had an academic appointment at a medical school in New York City, “I have been using these supplements with a great deal of success.” My friend is not medically or scientifically sophisticated, but this made her a little uncomfortable. In that, she was entirely justified.

During our recent panel discussion at the NECSS, a member of the audience identified himself as a clinical pathologist at a major medical center, and wondered what he might do to become involved in the good fight against encroaching pseudoscience in medical schools. Clinical pathology is the medical specialty that concerns itself, in summary, with laboratory tests—their development, their validity, their interpretation, their usefulness and, by implication, their misuse. A topic that we haven’t much featured on SBM (we touched upon it here, here and here, and probably elsewhere) is that of bogus laboratory or other diagnostic tests.

Early in my own education in modern quackery, I found it particularly distasteful not merely that quacks misuse laboratory tests, but that several commercial laboratories market misleading tests. To the untrained eye these laboratories appear to be legitimate, even to the point of their being approved by apparently legitimate certifying bodies. We’ll discuss that below, but first let’s look more closely at the psychiatrist’s recommendations to my friend’s daughter and at other examples of bogus tests.

A Full Service Company

If my friend’s daughter had followed her psychiatrist’s recommendation, she would have sent her saliva and urine samples to a company called NeuroScience, which would have had them tested for certain hormones and neurotransmitters. The psychiatrist would have chosen those tests based on prompting by NeuroScience itself. Here’s what would have happened next:

Based on the laboratory results, NeuroScience, Inc. works with healthcare providers to develop Targeted Amino Acid Therapy (TAAT™) protocols designed to address the spectrum of neurotransmitter and hormone imbalances. Addressing neurotransmitter and hormone imbalances through TAAT™ can lead to significantly improved patient outcomes for a number of today’s most challenging conditions. Why wait? Get Started with NeuroScience, Inc. today.

NeuroScience will even help providers convince insurance companies to pay for the tests. And there’s no extra waiting time, because NeuroScience sells not only the tests, but the remedies. But it sells them exclusively to practitioners, who are then expected to resell them to their patients for a markup (look here for an example of the report that the practitioner will receive). If all goes according to plan, that sweet deal will last quite a while:

It is possible to decrease chances of excitatory overload by introducing inhibitory support for one to two weeks prior to the addition of excitatory support. This 1st phase strengthens just the inhibitory system, allowing it to regain control over the excessive excitatory activity during the night. This often leads to improvements in the quality of sleep in many patients. Excitatory support is then introduced in the second phase to enhance excitatory neurotransmission throughout the day, to increase motivation and reduce fatigue.

The second phase of therapy is structured in a way that mimics the body’s natural circadian rhythms. Excitatory neurotransmitter support, if needed, is typically recommended earlier in the day, when the body requires the energetic and cognitive effects of the excitatory transmitters. Likewise, inhibitory support is typically suggested in the latter half of the day, to calm the body and set the stage for sleep.

Even though specific amino acids can change single neurotransmitter levels rapidly, it is difficult to predict when a patient will experience symptomatic improvement. Many report improvement within the first week, whereas others may require several months of continued therapy to note significant changes. It is our experience that 3-6 months is the average amount of time it takes to optimize neurotransmitters overall.

The transition to the final phase of therapy is recommended when the patient has reached their health goals and their neurotransmitter levels have been optimized, as determined through follow-up lab tests. This phase serves as a maintenance phase, whereby the dosing of products is reduced to the minimum level that maintains the symptom resolution. The unfortunate reality of any approach to neurotransmitter imbalances is that the effects of the intervention may not be maintained with discontinuation. Due to ongoing factors that influence neurotransmitter levels, including stress, diet, and genetics, some individuals will require long-term neurotransmitter support. Hence the focus of the third phase is to maintain optimal neurotransmitter levels long-term to offset factors contributing to their imbalance and in the interest of preventing a recurrence of symptoms. (emphasis added)

Wow! Not only can “addressing neurotransmitter and hormone imbalances through TAAT™ lead to significantly improved patient outcomes,” it can also lead to significantly improved practitioner incomes! What a company! What doc, squeezed by diminishing 3rd-party reimbursements, wouldn’t be tempted to sign up?

There are only a couple of problems. Hormone levels measured in saliva are almost never legitimate. There is no physiologic reason to measure most salivary hormone levels and no generally published ranges of normal levels of hormones measured in saliva. Hormones are typically measured in blood, which makes physiologic sense; some hormones and their metabolites can usefully be measured in urine, but not for the purposes that NeuroScience claims. On the other hand, it is likely easier for NeuroScience to solicit samples when blood-drawing is not involved, and easier for the company to make assertions about “test results” that are unfamiliar to most physicians or labs.

Moreover, even if the test results are technically accurate, I’m aware of no science that links them to non-optimal levels of hormones or neurotransmitters, other than in extreme cases such as pan-hypopituitarism or pheochromocytoma (which are quite different from what NeuroScience is claiming). Nor, even if the tests were entirely legitimate, is there any evidence that the proposed treatments will “optimize” neurotransmitter or hormone levels.

Finally, the conflicts of interest among the seller of the tests, the wholesaler of the supplements, and the retailer of the supplements (i.e., the physician) are obvious.

When Bogus Tests fall into the Wrong Hands

In 2005, an autistic 5 year-old boy died in the office of Dr. Roy Kerry in Butler County, PA, after receiving an intravenous injection of disodium EDTA, the same chelating agent that is being used in the NIH-sponsored Trial to Assess Chelation Therapy (TACT). Kerry, a member of the Mother of all PPOs, the American College for Advancement in Medicine (ACAM), had given this agent to the boy ostensibly to treat “heavy metal toxicity” involving aluminum, mercury, and lead, among other possibilities.

According to the PA medical board’s Factual Allegations, Kerry had used at least two bogus tests to make these purported diagnoses. The nature of the first is unclear, because in the written record Kerry described it only as “testing for the deficiency indicator.” Such vague language suggests not a legitimate blood test but, perhaps, a quack “electrodiagnostic” device such as the “Vegatest” or “Electroacupuncture according to Voll.”

The second bogus test was a “post-provocative urine sample” collected a few hours after the first chelation treatment. This yielded an “elevated” urine lead level, but that is exactly what would be expected for anyone who has just been treated with such a chelating agent, and is thus not indicative of true lead toxicity.

Kerry had also diagnosed the boy with “candidiasis” and “multiple food allergies,” two highly unlikely possibilities that suggest other bogus tests, such as “cytotoxic testing” or the paranormally-based applied kinesiology. He may or may not have used these tests, but such “diagnoses” are common among quacks who preach “detoxification” or who belong to the ACAM.

The Commercial Laboratory Hall of Shame

We are not told the name of the laboratory that Kerry used for the “provocative urine test,” but it was likely Doctor’s Data, Inc. (DDI), a company with a long history of dubious offerings. DDI and another company, Genova Diagnostics (GDX), formerly the Great Smokies Diagnostic Laboratory, sell such bogus tests as hair analysis, urinary amino acids, “intestinal permeability,” “DNA oxidative damage assay,” and various “comprehensive panels” that generate reports explicitly or implicitly calling for “detoxification” schemes, “supplements,” “nutriceuticals,” or “bioidentical hormones,” which participating practitioners are only too happy to provide. Doctor’s Data is proud of its close ties with such PPOs as the ACAM and DAN!, and like GDX is a “supporter” of the ACAM.

Genova also has a cozy relationship with naturopath Michael Murray, a long-time shill for “natural remedies” and co-editor of the Textbook of Natural Medicine, previously discussed here. One of Genova’s former divisions was BodyBalance, which peddles “test kits” directly to consumers ostensibly to measure minerals, hormones, “antioxidant reserves,” and “the body’s natural safeguard for optimal sleep, mood and cell function — melatonin” in saliva, hair, or urine. According to the current BodyBalance website,

BodyBalance is a division of Dr. Murray Natural Living, Inc., that specializes in direct to consumer health screening products. Dr. Murray is one of the world’s leading authorities on natural medicine and the author of over 30 books on natural healing. Dr. Murray and James Kammann, the General Manager of the BodyBalance Division, played key roles in the initial launching of the BodyBalance product line in 1999 when it was launched by Great Smokies Diagnostic Laboratory. BodyBalance was acquired by Dr. Murray Natural Living, Inc. in January 2007.

Our goal at BodyBalance is to help empower consumers to take charge of their health by providing them access to the world’s leading functional medicine laboratory — Genova Diagnostics (see http://www.GDX.net). Established in 1986 as Great Smokies Diagnostic Laboratory, Genova Diagnostics today serves over 8000 primary/specialty physicians and healthcare providers, offering over 125 specialized diagnostic assessments. BodyBalance has the exclusive rights to direct-to-consumer testing with Genova Diagnostics’ innovative tests — a lab that has achieved the highest national and certain state certification standards including CLIA (Clinical Laboratory Improvement Amendments) and the College of American Pathologists.

How is it that commercial laboratories can so easily flout the standards of their field? Don’t the “certifications” just mentioned mean anything? Well, yes and no. The Centers for Medicare & Medicaid Services (CMS) regulates laboratories through the program identified above, the Clinical Laboratory Improvement Amendments (CLIA). There are other certifying bodies and various state requirements. These initiatives have made it more difficult for laboratories to peddle some dubious tests, but clearly there is still ample opportunity for what amounts to diagnostic testing fraud. Doctor’s Data, for example, calls itself

a licensed CLIA laboratory with appropriate state certifications and participates in numerous quality assurance/proficiency testing programs including the College of American Pathology, New York State DOH and Le Centre de Toxicologie du Quebec.

The company offers numerous other “Qualifications,” including “Chinese Certified Hair Standard GBW 09101.” Genova Diagnostics, as previewed above, is just as confident:

a fully accredited medical laboratory, certified in the areas of clinical chemistry, bacteriology, mycology, parasitology, virology, microbiology, non-syphilis serology, general immunology, hematology, toxicology, as well as molecular genetics by six separate health agencies including the Centers for Medicare & Medicaid Services which oversees clinical labs in the United States under the federal Clinical Laboratory Improvement Amendment (CLIA).

NeuroScience also boasts of the legitimacy of its laboratory tests. It outsources these to a convenient “independent” lab, Pharmasan, which seems to be right next door and which shares its founder with NeuroScience:

Gold Standard Laboratory Testing
NeuroScience, Inc. uses an independent, CLIA certified testing lab that is licensed in every state–including New York, which holds the highest level of qualification standards.

Quackwatch: Your Guide to Bogus Diagnostic Tests

You can’t help but have noticed that many of the links in this post are to articles on Quackwatch. That’s because the site is chock full of useful information about bogus tests, far more than can be found elsewhere. There you will find a more comprehensive list of bogus tests than I’ve mentioned here, and a larger list of laboratories peddling them. You’ll also find an article on “Dubious Genetic Testing” co-authored by the Quackwatch founder, Stephen Barrett, and our own Harriet Hall, and an article about bogus “biomedical treatments” for autism showing that—surprise!—Doctor’s Data and Genova Diagnostics are major players there, too.

One place where you will find nothing at all about bogus diagnostic tests is the NCCAM website. This is unfortunate, because the site is widely touted as providing information necessary to “be an informed consumer.”

To the clinical pathologist who asked the question at NECSS, if you’re reading this, and to any others who may be out there: There is a real need for those with expertise in lab tests to get involved in the effort to expose pseudomedicine. This is especially true for any of you who are involved with CLIA. Let’s hear from you!


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Florida’s Best Beaches

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I’ve written about Florida beaches many other times, but now I’ve pulled together my top dozen and created a photo and audio log that allows me to tell you about these great beaches in my own voice. Enjoy!

Casperson Beach

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Treasure Island

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St. Pete Beach

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Clearwater Island Beach

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Siesta Key, Sarasota

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Lido Beach, St. Armand’s Key, Sarasota

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Nokomis Beach, Casey Key

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South Beach, Miami Beach

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Anne’s Beach, Islamorada, Florida Keys

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Sandspur Beach, Bahia Honda State Park, Florida Keys

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Palm Island, Punta Gorda, Florida
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Caladesi Beach, Dunedin, Florida
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Summer Hill Island

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summer-hill-glenville-3Summer Hill Island is a rare change to live on a private island located on the pristine Lake Glenville, one of the treasures of North Carolina’s Southern Blue Ridge Mountains. Amidst all this wealth of natural wonders sits 4.6-acre Summer Hill Island.

 Offering a well appointed, custom, four-bedroom, four-bathroom home with antique heart pine wood floors, the island is the perfect weekend and summer getaway. A fine family kitchen offers upscale cottage elegance. Expansive covered decks are perfectly positioned for enjoying the beautiful lake and Blue Ridge Mountains views and cool summer breezes.

Keep the entire island for yourself or take advantage of Summer Hill Island’s gentle topography—ideal for the construction of up to three additional guest homes or other amenities. This splendid property is offered for sale for $3,450,000. Visit Private Islands Online for more information.

Plywood Cars and Hydraulic Drive

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Frustrated Automotive Tinkerer Hall of Fame candidate No. 347: Alfred Raymond "Ray" Russell of Grosse Pointe Park, Michigan.

In 1942, while the rest of the automotive world geared up for the production of war machines, and while every other backyard tinkerer spent his time dreaming up n

ASCP 2010 Annual Meeting Digital Pathology Course Offerings

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The upcoming ASCP Annual Meeting will feature several sesssions discussing Pathology 2.0, digital pathology, including telepathology and image analysis and personalized healthcare. 

Looks like an excellent faculty for these sessions.  The meeting will take place in San Francisco between October 27-31, 2010. 

A257 Harnessing Web 2.0 to Improve Consultation and Communication

Thursday, October 28 9:30 am - 11:30 am

Get an overview of the power of Web 2.0 to link laboratory practitioners across the globe. Discussions will include a big-picture view of how the internet is changing communication among professionals, how digital pathology can facilitate consultations, and much more. Interactive lectures will offer you an opportunity to connect with select web sites and participate in a Q&A session. You will leave with the ability to:

Establish communication networks with colleagues around the world.
Understand how digital image capture/sharing will transform practice in the next decade.
Access web sites that offer specialized content in pathology and laboratory medicine.

Moderator:
William E. Schreiber, MD, FASCP, University of British Columbia

Faculty:
Dean Giustini, MLS, MEd, University of British Columbia
Michael Feldman, MD, FASCP, University of Pennsylvania

Credits: 2.0 CME

SP88 Hauling Pathology and Pathologist into the 21st Century – Telepathology and Image Analysis

Thursday, October 28 9:30 am - 11:30 am

Review telepathology for patient care, including new systems, software, government regulations, and a real-world two-year experience with a successful telepathology deployment. You will also benefit from a multifaceted view of image analysis, including a brief overview, current commonly used applications, potential research applications, and possible future developments in image analysis. You will leave with the ability to:

Recognize the challenges for so-called low- and high-end telepathology systems.
Appreciate the utility of image analysis for patient care and how these solutions can generate revenue for pathology departments.
Appreciate how images analysis can be applied to daily practice and research.

Moderator:
N. Volkan Adsay, MD, FASCP, Emory University

Faculty:
Alexis B. Carter, MD, FASCP, Emory University
Alton B. "Brad" Farris, III, MD, FASCP, Emory University

Credits: 2.0 CME

SP89 Expanding the Pathologists’ Toolbox in the Era of Personalized Healthcare – Next-Generation Pathology Technology

Thursday, October 28 3:00 pm - 5:00 pm

Hear about new information regarding several technologies – including virtual slide imaging/image analysis, circulating tumor cells, and quantum dot multiplexing – with the potential to form the basis of future high-value medical diagnostics performed and interpreted by pathologists. The faculty will discuss the need for research-grade discovery technologies to be adapted rapidly into diagnostic products that are not only analytically accurate, but also fit into routine clinical practice. You will leave with the ability to:

Recognize the relevance of the Personalized Healthcare (PHC) model for pathologists.
Understand the basic principles underlying key technologies that may play an important role in the future of pathology.

Moderator:
Jared Schwartz, MD, FASCP, Aperio Technologies, Inc.
Gary Pestano, PhD, Ventana Medical Systems
Mara Aspinall, MBA, On-Q-ity

Credits: 3.0 CME

The Vaccine War

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On Tuesday night PBS FRONTLINE aired an episode about the anti-vaccine movement entitled The Vaccine War (which, by the time you read this, should be available for online viewing in case you missed it). When I first heard that this show was going to air, I was a bit concerned. My concern, of course is what I’m always concerned about when journalists do a story about pseudoscience, be it the anti-vaccine movement, “intelligent design” creationism, various “alternative medicine” modalities, or whatever. We’ve written about such things right here on SBM on more than one occasion, be it Dr. Jay Gordon on The Doctors or Andrew Wakefield being interviewed by Matt Lauer. Although FRONTLINE has done a pretty good, science-based job on controversial topics, I felt some trepidation, particularly after seeing some of the promos for the show, even though it featured Dr. Paul Offit, and other physicians and scientists.

Fortunately, I needn’t have worried. The Vaccine War is not perfect. There are some definite flaws, but by and large it is a rare thing on TV: A science-based discussion of a pseudoscientific movement. True, the opening montage did bring back a bit of that anxiety that this was going to be a “tell both sides” bit of false balance in that it included J.B. Handley blathering and Jenny McCarthy spewing her same false dilemma of measles versus autism. (She’d choose the measles, of course.) I was able to forgive that, because it’s very clear that the producers were just setting up the story. The show then launched straight into a birth and a list of the vaccines that children get, with Melinda Wharton of the CDC and Paul Offit pointing out how much good vaccines do, how we no longer see diseases that once killed thousands or even milions.

Then it was straight to Ashland, OR and the woo, personified by a mother named Jennifer Margulis, a writer for that “natural” repository of woo Mothering Magazine. She wasted no time spewing nonsense about “natural immunity” versus vaccines, claiming that it is better than vaccine-induced immunity. (Yes, it may be more long-lasting, but it comes without the risk of actually getting the diesease.) Dr. Donna Bradshaw-Walters was then introduced, and she described how 28% of Ashland’s children are missing some or all of their vaccines, pointing out that it is only a matter of time before there is an outbreak there. (I wonder how far Ashland is from Portland. Our intrepid fellow SBM blogger Mark Crislip is in the Portland area somewhere.) It was refreshing to note that there are actual pro-vaccine parents in Ashland, one of whom predicted that it would get ugly if there were an outbreak in which vaccinated children started to get sick because of unvaccinated children forming a repository for disease that can spread to vaccinated children whose vaccines didn’t “take,” for whatever reason. The show then described the San Diego measles outbreak and how unvaccinated children are a vector for infection, even to the vaccinated, who are less likely to be infected but not immune, as no vaccine is 100% effective.

Next, there was a segment at Pfizer. This may not have been the best idea strategically, given how it feeds into the distrust of big pharma exhibited by the vaccine fearful, although the scientist interviewed, Dr. Emilio Emini, did a good job of pointing out how vaccines prevent disease. Still, right there, I could envision doubting parents becoming suspicous. Then, of course, there was Dr. Paul Offit, who, although he is the Dark Lord of Vaccination to the antivaccine movement, is nonetheless the one of the most effective provaccine voices. Happily, Offit makes no apologies for having gotten rich from a vaccine. He is enormously proud of it, as he should be. But what he’s proud of is not having gotten rich, but have invented a product that has saved thousands upon thousands of children’s lives. That is truly something to be proud of.

One thing The Vaccine War revealed that I didn’t know was that bioethicist Arthur Caplan had actually contracted polio in his youth. No wonder he is so effective when he argues for vaccines. Equally effective is a scene in which paramedics are being trained, part of their training being to watch videos of children with pertussis and rotavirus. The video of the child with pertussis is horrifying; the suffering of such children is incredible. This class even pointed out that chickenpox can actually be fatal, showing a child with staph sepsis in the pox lesions.

Unfortunately, at this point the aforementioned Margulis demonstrates her extreme ignorance by asking why we are still vaccinating for polio as polio has become more rare. This woman was truly irritating in her arrogance of ignorance. Worse, she kept popping up throughout the show, sadly enough. But that wasn’t enough. There had to be Barbara Loe Fisher, too, spewing her usual anti-vaccine line. Unfortunately, here’s where FRONTLINE fell down on the job. The show actually described BLF not just once, but multiple times, using terms like “vaccine watchdog” or “vaccine safety” advocate, rather than what she is, an anti-vaccine propagandist. Bad FRONTLINE!

Similarly, the interview with Jenny McCarthy was infuriating, as usual. I suppose I should be used to her smug anti-science attitude. Buried in McCarthy’s assault on science and reason, though, there was a rather interesting tidbit. However, you have to go to her complete online interview to find it:

How long after the MMR was that first seizure?

You know, a lot of people think, and probably from me saying in some interviews, that it was after the MMR I noticed changes.

I don’t think it was just the MMR shot that caused any kind of trigger with autism. I think it was a compilation of so many shots to a kid that obviously had some autoimmune disorders. So I would say maybe a couple of months, a month or so after the MMR, I started to notice some physical ailments such as constipation, rashes, eczema. That was like the first little sign. And then the train just kind of descended from there.

This is very different from the stories McCarthy was telling around the time she released her first book, and she even seems to be acknowledging it as she dances around a very simple question. Indeed, I remember McCarthy saying in interview after interview how she saw the “light go out of Evan’s eyes” soon after the shot. That’s why her story resonated with the anti-vaccine movement so strongly, as shown when anti-vaccination activist Ginger Taylor cited what Jenny McCarthy said in her 2007 interview with Oprah:

Jenny says even before Evan received his vaccines, she tried to talk to her pediatrician about it. “Right before his MMR shot, I said to the doctor, “I have a very bad feeling about this shot. This is the autism shot, isn’t it?’ And he said, ‘No, that is ridiculous. It is a mother’s desperate attempt to blame something,’ and he swore at me, and then the nurse gave [Evan] the shot,” she says. “And I remember going, ‘Oh, God, I hope he’s right.’ And soon thereafter-boom-the soul’s gone from his eyes.”

Notice how Jenny appears to have changed her story from its being the MMR to its being a gradual process due to too many vaccines. Truly, her story shifts more than the sands of the Sahara, or the waves of the ocean, or your favorite metaphor for something shifty and lacking substance.

Speaking of shifty and lacking substance, the first Jenny McCarthy segment ran right into an interview with J.B. Handley. There was really nothing new there in that J.B. claims that “tens of thousands” of parents tell him that their children were “never the same” after vaccines, combined with his simplistic mantra: Vaccines cause brain damage and autism is brain injury. Ergo, to him, vaccines cause autism. Of course, it is not really true that autism is “brain injury.” It is a difference in the brain, but there’s no good evidence that autism is primarily due to “brain injury,” although there’s all sorts of quackery out there that purports to treat “vaccine injury” to the brain.

Here’s another point where the FRONTLINE special dropped the ball a bit. The show immediately went into the MMR fear mongering provoked by Andre Wakefield. The problem is that J.B. Handley wasn’t really about MMR, at least not until recently. He was about mercury and thimerosal. Indeed, Generation Rescue until a couple of years ago proclaimed on its website that autism is a “misdiagnosis for mercury poisoning.” (And guess where that mercury exposure came from? That’s right, vaccines.) But the MMR has never had mercury in it, ever. In conflating these issues, FRONTLINE confused two related issues that are not really the same thing, particularly when it started showing a speech by Robert F. Kennedy, Jr. at the Green Our Vaccines rally from two years ago. As someone who knows about the anti-vaccine movement and its history, this was irritating, and it is more than just a nit to pick.

That being said, I do like how, right after a segment in which Jenny McCarthy claims that scientists won’t study whether vaccines cause autism, the show immediately launched into a segment that demonstrated conclusively that that she is either mistaken or lying (take your pick). The issue has been studied extensively in multiple countries, and no link between vaccines and autism has been found. Thus, right after McCarthy made a claim, the claim was demolished totally. Moreover, FRONTLINE did a good job of explaining how correlation does not necessarily mean causation. Just because a diagnosis of autism is made soon after a vaccine does not necessarily mean the vaccine caused autism. It finished this middle part of the documentary by documenting the fall of Andrew Wakefield, in particular pointing out how some of the children in his studies had been referred through lawyers suing vaccine manufacturers.

The beauty of this segment is how FRONTLINE showed that, no matter how much evidence, with J.B. Handley saying, “I don’t give a fuck about what the MMR study said.” (Yes, he did use the F-word, although it was bleeped out and turned to “crap” in the online transcript. Stay classy, J.B.) This was rapidly followed by a demonstration of Barbara Loe Fisher shifting the goalposts asking for more epidemiological studies and basic science studies. It is, as Dr. Offit put it, a classic shifting of goalposts, with Jenny McCarthy blathering about her “mommy warriors” and how “Evan is her science.” In fact, I particularly liked how Dr. Offit explained exactly how the anti-vaccine movement is constantly shifting the goalposts in a way that a lay peson could understand.

Unfortunately, this segment depressed me, because it showed just how much science doesn’t matter in trying to persuade these parents and how the web perpetuates not just the old vaccine myths, but facilitate the spread of new ones. It demonstrates just how much the Internet’s “democratization” of knowledge devalues knowledge, expertise, and science. The forces of pseudoscience proliferate and infiltrate, and, quite frankly, those of us who promote science-based medicine are way behind the eight ball in trying to counter these messages. One thing I had no idea about was just how effective the Desiree Jennings story had influenced high school students not to vaccinate. Roughly half of one class who hadn’t taken the H1N1 vaccine said that the reason they didn’t take the vaccine was because they saw Desiree Jennings on YouTube. This makes me think, more than ever, that blogs such as this one and others are essential in tearing apart such bad information. The result of this information is people like the mothers in Ashland that I discussed last time who ask, “If vaccines work, who am I hurting by not vaccinating?”

The result was shown in the story of a baby who came down with pertussis and almost died. Her situtation was so bad that a chaplain was brought in for possible last rites.

Near the end of the show, there was presented a focus group of people who discussed vaccination. What was interesting is how much vaccination is viewed as a parental choice rather than a societal duty. This in and of itself is not necessarily a bad thing. It’s completely consistent with the psyche many people in the U.S. and the principles of limited goverment and self-reliance. The problem is that this choice is being increasingly undermined by misinformation on the Internet and elsewhere in the media. The message of the anti-vaccine movement that the days of “paternalism” are over echoes very strongly with the whole “health freedom” movement. The problem with this “freedom” is that refusing vaccination endangers more than just the child of the parent making the choice. It endangers other children, vaccinated or unvaccinated. It’s very difficult for anyone to make a well-informed choice when most of the information that pops up when you search the Internet is from the anti-vaccine side.

In the end, I was mostly relieved by The Vaccine War. It was science-based, and it pulled no punches in asserting that there is no good scientific evidence that vaccines cause autism. True, it did confuse the issue of the MMR vaccine and thimerosal-containing vaccines, and that’s more than a minor mistake. It also failed to address the valid reasons why we vaccinated for hepatitis B to neonates. Worse, it was far too kind in its treatment of Barbara Loe Fisher, calling her organization, the National Vaccine Information Center a “vaccine safety” advocacy organization, when it is an anti-vaccine organization, plain and simple. It did a little better with Generation Rescue, showing a bit of the sheer insanity behind the organization and how, no matter how much evidence there is against its position, it never loses sight of its founding principle, namely that it’s absolutely, positively always the vaccines. Always. Those complaints aside, FRONTLINE did a far better job than I expected in deconstructing the anti-vaccine movement. It didn’t compromise on the science, although it may have compromised a bit in how it describes, for example, the NVIC and Generation Rescue.

Will The Vaccine War change minds? Maybe. There’s no way it’s going to change the minds of hard core antivaccinationists of J.B. Handley’s ilk. Almost nothing I can think of can. But it might–just might–reassure parents on the fence that all that horrible stuff they’re hearing on the radio, seeing on TV, and, above all, reading on the Internet about the evils of vaccines are not based in science. That’s actually quite an achievement.

ADDENDUM: There was a segment in which a pro-vaccination parent in Ashland was profiled. In a shot in which she was surfing the ‘net, guess what blog showed up?

Yep:

vlcsnap-2010-04-27-22h43m45s152


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Google Enterprise meets HIPAA and HITECH Compliant Laws

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[in response to comment from sockpuppet? about how Google is "not HIPAA compliant" and that its use is "a felony."]

If you pay for Google Enterprise, Google Enterprise works for healthcare. Google is secure, Google is private, and Google is reliable. Google Enterprise today is the world’s best software system generally and thus immediately applicable to healthcare systems specifically. I can say this with the confidence of working experience because I, my colleagues, and my patients successfully use Google Enterprise to provide medicine in medical practice today. I have the experience to understand the superiority of Google Enterprise over competing and legacy systems both technically and economically. I respect and trust the claims of Google’s commitments to privacy, security, and ethics.

I do know that any form of “disclosure” of “protected health information” for reasons including “commercial advantages” is both unlawful and unethical. However, I am not aware of any such violations in a property configured Google Enterprise service.

So: yes, the Web 2.0 of selling user data for targeted advertising does not apply to medicine —nor should it. It’s wrong. It’s unlawful. Sell an honest system for an honest price. Let people have their dignity —even when its so tempting, so profitable, so easy —it’s within your power, yes?— to convince us otherwise —briefly. Medicine is serious. People are sick. Everybody dies. You die. Have some respect. Trying to solve “not dying” is not a silly game. I would appreciate some gravity where gravity is appropriate and some privacy where privacy is appropriate regarding a service presented to be entrusted with the life and death of other people.

Google Enterprise Terms of Service: covers 45CFR165.502 clauses

http://www.google.com/apps/intl/en/terms/premier_terms.html

A known misconception among engineers is that support staff must not be able to disclose patient information to themselves during regular system maintenance. However, the Code of Federal Regulations specifically does allows such disclosures as cited below.

It is appropriate in medicine.

Law citations regarding disclosure of protected health information for administrative use

(emphasis mine)

CITE: 45CFR165.502

(e)(1) Standard: Disclosures to business associates. (i) A covered entity may disclose protected health information to a business associate and may allow a business associate to create or receive protected health information on its behalf, if the covered entity obtains satisfactory assurance that the business associate will appropriately safeguard the information.

(2) Implementation specification: documentation. A covered entity must document the satisfactory assurances required by paragraph (e)(1) of this section through a written contract or other written agreement or arrangement with the business associate that means the applicable requirements of 164.504(e).

CITE: 45CFR164.504(e)

(e)(1) Standard: Business associate contracts. (i) The contract or
other arrangement between the covered entity and the business associate
required by Sec. 164.502(e)(2) must meet the requirements of paragraph
(e)(2) or (e)(3) of this section, as applicable.

(2) Implementation specifications: Business associate contracts. A
contract between the covered entity and a business associate must:
(i) Establish the permitted and required uses and disclosures of
such information by the business associate. The contract may not
authorize the business associate to use or further disclose the
information in a manner that would violate the requirements of this
subpart, if done by the covered entity, except that:
(A) The contract may permit the business associate to use and
disclose protected health information for the proper management and
administration of the business associate, as provided in paragraph
(e)(4) of this section; and

[[Page 748]]

(B) The contract may permit the business associate to provide data
aggregation services relating to the health care operations of the
covered entity.
(ii) Provide that the business associate will:
(A) Not use or further disclose the information other than as
permitted or required by the contract or as required by law;
(B) Use appropriate safeguards to prevent use or disclosure of the
information other than as provided for by its contract;
(C) Report to the covered entity any use or disclosure of the
information not provided for by its contract of which it becomes aware;
(D) Ensure that any agents, including a subcontractor, to whom it
provides protected health information received from, or created or
received by the business associate on behalf of, the covered entity
agrees to the same restrictions and conditions that apply to the
business associate with respect to such information;
(E) Make available protected health information in accordance with
Sec. 164.524;
(F) Make available protected health information for amendment and
incorporate any amendments to protected health information in accordance
with Sec. 164.526;
(G) Make available the information required to provide an accounting
of disclosures in accordance with Sec. 164.528;
(H) Make its internal practices, books, and records relating to the
use and disclosure of protected health information received from, or
created or received by the business associate on behalf of, the covered
entity available to the Secretary for purposes of determining the
covered entity’s compliance with this subpart; and
(I) At termination of the contract, if feasible, return or destroy
all protected health information received from, or created or received
by the business associate on behalf of, the covered entity that the
business associate still maintains in any form and retain no copies of
such information or, if such return or destruction is not feasible,
extend the protections of the contract to the information and limit
further uses and disclosures to those purposes that make the return or
destruction of the information infeasible.
(iii) Authorize termination of the contract by the covered entity,
if the covered entity determines that the business associate has
violated a material term of the contract.
(4) Implementation specifications: Other requirements for contracts
and other arrangements. (i) The contract or other arrangement between
the covered entity and the business associate may permit the business
associate to use the

[[Page 749]]

information received by the business associate in its capacity as a
business associate to the covered entity, if necessary:
(A) For the proper management and administration of the business
associate; or
(B) To carry out the legal responsibilities of the business
associate.
(ii) The contract or other arrangement between the covered entity
and the business associate may permit the business associate to disclose
the information received by the business associate in its capacity as a
business associate for the purposes described in paragraph (e)(4)(i) of
this section, if:
(A) The disclosure is required by law; or
(B)(1) The business associate obtains reasonable assurances from the
person to whom the information is disclosed that it will be held
confidentially and used or further disclosed only as required by law or
for the purpose for which it was disclosed to the person; and
(2) The person notifies the business associate of any instances of
which it is aware in which the confidentiality of the information has
been breached.

The confusions of definitions across borders | Gene Expression

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blackheadofstateJust reading this article in Slate, How To Throw an Election:

On paper, that’s what Sudan’s 21-year civil war was all about. More than 2 million people died in that terrible religious-themed conflict between the Muslim, Arab-led north and the pagan and Christian black south. In reality, almost no one in the south bought the unity line except their charismatic (and autocratic) leader, John Garang. Garang, a favorite of the West, negotiated Sudan’s 2005 peace treaty, the Comprehensive Peace Agreement, that finally ended the war. The document was essentially written to ensure he would be elected Sudan’s first black president.

How is it that the current president of Sudan (picture to the left) isn’t black, but Barack Hussein Obama is black? I’m in the category of people who think the world “race” has some utility and maps onto real patterns of human variation, but sometimes it’s just funny. The distinction between the Arabs of Sudan and blacks of Sudan is kind of weird, because Arab is not a race, and Arabs can be of any race theoretically (there are even Arabs in Yemen’s Hadhramaut who have a lot of Malaysian ancestry because of international trade), though generally they are of the olive persuasion. Perhaps the Sudanese Arab elite wouldn’t want to be identified as black because that isn’t particularly prestigious, but they’d certainly be identified as such in other Arab countries. Anwar Sadat was the subject of some racist attitudes within Egyptian society because of his Sudanese ancestry (his mother was Nubian) and his dark skin.

Anyway, my amusement was mostly the fact that they went with this text, and, added a picture of a man who most Americans would identify as black but noted implicitly that he wasn’t black. American journalists are generally punctilious about following the rule of hyodescent when it comes to Americans, even when those individuals object to this framing, such as Tiger Woods (who is twice as Asian ancestrally as he is black). But I guess in an international context they will bend more. It reminded me of stories that Afro-Arabs were often allowed to stay at “whites only” facilities in the USA when segregation was the norm because they were foreign.

Note: Hypodescent isn’t just an American issue. There are controversies about a new biopic of Alexandre Dumas where he is played by Gérard Depardieu. Some people wanted a non-white actor cast because Dumas’ mother was mixed-race. But of course Dumas was mostly white, and he seems to basically looked like a white guy. France of the 19th century was not the American South of the 19th century, and a drop of black blood did not make you persona non grate within white society. If you want real accuracy, perhaps cast Wentworth Miller as a young Dumas, he’s a white-looking mixed-race actor.

Image Credit: Slate & Whitehouse.gov

Blunt Talk in Houston

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Bolden tries to raise spirits at JSC, Houston Chronicle

"But unlike the president's stop in Florida, where he offered to provide the work force there with $40 million in transition aid and made other concessions, Bolden announced no new initiatives that might benefit Johnson Space Center."

Houston Layoffs Not in NASA Plan ... Yet, My Fox Houston

"For you to go to members of Congress, the media and the American public with contradictory information about the road ahead and the need to move beyond the Constellation program isn't helping," said Bolden."

Bolden in Houston to discuss future of NASA, KTRK

"Reasonable people can agree to disagree," Bolden said in his speech, of which a copy was obtained by ABC13. "However, my friends, now is the time that we must pull together."... "If we flounder and lose out on this opportunity, it is unlikely that our nation will have a similar opportunity in our lifetime," Bolden said."

EPA’s Lisa P. Jackson on Leading the World on Climate

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Lisa P. Jackson Talks about How the US Can Lead the World on Climate

Planet Forward – Lisa Jackon On How America Leads the World on Climate from Center for Innovative Media

From our live Planet Forward event on April 20… Planet Forward Host, Frank Sesno, asks Lisa Jackson to explain how the US can be a global leader on climate change if Washington gridlock kills a climate bill.

From our live Planet Forward event on April 20… Planet Forward Host, Frank Sesno, asks Lisa Jackson to explain how the US can be a global leader on climate change if Washington gridlock kills a climate bill.

In this clip, “The Case for EPA Action” On April 1 the Environmental Protection Agency established rules restricting greenhouse gas emissions from cars and trucks, starting in 2012. This is the first of what could become a sweeping series of regulations stemming from the agency’s conclusion that greenhouse gases harm human health. But a dangerous assault on the agency is gathering momentum in Congress, corporate boardrooms, the media and the courts. “The fight over EPA rulemaking may be the most important environmental battle in a generation.”

Planet Forward – EPA Administrator Lisa P. Jackson on Coal from Center for Innovative Media on Vimeo.

In a clip from Planet Forward’s Earth Week event Lisa Jackson talks about the business impact of uncertainty regarding potential carbon regulation.