The Daily Scan

Scientists develop purple, cancer fighting tomato

This is potentially a worthwhile finding, but I couldn't help enjoying the humor of it too; China Daily reports Scientists develop purple, cancer fighting tomato. 

A purple tomato genetically engineered to contain nutrients more commonly seen in dark berries helped prevent cancer in mice, British researchers said on Sunday.

The finding, published in the journal Nature Biotechnology, bolsters the idea that plants can be genetically modified to make people healthier.

Cancer-prone mice fed the modified fruit lived significantly longer than animals fed a standard diet with and without regular tomatoes, Cathie Martin and colleagues at the government-funded John Innes Centre in Britain reported.

Sadly, the story does not contain any pictures, but if I can find any I'll post 'em ;) please stay tuned...

Pathology Visions - day two: Home Run

Day two of the Pathology Visions conference in San Diego was excellent...  it began with a couple of fine keynotes, including a rousing presentation from Dr. Mary Kass, President of the CAP Foundation, about Pathology in the 21st Century.  She encouraged Pathologists to think of their role as transforming into the center of medical care, the "doctor's doctor", and pointed out that many current trends including a movement toward personalized medicine and inceasing involvement of consumers in their own medical care will expand the role of Pathologists.  Really inspiring, her passion for working through the CAP foundation to help effect this transformation was evident.

Mary Kass' keynote - Pathology in the 21st Century (click to enlarge)

Next I attended a great presentation by Dr. Sylvia Asa, Professor of Pathology at the University of Toronto, describing the University Health Network Experience across Ontario.  Dr. Asa's team are living the transformation described by Dr. Kass, and have been incorporating digital pathology into their daily workflow.

I also saw a nice talk by Bob van Gemen, General Manager of Digital Pathology at Philips, Digital Pathology from a Radiology Perspective; Bob leads a "startup" within Philips created to pursue digital pathology opportunities, starting from Philips' extensive experience with Radiology PACS systems.  It is great to see major medical imaging companies like Philips, GE, and Siemens entering digital pathology, as it shows the maturity and growth of the market.

Bob van Gemen describes Philips' approach to digital pathology
(click to enlarge)

Comparing image based diagnostics: Pathology and Radiology
(click to enlarge) 

Cliff Slaughterbeck, Engineering Manager at the Allen Institute for Brain Science, gave a facinating overview of High-Throughput Imaging and Analysis at the Allen Institute.  The diverse types of data being captured and the volumes are impressive; Allen have been creating in taking commercially available tools and adapting and enhancing them for their use. 

Cliff Slaughterbeck describes Allen Institute's Pathology Informatics Approach
(click to enlarge)

Following a great lunch (the food at the Manchester Hyatt truly exceeded expectations), Dr. Alexander Judkins of Children's Hospital of Pennsylvania spoke about Virtual Microscopy Clinical Interface Issues, a nice survey of the challenges faced and overcome by CHOP while integrating digital pathology into their workflow.  CHOP continue to be an innovative leader in pathology.

The last sessions of the day were a couple of great panel discussions: Clinical Trials in a Global Environment, and The Role of Pathologists in Diagnostics.

Panel: The Role of Pathologists in Diagnostics (click to enlarge)

And then the final event of the conference, an ice cream social in the exhibit hall.  It was a great couple of days - stimulating, informative, and exciting (and exhausting!)  A conference like this is attended by leaders and early adopters, but you could really sense that digital pathology is getting traction in mainstream applications. 

Pathology Visions - day one second half: Midway

Wrapping up the first day of the Pathology Visions conference in San Diego, there were a ton of great talks, in fact, there were three tracks taking place concurrently, Clinical, Research & Education, and Vet/Tox Path, so it was impossible to see them all.  Which ones did I attend?  Well, I enjoyed Dr. Keith Kaplan's talk on New Applications in Whole Slide Imaging; if you don't know, in additional to being a staff Pathologist at Mayo Clinic, Keith is proprietor of the Digital Pathology blog.

Dr. Keith Kaplan presents at Pathology Visions (click to enlarge)

Next I attended a great talk by my friend and sometime collaborator Dr. Ulysses Balis, a staff Pathologist and Director of Informatics at the University of Michigan, who talked about Whole Slide Imagery as an enabling Technology for Content Based Image Retrieval.  Ul knows more math than most Pathologists, and more Pathology than most Mathematicians, and more about implementing image analysis algorithms than just about anyone.  He has developed a novel technique called Spacially Invarient Vector Quantization which has tremendous promise for CBIR as well as various pattern recognition techniques.

Dr. Ulysses Balis speaking at Pathology Visions (click to enlarge)

After lunch Dr. John Spinosa, Chief of Staff and Chairman of Pathology at Scripps Hospital, gave a great talk on Using Digital Pathology for Tumor Boards, describing how Scripps have used Aperio's systems to make preparation for tumor boards more efficient and improving the experience for Pathologists in tumor boards (by giving them more information, and the tools to present it).

Another great session was given by Dr. Keith Cheng, describing his research with Zebrafish and development of the definitive zebrafish atlas (using digital pathology), in a talk called Digital Morphology and its Critical Role in Systems Biology.

And wrapping things up for the first days' presentations, I attended a talk on Multi-site Integration of Digital Pathology: three countries, four time zones, one oncology, given by Dr. Humphrey Gardner and Dr. James Deeds of Novartis.  Their work is especially interesting for the innovative ways they've used and enhanced the capabilities of Aperio's Spectrum digital pathology information management system to meet Novartis' challenges.

Then it was time for the highlight of the day; a tour of the U.S.S. Midway aircraft carrier, with a banquet on board to boot.

The dinner banquet on board the U.S.S. Midway!  (click to enlarge)

Absolutely amazing, day one was great.  Who can say what day two will bring?  Stay tuned...

Pathology Visions - day one first half: Crossing the Chasm

I'm attending the Pathology Visions conference in San Diego, and so far it has been a great experience.  The reception last night was really fun - so great to see so many customers and partners, many old friends by now.  Having the reception in the exhibit hall was a great idea, it spread everyone out and gave the exhibitor's great "flow"...  and all that digital pathology equipment made for an interesting background to discuss - digital pathology!  (Or the Phillies, or the effect of the financial meltdown on health care, or... etc.)

Speaking with people last night, I was struck by the realization that digital pathology is really "crossing the chasm" and becoming mainstream.  The keynote speakers this morning reinforced this; Dr. Richard Friedman of Baystate Health gave a great talk about Imaging in diagnostic medicine (from a Pathologist's perspective), and Dirk Soenksen, CEO of Aperio, gave a great overview of The adoption of digital pathology.  Later I attended Dr. Jared Schwartz' inspiring breakout on Pathology in the age of digital imaging; Jared is the President of the College of American Pathologists, and has a clear vision that Pathologists are moving toward being at the center of healthcare, and that digital pathology will help them do so.

Pathology Visions keynote (click to enlarge)

One great thing about Pathology Visions as a conference is that it is fast paced; the sessions are 30 minutes, the breaks are short, lunches are short, and in general everything keeps moving (although it does leave one feeling a bit breathless!)  In fact, I have to go to my next session NOW...  stay tuned for more...

Beyond a Dying Private Health Insurance Industry: A Hidden Solution in Plain View

From the Medscape Journal of Medicine, a nicely argued video from Dr. John Geyman about the fact that the private health insurance industry is dying, and what can be done to revive it.

From the article:

The health insurance industry in America is dying. How can that be -- such a powerful, $300 plus-billion industry with so many lobbyists? Here are some benchmarks of its death march:

Growing unaffordability of premiums, which grew 87% between 2000 and 2006, and are projected to consume one third of family income by 2010 and theoretically all of it by 2025. Forty-six million Americans are without health insurance, and at least another 25 million are underinsured. Four of 10 Americans are "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year. The private market now includes less than 60% of employers, and in 2005, only 6% of US employers covered the full cost of family coverage. While the insurance market fell by 1% between 2000 and 2005, its work force grew by one third (mostly new employees involved with denial management). Private insurers can't compete with public financing on a level playing field. For example, private Medicare Advantage plans require government overpayments of 112% to 119% compared to traditional Medicare.

Fortunately, we have a solution -- strengthened Medicare for All (H.R. 676), coupled with a private delivery system. Reliable public financing and shared risk across all 300 million Americans creates a win-win for everyone except a failed insurance industry. Physicians can rid themselves of the bureaucracy of 1300 private insurers and have more time and clinical autonomy for patient care. To learn more, read references 9 and 10. We physicians need to join with patients in working toward real healthcare reform, thereby asserting the public interest over corporate self-interest.

Interesting...  I encourage you to click through and watch the video for yourself.

CAP Campaign for the Transformation of Pathology

The CAP have launched a cool new website for their Campaign for the Transformation of Pathology.

Why is Transformation Needed?

This is an urgent call to action. Transformation is a big word and it's exactly right. The context is significant. All of medicine continues to evolve and the pathologists' preventive, diagnostic and prognostic role can become more relevant than ever before.

But, we must take action now. We must step up and embrace transformation, pursue new roles in the workplace and be part of the clinical care team. If we are to survive, we must adapt. And the CAP will help you get there.

Transformation of our specialty is going to be terrific for us, our clinical colleagues and most of all, for our patients.

More information: Emerging Developments and Your Future in Pathology
PowerPoint presentation by Jared Schwartz, MD, PhD, FCAP, CAP President
March 2008 Residents Forum Meeting

Excellent!  Of course digital pathology is a crucial part of this transformation, providing additional information, making pathologists more efficient, and reducing the geographic challenges of pathology.

Medicine 2.0 in action: Her2 testing errors

I wanted to call y’all’s attention to this website:

Her2 testing errors

Seems Seattle Breast Pathology Consultants have a website where patients can ask questions.  Anyone can answer, moderated by the site operators.  So you end up with an open discussion about a patient’s case.  For example, this patient asked:

Question: My pathology results showed my cancer was 3+ but FISH was done too and it showed a 1.7 so my doctor said I am not positive and therefore don’t qualify for Herceptin. From what I read 3+ is positive.

Pretty good question, right?  From what I know, disagreement between IHC and FISH isn’t uncommon.  Here’s the site's reply:

Answer: You are correct—a 3+ result by immunohistochemistry (IHC) is positive. If the laboratory that did your test is following the new rules for HER2 testing then there was no need to go to FISH. There is usually an outstanding correlation with 3+ by IHC and amplification by FISH so I am concerned maybe the lab over-called the IHC and you were really a 2+. Most cancers that are 2+ are not amplified by FISH which your cancer wasn’t with a ratio of 1.7. I would ask your doctor to check into why FISH was done and to see if the pathology lab that ran your IHC test really called it 3+ and maybe ask to have it repeated or performed at another laboratory.

So that’s a good answer, getting a second opinion seems warranted.  But what is cool is that I was able to post my own answer:

Definitely, get a second opinion from another pathology lab. Scoring Her2 is difficult and subjective, and it isn’t unusual for two pathologists to disagree on the same case. This is important enough to get right; you want to take Herceptin if it can help you, but you don’t want to expose yourself to the side effects and expense if it can’t.

So now this patient is getting the benefit of a reply from some guy who has nothing to do with this case – happens to the CTO of a digital pathology company, but could be Joe the Plumber – and anyone else could comment too.

This is Medicine 2.0, and it will be an interesting trend.  You can see digital pathology right in the middle of this, in future the patient would post a link to her slides, and I could read them.  Heck, I could even perform IHC Quantification on them, and post the results!

 

UCSF Launches Nationwide Clinical Trial Matching Web Site for Breast Cancer

CBS MarketWatch reports UCSF Launches Nationwide Clinical Trial Matching Web Site for Breast Cancer:

The University of California, San Francisco (UCSF) Center of Excellence for Breast Cancer Care today launched BreastCancerTrials.org, a free, non-profit, clinical trial matching service that provides nationwide information for individuals diagnosed with or at risk for breast cancer.

 

BreastCancerTrials.org is the only clinical trial matching service dedicated exclusively to breast cancer, with an online database that includes information about clinical trials taking place at more than 1100 medical facilities across the country. The site is an outgrowth of a successful regional pilot initiated by the UCSF Carol Franc Buck Breast Care Center, the National Cancer Institute (NCI) and patient advocates. The nationwide launch of BreastCancerTrials.org is made possible by a grant from The Safeway Foundation, the philanthropic arm of Safeway, Inc.

Very cool.  And one can anticipate the day - not far off - when such databases will include digital pathology images...

 

EU creates Ebay for radiologists

Here's an interesting development: HealthImaging reports EU creates Ebay for radiologists:

A European Union project aims to create an Ebay-style online market for radiology services.

Called R-Bay, the e-TEN project will test the concept and technical components needed create an online marketplace for e-radiology services. Carestream Health will provide the RIS to be used in the project’s test platform. This test phase will focus on enabling the remote reporting of images from hospitals in Denmark, Finland and Czech Republic by clinical providers in Estonia, Lithuania and the Netherlands.

...

The R-Bay project is intended to provide the foundations for the creation of a unique internal online marketplace for e-health services in Europe that will act as a cross border commodity brokering and exchange place. If it proves a success, it could enable the sale and purchase of remote viewing, consulting and second opinion radiology services across the EU, according to Carestream.

Wow, that's pretty wild.  I guess the part that will really get everyone's attention is the "auction" aspect; most medical services are provided fixed-priced, using generally accepted price scales (in many cases set by Medicare reimbursement).  To think that health services might actually be a market would be wild :)

 

ScienceRoll's 1,000th post!

Congratulations to Bertalan Meskó for 1,000 posts to ScienceRoll.  Of course it is the quality of the content that keeps us reading, not the quantity, but this is impressive.  We look forward to the next 1,000 with great interest!