And now it’s free
The stethoscope is coming of age – that is, making a giant leap into the present. Like hundreds of other tasks, iPhones now have an app for listening to the heartbeat with iStethoscope.
It’s been around for a while and has, in fact, been downloaded well over 3 million times, by healthcare professionals and the lay population alike. But now, it’s free. Or, for 99¢ you could procure the “pro” variety. The latter allows you to email the heart wave and 8 seconds of the audio, on top of being able to listen to the beat.
As long as the user (of whom there are 500 new ones daily) knows where to place the iPhone’s microphone – any of those 6 vital locations between the ribs -- not press too hard, and make sure to press the device against skin – not clothing – the heartbeat will be heard -- strong and true.
It’s predicted that 80% of physicians will be whipping out their iPhones to gauge patients’ heartbeats by 2012. In fact, at least three American universities already require undergraduates to use one – Georgetown U., the University of Louisville, and Ohio State. These students have the luxury of seeing a phonocardiograph and spectrograph in seconds, as they learn to decipher the beats.
Apple’s iStethoscope app’s creator Peter Bentley, a researcher from Britain’s University College London, is a happy man and has many other applications he’s anxious to have approved (such as one to measure oxygen in the blood) – no easy feat for novel technologies in healthcare, due to the grey area of new medical device regulations.
Among the many others that do exist, however, there’s an app for instant ECGs, and one for fetal heart tracings used during labour, called AirStrip OB. But I don’t think stethoscope makers need to worry just yet.
Milena Katz
Latest headlines
Thursday, 2 September, 2010
A stethoscope app
Friday, 20 August, 2010
Obama crashes CMA annual meeting
Well, not really. But with the CMA’s annual meeting set to begin this weekend, the long shadow of the US president is definitely looming over the coming debate on the future of Canada’s healthcare system.
It’s become a tradition in recent years for the CMA to release a discussion document prior to their annual shindig, laying out the leadership’s thoughts on weighty matters of health policy. And it’s also become traditional that this document should be a thinly-veiled call for more privatization, hidden under a few unconvincing nostrums about patient welfare.
But not this year. This year’s document actually calls for the principles of the Canada Health Act to be extended to prescription drugs and long-term care. Nor is there any of the nagging for private insurance and for-profit delivery that we’ve come to associate with these releases.
Is it coincidence that the CMA is changing its tune right after the US acted to curb the worst excesses of private healthcare? Unlikely. Obama’s reforms have changed the landscape.
In recent years, while Canadian patients looked at the US system and wanted to run away from it as fast as possible, CMA leaders looked at America and saw something quite different. They saw the doctors’ fat incomes, and they made it their task to keep up with the Joneses.
But now, we’re treated to the spectacle of the Americans themselves running away from their private system, albeit not very far away. No-one, least of all reform’s opponents, believes that the US will go back on these reforms, even if Republicans gain power. A slew of polls have just shown Obama’s health reforms steadily gaining in popularity south of the border. You can’t stop history. Privatization is in retreat.
The advocates of privatization within the CMA are also on the back foot. The CMA can’t credibly bemoan the “unsustainability” of Canadian healthcare expenditure– a theme they repeat this year – when their proposed role model is a system that was threatening to consume the world’s largest economy. They can’t credibly claim to be speaking for patients when they are the main source of schemes to squeeze more dollars out of the patient’s pocket.
Previous CMA leaders have nevertheless sought, like Obama’s health reform opponents, to portray themselves as the patient’s defenders against a heartless government. But the shoe fit poorly – poll after poll has shown that Canadians overwhelmingly favour government-run, publicly financed healthcare. It’s the CMA leadership that has been the odd man out, and its motives have been all too transparent.
The organization has done itself considerable harm with self-serving and intellectually dishonest arguments unworthy of a scientific body. For example, CMA leaders have argued that Canada needs reform because international monitors rank it poorly in quality of health delivery among developed nations. They make the same point this year, in fact. But they’ve routinely failed to mention that the same rankings score the US – towards which they’ve advocated moving – far below all publicly-funded systems including Canada.
The apparent shift in CMA policy is a step in the right direction. Canada's health system has many problems, but underpaid doctors really isn't one of them. One of the leadership’s new recommendations is a Charter for Patient-centred Care. Because, the CMA now says, the discussion in recent years has drifted too far from what should be the central issue: the needs of the patient. That is certainly true. Physician, heal thyself.
Owen Dyer
Friday, 13 August, 2010
Ask pregnant women if they’d like a drink
But be sure to ask nicely
Canada may be a little short of babies, but it’s got plenty of alcohol. Keeping the two separate has mostly been the task of GPs. But the Society of Obstetricians and Gynecologists of Canada says they’re falling short. Many pregnant women who drink are missed, says the SOGC, often because physicians are unwilling to ask questions about alcohol.
Doctors who don’t make alcohol use a routine question on all visits may be particularly unwilling to suddenly raise the issue during pregnancy, given the stigma associated with mothers who drink. And even those who do raise it may not be getting honest answers.
“Many physicians don’t even ask the question,” says Gideon Koren, director of the Motherisk Program at Toronto's Hospital for Sick Children. “It’s not an easy thing to ask. We have a sad reality that physicians and other health professionals are not doing their job on that — namely that a lot of women are not asked and we do not identify the cases. At the end are kids who are very heavily affected.”
Dr Koren sat on an SOGC panel that has just issued new guidelines on alcohol screening in pregnancy. The guidelines offer an interesting snapshot of female drinking in Canada. Did you know that richer, more educated women, while less prone to binge drinking, are more likely to consume alcohol on a daily basis? Or that Quebec has the highest number of frequent women drinkers, by a wide margin? And where can you find the highest proportion of female teetotalers? You’d never guess – it’s Nunavut.
The SOGC takes a nuanced position on abstinence, recognizing that there’s just not enough evidence on the effects of low-level consumption. Essentially, the guidelines suggest you recommend abstinence in cases where you think you can make it stick, but avoid an all-or-nothing approach if you think it will scare the patient away.
Not scaring the patient away is the key thing in alcohol screening. While a record of maternal alcohol use has proven health benefits for the infant with FASD, its benefit to the mother is far less clear – it can lead to them losing custody of their kids and they know it.
A reliable lab test for long-term alcohol use is on the way, but it requires a six-inch lock of hair, and the SOGC acknowledges – perhaps a little wistfully – that it can’t really be applied to most patients. So we have to make do with self-reporting, and in that game, you catch more flies with honey.
Don’t ask patients how often they “use alcohol”, but instead enquire how frequently they “enjoy a drink”. Don’t tell them that by drinking they may have harmed their baby, but instead emphasize how cutting alcohol could help the baby’s health.
Don’t lowball. When prompting the patient on how many drinks she consumes a week, suggest a high number, because if you suggest a low one, the patient will be reluctant to incur your disapproval by admitting she drinks more than that.
While a warm, informal approach is generally best, validated alcohol dependence questionnaires like CRAFFT and TWEAK are useful. They avoid stigma because the patient tends to assume they’re routinely given in all pregnancies. (Or you could try our non-validated WYLAB questionnaire, which identifies at-risk patients with just one question: “Would you like a beer?”)
However you screen, the effort will pay dividends, says Dr Koren, who notes that 40% of pregnancies with high alcohol consumption result in a fetal alcohol spectrum disorder. About 3% of Canadian children are born with such a condition, with effects ranging from reduced IQ to violent aggression. In fact, says Koren, about half the inmates of Canada’s prisons are the offspring of hard-drinking mothers.
Owen Dyer
Thursday, 12 August, 2010
Listening in to brain chatter
A microchip will soon be wedded to human neurons
It looks like Canadian researchers are at the threshold of a scientific breakthrough that may pave the way to better meds and superior control of artificial limbs.
Dr. Naweed Syed, a neurobiologist at the University of Calgary, was part of the team that wowed the international scientific world six years ago by successfully fusing mollusc brain cells (in this case pond snails) with a one-millimeter square silicon chip. Now he’s at it again. Dr. Syed, who heads cell biology and anatomy at the U of C, intends to marry human neurons this time around – taken from the brain tissue of a patient undergoing surgery for epilepsy – with the silicon-polymer chip (Biomedical Microdevices).
This will be another step towards being able to not only “listen in on conversations” between synaptic connections as well as ion channels but may lead to more accurate use of drugs. “It means we can track subtle changes in brain activity at the level of ion channels and synaptic potentials, which are also the most suitable target sites for drug development in neurodegenerative diseases and neuropsychological disorders,” says Dr. Syed, who works out of a lab at the U of C's Hotchkiss Brain Institute. The research is also being supported by the National Research Council.
The prototype biochip in its new, more refined state will record messages of excitation and inhibition between neurons. It will also allow for communication between computers and itself. This could mean that future hybrid chips might operate protheses, help improve sight or language after a stroke, and repair malfunctioning neurons for those with Parkinson’s and Alzheimer’s disease.
The current chip is automated, making its use quick and easy, unlike the previous version, but 750 reuseable chips currently cost $300,000 – a definite deterrent for anyone planning to use them to build an Bionic Man.
Milena Katz
Wednesday, 4 August, 2010
Relistor may weaken the GI wall
When to beware
As all meds do, mythylnaltrexone bromide (Relistor) has its share of possible side effects, the most common being dizziness, flatulence, mild diarrhea, nausea, stomach pain, vomiting, and hyperhidrosis. Severe reactions include a serious case of any already mentioned, or allergic reactions.
Today, Health Canada and Wyeth Canada added a new possible adverse reaction to the list: a heightened risk of gastrointestinal perforation, especially in those with GI cancers and other conditions that could weaken the gastrointestinal wall.
When Relistor came onto the scene – it was approved by Health Canada on March 28, 2008 – it relieved opioid-induced constipation in palliative-care patients with incurable cancers, end-stage COPD from emphysema, heart failure, Alzheimer’s disease, and so on, when other laxative therapies could not – in under 30 minutes. Administered by subcutaneous injection, it blocks opioids from entering cells, allowing bowels to revert to normal function, while not interfering with the opioid’s ability to relieve pain.
The current warning advises discontinuing Relistor and seeking professional help if severe, persistent symptoms like abdominal pain intensified by movement, nausea and vomiting -- possibly accompanied by fever and chills – worsen, as these can be signs of GI perforation.
It makes one wonder, though, if the original studies on this drug should have lasted a wee bit longer than four months.
Milena Katz
Friday, 30 July, 2010
MS and the powers that be
MS patients may have a range of symptoms that include balance problems, vision impairment, muscle spasms and weakness, diplopia, dysphagia, extreme fatigue, chronic or acute pain, and bladder and bowel difficulties, including incontinence. And the majority tends to live about as long as the healthy population.
It seems only natural that a minimally invasive procedure would be worth the risk to such individuals.
Dr. Paolo Zamboni, an Italian neurologist and director of vascular diseases, came up with the liberation therapy theory at the University of Ferrara, while trying to help his wife, who has the disease http://jnnp.bmj.com/content/early/2008/12/05/jnnp.2008.157164.full.pdf). Examination of the venous system of MS patients showed that 90% had stenosis or restricted valves in the jugular and azygos veins, interfering with blood draining. He also found high levels of iron deposits in their brains, which he surmised might be the cause of the abnormal MS immune response, where the immune system attacks the myelin sheath of brain and spinal cord nerves, causing scarring and plaques.
Dr. Zamboni dubbed the phenomenon “chronic cerebrospinal venous insufficiency” and used a type of angioplasty to relieve the blockage in these veins. He found 73% of his patients improved. But after about nine months, “re-stenosis” made it necessary to repeat the procedure.
Despite this drawback, it seems clear, with so many positive anecdotal reports on the Internet, that Canadian governments should consider giving more attention to this possible break-through therapy. Either that, or launching a thorough investigation of Canadian Hutterites, a group known to have a much lower than average risk of contracting MS.
Friday, 23 July, 2010
Between a rock and a hard place?
Commission a report, then ignore it
With only 94 general practice posts, Prince Edward Island is small, but it's a microcosm of the health budget squeezes being felt around the world. Something needs to be done to arrest the spiralling expenditure ... but what? Time to call in global management consulting firm Hay Group to produce a $200,000 report.
Hay Group, not surprisingly, focussed their attention on one of the province's biggest expenses: doctors. How could the government reduce the amount it spends on doctors? To an accountant, the answer is simple and obvious - have fewer doctors.
That's precisely what the Hay Group is recommending as its report nears completion, and the area in which it finds the most room for cuts is family practice. In fact, Hay suggests cutting the number of GPs on P.E.I. from 94 to as few as 65.
Doing this would naturally require somebody else to shoulder the GPs' burden, and that's what the report recommends, suggesting new roles for nurses, nurse practitioners, and so on.
The province's College of Family Physicians argues it's already adopting these new models. But, says president Dr. Andrew Wohlgemut: "We're not for substituting or getting rid of family physicians and replacing them with other people."
On that issue, it seems, he has friends in high places. On the day the report's recommendations were made public, P.E.I.'s Health Ministry issued a press release trumpeting the hiring of seven new physicians, three of them GPs.
Provincial Health Minister Carolyn Bertram said she won't comment fully on the report until the final draft is submitted to the cabinet in about six weeks, but it seems she's already decided how to address its main recommendation: "We are not cutting doctors' positions," she told the CBC.
Some political realities can still trump even the budget squeeze.
Future looks bleak for Avandia as safety trial put on hold
Last week saw an FDA panel rule that there is reason to believe the troubled diabetes drug Avandia (rosiglitazone) does indeed increase cardiovascular risks compared to its direct competitor Actos (pioglitazone).
Now, the FDA appears to be moving to shut down the Canadian-led trial that represented the last chance for maker GlaxoSmithKline to prove its drug is safe. The agency put a "partial clinical hold" on new recruitment for the TIDE trial while it updates the lead investigators - Drs Salim Yusef and Hertzel Gerstein of McMaster University - on the results of last week's panel meeting.
While the FDA safety panel stopped short of voting to remove Avandia from the market, the agency can still take action without a vote, and most observers suspect the end is near for Avandia, which has already seen sales collapse in the wake of data suggesting it increases cardiovascular events.
In fact, the same safety concerns were inhibiting recruitment to the TIDE trial. GSK, which agreed in 2007 to fund a head-to-head comparison with pioglitazone, said last week that only 1,100 of an intended 16,000 study participants have volunteered to date.
Little sympathy for lung cancer patients
A critical perspective
Canadians tend to judge people stricken by lung cancer to a greater extent than do people of many other countries, according to a recent study conducted by Ipsos MORI for the Global Lung Coalition. Although this form of cancer is as painful and frightening as any other, consisting of symptoms that can include coughing (with and without blood), shortness of breath, chest and/or abdominal pain, weight loss, dysphagia, etc., because lung cancer is commonly believed to be brought on by the patients themselves, there tends to be less sympathy towards sufferers.
Survey results found 1 in 5 of us admit to this attitude – generally 22% of our population – with men making up 27% and women 19%. Though the Canadian view has much company among the other 15 countries surveyed, we’re far more critical than those with greater empathy such as Argentina – the most caring country, coming in at only 10%. Countries shown to have the lowest rates of smoking tended to be the least sympathetic to lung cancer patients, despite the fact that 15% of these individuals never smoked and acquired the disease through exposure to radon, asbestos, air pollution or second-hand smoke – often from co-workers or people with whom they live. Regardless of the cause, lung cancer currently kills four times as many people as does breast cancer – roughly 20,000.
Heather McQuaid, an oncology social worker maintains that lung cancer patients feel stigmatized. The superficial attitude that gives way to this stigma may very well be the reason why $25 million was invested in breast cancer research in 2007, compared with a paltry $8 million towards lung cancer, directly “impacting on the support these cancer victims receive, particularly from the healthcare system,” according to CEO and President of the Canadian Lung Association, Heather Borquez. Can’t we do better?
Monday, 19 July, 2010
5 risks to a woman's health
Most physicians believe that too many Canadians eat too much and exercise too little. There are other health risks faced by women in particular. US gynecologist Jennifer Young put together a list of five female risks that can be avoided . It's been one of the most popular items on the Ivanhoe News Wire for the last couple of weeks.
Dr Young's Top Five
1) 50% of women with abnormal pap smears don't follow up.
2) Many avoid birth control pills believing they increase the risk of cancer. Dr Young suggests they actually reduce the risk of ovarian cancer by half. She asserts that studies done in the 1980s that linked breast cancer with the pills turned out to be wrong.
3) Quitting antidepressants cold turkey. Young advises lowering the dosage by ¼ a week for four weeks to mitigate the effects of sudden withdrawal.
4) Drinking too much. Women are smaller, have less body water and lower amounts of an enzyme that breaks down alcohol. She asserts that women who get drunk just once a month increase their risk of heart attack by one third.
5) Not taking folic acid regularly until they become pregnant. She recommends taking the vitamin for six months before pregnancy begins.
