Monthly Introduction to Tech Medicine

What's this blog all about?

My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.

What are some recent posts on Tech Medicine?

Topics of recent posts have included my interview about Google Book Search, interesting links and followups, Healthline's new drug search tool, a study on patient-physician email, the National Library of Medicine's Drug Search Portal, a better pillbox from MIT, Heath Ledger's drug interactions, Google Book Search and medical education, and rounding on surgical patients by robots.

Who are you?

I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. (Recently, I have also written a blog on personal productivity called The Efficient MD.)

There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.

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My Interview With Google Discussing Google Book Search

Google interviewed me a few weeks ago about Google Book Search -- why it's innovative and how doctors can use it. The 2 minute video is posted on The Efficient MD.

Labels: google, google book search

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More Tech Medicine Links

Reviewing my files, these are more stories that have recently caught my eye:

Medical Economics has a story about one physician's awful experience with online web ratings.

Jane Brody from the New York Times discusses the importance of vitamin D (vying for "nutrient of the decade.")

The eDrugsearch blog interviews Matthew Holt and Indu Subaiya, who discuss their pics for top Health 2.0 apps. ReadWriteWeb also discusses the interview.

HealthMap is a global disease alert map. From the press release:

Need to know where avian flu, salmonella or dengue fever been popping up? A quick view of HEALTHmap shows you where more than 50 diseases have been reported around the world, who is reporting and how “hot” an outbreak is based on the number of reports. Drill down by content and city or narrow by disease and read what has been reported in the last 30 days.

According to a recent study, patients who are highly involved in their care don't necessarily have better outcomes.

Dean Giustini of the Google Scholar Blog, in a paper on Web 3.0:

"This paper introduces some of the main concepts and principles of web 3.0 for health librarians. In doing so, it aims to explore some of the issues and terminologies associated with the web's projected development over the next ten years, and at a level of generality that we hope will raise awareness and encourage debate. Many health librarians have recently adopted the underlying principles and social software tools of web 2.0 into practice [1]. Can we be moving into the early stages of web 3.0 already?

To answer that question, let’s explore some of the many (conflicting) definitions of web 3.0. According to Wikipedia, “There is considerable debate as to what the term web 3.0 means, and what a suitable definition might be.” [2] Web futurist Nova Spivack suggests that web 3.0 refers to the web's third decade of development from 2010-2020 [see table 1] during which several information trends will converge and predominate. Internet experts say that we are already moving toward the technologies that herald this new era [3]. However, one non-librarian blogger is vehement that 'web versions' do not (or should not) exist [4]."

And finally, Google Health records may not be subject to the HIPAA privacy law.

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Followups and Links of Interest

A few things that caught my eye these last few weeks:

OR-Live offers live and archived webcasts of more than 600 surgical procedures.

From the NEJM:

This spring the U.S. Supreme Court in Baze v. Rees1 will rule on the constitutionality of the three-drug regimen currently used for lethal injection in most state executions. The Eighth Amendment to the U.S. Constitution prohibits punishment that is "cruel and unusual." The central question before the Court in Baze is whether the use of sodium thiopental, pancuronium bromide, and potassium chloride violates that constitutional prohibition.

The Marpac 980 Sound Screen & SleepMate Sound Conditioner. Highly recommended.

I previously asked if there were any free, HIPAA-complaint patient-physician email systems available. As far as I can tell, there's only one, and the site is named iMedicor. It also offers CME, a dictation service, and a system that allows secure communication between physicians. A review will follow.

Alcohol hand rubs alone are not enough to curb hospital infections.

Depressed and burned out residents make 6.2 times as many errors.

Jay Parkinson is awarded quote of the week: "Today’s doctors are like feral children found living in their own little communication wilderness."

And the unlikely saga of a medical checklist has a happy ending -- ""The Office for Human Research Protections (OHRP) – part of the U.S. Department of Health and Human Services – has concluded that Michigan hospitals can continue implementing a checklist to reduce the rate of catheter-related infections in intensive care unit settings (ICUs) without falling under regulations governing human subjects research."

(Also posted on The Efficient MD.)

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Healthline's New Drug Search Tool

Patients and health care providers often search the internet for health information -- for information on medical conditions, on treatments, and on medications. Identifying reliable sources of knowledge is important, but finding good sources is sometimes difficult. Last week, I wrote about one new source of health information: the drug information portal at the National Library of Medicine. This week, I''ll discuss Healthline's new drug search tool.

To recap: the National Library of Medicine's drug information portal provides a wealth of information, but the NLM's website site is aimed primarily at at health care providers. In contrast, Healthline's drug seach tool is directed at consumers.

Three novel services are offered: drug information and comparisons, drug identification, and drug interactions.


Information provided by Healthline includes a description of the drug and typical uses, side effects, and other information, like what to do if you miss a dose. The drug search tool also allows you to compare two similar medications side by side.


The "pill finder" is a novel service offered by the drug search tool. Not sure what that green oval tablet in your medicine cabinet is? By entering the pill color, shape, and any visible markings, you can narrow down the possibilities. (There were 13 results for green oval tablets.)


Lastly, the drug search tool also allows you to determine whether there are any significant drug interactions among medications. A word of caution -- the drug interaction checker may mark interactions as potentially "severe," even if the chance of an interaction may be very low and even if the interacting medications are used together commonly. (As always, if you have any questions, check with your doctor.)

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Does Providing Email to Patients Benefit Patient-Physician Communication?

I'm a strong advocate of patient-physician communication by email.

In the Archives of Surgery, a paper was recently published examining the effect of surgeons providing email addresses to patients prior to thyroid or parathyroid surgery. Half the patients received a sheet providing the email address and a statement saying that email was the surgeons' preferred means of communication. The other half received an information sheet without an email address or remark about a preferred means of communication. (The email addresses, however, were also available to both groups on the appointment card and website.)

Here are the results:

Overall, 26 of 100 patients (26%) initiated additional perioperative communication with the surgeon, 19 of 50 (38%) in group E [recipients of email addresses] and 7 of 50 (14%) in group S [no email addresses provided](P < .001). Of those who initiated communication, 22 of 26 (84%) did so by e-mail; 3 (12%), by fax; and 1 (4%), by telephone. For patients using e-mail, 18 of 22 (81%) were in group E and 4 of 22 (18%), in group S (P < .02). Overall, 34 e-mails were sent by 22 patients in the study group. Most e-mails sent focused on only 1 issue; however, some patients raised multiple issues, with the most being 4 issues in a single e-mail. There were no differences in any of the outcome measures in relation to patient satisfaction with communication.

The study authors remark that "Despite concerns about potential medicolegal issues and other disadvantages, providing patients undergoing elective surgery with e-mail access to their surgeon results in improved levels of communication without any demonstrated impairment of satisfaction with outcomes."

What can we learn from this study? When provided with an email address, more than twice as many patients contacted their doctors. On the face of it, this seems like a good thing -- more communication, more questions answered, better informed patients, better patient-physician relationship.

However, the study failed to show a significant difference in patient satisfaction between the two groups. Those who are skeptical about the value of email between physicians and patients might argue that this proves that email provides no demonstrable benefit. With all this additional communication by email -- none of which is reimbursed -- where's the increase in patient satisfaction? The skeptics might reasonably ask: why bother?

In balance, I think this study provides ammunition to both sides of the patient-physician email debate.

(Also posted on The Efficient MD.)

Photo Credit: Eduardo O.

Labels: email

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New Drug Information Portal from the National Library of Medicine

The National Library of Medicine just released a new Drug Information Portal for patients and health care professionals. From the announcement:

More than 12,000 drug records are available for searching. The search interface is straightforward, requiring only a drug name as a search term, and successful searching is enhanced by the assistance of a spellchecker. Information buttons and balloon pop-ups guide the user by providing helpful hints or a description of the resource and links to the source website. Links to the following resources contribute to the search results: MedlinePlus®, AIDSinfo®, Medline/PubMed®, LactMed, HSDB®, Dietary Supplements Labels Database, TOXLINE®, DailyMed®, ClinicalTrials.gov, PubChem, NIAID Anti-HIV/OI Database, ChemIDplus®, Drugs@FDA, DEA, and USA.gov.

The main search page is as uncluttered as Google. It suggests trying valium, so here's the search result as an example:
For physicians, Epocrates, UpToDate, and PDR.net still offer more readable presentations of drug information, but if you're interested in patient information -- or for sheer quantity and breadth -- the Drug Information Portal is hard to beat.

(Also posted on The Efficient MD.)

Labels: drugs, epocrates, nlm

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A Better Pillbox from MIT

Researchers at MIT have built a better pillbox.

The hurdles to taking medications are many. Patients forget their medications, purposefully don't take their medications, or accidentally take too much or too little. And sometimes, taking medications the wrong way can cause life-threatening complications, or can make the difference between the successful treatment of an severe infection -- like tuberculosis -- and the creation of a drug-resistant organism -- like MRSA or multi-drug resistant tuberculosis.

In order to overcome these barriers, scientists at MIT designed the uBox:

The first part of the two-component system is a kind of "smart" pillbox, called the uBox. It has 14 chambers that can each be loaded with several pills, which it dispenses from one chamber per day. To alert the patient that it's time to take the medicine, the box flashes its lights and sounds a buzzer. When the compartment is opened, the uBox records the exact time and prevents double-dosing by refusing to open again until the next treatment is due.

After two weeks, a health care worker reloads the box and digitally records and transmits the information stored in it. Doctors and public health services can then get complete data on compliance, patient by patient, in almost real time, instead of having to wait until the end of the six-month treatment.

The uBox will initially be used in Bihar, India, as part of a tuberculosis treatment program.

But there's a second component of the uBox which allows real-time communication between health care workers in remote areas and those monitoring the study. It's called the uPhone:

The second part of the group's new system is a cell phone, called the uPhone. By using special software, health care workers can record a patient's temperature, weight, and answers to a list of questions related to symptoms, which adds to the set of detailed patient data analyzed by doctors monitoring the study.

By looking at patterns of effects, the doctors can tell which field workers are achieving the best adherence rates with their patients and find out just what it is that those people are doing right. They can then be recruited to train additional workers...

More information about the uBox may be found at Technology Trends, MIT News, and Innovators in Health.

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Heath Ledger's Drug Interactions

According to the Chief Medical Examiner of New York, Heath Ledger "died as the result of acute intoxication by the combined effects of oxycodone (Percocet), hydrocodone (Vicodin), diazepam (Valium), temazepam (Restoril), alprazolam (Xanax), and doxylamine (Unisom)."

To illustrate why he died, the following is a list of potential drug interactions from Epocrates, an online drug database:

1. diazepam <-> oxycodone
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

2. diazepam <-> temazepam
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

3. diazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

4. diazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

5. oxycodone <-> temazepam
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

6. oxycodone <-> Vicodin
caution advised, consider dose reduction: combo may incr. risk of CNS and resp. depression, profound sedation, hypotension, other adverse effects (additive effects)

7. oxycodone <-> Xanax
caution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)

8. temazepam <-> Vicodin
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

9. temazepam <-> Xanax
caution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)

10. Vicodin <-> Xanax
caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

(Also posted on Kidney Notes.)

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Google Book Search and Medical Education

Addedum: My interview with Google is here.

Somewhat unexpectedly, Google asked me to talk on film about doctors who use Google Book Search. So lately, I’ve been thinking about the strange beast that Google Books has become. If you haven’t seen it recently, take another look. Initially modest, the project has evolved into a screamingly useful, many-headed creature built on a massive body of books — and I mean massive, as in the complete searchable text of several university libraries. Google Book Search also includes lots of extras, including links to book reviews, references on websites, references from other books, and Google Maps of every place each book mentions.

It’s safe to say, there’s never been anything like this before.

But how might doctors use Google Book Search? Several months ago, a group of medical students, residents and I were in the emergency department examining a patient who might have had necrotizing fasciitis. This condition, also known as “the flesh eating bacteria,” is as evil as it sounds. It must be diagnosed and treated quickly — often with extensive surgical debridement — or the patient will die. Atul Gawande, one of my favorite medical authors, had written about a patient with necrotizing fasciitis in his book Complications, which I’d recently read. It’s a great book, it contains a perfect description of the disease, and at that moment, I wished I had it in front of me. So I punched “gawande necrotizing fasciitis” into Google Book Search, and instantly the exact passage was on the screen.

It got me thinking. How many potential opportunities for teaching are lost because the original text isn’t available, short of taking a trip to the nearest medical library? How much knowledge lies dormant because no one can find it?

Choose any medical topic. Say, pheochromocytoma, a rare adrenaline-secreting tumor. Punch the topic into Google Book Search. In less than 10 seconds, the actual pages of the most recent textbook are scrolling on your screen, complete with all the figures, charts, and photographs relating to the diagnosis and treatment of this tumor. Google Book Search is an underused and unparalleled teaching resource. It's worth saying again: there’s never been anything like this before.

The full potential of Google Books has yet to be realized. What’s next? An Ebook reader? A subscription based service for the full text of books? A print on demand service? An artificial intelligence? The last idea may sound far-fetched, but George Dyson, visiting Google, had this to report:

Despite the whimsical furniture and other toys, I felt I was entering a 14th-century cathedral — not in the 14th century but in the 12th century, while it was being built. Everyone was busy carving one stone here and another stone there, with some invisible architect getting everything to fit. The mood was playful, yet there was a palpable reverence in the air. "We are not scanning all those books to be read by people," explained one of my hosts after my talk. "We are scanning them to be read by an AI."

(Also posted on The Efficient MD.)

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