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Cardiologists, it is time to say goodbye to linear thinking and embrace exponential

March 12, 2013 1 comment

Screen Shot 2013-03-12 at 2.37.50 PMAdvances in  artificial intelligence, robotics, infinite computing, ubiquitous broadband networks, digital manufacturing, nanomaterials, synthetic biology, and many other exponentially growing technologies will enable us to make greater gains in the next two decades than we have in the previous two hundred years.

In order to understand why I say this, one needs to understand the basis of Moore’s law and exponential thinking. What does this mean? It means that the technology created in the past has helped develop the technology of tomorrow in an exponential pace and will continue to do so.  Say what?  Lets say you were asked the following question “From your current location, where would you be if you took 30 steps?” You would probably be able to say with accuracy your location. Now, if we address this in an exponential concept. Taking 30 steps exponentially (1-2-4-8-16-32-64-128 etc) you would end up 1 billion steps away. Would you have been able to predict this? Likely not since most of us are linear thinkers.  This is the foundation of exponential technology. Most people in healthcare are not used to thinking about how technologies that grow at this rate will impact our future and doing so is a key component in making this a better world. If you want more information regarding this, don’t miss the article from Nature “Moore’s law is not just for computers”

Ok… What does any of this have to do with cardiology or the ACC? ACC ’13 marks the third year that The Cardiovascular Education Innovation Forum has been a part of the annual meeting. Despite it’s recent inception, this Forum has been growing linearly (I am trying to change that but there are many obstacles!). This year’s Forum was a little different than prior years. Three fellows, including myself, joined the program committee and helped determine the topics and speakers. Our goal is to mold the Forum into what we know it can become. I have been fortunate enough to be a Singularity University Futuremed alumni in 2011 and 2013. The mission of Singularity University is “How to impact the lives of 1 billion people in 10 years”. Will this happen by placing better drug-eluting or bioabsorbable stents? How about renal artery denervation or TAVR. Change of this magnitude in healthcare will require new strategies and technology along with a different way of thinking. Not just a new design of an existing product. And by the way, I am starting interventional cardiology in June 2013, but then pursuing a biodesign or endovascular/innovation fellowship. I am certain that tech-savy healthcare providers who have embraced technology will lead the revolution in healthcare change.Screen Shot 2013-03-12 at 2.33.37 PM

That is the goal of the cardiovascular innovation forum. To show and motivate every cardiologist to try and impact the life of hundreds at a time.  This year the CVIEF invited The Society of Physician entrepreneurs to help and orient cardiologists on the path to materializing our ideas. Venture Capitalists and Angel investors that talked about what type of ideas they are likely  to fund, how to approach them, a gameplan to follow.

Categories: Health, TechMed

Real Time Monitoring is about to make sports far more Exciting!

August 24, 2012 Leave a comment

The Future of Sports is about to get a Major Facelift

 

It was recently announced at Manhattan’s New Museum of Contemporary Art an exciting concept that will change the way we see sports as spectators and how teams manage their performance tactically.

Adidas and Major League Soccer announced a new initiative that will likely turn the MLS into the most technological sports league in the world. The initiative is to make every soccer player  to wear small sensor that’ll track their movements and vital signs. This will be sent back to the coaches in real-time for monitoring in their tablet. Now how this information will be used has innumerable applications.

You are probably familiar with the miCoach app for android or iOS in which it monitors your physical activity. Similar apps would be endomondo, run keeper, nikes app etc. The new miCoach system uses a collection of sensors that fit into a small pocket in the player’s  shirt. That is not all, additionally there are sensors woven right into the the players uniform and senses heart rate as well as other vitals. If you think that weight could be an issue think again since the data cell itself weighs only 52 grams. Sensors incorporated into the system include; a tri-axis accelerometer, GPS, magnetometer, gyroscope which will be worn by every player in all 19 teams

How does it work?
The data captured by the sensors is then sent by Wi-Fi to the coach’s tablet (in this case it seems it will be iOS iPad)

How can it be used? Well even gambling will change…
The most important use of such technology is player safety in my opinion. Many of us have witnessed players having syncopal episodes (passing out) and even dying in the field. In a vast majority it is due to an underlying problem related to electrical conduction of the heart causing life threatening arrythmias or enlarged hypertrophic heart walls affecting the way the heart pumps and therefore delivering blood properly to the brain and other organs.

This appears to be originally designed for the coach, but as I just mentioned, potential uses include the team’s doctor or healthcare providers. Using this information not only for strategic instruction but medical. If you see a player is having a severe arrhythmia, blood pressure drop, etc then the doctor or even the application itself could let the coach know “GET THIS PLAYER OUT NOW!”  If you are the other team and you are able to see how the other team’s endurance is doing, the coach could potentially make appropriate strategic changes. Finally doctors can have a bigger roll in recommending a coach what to do 😉

Think about it in the gambling perspective. Online gambling is even being explored in a social concept now by different game companies one example is Zynga. Everything is becoming social now.  Real time monitoring provides more data, more paramaters that could be used for such.  Fantasy football is about to get a “steroid” injection.

If you are in america you probably do not care much about soccer (let’s be realistic) so how about football? Monitoring NFL players and having sensors in their helmets which measure temperature, and force of impact? If a force of impact is significant ant there is risk for severe concussion the app will let you know and doctors as coaches will get the player out and seek medical attention.

An #Awesome Twist? How would you feel about knowing this information in real time when you are watching the game?

Think about what the fans would do with this information? How this will affects the social interaction with fantasy football? Will it change how gambling happens? Imagine you are  watching a game in which your team is losing. You see your smartphone and you are aware that the mean endurance of your team surpasses significantly that of the other team. It gives you a reason why to stay in your seat and wait for the scoring point doesn’t it? (At the same time you probably will also get an AD from gatorade saying “Improving endurance” or some other nonsense since ads are everywhere)

Have many more ideas and concepts but you would probably not read them all 😉 If you have more post them!

Categories: TechMed

Impact of Emerging Exponential Technologies in the way we practice Medicine

August 2, 2012 Leave a comment

I was asked to give a talk in my University which is The University of Texas Medical Branch, regarding exponential technologies in Medicine. For those who do not know me, I am a cardiologist who is passionate about incorporating technology into  medicine. I have no doubt that major changes will be happening in the incoming years in the way we practice as well as how we engage with our patients. Click here for the link to see or download or copy paste http://goo.gl/IwCdB

Before giving the talk I overheard people saying “it is a joke, this is a cardiology meeting, what is he talking about” I also heard others with more positive comments.  As one of my slides states “The problem with close minded people is that their mouths are always open”.

Soon after initiating my talk I could see how the audience became captivated with what I had to say. My goal was to open some eyes to the potential of exponential technologies. I wanted to show them technologies that are and will be game changers in our every day practice, and hopefully ignite some light bulbs to stop conventional routine thinking and dream a little…

Hope you like the slides

Update: 3 hours after the upload it became top presentation of the day, 6 hours later top presentation talked about in facebook, and 36 hours later 30,000 views

Contact:

Twitter: @christianassad

E-Mail: christian.assad-kottner at singularityu.org

Categories: Health, Social Media, TechMed

Test your Medical Knowledge on a Virtual Patient before a Real one

July 16, 2011 1 comment

The way knowledge has been taught to medical students over the last couple of decades has not changed much. The medical student basically has to sit down, read for countless number of hours and then try to incorporate his knowledge to the hospital setting with the help of residents, faculty, and fellows. Yes, I know, I have simplified things too much but hey, I am a “Keep it simple Kinda guy”…


            More recently, over the last couple of years we have seen how technology has been changing the way we practice and learn medicine.  Now, when rounding in a hospital “everyone” has a smartphone, tablet, or netbook that gives the information in a heartbeat. Those that do not, likely can access the information from a nearby computer.  All this is truly amazing but, if you were an intern once; Do you remember what was your first day like? Every medical student that is in a Residency program had to sit down countless amounts of hours in order to get there, but  nothing prepared them  really for that first day. That first day when you are on call and your beeper starts ringing. Dr. Butterfinger, my patient has chest pain, EKG  changes and machine reads STEMI (ST Segment Elevation Myocardial Infarction).  What do you want to do? From one day to another everything changed. Before this day you were the one sitting with the audience, enjoying the show. Now you are the one (in part ) making decisions that will directly impact someones life. Gulp….

And so comes the “July Effect”.  The July effect is a hypothesized scenario in which changes in training hospitals occur. Medstudents becoming 1st year residents or interns, and interns becoming residents and therefore “head” of the team. Some say July is the worst time to be in the hospital some do not agree. Different studies are out there but a recent one got the eye of the News,  it was a publication in the Annals of Internal Medicine : “July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes. A Systematic Review which concluded  with  “ Mortality increases and efficiency decreases in hospitals because of year-end changeovers, although heterogeneity in the existing literature does not permit firm conclusions”. It is an interesting read and recommend it to anyone but the point is not to discuss this, the point is what follows.

What if you could practice your medical knowledge before you became an intern?  Simulators out there exist but lets face it they are not very appetizing to the users. You have books, interactive tablet books, software etc with a similar mechanism as the “Choose Your own Adventure” type of books we read as kids but thats about it.

Here is where Second Life  a free 3D virtual world where users can socialize and connect, could have an important role in medical education.  Imagine the following scenario. You read about treatments for Diabetic Ketoacidosis,  Respiratory Failure, STEMI, Pulmonary Edema, Heart Failure etc you name it. Once you read about it instead of having your usual, boring and annoying test your test becomes a 3d Virtual game where you get to exercise your knowledge. Far more interactive and realistic than a couple of questions. This will stick better to your brain and you will be less likely to forget it (Use it or Lose it)  So instead of having a Multiple Choice Test on the subject have a 3D Virtual Test! It’s kind of a Gamified Test!  Still do not get the picture? Here take a look at the following link by Second Health which have done an amazing job.

I am aware this has been present for years, which in my opinion, makes it more surprising that we have not incorporated it to a teaching setting.

Categories: TechMed

E-Cigarette: “But DOC! I am not Smoking I am Vaping”

June 17, 2011 55 comments

There is little data on Electronic Cigarettes aka E-Cigs in medical literature. For those not too familiar with the E-Cigarette, it is basically a vaporizer the size of a cigarette.  As the FDA described it in their website “Electronic cigarettes are products designed to deliver nicotine or other substances to a user in the form of a vapor. Typically, they are composed of a rechargeable, battery-operated heating element, a replaceable cartridge that may contain nicotine or other chemicals, and an atomizer that, when heated, converts the contents of the cartridge into a vapor” Today I learned from someone that uses an E-Cigarette a new term and that is that the act of using an E-Cigarette is not smoking but VAPING.  I got curious about the concept and decided to look in Pubmed for medical literature and this is what I found.

     There are limited studies to draw conclusions about Vaping. Question is; Is it reasonable to assume that vaping is better than smoking? I mean, approximately over 4000 chemical compounds are created by burning a cigarette, of these; it is known that many are toxic and/or carcinogenic. In the other hand recent publications have found that e-cigs contain carcinogens such as nitrosamines and diethylene glycol, an ingredient in antifreeze.

In the FDA webpage you can find Concerns that they have about E-Cigarettes;
1.- FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent.
2.- Cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff.
3.- Concerns that the marketing of products such as e-cigarettes can increase nicotine addiction among young people and may lead kids to try other tobacco products.
All very valid points if you ask me, I am particularly concerned about #3.

Recently the FDA issued a letter to the Electronic Cigarette Association inviting electronic cigarette firms to work in cooperation with the agency toward the goal of assuring a lawful marketing approach.
Searching for more information in PUBMED brought the obvious. More studies need to be done in order to say that Vaping is better, equal, or worse than Smoking for several reasons.  As mentioned above Vaping has also shown to have carcinogens but nowhere near the  4000 chemical compounds.
So as for what the future holds for vaping it is still uncertain. So as someone who has seen family members and friends being unable to stop smoking after trying all the possible medications out there; chantix, bupropion, nicotine patches, nicotine gum, etc. Would it be wrong or irresponsible of me to tell them to try electronic cigarette instead of a normal one? Vaping is not free of risk but is sure sounds like a good option for those that have tried approved options and have been unsuccessful.

 What do you think?

 Being new to social media and maybe being extra careful. I will say that until further studies are done, VAPING is not a recommended treatment or option to stop smoking… but it sure sounds better to me than the latter.

This post was done several months ago, but now got revived recently.  Wanted to see if I could get different opinions or experiences! Thanks!

Bibliography

http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm

Am J Prev Med. 2011 Apr;40(4):472-5. Electronic cigarettes as a smoking-cessation: tool results from an online survey. Siegel MB, Tanwar KL, Wood KS.

Addiction. 2011 May 18 [Epub ahead of print]Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Etter JF, Bullen C.

Nicotine Tob Res. 2011 May 12. [Epub ahead of print] Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes. McQueen A, Tower S, Sumner W.

Categories: TechMed

Hey Doc, Are You a Cyborg? Close… I am an Inforg

May 30, 2011 3 comments

I recently attended Singularity’s Futuremed 2011 conference and it was an invigorating experience to say the least. A breath of fresh air for all those who attended, mixing sci-fi with modern day technology/medicine. There was not a single subject that was not interesting.  People were glued to their seat from 8:00am to 10:30pm just to  continue later  discussing important subjects at the lounge in the hotel we were staying at. I do not exaggerate when I say;  this is without a doubt my favorite conference of all time.

When the conference was over, my mind was spinning. The amount of knowledge presented was impressive and demonstrated in a very digestible manner. But at the end, retaining all this information was very difficult and that is why Futuremed very cleverly made a portal were the attendees can log in, review notes, concept maps , and  presentations.  One can have access to this knowledge just with a couple of button clicks or finger taps in the case of your smartphone/tablet.

A very important concept mentioned over and over again was  “The Law of Exponentiality”. In brief, this just means that our world is picking up speed in a very significant manner in every aspect; technology, medicine, engineering, etc you name it. Everything is evolving; Computers, Smartphones, Smarthouses, Cars that drive by themselves (Google Car), Nanotechnology, Artificial Intelligence, Genomics or Regenerative Medicine

Information is available at our fingertips. You can now see teenager’s thumbs moving quicker than hummingbirds wings when browsing the internet in their smartphone. Everything is getting quicker and more efficient, everything but one thing, Our brain… It seems like everything has evolved but our gray matter, the seat of a person’s intelligence and IQ, as well as the mental strengths and weaknesses of the human being.

As mentioned in Futuremed at Singularity University  “Our brain has not evolved to the Era we live in”. We have all these gadgets that help us become more efficient, smarter if you so please.  Smartphones or Smartdevices that help us remember. They are not yet a part of us, so the word cyborg  is still futuristic, but it seems everyone has one, so we might as well call ourselves human  Inforgs?  We are entering the Fourth Revolution or so called the “ Information Revolution”.  Such revolution is obliging us to become    “interconnected informational organisms “ ( INFORGS ) and indeed we are sharing the informational environment resulting in the INFOSPHERE.  This concept was mentioned at TEDxMaastricht – Luciano Floridi – “The fourth technological revolution”. (Video is below)

So what is my point?  My point is that teaching medical students, residents and knowledgeable doctors how to use efficiently computers, smartphones and gadgets is of paramount importance at this stage of human evolution. Anyone who is resourceful and knows how to use his smartdevice in an efficient manner could speed up diagnosis and treatment in many situations. As years go by, technology will continue to advance in an exponential pace and those that do not keep up with it, those that do not see the profound impact that the Informatic Revolution is having upon us, those that do not comprehend the directions of the disruptive innovations and the implications of the new developments  will find themselves stuck in an abyss of overwhelming information.

If you think this is non-sense… what If I told you that in the near future a machine could be doing the job of a doctor? You would say preposterous,  ridiculous, BLASPHEMY.. OFF WHITH HIS HEAAAAAD… or in the other hand, believe it is reasonable.

I would like to end with an advise given by Bob Metcalfe, Founder of 3Com and Co-Inventor of the Ethernet: “ Be prepared to learn how the growth of exponential and disruptive technologies will impact your career and your life”

Well ladies and gentlemen I invite you to read a little about Peter Diamandis and The X Prize Foundation who is offering  $10 Million For a Tricorder to Diagnose Patients.  Just do an internet search (aka googleit).  If you still think this is ridiculous, I respect your opinion, I know this is farfetched,  but I would recommend anyone who got this far to read a little about exponential technologies, what do they mean and where they are heading.

Another  Crazy. Crazy. Crazy. Obvious scenario?

Questions for the audience;

1) The Tricorder concept  “replacing” Primary Care Physician is a very interesting one, which in part, could help significantly help with the the issue regarding lack of primary care doctors.  Is it possible that this could be a solution? (Keeping an open mind is always helpful with this type of questions)

2) Should  “Technology Updates Course” be added to the Curriculum of Medical Schools or CME for already practicing Physicians?

Categories: TechMed