Medicine | Medical Futures Lab

Feb 07 2014

Communication, e-patient, Education, Health, Medicine

Leading Patients into the Unknown

The most glaring impediment to scientific progress in medicine is patient enrollment in clinical trials. Adult enrollment is worryingly low and demands an impactful solution. While the current situation of patient involvement in clinical trials is dire, my team is hopeful the solution exists in remedying communication and awareness issues. Undoubtedly, both of which can be aided through the use of burgeoning social media technologies.

When I lay everything out like I just did this problem seems to have an easy solution. Not so. While one can determine that the origin of this issue stems from patient communication with doctors and awareness of clinical trials, one must fully understand why this issue has persisted and no effective solution has yet been implemented. At the end of the day, it is up to the patients to forgo standard of care and take a leap into something they know very little about.

Like any reasonable human being, the patients are reluctant to try something unknown to them. No one wants to be a guinea pig for a clinical trial they know nothing about. What my team will attempt to create is a more transparent and immersive patient experience to increase their involvement in the healing process. Eventually this will accomplish our goal of markedly increasing enrollment in clinical trials.

We already know from research conducted by the Pew Center that patients with chronic conditions are more likely to be online, exploring further treatment options and commentary. From this data it is evident that our target patients are already eager to explore any possible solution. By utilizing a medium of which patients are already well aware we can more effectively educate and familiarize them with the clinical trial process, making the unknown known.

In order to further decode the reasons why a patient should consider clinical trials as a treatment option, it is imperative that we increase collaboration. Increasing patient involvement by providing them the framework to organize and discover clinical trials themselves will surely make them more knowledgeable and possibly be able to incorporate others like them into the process. This sort of self-sufficient growth is the ultimate prize in increasing the awareness of any unfamiliar subject. For us awareness means participation and participation means success.

Feb 05 2014

Communication, Design, Health, Medicine, Technology

We Define the Medium

If you’ve ever been poked on Facebook and wondered what it meant, this essay from Slate raises some interesting insights.

Over the years, the “poke” has taken on varied meanings in diverse contexts: a hello between acquaintances, a romantic gesture from an admirer, a discreet signal in the collegiate hookup scene. And, as Wickman writes, that’s exactly as Facebook intended it:

“When we created the poke, we thought it would be cool to have a feature without any specific purpose,” Facebook said. “People interpret the poke in many different ways, and we encourage you to come up with your own meanings.”

But this is about more than teenage culture and social trends; it’s a powerful reminder that, in the Digital Age, we are the true architects of the online platforms we inhabit.

Social media platforms give us the ability to write on others’ walls, to share messages in 140-character installments, to send ephemeral photographs. But we’re the ones who decide what those social interactions mean. We’re the ones who give life to the medium, establish a vision for it, and really define its purpose.

Twitter users, for one, are witness to this social evolution. What started out as a stream of consciousness and a minute-to-minute narration of our lived experiences has now become a digital hub for creation, curation, and conversation. Now, every academic conference and grand rounds presentation simultaneously takes place online. Formerly voiceless patients congregate online to self-advocate share their experiences. Physicians and scholars can bypass the traditional gatekeepers of content to shape the public health dialogue.

Jack, Biz, and co. didn’t do that. We did. And that means the opportunity—and challenge—to create channels for meaningful health dialogue is on us.

In recent weeks, as “Medical Media Arts Lab” has examined Stuart Hall’s Encoding-Decoding, we’ve discussed how social contexts influence the ways users decode the meanings that content creators (intend to) convey in their work. Facebook’s “poke” feature takes that a step further. When Facebook introduced a feature without an encoded meaning, it left a vacuum for users themselves to spontaneously construct that meaning. The social experiment of the titular Social Network speaks to the power we have to assemble social networks and build shared cultures. We can, and should, apply that power to digital health communication.

Today, the critical conversations about medicine and healthcare are happening not inside the walls of the clinic, but on the open frontiers of the Internet. With every new social media platform, ask, how is this an opportunity to transform medicine? How can we leverage these tools to engage patients, to connect with clinicians, to aggregate and critically evaluate information? It’s up to us to think bold and innovate big. In the 21st century, we have the power to define the medium and give it purpose, and our only barriers are our own perceptions of our limitations.

This post has been modified from the original version, available here.

Sep 16 2013

History, Medicine

Louis Pasteur Visits Medical Futures Lab

Way back in 1895, a French physician by the name of M. Jeanne attempted to persuade his fellow doctors that big changes were coming to the field of medicine. As he wrote in the Concours Médical,

“It may not be too soon to look ahead into the future that the scientific revolution, brought about by the beneficent discoveries of the illustrious Pasteur and his school, has in store for the medical profession. […] Diagnosis, that primordial element of our art, will soon no longer be able to do without the microscope, bacteriological or chemical analysis, cultures, inoculations, in a word everything that may give our clinical judgments absolutely precise data. […] Let us go back to school, and prepare the ground for an evolution, if we are to avoid a revolution.”

We’re using Bruno Latour’s The Pasteurization of France (1984) – the source of the quote – in my graduate seminar, “Emergent Media: Technologies, Networks, Culture” at Rice University. Our focus is on the complex interplay between the emergence of new media technologies in different historical periods (past, present and future), the networks of commerce and creativity that fuel and arise from these innovations, and the cultural productions that result. While much of our reading looks forward at digital interfaces, we can learn a lot about contemporary evolutions and revolutions by looking back – and the bacteriological revolution was about as disruptive as they get. But the key point is that it was a revolution that came from outside of medicine, and it only gained momentum through an accumulation of forces, including professionals and the lay public, who all felt they shared a common goal.

In one hundred years, will we have a Louis Pasteur of digital medicine? Will the eventual embrace of digital tools seem as obvious then as the embrace of bacteriology seems to us now?

Latour argues that physicians in France finally joined the Pasteurians only after the development of the diptheria serum, which required the doctors’ services to diagnose the disease. By devising a serum that treated but did not prevent disease, the Pasteur group allowed doctors to keep their jobs and get on the bacteriology bandwagon without losing face. What will be the magic serum that allows medicine to join the digital revolution? Self-tracking? Personalized genomics? 3-D printing? Whatever it is, history tells us that it will only take over by making itself seem inevitable.

May 15 2013

Communication, Culture, Education, Humanities, Medicine

Millennial Medicine symposium videos are up!

Marc Triola’s talk featured NYU’s Virtual Anatomy Lab

All of the fabulous talks from our speakers at Millennial Medicine are now up on the Medical Futures Lab website under a new tab called “Videos.” Check them out, let us know what you think, and stay tuned for more as yet unseen content from that event in the weeks and months to come.

Apr 22 2013

Culture, Design, Electronic Medical Record, History, Medicine

EMRs and the Problems of Diagnoses, Part 2

Guest post by Olivia Banner.

“Schematic Flow Chart for DIAGNO II Computer Program,” Robert Spitzer and Jean Endicott, American Journal of Psychiatry 125, 7 (1969): 15.

In a previous post, I wrote about Ted Gup’s critique of the current rush to organize human differences into diagnostic categories, which he published on the heels of the CDC’s recent report that 11% of U.S. children are currently diagnosed with ADHD (see “Diagnosis: Human”). It’s interesting to consider this critique in light of the DSM’s history, and in light of projects to automate diagnoses using computers, all of which produces some intriguing questions about the future of EMRs.

Some readers may already be familiar with the vagaries of how the DSM has treated “homosexuality” over the years: it wasn’t until 1986 that editors completely removed it from the DSM.

This is only one among many examples of how the DSM mirrors cultural attitudes toward the groups of “symptoms” it classifies as psychiatric disorders.

In the late 1960s, one of the DSM’s previous editors, Robert Spitzer, developed a computer program intended to automate diagnosis. Called DIAGNO, the program was envisioned for use during intake at psychiatric facilities. Spitzer’s basic premise was that, since clinicians employ a decision tree to arrive at a differential diagnosis, and software code also uses decision trees, a computer program could be equally if not more precise than humans at determining diagnoses. DIAGNO went through three versions as Spitzer fine-tuned it over the years, aiming for a program that could one day skip the clinical encounter altogether.

As far as I’ve been able to figure out, DIAGNO remained a dream that was never implemented; however, it’s interesting to note that Spitzer was building on other researchers’ programs to automate recommendations for which drugs to use to medicate specific disorders. One of these was used in the late sixties at the University of Texas Medical Branch in Galveston. (Please comment if you have any additional information on DIAGNO’s implementation!) The dream of automating diagnoses lives on, however, whether in technologies intended for use in the home such as SCANADU, which would diagnose medical conditions, or those for use in clinical settings. In the latter category we could include a fascinating project that attempts to integrate findings from cognitive science to help automate psychiatric diagnoses, so that diagnoses can be reached through a computer program analysis of a patient’s narrative (see Cohen et al., “Simulating Expert Comprehension”).

I wonder what Ted Gup would say about this latter effort. In this dream of a future where diagnoses are automated, his narrative about his suffering might, when analyzed by software, be diagnosed as a condition suitable for treatment. Do we want this future where computers can diagnose? What happens when EMRs are based on diagnostic categories that can’t reflect the particular exigencies of their historical moment that drive the diagnosis?

How does automating diagnoses occlude broader cultural debates about the diagnoses themselves? And how can we, as educators, best alert our students to these problems, even as we search for more efficient ways to implement new digital technologies into clinical practice?

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