Brown2020

Emerging infectious diseases that start with a fever or a rash can pose a risk to public health because they might not be recognized at the early stages when containment or treatment is possible. After September 11, our fears were stoked by anthrax. Then came SARS, and we still wait anxiously for bird flu.

A patent recently issued to Health Hero Network describes a simple but powerful idea that addresses the pandemic challenge by enabling near-real-time syndromic surveillance that can be adapted on the fly. Easy-to-navigate survey devices collect data from hospital waiting rooms, school nurses, and other points of care. The survey script can be changed and updated remotely by public health authorities based on the latest information. The devices report data to central computers that look for any unusual patterns and then alert public health authorities immediately so that they can investigate further.

Disease outbreaks that look like the flu at the beginning can be hard to detect early because flu-like symptoms are common and are not always reported. The first cases of an outbreak may be spread out over many different clinics, hospitals, and schools in a metropolitan area. Unusual patterns might emerge only when looking at a broader cross section of a region. The other challenge is that we may not know what data is relevant and important at the beginning stages of an outbreak. Where it might have been fever, rash, and working in a mail room for one threat, it might be diarrhea and travel to a specific region or eating a particular food in another threat.

While many efforts have been discussed and may even be underway to facilitate early detection of outbreaks by sifting through electronic medical records and pharmacy data, the most important information might be missed because no one knew to ask the right question. When we do figure out what question to ask, we won’t have time to add fields to medical records or change forms. Our public health authorities need the ability to change the script as soon as they learn new information.

Despite the simplicity of the approach, it is not easy to organize health systems around new ways of doing things. On the other hand, maybe we won’t need to. Public health surveys could be pushed to iPhone users, for example. There just might be enough iPhones out there by now to provide a statistically significant sample size enabling highly sensitive early detection of potential public health emergencies. If you want to read the patent, you can find the full text here.

This is a time of year we sometimes think about starting new journeys. After browsing the graduation speeches on YouTube, I am still drawn to this commencement address at Stanford University in June 2005. Steve Jobs, the founder of Apple Computer, tells us some of his stories to convince us to follow our dreams and not to settle, to “stay hungry and stay foolish.”

Yes, We Can! - Si, Se Puede!

Song & video by Will.i.am of The Black Eyed Peas. Inspired by Barack Obama’s ‘Yes We Can’ speech.

http://www.yeswecansong.com

http://www.barackobama.com

It was a creed written into the founding documents that declared the destiny of a nation.

Yes we can.

It was whispered by slaves and abolitionists as they blazed a trail toward freedom.

Yes we can.

It was sung by immigrants as they struck out from distant shores and pioneers who pushed westward against an unforgiving wilderness.

Yes we can.

It was the call of workers who organized; women who reached for the ballots; a President who chose the moon as our new frontier; and a King who took us to the mountaintop and pointed the way to the Promised Land.

Yes we can to justice and equality.

Yes we can to opportunity and prosperity.

Yes we can heal this nation.

Yes we can repair this world.

Yes we can.

We know the battle ahead will be long, but always remember that no matter what obstacles stand in our way, nothing can stand in the way of the power of millions of voices calling for change.

We have been told we cannot do this by a chorus of cynics…they will only grow louder and more dissonant ……….. We’ve been asked to pause for a reality check. We’ve been warned against offering the people of this nation false hope.

But in the unlikely story that is America, there has never been anything false about hope.

Now the hopes of the little girl who goes to a crumbling school in Dillon are the same as the dreams of the boy who learns on the streets of LA; we will remember that there is something happening in America; that we are not as divided as our politics suggests; that we are one people; we are one nation; and together, we will begin the next great chapter in the American story with three words that will ring from coast to coast; from sea to shining sea –

Yes. We. Can.

Featuring: Jesse Dylan, Will.i.am, Common, Scarlett Johansson, Tatyana Ali, John Legend, Herbie Hancock, Kate Walsh, Kareem Abdul Jabbar, Adam Rodriquez, Kelly Hu, Adam Rodriquez, Amber Valetta, Eric Balfour, Aisha Tyler, Nicole Scherzinger and Nick Cannon

Gastric bypass surgery is a rapidly growing procedure in which the stomach is reduced from its normal football-size to something between the size of a thumb and a hardboiled egg. In each case, the stomach itself is healthy: the purpose of the surgery is to force the patient to change behaviors that are leading to obesity.

The images above came from a live Webcast of a gastric bypass surgery performed at Tufts-New England Medical Center in Boston by Dr. Scott Shikora, Chief of Bariatric Surgery at Tufts-NEMC, along with bariatric surgeons Dr. Michael Tarnoff and Dr. Julie Kim. Click on the images to watch the complete video on YouTube.

You also can watch Dr. Stan Hoehn perform a minimally invasive gastric bypass at Shawnee Mission Medical Center in Kansas by clicking on the image below.

A Consensus Panel convened by the National Institutes of Health (NIH) indicates bariatric surgery for people with a body mass index (BMI) of 40 or higher, or people with a BMI of 35 or higher with one or more related comorbid conditions such as diabetes, hypertension, and cardiovascular disease.

Bariatric surgery is regarded by leading physicians on the panel as a lifesaving tool that enables, or in fact forces, the patient to change lifestyle and eating habits. Check out the BMI calculator below to see if you should be changing your behavior.

BMI Calculator (C) 2008 Brown2020.com

With 100 million Americans struggling with at least one chronic condition, and over 60 million Americans considered to be clinically obese, we can expect a lot of bariatric surgery ahead. Can we really address the issue of obesity by forcing ourselves to change behavior under the knife, or are there other ways to address this epidemic?

Stay tuned to this blog for an ongoing discussion of obesity and of new approaches to improving health behavior.

Patrick Goschy recently became a mini-hit on YouTube and then just made the evening news with a video shot in June 2000 demonstrating his invention of a hand-held accelerometer-based video game controller. Wearing only boxer shorts and a tee shirt, Goschy demonstrates his motion control unit playing Ready 2 Rumble on a Sega Dreamcast in his living room, Nintendo Wiimote style, years ahead of his time.

Much has been blogged about the ex-employee of video game company Midway and his purported plan to sue Nintendo for stealing the idea for the Nintendo Wii controller. Bloggers and commenters are raising two lines of questions: First, if accelerometers for detecting motion were around before 2000, how could Goschy claim to have invented the accelerometer-based game controller? Second, if Goschy did invent the video game motion controller over seven years ago, why did it take so long for this to come out?

Accelerometers may have been around for a while, but Pat Goschy’s video still looks like it could be full of inventive ideas given the fact that this was over seven years ago. It is not the invention of the accelerometer that is in question, and maybe not even the accelerometer as a game controller. The inventive steps may have been a series of innovations around design, coding, and calibration that would give game players the agility and speed to take on B. Knoximov in Ready 2 Rumble from the comfort of their living rooms.

Inventing is about taking that next creative step past the current frontier and making things a little better. The fact that Goschy was building motion-based controllers and hacking a Dreamcast interface in what looks like a very workable system seven years before the technology matured and became popular tells us there probably could have been some patentable material back in 2000.

There are two patents that list Goschy as a co-inventor: Patent 6,545,661, filed on June 21, 1999, entitled Video Game Systems Having A Control Unit With An Accelerometer For Controlling A Video Game, and patent 6,315,673, filed on October 5, 1999, entitled Motion Simulator For A Video Game. Both patents are assigned to Midway. These patents do not appear to claim the motion controller from the Goschy video. The 661 patent is the closest, but it is really about sensing light from the screen to know if you hit your target with a game controller gun.

The light sensor is required in all the claims. Here is the exact text of the first independent claim:

1. A video game system comprising:
a game controller;
a hand-held control unit coupled to the game controller and housing an accelerometer and a light sensor,
the accelerometer sensing tilt of the control unit with respect to an axis, the accelerometer producing an acceleration signal indicating the tilt of the control unit with respect to the axis,
the game controller processing the acceleration signal to control the movement of a game character on a video display coupled to the game controller and further processing the acceleration signal to control directional navigation of the game character through a game environment, said navigation corresponding to the tilt of the hand-held control unit,
the light sensor detecting one or more light pixels from the video display corresponding to a direction in which the hand-held control unit is pointing, the light sensor producing a detection signal to the game controller, the game controller determining from the detection signal the light pixels from the video display detected by the light sensor.

The question is not how did Goschy get a patent on this. He didn’t. The real question is why didn’t Midway patent the controller that Goschy is showing in the video? That would have been valuable, but then again, hindsight is always 20/20.

According to some of the blogs, Goschy circulated the video among Midway employees back in 1999 to show his idea, but the company obviously didn’t file patents and didn’t develop the technology either. This is a common fate of many great inventions. If you are early enough to have something truly new and innovative, and you are sufficiently ahead of the crowd to get great patents, chances are you are way ahead of the market and way ahead of the marketing people as well.

Great ideas and great patents need to be five to ten years too early, and they are usually only recognized in hindsight. Thank you, Pat Goschy, for reminding us of the many years of innovation and creative work that leads up to what most people see as an instant sensation when a product like the Nintendo Wii becomes a hit. We also shouldn’t forget that Nintendo has been a grandfather of the modern video game field, at it for the past two decades, and who knows what they also have in their labs that started many years ago.

The question is not why the video took so long to come out. The market has only just now emerged. If the video had come out earlier, we never would have found it.

At TEDGlobal 2007, William Kamkwamba showed us how necessity is the mother of invention, making a windmill out of simple scrap materials to power his home in Malawi. Without any money, but armed with a book from the library and some ingenuity, this teenager from a rural village in Malawi gave a fitting answer to an earlier speaker’s opinion that renewable energy is “too expensive” for developing countries.

I had the opportunity to visit the district health center in Rwinkwavu, Rwanda, where Dr. Michael Rich explained why the Partners in Health model of care is able to achieve better medication adherence in Rwanda than even our best practices in the United States.

It is not just the fact that Bill Clinton and The Clinton Foundation negotiated a deal on antiretroviral (ARV) drugs. It’s not just the fact that the once complex cocktail regimen of pills can be combined into one generic pill. It is because an army of community health workers visit patients in their villages every day, checking in to make sure everything is OK, and to make sure that everyone is taking their medicine.

Daily support and monitoring at home, working with informal caregivers in the community to surface problems early so that bigger problems can be prevented: That is the key to improving quality of care with limited resources.

Dr. Paul Farmer, as chronicled in the book “Mountains Beyond Mountains” by Tracy Kidder, realized this in Haiti a decade ago, and now the Partners in Health “accompagnateur” system is being rolled out in developing countries around the world. Is there something we might learn from Rwanda?