NIRVANA HEALTH?

Do you have a blender? Of course you do. Almost everyone does. Now take a few ingredients:

1.       Patient centered.

2.       Shared Responsibility

3.       Patient determined diagnostic tests

4.       Google

5.       Expert opinions

6.       Population Medicine

7.       Genetics

8.       Epigenetics

9.       Medical Apps

10.   Digital Electronic Medical (Health) Records

Put them in the blender and press the switch. And what do you get?

CHAOS!

Remember Mark Cuban’s self-monitoring regimen of serialdiagnostics?  Now add to that the new Arizona law that allows patient to seek diagnostic tests on demand, sponsored and perhaps lobbied, I believe by at least one private company Theranos, now defunct because of fraud, hubris and conceit. and then for good measure throw in the $1000 genome sequencer (available soon from MinION) and what will you have? I am all for low costs and freedom to violate the vein where truth flows, but shouldn't we also have the wherewithal to understand the information that elixir of life holds and its true meaning?

Otherwise we have, health-ism on steroids! Think Road Rage was a 2014 issue, think again. Wearables, forget them our sodium and potassium levels will be on TV just like the lady that walks smiling at everyone and finally levels with her co-conspirators in the ad that her cholesterol dropped by a few % points because of the pill. And what does that mean exactly for her health anyway? Now we find out…little. But that ad sold the pill to the tune of many billions of dollars and may reach $1 Trillion by 2020  .

Information is great if one can interpret it. Information is good if it can be assimilated and the individual can draw an understanding from it. (And there is no political correctness here about how smart the average person is) Even an above intelligent person, (reference to the average intelligent person cannot be found anywhere) with a science background but without the medical reasoning will be lost in the cold waters of the Atlantic Ocean just like Mr. DeCaprio in the Titanic or the warm waters in a pool in Hollywood, your call.

You see, and this is not a paternalistic statement, when fear envelops a person, reason is thrown to the wind. Everything becomes dark as fear and caution arrive at the doorstep. So yes Mark Cuban is a very smart business man and he has tens of interpreters of maladies available to him that assign risks as related to his medical tests. Do we all have that capacity? Yes you say, I have Google! Sure you do as does the rest of the world. But is the information in Google easily assimilated? For instance can you easily figure out what the following paragraph means? And then we circle back to is Mark Cuban correct in his interpretation?

“MIR-21 expression was demonstrated in 63 (79%) pancreatic cancers ( 1+ in 49, 2+ in 14 ) compared to one of 12 (8%, p < 0.0001) benign pancreas and 12/45 (27%, p < 0.0001) chronic pancreatitis. None of the benign tissues demonstrated strong miR-21 expression. Although miR-21 expression did not correlate with tumor size, differentiation, nodal status, or T stage, strong miR-21 expression was predictive of poorer outcome compared to absent or faint/focal miR-21 expression in patients with node negative disease (median 27.7 months vs. 15.2, p=0.037). Nodal status was also predictive of survival (p=0.029)”

Or for that matter, here in this article is the inverse of the loop-hole of expression, and benefits are told through the worm-hole of inhibition…

“This strategy was explored in the current study, where p53 downstream target miR-34 was restored in p53-mutant pancreatic cancer MiaPaCa2 cells with a high level of Bcl-2 and low levels of miR-34s, resulting in downregulation of Bcl-2 and Notch1-2, together with the inhibited clonogenic cell growth and invasion; increased apoptosis and G1 and G2/M arrest in cell cycle; and sensitization to chemotherapy and radiation. miR-34 restoration could thus re-build, at least in part, the p53 tumor suppressing signalling network in pancreatic cancer cells lacking functional p53. This multi-mode action of miR-34 provides a therapeutic advantage over the siRNA-based therapies in that miR-34 has multiple targets, can work on multiple cell signalling pathways at the same time, leading to synergistic effects which may translate into improved clinical efficacy for pancreatic cancer patients with p53 deficiency and advanced disease.”

Interpretation is filtered through the lens of one’s experience. Reasoning is based on critical evaluation that is derived from years of knowledge gathering and experience, sifting through what was evidence to what is evidence now and only through squeezing the fruits of your labor through the ethereal filter of the cognitive cloth, the nectar of reason appears. I doubt that Google searches can deliver that. Sergey might disagree.

So yes, the world is agog with patient centricity but rational decisions can be irrational in times of stress. Take for example the rate of the C-Difficile infection rate differencesbetween the Northeast, 

where everyone seems to know everything, the C-Diff rate is 8/1000 hospital patients. In the South the rate is 5/1000 hospitalized patients. Here the prodigious use of antibiotics is the culprit- a problem both at the consumer demand level and the physician care-delivery level. Judicious use of therapy is equally as important as the reasoned use of diagnostics.

Speaking of Genetics, now there is where real information will flow; and lots of it. But will anyone be able to accurately decipher it. Probably not well. Even geneticists have problems merging the science of DNA (easy) with miRNA (not so easy) and that to translatable proteonomics (even more difficult). Our thinking that one gene defect equates to one disease is unfortunately archaic. Now we have come to realize that even mutations within the BRCA 1 gene segment have varying consequences on health.

From there we have come to the “BRCAness of breast cancer disease process.” Things do go bump during a lifetime with the jumping genes or transposons as Barbara McClintock called them; mating, fusing, halving at will, to always create the “fittest” model of human being.“The progeny of two (such) sister cells are not alike with respect to the types of gene alteration that will occur. Differential mitoses also produce the alterations that allow particular genes to be reactive. Other genes, although present, may remain inactive. This inactivity or suppression is considered to occur because the genes are ‘covered' by other non-genic chromatin materials. Gene activity may be possible only when a physical change in this covering material allows the reactive components of the gene to be ‘exposed' and thus capable of functioning." -- Barbara McClintock”

BRCA 1 & 2 Gene Segments

Such inner experiments by the DNA are not uncommon. So it is better to realize the shades of meanings before we start touting the virtues of genomic diagnostics. We could end up ruining lives and for their “forever,” live in a state of fear of a hazard that never materializes, like a benign nodule in the lung on X-Ray. Yet the fear throws them into the caves of depression and enforces consumption of fifteen different pharmaceutical agents via televised broadcasts of longevity and that, my dear friends in some cases becomes the norm.

Just before we go drinking that “milkshake of nirvana health” from the blender, let us consider the consequences of such a drink. Shall we?

Above all do no HARM!