A Tiny Glimpse into the Immensity of Nanomedicine

Cynthia Beynon, PhD Student

University of Utah College of Nursing

The Change

After Robert Hooke and Antoni van Leeuwenhoek first saw microscopic fungi, protozoa, and bacteria in the 1660’s, the whole world of medicine was transformed.  This new perspective revolutionized our understanding of illness prevention and intervention, making the previous best efforts of well-meaning individuals not only obsolete, but imprudent (Gest, 2004).  Decades from now, we may compare this change with current discoveries underway in the even more minute world of nanotechnology.

Size

According to nano.gov, “the prefix "nano" means one-billionth, or 10^-9; therefore one nanometer is one-billionth of a meter” (Nano.gov, 2017).

(Paumier, 2003)

For a bit of perspective, watch this video from the World Science Festival (Festival, 2013): How Big is a Nanometer?

Definition

Nanotechnology is manufacturing and manipulation of particles with at least one dimension that measures between 1-100 nm (Nano.gov, 2017).  Components used include nanoparticles, quantum dots, nanotubes, fullerenes, nanowires, etc. (Nanowerk.com, 2017).  This site can even direct you to order these nanoproducts!

Nano-size fragments exponentially increase the surface area available for manipulation and demonstrate unique properties in composition, agglomeration, structure, charge, and solubility (Nikalje, 2015).  Additionally, “Cellular responses are critically different at the nano-scale level” (Banik, 2016, p. 271).

History

Evidence of the use of nanotechnology dates as far back as the 4^th century, but it was not until the late 1800s that scientists began to understand and experiment with nanostructures.  The term “nanotechnology” was first coined by Taniguchi, a professor in Tokyo in 1974.  Nanotechnology companies emerged in the United States in the 1990s, and during the next decade, products that contained nanotechnology began to appear on the market.  Also in 2000, the National Nanotechnology Initiative (NNI) was created, and funding from Congress followed in 2001 (Nano.gov, 2017).

In 2008, Science Daily reported there were 2-4 new products entering the market every single week (ScienceDaily, 2008).  Maintaining a useful Nanotechnology Consumer Products Inventory has proved challenging, in part due to a lack of standardization and measurement in composition and labeling. Additionally, a significant number of products that claimed to use nanomaterials do not appear to be credible. A revised inventory from 2013 listed “1814 consumer products from 622 companies in 32 countries” (Vance, 2015, p. 1769).

Applications

Research in nanotechnology results in an almost incomprehensibly broad range of applications:  fabrics, personal care, household products, computers, vehicles, electronics, transportation, energy, water purification, and environmental sustainability, just to name a few.  Here are some examples of nanotechnology-developed products you may be familiar with ("Discover," 2010).

In the field of Nano medicine, some areas of particular focus have included cancer treatment, antibiotic resistance, drug targeting, diagnosis and imaging, and vaccine delivery.  Current research in immunotherapy is investigating the use of nanoparticles that incorporate peanut extract as an oral agent to desensitize patient and prevent anaphylaxis  (Nowak-Wegrzyn, 2017).  Researchers are working to increase availability and serviceability of the Hepatitis B vaccine by developing a mucosal delivery method utilizing nanotechnology (Eng-Kiong, 2016).  Other scientists concerned with the detrimental effects of ultraviolet radiation on human skin introduced nanoparticles titanium dioxide and zinc oxide to develop a sunscreen that no longer leaves the familiar white cream on the skin (Baron, 2016).  

As of July 18, 2017, ClinicalTrials.gov search results for “nanotechnology AND nano” yielded 185 studies in the following areas: heart failure, hernia, multiple sclerosis, asthma, chronic obstructive lung disease, renal cell carcinoma, prostate cancer, dental caries, Parkinson’s disease, coronary stenosis, metabolic syndrome, diabetes, yeast infection, environmental contamination, cryptococcal infections, leukemia, menopause, and many more (ClinicalTrials.gov, 2017).  

ClinicalTrials.gov - provides patients, their family members, and the public with easy and free access to information on clinical studies for a wide range of diseases and conditions.

Risks and Concerns

Nanotechnology is not without its concerns.  Some researchers have expressed apprehension regarding potential toxicity.  What effect will nanoparticles have when they are percutaneously absorbed (Baron, 2016)?  What effect will breathing nanoparticles have on the respiratory system (Goldman, 2017)?

In Europe, regulators took a more cautious position about the introduction of nanotechnology, while regulation has been minimal in the USA. There is a lack of research regarding long-term implications, and concerns about nominal regulation and limited guidelines  (ScientificAmerica.com, 2009).

Other concerns involve financial and ethical implications of developments in nanotechnology. An article published in The New York Times in July of 2017 announced the approval of a gene-altering leukemia treatment.  The drug, CTL019, was associated with an 82.5 percent remission rate.  The exciting news brings hope, but it is not without misgivings.  Treatment is predicted to cost $300,000 or more (Grady, 2017).  The financial ramifications of nanotechnology are worth consideration.  Who will pay for this treatment?  Will it be available for everyone? Or will physical suffering and life-expectance be directly dependent on economic status?

Additionally, nanotechnology is a booming business.  According to the National Science Foundation, worldwide revenue from Nano-enhanced products was 1 trillion dollars in 2013 ("Market report on emerging nanotechnology now available," 2014). When something is so profitable, how closely do producers look at the long-term ramifications and safety concerns?

To Learn More

1. Order the Big Things from a Tiny World brochure from Nano.gov.
2. Watch a video about nanotechnology.  Here are some options from NBCLearn and YouTube.
3.  Read a journal.  Multiple publications are devoted to nanotechnology research and application, including Nanotechnology; Journal of Nanoscience and Nanotechnology; Nanomedicine: Nanotechnology, Biology, and Medicine; Journal of Nanoparticle Research; Nano Research; NANO.  Check out this link for information about Nanotechnology Journal Impact Factors. (OMICSonline.org, n.d.)
4. Attend a conference.  There are many opportunities to attend a workshop or conference and learn more about nanotechnology.  Here are some conference ideas.  (OMICSonline.org, n.d.)

In Conclusion

This October, celebrate Nano Day!  Since a nano is 10^-9, October 9^th has been designated the day to celebrate all things Nano.  You can participate in films, podcasts, and seminars—and even run the one hundred billion nanometer dash! 

The impact of nanotechnology is reaching into multiple aspects of our lives, and so far we are barely seeing the tip of the iceberg.  Look for exciting things ahead as previously unimaginable things become possible through nanotechnology! 

References

Banik, B. L., Fattahi P., & Brown, J. L. (2016). Polymeric nanoparticles: the future of nanomedicine. WIREs Nanomed Nanobiotechnology, 8, 271-299. doi:10.1002.wnan.1364

Baron, E. D. (2016, December 7, 2016). Selection of sunscreen and sun-protective measures. UpToDate.  Retrieved from https://www-uptodate-com.ezproxy.lib.utah.edu/contents/selection-of-sunscreen-and-sun-protective-measures?source=search_result&search=selection%20of%20sunscreen%20and%20sun-protective%20measures&selectedTitle=1~150

ClinicalTrials.gov. (2017).   Retrieved from ClinicalTrials.gov

Discover. (2010). Science for the the curious; the 9 best nanotechnology-powered products.  Retrieved from http://discovermagazine.com/galleries/zen-photo/n/nanotech-products

Eng-Kiong, T. L., A. (2016, August 9, 2016). Hepatitis B virus vaccination. UpToDate.  Retrieved from https://www-uptodate-com.ezproxy.lib.utah.edu/contents/hepatitis-b-virus-vaccination?source=search_result&search=hepatitis%20b%20virus%20vaccination&selectedTitle=5~150

Festival, W. S. (2013). How Big is a Nanometer?

Gest, H. (2004). The discovery of microorganisms by Robert Hooke and Antoni van Leeuwenhoek, Fellows of The Royal Society. Notes and Records of the Royal Society of London, 58(2), 187-201. doi:10.1098/rsnr.2004.0055

Goldman, R. H. (2017, Feb 21, 2017). Overview of occupational and environmental health. UpToDate.  Retrieved from https://www-uptodate-com.ezproxy.lib.utah.edu/contents/overview-of-occupational-and-environmental-health?source=search_result&search=overview%20of%20occupation%20and%20environmental%20health&selectedTitle=1~150

Grady, D. (2017). F.D.A. panel recommends approval for gene-altering leukemia treatment. The New York Times, p. 5. Retrieved from http://nyti.ms/2ua97p5

Market report on emerging nanotechnology now available. (2014). [Press release]. Retrieved from https://www.nsf.gov/news/news_summ.jsp?cntn_id=130586

Nano.gov. (2017). Size of the nanoscale. National Nanotechnology Initiative.  Retrieved from https://www.nano.gov/nanotech-101/what/nano-size

Nanowerk.com. (2017). Nanomaterials database.   Retrieved from nanowerk.com/nanomaterial-database.php

Nikalje, A. P. (2015). Nanotechnology and its applications in medicine. Medicinal Chemistry, 5, 81-89. doi:10.4172/2161-0444.1000247

Nowak-Wegrzyn, A. (2017, July 10, 2017). Investigation therapies for food allergy: oral immunotherapy. UpToDate.  Retrieved from https://www-uptodate-com.ezproxy.lib.utah.edu/contents/investigational-therapies-for-food-allergy-oral-immunotherapy?source=search_result&search=nanoparticles&selectedTitle=2~12

OMICSonline.org. (n.d.). Nanotechnology journals.   Retrieved from https://www.omicsonline.org/nanotechnology-journals-impact-factor-ranking.php?gclid=CjwKCAjw8IXMBRB8EiwAg9fgMPez-OqVHoBcjU0HqCcxOvQi-RD9yRudfe1EfMiH-qTSJfUKIPrgtxoCe6oQAvD_BwE

Paumier, G., Ronan, P., NIH, Fijalkowski, A. J., Walker, J., Jones, D., Heal, T., & Ruiz, M. (2003). Biological and technological scales compared Biological and technological scales compared-en, CC BY-SA 2.5

 Science Primer (National Center for Biotechnology Information), Liquid_2003, Arne Nordmann & The Tango! Desktop Project.

ScienceDaily. (2008). Project on Emerging Nanotechnologies: new nanotechnology products hitting the market at the rate of 3-4 per week. ScienceDaily. Retrieved from sciencedaily.com/release/2008/04/080424102505.htm

ScientificAmerica.com. (2009). Are nanotech consumer products safe? Scientific American.  Retrieved from https://www.scientificamerican.com/article/are-nanotech-consumer-products-safe/

Vance, M. E., Kuiken, T., Vejerano, E. P., McGinnis, S. P., Hochella, M. F., Jr., Rejeski, D., & Hull, M. S. . (2015). Nanotechnology in the real world: redeveloping the nanomaterial consumer products inventory. Beilstein Journal of Nanotechnology, 6, 1769-1780.

Glucose Control in Intensive Care Unit: Where Innovation and Technology Will Help?

Vanessa De Azevedo, RN - PhD Student
College of Nursing
University of Utah

What is Stress Induced Hyperglycemia?

Stress Induced Hyperglycemia (SIH) is characterized by level of blood glucose of 140 mg/dl or higher in patients receiving treatment in Intensive Care Unit (ICU) from surgery, traumatic injury, and critical or acute medical illnesses. Regarding the reason for admission in ICU, the presence of hyperglycemia is associated with increased morbidity and mortality. Patients with or without previous diagnose of Diabetes are also susceptible to present hyperglycemia when involved in critical scenarios.

Excessive counter regulatory hormones (e.g. glucagon, growth hormone, catecholamine and endogenous or exogenous glucocorticoid), and high circulation or tissue levels of cytokine are the causes of SIH. Such a condition makes insulin incapable of combating hepatic gluconeogenesis (the formation of glycose by the liver) responsible for blood glucose levels, and also makes the absorption of glucose into skeletal muscles impaired. In addition, intravenous nutrition therapy commonly received in critical settings is also responsible for events of hyperglycemia.

It is well known in medicine that controlling SIH in critical patients is a challenge for health care providers. The ideal blood sugar target range is 70-110 mg/dl; however, the high risk of hypoglycemia is eminent when such a target is applied. Researchers are trying to find a safer ways to control patients’ glycemic level without producing adverse hypoglycemia events. Insulin protocols, randomized control trials (RCT), and revision of guidelines have been done to solve such an important issue.

        What happens if a patient presents hyper or hypoglycemia when in ICU?

        Hyperglycemia is characterized by blood sugar level higher or equal to 110 mg/dl in a healthy person. Considering critical patients, high levels of blood sugar (< 140 mg/dl) can result in mitochondrial damage, endothelial dysfunction, and immune suppression, leading to an increased risk of infection. Indeed, SIH can result in polyneuropathy which requires a longer use of mechanical ventilation and longer hospitalization in ICU.      

        

       Hypoglycemia is defined as blood glucose level below or equal to 70 mg/dl. Glucose is not a villain for our body, it is also a metabolic fuel for the brain. Lack of glucose in the human body can be the consequence of a tight glucose control in ICU, in other words, excessive amount of insulin administrated when restrictive insulin protocols are applied. Other causes of hypoglycemia are inadequate nutrition, and insufficient provision of glucose. If untreated, hypoglycemia can result in permanent brain damage and death.

        

       Both hyperglycemia and hypoglycemia if not properly treated can result in poor care outcomes and even death.

        What has been done to avoid SIH in ICU settings?

        After a detection of blood sugar elevated, physicians prescribe an insulin protocol which consists of an intravenous administration of regular insulin (fast acting) through a pump. The dose of insulin is calculated by the level of glucose measured at the moment of administration. Through a simple but reliable glucometer, the blood glucose level is measured. The blood sample can be collect through finger sticks, and venous or arterial line. Arterial blood is the most accurate source for accessing glycemic level. 

       The insulin protocol requires hourly glycemic assessments in order to manage the insulin dose administrated. Such approach causes a delay in treatment which might result in adverse events such as hypoglycemia. The American Diabetes Association (ADA), the American College of Critical Care Medicine (ACCM), and the American Association of Clinical Endocrinologists (AACE) recommend a target glucose range of 140-180mg/dl. They also recommend the use of paper-based or computerized protocols that allow for predefined adjustments in infusion rate based on glycemic fluctuations and insulin dose, and initiation of intravenous insulin protocol at 180 mg/dl. Furthermore, hypoglycemia protocols should be established for each patient. The goal of the guidelines above is to avoid hypoglycemia and hyperglycemia and to mitigate adverse outcomes.

What is the role of nurses taking care of patients with insulin protocol in ICU?

        Nurses play a crucial role in glycemic management. They assess glycemic level from the beginning to the end of the therapy, making critical decisions that will impact the evolution of the therapy, and patient care outcomes.

        

       Such responsibilities require time, attention, dedication, and application of scientific knowledge. Once insulin therapy is initiated, nursing workload will increase.

Why do we need a change?

        Hourly glycemic assessment is not enough when managing insulin protocols. The need for a more tight control is essential to avoid adverse events such as hyper or hypoglycemia.

        

        There is consensus among researchers that the more tight the glucose levels (70 -110 mg/dl) the more benefits patients will have. However, such a tight control is not recommended due to high incidence of hypoglycemia it may cause.

        

         Hourly measurement with glucometers and finger sticks will result in hematomas, and consequently poor quality of a blood sample. Indeed, such an approach will increase nursing workload which can drive nurses away from other critical care conditions that might require special attention.

Where innovation and technology can help?

        Currently in the market we have devices such as continuous glucose monitoring and bionic pancreas that are helping patients with Diabetes types 1 and 2 to self-manage their blood glucose. Even though, critically ill patients are not necessarily in the scope of diabetes, they will certainly be beneficiated with such technology in ICUs.

What is CGM? 

Illustration of a continuous glucose monitoring Dexcom G4, retrieved from: https://diatribe.org/issues/48/test-drive

Continuous Glucose Monitoring (CGM) is a device that was initially designed with the purpose of helping Diabetes Type 1 patients to self-manage their blood sugar. Such an equipment contains a glucose sensor, a transmitter, and a display. The sensor captures and measures in real-time glucose fluid in the subcutaneous tissue. Connected to a transmitter, glucose levels are send wirelessly via radio frequency to the monitor display device.

What is Bionic pancreas? 

Top figure represents a bionic pancreas monitor, retrived from: https://diatribe.org/introducing-beta-bionics-bringing-ilet-bionic-pancreas-market . 

Bottom figure respresents an ilustration of how artificial pancreas works. Retrieved from: http://discovermagazine.com/2016/may/13-priming-the-pump

Bionic pancreas is a device that aims at imitating the human pancreas delivering insulin and glucagon hormones based on a blood sugar result measured every five minutes. The system consists of a dual pump (one for insulin and one for glucagon) that receives information from a separate sensor –CGM- and automatically calculates the exact dose of hormone a patient needs.

What to expect using CGM and Bionic Pancreas in ICU?

In conclusion, the addition of the new technology in ICU settings will lead to a real-time management of glycemic levels, reduction of nursing workload, and more accurate and safe levels of glucose. CGM and bionic pancreas will help prevent/manage SIH by simulating an almost real and effective human pancreas resulting in reduction of incidence of infection, hospital length of stay, and better patient outcomes.

References and suggested links for further reading:

https://www.medtronicdiabetes.com/treatments/continuous-glucose-monitoring

http://www.ndei.org/ADA-diabetes-management-guidelines-in-patient-glycemia-targets-critically-ill.aspx.html

http://inpatient.aace.com/strategies-for-achieving-glycemic-control-management-of-hyperglycemia-in-the-critical-care-setting

http://www.bionicpancreas.org

https://diatribe.org/introducing-beta-bionics-bringing-ilet-bionic-pancreas-market

McCowen,K.C., Malhotra, A., Bistrian, B.R. (2001). Stress-Induced Hyperglycemia. Critical Care Clinics, 17(1), 107-124. Doi http://dx.doi.org/10.1016/S0749-0704(05)70154-8

Harp, J. B., Yancopoulos, G. D., & Gromada, J. (2016). Glucagon orchestrates stress-induced hyperglycaemia. Diabetes, Obesity and Metabolism, 18(7), 648-653. doi: 10.1111/dom.12668

Godinjak, A., Iglica, A., Burekovic, A., Jusufovic, S., Ajanovic, A., Tancica, I., & Kukuljac, A. (2015). Hyperglycemia in Critically Ill Patients: Management and Prognosis. Medical Archives, 69(3), 157-160. doi: 10.5455/medarh.2015.69.157-160

Lacherade, J.-C., Jacqueminet, S., & Preiser, J.-C. (2009). An Overview of Hypoglycemia in the Critically Ill. Journal of Diabetes Science and Technology, 3(6), 1242–1249.

Brunner, R., Kitzberger, R., Miehsler, W., Herkner, H., Madl, C., & Holzinger, U. (2011). Accuracy and reliability of a subcutaneous continuous glucose-monitoring system in critically ill patients. Critical Care Medicine, 39(4), 659-664. doi: 10.1097/CCM.0b013e318206bf2e

De Block, C., Manuel, Y. K. B., Van Gaal, L., & Rogiers, P. (2006). Intensive insulin therapy in the intensive care unit: assessment by continuous glucose monitoring. Diabetes Care, 29(8), 1750-1756.

Harris, D. L., Battin, M. R., Weston, P. J., & Harding, J. E. (2010). Continuous glucose monitoring in newborn babies at risk of hypoglycemia. Journal of Pediatrics, 157(2), 198-202.e191. doi: 10.1016/j.jpeds.2010.02.003

Research Dissemination using Social Media: Your chance to “Go viral”

Ruth Tadesse, RN, MS

PhD Student, College of Nursing

University of Utah

A quick review of the history of the Internet may be useful when discussing the ongoing shift in research dissemination. The Internet Society briefly summarizes the history of the Internet and reminds us what the Internet does by stating “The Internet is at once a world-wide broadcasting capability, a mechanism for information dissemination, and a medium for collaboration and interaction between individuals and their computers without regard for geographic location.”  It is this remarkable aptitude to connect people like any other medium that has made the Internet a unique platform to researchers who are not only are responsible for producing new knowledge but also for disseminating it.  As the graph below depicts, the Internet has come a long way since its inception in 1969.  Today, with available social tools, such as blogging and microblogging, the way scientists communicate about their research work is shifting undeniably from the traditional method of publishing in peer-reviewed journals. 

Image source: MALONEMEDIAGROUP

What is available on google?

A preliminary search on google using words “social media for health science researchers” resulted in close to 5-milion sites; another search using “twitter and blogs for health science research dissemination” retrieved 881,000 sites discussing topics ranging from public health to ePatient and eMedicine. Most of the information found on the Internet on research and social media is filled with information on “how to tips” signaling that the use of social media for research dissemination is new and an ongoing paradigm shift, and one that may not be fully utilized by current researchers.   

Social Media: A guide for researchers is published by scientists in the UK who have experience using social media, and introduces readers to ten other social media users.  Using the words of the authors, the guide was created “to show how social media can change the ways in which you undertake research, and open up new forms of communication and dissemination.” The content of the guide includes advantages and disadvantages of using social media for researchers.  Most importantly, the guide encourages readers to consider the following questions when using social media for research dissemination:

• What is the appropriate tone for publication of scholarly ideas via social media?  Do I write as if I were producing a conventional academic article or do I need a different approach?
• What should I publish and when?  Do I wait for things to be published in academic journals or can I start dissemination earlier?
•  Are there intellectual property and copyright implications if I make ideas and results available using social media?
•  Who is my audience?   

Social media impact and popularity: Intended or unintended consequence?

While researchers are advised to be thoughtful and consider the above questions, they are also encouraged not to be fearful of the impact of social media. Anne Weiler, co-founder and CEO of wellpepper, a website that declares to deliver “powerful analytics for healthcare organizations and awesome tools for end-users both patients and providers” wrote a blog about research dissemination with a little twist of “Publish or Perish” mantra.  She titled her blog post: “Post or Perish: Disseminating Scientific Research and the Kardashian Index.” She is one of the several bloggers who provides several useful tips about using social media for disseminating research. She cautions her readers to not dismiss the Kardashian Index stating “Popularity and valid information do not need to be mutually exclusive.”  

Image source: The HOST GROUP

Becoming viral: What does it mean for your research?

If you have posted your research on social media, whether it went viral or not, it is likely that your work has gone noticed and created a discussion.  In fact, this is one of the stark differences between the traditional method of research dissemination - publishing in peer-reviewed journals and disseminating research using social media. Nonetheless, anyone who is doubtful of this fact may want to read the paper written in 2011 by Dr. Gunther Eysenbach, a researcher who is known for his work on eHealth and consumer health informatics.  He wrote a paper in the Journal of Medical Internet Research on a study he conducted about twitter impact factor.  His paper titled “Can Tweets Predict Citations? Metrics of Social Impact Based on Twitter and Correlation with Traditional Metrics of Scientific Impact” explores the impact of twitter and compares it with the traditional method.  He reported highly tweeted articles are 11 times more likely to end up being highly cited. Dr. Eysenbach recognizes the relationship between social media buzz and articles cited is an association acknowledging a causation does not exist.  However, scientists will be wise to pay attention to this correlation and be informed about the impact of social media. 

In 2014, Gibbs et al., nurse leaders invited their core research team to pose for a photograph holding a sign explaining why they do research.  They posted the photograph on their department Twitter account using hashtag #WhyWeDoResearch and they write “what began as a simple way to introduce the research team to clinical colleagues, patients, and the local public gained momentum and attracted national and international attention…”  Their campaign has now reached 22 countries, has 8,600 participants, over 137 million impressions and over 93,000 tweets. Gibbs et al. (2015) paper published in Nursing Times titled “Clinical research benefits go viral via Twitter” is worth reading for those of us who are still contemplating of using social media or are not informed about the potential of this new paradigm. 

Blogging for reach and impact

For researchers who feel 140 words afforded by Twitter are a constraint for research dissemination, Research Blogging (RB) may be their answer.  The site was created in 2007 by the scientific blogger Dave Munger who was using an icon to distinguish posts about peer-reviewed research from other blogs.  Currently, Research Blogging site has over 1,230 active blogs, with over 26,960 entries posted about peer-reviewed research on different subjects in seven different languages including English, Spanish, and Chinese to name a few.  The site is known for being “a central means of disseminating findings of peer-reviewed research that bloggers have found interesting to read and analyze.” You can learn all about RB by reading an online article What is: ResearchBlogging.org posted on Scientific American by Bora Zivkovic.

Summary

On a final note, researchers are sensibly advised to choose their audience when disseminating research. One audience that they may not afford to discount are health policy makers who are in a position to translate evidence into practice. With regards to this, the findings of Kapp et al. (2015) paper may be informative for those who want to communicate with policy makers at the congress level in a timely manner.  In an era, when direct communication with congress and the public is possible using social media, researchers should take a note and capitalize on this ongoing paradigm shift of research dissemination.

Links to Hyperlinked Text:

Internet Society: http://www.internetsociety.org/internet/what-internet/history-internet/brief-history-internet

Social media for health science researchers: https://www.google.com/#q=Social+media+for+health+science+researchers

Twitter and Blogs for health science research dissemination: https://www.google.com/#q=Twitter+and+Blogs+for+health+science+research+dissemination

Social Media: A guide for researchers: http://www.rin.ac.uk/system/files/attachments/social_media_guide_for_screen_0.pdf

wellpepper: http://www.wellpepper.com/

Post or Perish? Disseminating Scientific Research and the Kardashian Index: http://www.wellpepper.com/post-or-perish-disseminating-scientific-research-and-the-kardashian-index

Kardashian Index:

http://genomebiology.biomedcentral.com/articles/10.1186/s13059-014-0424-0

Dr. Gunther Eysenbach: http://ehealthinnovation.org/people/gunther-eysenbach/

#WhyWeDoResearch: http://whywedoresearch.weebly.com/

Research Blogging: http://researchblogging.org/

Key References:

Eysenbach, G. (2011).  Can tweets predict citations?  Metrics of social impact based on Twitter and correlation with traditional metrics of scientific impact.  Journal of Medical Internet Research, 13(4):e123.

Gibbs, CL, Greaves, A., Keeling, M., Gaw, A., & O’Neill, F. (2015).  Clinical research benefits go viral via Twitter. Nursing Times, 111(19): 16-17.

Kapp, JM, Hensel, B., Schnoring, KT (2015).  Is Twitter a forum for disseminating research to health policy makers?  Annals of Epidemiology, 25(12), 883-887.

Zivkovic, B. (2011).  What is: ResearchBlogging.org retrieved from 
http://blogs.scientificamerican.com/network-central/what-is-researchblogging-org/

Personalized Healthcare, Personalized Medicine, Precision Medicine- what are they, do they mean the same thing, and why is it important?

Natalie Jackson
PhD Student, College of Nursing
University of Utah

Image:  www.123rf.com

I conducted an unscientific poll by simply asking people what these terms meant to them.  The most common answer (again, remember, unscientific poll) was, “healthcare that’s about you personally.”   When pressed for greater specificity as to whether the three terms all mean the same thing, the majority of people said "yes".  Very few people could provide a precise definition for any of the three terms, and most head never heard on any of the terms.  Does a precise definition exist, and does the average person need to know what these terms mean?  A google search for each of these terms was conducted. 

Personalized Healthcare:

Very conveniently, the Cleveland Clinic asked my very question, “What is Personalized Healthcare?  From patients to medications, one size does not fit all,” https://health.clevelandclinic.org/2012/05/what-is-personalized-healthcare/.  The article notes that many definitions exist, and that (as in my unscientific survey) people will use personalized healthcare and personalized medicine interchangeably.  They note that personalized medicine includes genetics and genomics; more broadly, personalized healthcare includes both of these items but adds in, “any other biologic information that helps predict risk for disease or how a patient will respond to treatments.”

Even though my poll was unscientific, I know we can’t choose only one website and think we have an answer.  Further down on the first page of my google search I find, “Program in Personalized Health Care - University of Utah Sciences” http://healthsciences.utah.edu/phc/.  Luckily, this website has a tab that asks the same question that the Cleveland Clinic does, “What is Personalized Healthcare?” The answer is, “Personalized Health Care is the tailoring of health care to the individual characteristics of the patient. These characteristics can include environment, social history, health history, family history, genetics, proteomics, and more.”  Note the word “can”.  This definition seems to imply that genetics and genomics don’t necessarily need to be part of personalized healthcare. 

Already, we can see that different definitions of personalized healthcare exist.

Personalized Medicine:

We already know from the Cleveland Clinic’s website that they believe personalized medicine includes genetics and genomics.  Again, let’s see if there are other definitions.

A google search of the term “personalized medicine” leads to the following governmental website: http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PersonalizedMedicine/UCM372421.pdf. This pdf titled, “Paving the Way for Personalized Medicine, FDAs Role in a New Era of Medical Product Development” includes the following definition of personalized medicine from the Commissioner of the FDA, Margaret A. Hamburg, “the tailoring of medical treatment to the individual characteristics, needs and preferences of each patient..."  The article emphasizes that this paradigm introduces emerging science and technology that will focus on therapeutics targeted to the individual while also considering the interplay of genes, anatomical and physiological differences, environment, social, and cultural and how all of these elements might affect how each individual responds to disease. The FDA description appears to include the whole person and even elements outside of the individual that might affect a person’s response to disease. However, the shift toward personalized medicine is not without potential downsides.  An article from CNBC,  http://www.cnbc.com/2015/12/04/personalized-medicine-better-results-but-at-what-cost.html, discusses the expense associated with this paradigm, and notes that it will take time to determine if the expense pays off.

Precision Medicine:

Again, as with the previous two terms, I conducted a google search of “precision medicine”.  The National Institutes of Health notes that, "Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person,” https://www.nih.gov/precision-medicine-initiative-cohort-program.  President Obama has launched a Precision Medicine Initiative with $215 million in funding for 2016 that includes formation of over a million participants to be part of a precision medicine research cohort.  See the infographic below for more details.

Again, as with personalized medicine, questions exist as to whether the money is worth investing in precision medicine. The website for the journal “Scientific American” has a June 1, 2016 article titled, “The Paradox of Precision Medicine” http://www.scientificamerican.com/article/the-paradox-of-precision-medicine by Jeneen Interlandi.  The article notes that debate continues over whether precision medicine will indeed transform healthcare, and, as with the article from CNBC, cost is a concern.

What did my unscientific search for the definitions of the three terms reveal?

Hard and true definitions for any of these three terms seem to be elusive.  What can be said is that these terms all appear to reference a changing paradigm in health care that focuses more on individual characteristics than the previous one “one size fits all” paradigm.  These characteristics might include genetics, environment, family history, social history, culture… all factors that influence your individual health.  A predominant concern regarding this paradigm appears to be cost.

FINALLY….IS THIS TYPE OF HEALTHCARE OR MEDICINE IMPORTANT TO ME AND WHY IS THIS NEW?

This paradigm shift assumes that accounting for factors such as genetics, environment, and lifestyle, to name a few, will provide improved health outcomes for individuals.  The previous paradigm and its assumption of “one size fits all” has not shown great results, despite spending nearly 18% of GDP on healthcare health metrics do not show stunning success.  According to a Commonwealth Fund article, The United States spends more money on healthcare than 12 other countries, but shows worse outcomes in life expectancy and for a number of chronic conditions, http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective. 

In monetary terms alone, these terms and this type of healthcare and medicine should be important to everyone because 18% of GDP represents a large amount of money being spent on current healthcare strategies that produces dubious healthcare.  Regardless of what it is called, the move to personalized healthcare, personalized medicine, or precision medicine will affect people on the individual and societal level.

Healthcare costs, resources, access, priorities of care, and ethics are beautifully covered in the following article. 

Just Caring:  Assessing the ethical and economic costs of personalized medicine, Leonard M. Fleck, Ph.D, UrologicOncology: Seminars and Original Investigations 32(2014)202–206  Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI,

Key Points from the article:

What is a just and caring society when our resources are limited and our healthcare needs are unlimited?  What are people willing to pay?

Constantly new and improving medical technology and interventions create new health care needs and increases costs

Need to prioritize- we cannot meet all the needs of every person

Social justice- how do we decide?  What are the norms to make these decisions?

An example from the article, and something to think about:

•       Personalized cancer research

•       Targeted cancer therapy costs: $70,000- $130,000/treatment

•       Most only increase life expectancy by weeks or months

•       Is this cost-effective?

•       Is this a fair allocation of limited social resources

•       QALYS- quality-adjusted life years

•       Nearly 600,000 people in US die each year from cancer- if each person used only one of these drugs, it would add $60 billion to our health care bill

•       Should this money be used on other healthcare needs that will yield higher quality life years at lower cost?

•       As a society we need to find a way to decide what we will spend our limited resources on

Additional Links:

The following links provide information on the University of Utah’s involvement in the paradigm shift toward personalized healthcare, personalized medicine, and precision medicine:

http://medicine.utah.edu/ccts/

http://healthcare.utah.edu/healthfeed/postings/2013/10/101013.ctsaaward.php

http://healthsciences.utah.edu/utah-genome-project/blog/2016/040516%20-Beckerle-blue-ribbon.php

http://healthcare.utah.edu/publicaffairs/news/2016/02/biden_visit.php

http://healthsciences.utah.edu/utah-genome-project/about/index.php

http://healthsciences.utah.edu/notes/postings/2015/01/012915_personalizedmed.php#.V4AHZKLe7nk

https://health.clevelandclinic.org/2012/05/what-is-personalized-healthcare/

http://healthsciences.utah.edu/phc/

http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PersonalizedMedicine/UCM372421.pdf

http://www.cnbc.com/2015/12/04/personalized-medicine-better-results-but-at-what-cost.html,

https://www.nih.gov/precision-medicine-initiative-cohort-program

http://www.scientificamerican.com/article/the-paradox-of-precision-medicine/

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

Just Caring:  Assessing the ethical and economic costs of personalized medicine, Leonard M. Fleck, Ph.D, UrologicOncology: Seminars and Original Investigations 32(2014)202–206  Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, MI.