Google's Project Loon - The (Ballon) Technology

Leprosy and eHealth

I found this story  in my Google Reader I think because my search query for RSS news feeds is set on Health informatics and bioinformatics. The focus of the article is the fund raising of David Bousfield for leprosy. I think Google picked up that David was "an expert in biomedical publishing and informatics". Anyway, who doesn't think leprosy is a terrible disease? We don't see it much here in Canada, but I have seen it in Guatemala, South Korea, Nepal and quite up close in India. Seeing it in South Korea was very rare until I remembered that a friend of mine worked there with the Peace Corps in the 1980s helping treat persons with leprosy.  In India, one may meet persons with leprosy on almost any given day of the week, or so it might seem.

Maybe there can be an eHealth solution to assist in this cause, as David says:

“Being a repeat rider you become aware of how global healthcare is evolving. What Lepra originally did was distribute drugs, but these days it’s about information. The drugs are there but it has become more focused on making that link between somebody who has the disease, where the drug is and what you’ve got to do to get it.”

Just get some recycled cell phones, and a used computer to act as a messaging server, and an SMS system can really do wonders in terms of collecting information and helping to create a support structure. It has been done successfully by FrontlineSMS all over the world. Of course some persons with this disease are not going to be able to handle a cell phone, and that's were some other forms of adaptive technology might come in. For example, isn't Google Glass kind of a hands free voice activated system?

Yes, I know that lepers wearing Google Glass isn't going to happen overnight and Google Glass isn't on the market yet in order to create recycled items or competitive items to drive the price down - it is just a fact that new technologies kind of cycle this way and end up on the "bottom of the pyramid" at the same time as they start to support the structures above.

David's £50k helps the fight against leprosy

David Bousfield recently completed his 10th gruelling cycle ride in aid of a charity at the frontline in the fight against leprosy – taking his fundraising total to almost £50,000. He tells LOUISE MARTIN why it’s time to remove the stigma associated with the disease.

Riders and support crew

Every two minutes in the world, and every four minutes in India, someone is diagnosed with leprosy. One of the oldest and most stigmatised of diseases, leprosy is a chronic infection of the skin and nerves; left untreated it can lead to loss of sensation in hands and feet, ulcers and deformities, and can even result in blindness.
India is home to more than half of the world’s new cases of leprosy each year. The disease thrives in the country’s poor, overcrowded areas where the chronic condition is easily spread via coughing and sneezing. Every year, the international health charity Lepra transforms the lives of 73,000 people with leprosy by working at the frontline to treat, educate and rehabilitate those affected by leprosy – as well as other diseases associated with poverty and prejudice including TB, HIV, lymphatic filariasis and malaria.

As the world’s first ever leprosy prevention organisation Lepra’s work is crucial, but it can only continue its life-saving work with the support of dedicated fundraisers like Cambridge resident David Bousfield.

An expert in biomedical publishing and informatics, 63-year-old David got involved with the charity in January 1999. “I saw a tiny advert in The Guardian saying ‘Do you want to get fit? Do you want to go to Brazil? Do you want to do something worthwhile?’” he remembers.

“They were all things on my list of New Year resolutions so I thought I could tick them all off in one go.”

The trip to Brazil was based around a 450-mile group cycle ride which helped to raise vital funds for the charity, while visiting some of the communities it works to support. Although interested in the charity’s work, David admits at the time, for him, the real draw was the cycling. “Brazil kind of got me hooked on the bike rides but my attitude has slightly changed,” he says. “To begin with it was an opportunity to go with a group of people and cycle in a country that I wanted to know more about and what Lepra did was the bit on the side. But now, because of the work that I do, I’ve become more interested in how health information is used in developed countries, so it’s an interesting way to learn more about what’s happening in developing countries such as India and Brazil.”

A couple of months ago, David completed his 10th cycle ride for Lepra and took his fundraising total for the charity to almost £50,000. As part of a team of 12 cyclists, he accompanied a Lepra health education van across project sites on a 500km route in the state of India’s Madhya Pradesh. The team was visiting poverty-stricken rural villages, health centres and hospitals to give vital health education. The poor areas have low or no literacy rates so the education team teaches communities how to detect the symptoms of diseases through the forms of plays, puppet shows and films broadcasted from the back of rickshaws.

“Compared to many other diseases, there is relatively little known about the leprosy transmission process, apart from that there is a cocktail of drugs to cure it,” explains David.

David back home in Cambridge

“Being a repeat rider you become aware of how global healthcare is evolving. What Lepra originally did was distribute drugs, but these days it’s about information. The drugs are there but it has become more focused on making that link between somebody who has the disease, where the drug is and what you’ve got to do to get it.”

Lepra ’s aim is to make people aware of the symptoms and curability of leprosy and other diseases through education and increasing the charity’s visibility. The organisation has 26 leprosy and TB referral centres across India providing specialist services such as testing and treatment for people with TB and physiotherapy and reconstructive surgery for those with leprosy but, despite there being a cure for leprosy, there is no vaccine to prevent infection in the first place and there is still much prejudice associated with it.

One of the aims of the Lepra cycle rides is to help break the stigma associated with diseases such as leprosy. During the trip, David met a father and his two children who live under a tarpaulin on the side of a road. The mother left her husband and two young daughters, Sita and Gita, after they contracted leprosy. “You see all sorts of things which are absolutely horrific. If you remove the stigma that is associated with leprosy and other diseases so that the village actually helps, people in the village will know what the symptoms are and spot the symptoms and then instead of telling people to get out of the village they’ll tell people to get help. The stigma is still very much there but by acting quickly the infection can be stopped. You have to be pretty quick off the mark to come out with no lasting consequences, but you can stop the infection.”

The November trip was David’s fifth visit to India. Previous cycle rides have been in the Orissa region and this was only the second time the Madhya Pradesh route had been undertaken by a Lepra group and, according to David, it was a positive experience. “It was really great,” smiles David. “The weather was perfect – apart from on the last day when it was very hot – but we cyclists love to grumble and I think at the end of the day if you haven’t had a few really tough days then you don’t have stuff to go back and moan about at home!”
The keen cyclist is modest about his impressive achievement, but the living conditions and hazards on the road are not for the fainthearted. “We rode on some motorways but mostly it was on quiet rural roads. There were some that were very badly water eroded so there were lots of potholes, loose gravel and boulders,” explains David. “Indian driving looks a bit chaotic, and it was a bit hairy in places, but the lorry drivers in particular seemed to be very forgiving and would give us a wide berth.”

In order to cover as many miles as possible the days were long and there was no five-star hotel to relax in at the end of a gruelling stint in the saddle. Yet despite the tough conditions on the road, the team only had to deal with three punctures during the whole 500km route and, to reduce the risk of food poisoning, most meals were prepared by the support team. “The quality of the cooking was so good that it was difficult not to put on weight during the ride,” says David. “We start and end in reasonable hotels and then there are quite a number of government properties in between. There was one guest house which was very basic. There was one double bedroom where the four men were and there was a sitting room where most of the women went, but they had to spill over into the hall. There was only one loo which was in the one bedroom.

A family outside their ramshackle home.

“You do forget the bad times but partly you do know they’re going to be there – there’s always going to be some horrible loo situation!”

David’s wife, Judy, and his two sons, Nick and John, are supportive of his charity work but they haven’t offered to join him on a ride just yet. “It’s just something I do and they absolutely don’t want to come with me,” he smiles.
David has seen first-hand how the vital money he has raised is making a difference and, despite saying that this year’s ride would quite possibly be his last, after just a couple of weeks back at home he is already thinking about next year’s Lepra trip.

“I’ve seen how the money is helping and I suspect if there is another one next year I’ll consider it.”

l For more information about Lepra or to make a donation visit www.leprahealthinaction.org.
louise.martin@cambridge-news.co.uk

40 million cases
40 million people are disabled by lymphatic filariasis. Items as simple as a bucket, soap and special shoes, together with simple techniques taught by Lepra, help people cope
India is home to more than half of the world’s new cases of leprosy each year.
£3 could pay for a special pair of shoes to restore dignity; £5 could pay for a self-care kit to help a patient manage their condition; £25 could pay for a healthworker to visit.
Last year LEPRA helped 700,000 people access diagnosis, treatment and testing.
More than 1.3 billion people worldwide are at risk from infection

iPhone EKG Case - Another piece in the Tricorder XPrize?

I thought the iStethoscope was a pretty good missing piece for the Qualcomm TriCorder XPrize.   I blogged about this before < here >. Here is another component which fits nicely.  It won't be long before a powerful point of care diagnostic smart phone finds it way to FDA approval - and an XPrize winner.

This $200 iPhone Case Is An FDA-Approved EKG Machine

HEALTH CARE IS HURTING, AND THE WORLD IS CHANGING. MORE AND MORE, HOSPITALS WILL FIT IN OUR POCKETS.

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Most iPhone cases just protect your phone from drops. If you’re getting fancy, it may have a fisheye camera lens or a screen-printed back. But what about diagnosing coronary heart disease, arrhythmia, or congenital heart defects? The AliveCor Heart Monitor is an FDA-approved iPhone case that can be held in your hands (or dramatically pressed against your chest) to produce an EKG/ECG--the infamous green blips pulsing patient-side in hospitals everywhere.

“We think that EKG screening can be as approachable as taking blood pressure,” AliveCor President and CEO Judy Wade tells Co.Design.

There are already apps that take your heartbeat, of course. But there’s a big difference between the fast-paced standards of casual electronics and the strict sanctions of government-approved medical devices. “The heartbeat camera apps are good at wellness,” Wade admits, “but we see ourselves for use by people who want clinical-quality equipment.”

IMAGINE THE POTENTIAL: IN-APP PURCHASE FOR A FOLLOW-UP APPOINTMENT.

So unlike most iPhone cases that are squirted by Chinese factories at extremely high margins, AliveCor’s case has been in serious development since 2010. Aside from building the gadget itself, to become approved for medical use by the FDA, AliveCor had to participate in two clinical trials to field test both the hardware and the accompanying app. One study investigated how its single-lead EKG compared to a traditional 12-lead device, the other examined if 54 participants could figure out how to use the case properly, with no previous medical training. The latter study was not only successful but led to the diagnosis of two serious heart problems.

THE COMPLICATIONS OF INNOVATING UNDER THE FDA

AliveCor was lucky. Though it took about six months to get the application ready, the approval arrived well within the 90-day approval window, allowing the company to come to market sooner. It was a necessary hassle; FDA approval opens a lot of doors. Instantly, what could be considered some scam iPhone case was marketable to health care professionals--doctors--who’d most likely pay out of pocket for a $200 stethoscope replacement without blinking. FDA approval also allows doctors to prescribe, and potentially have insurance cover, AliveCor’s device for their patients to take home.

But even with an approval in-hand, AliveCor will continue to juggle complicated regulations to stay competitive in the market. For one, the approved monitor was designed for the iPhone 4 and 4S. Before AliveCor can release an iPhone 5 version with the exact same hardware internals, they will need to seek out additional FDA approval. (With previous approval and clinical trials to cite, the process is mostly a formality, but it’s still paperwork that takes more time and resources.)

THE REAL QUESTION IS, WILL FDA REGULATIONS LEAVE SPACE FOR THE LITTLE GUYS TO INNOVATE RESPONSIBLY.

The company also intends to release an over-the-counter version of the case. The good news is, this device will be eligible for coverage in most employee spending programs. But because of FDA regulations, this OTC version cannot provide the raw EKG data to a consumer who might not know how to interpret the esoteric waveforms. Instead, AliveCor will redesign the app to provide an infographic-esque interpretation of the EKG. “An EKG means something to a trained physician, but we can provide a lot of insights to an untrained consumer that might help explain what triggered a cardiac event,” Wade explains. “Like caffeine is a trigger. With an app, we see being able to offer more insight to an individual about their heart health.”

From a product design standpoint, this second-level data analysis sounds like an ideal, consumer-oriented decision. But from a consumer rights standpoint, why is any government agency standing in the way of consumer access to our own raw data? I can see how strongly my iPhone’s antenna is reaching the nearest cell tower, but I can’t see how well my own heart is ticking inside my body? How absurd is that? Interestingly enough, AliveCor is using this regulation to their advantage, banking on the health care model as it stands now. Its OTC device will offer services to refer you to a physician for deeper result analysis (and access to your actual waveforms, if you’re so concerned), which will provide a backend revenue stream beyond typical hardware sales. Imagine the potential: In-app purchase for a follow-up appointment.

An eagle at the Edinburgh Zoo that had been shot, but AliveCor’s case measured a heartbeat through its feathers. The eagle was deemed fit enough for surgery, underwent the procedure and lived. Needless to say, the device has veterinary applications as well.

THE FUTURE OF MEDICINE

For the time being, AliveCor is continuing to develop their EKG cases into a full line, including that OTC device, which will also be a universal version working for both iOS and Android. (Since the case actually communicates with the phone wirelessly, once the software programming is done, these product differentiations are largely cosmetic in nature.) No doubt, AliveCor sees the case as a stepping stone to the company’s overall vision, that “everyone should have their health at their fingertips,” Wade says. But the company will have to solve a lot of larger problems that the industry is struggling with to make that future a reality.

SHOULD MEDICAL DEVICES BE REGULATED TO AUTOMATICALLY DIAL 911 IN CASES OF EMERGENCY? 

While diagnostic devices may be coming to the phone, we still have no standards to get such diagnostic information back to our doctors. AliveCor explained to me that it can send a push notification to my cardiologist every time I check my heart, but does my cardiologist really want push notifications all day from their client list? Or worse, would any doctor want a devastating cardiac episode just sitting under 30 other messages in the iOS Notification Center? Should my phone text or not text emergency information? Should doctors be held accountable for app-based information? Should medical devices be regulated to automatically dial 911 in cases of emergency?

No doubt, AliveCor’s Heart Monitor is another case of affordable consumer technology outpacing our brick-and-mortar hospitals, but to the credit of our hospitals, affordable consumer technology is outpacing most of the world. Still, just as Domino’s has figured out to deliver me a pizza through an app (no doubt, saving a few cents in the process), so, too, will the medical community come around to juggling big data at the individual patient level. The real question is, will FDA regulations leave space for the little guys--the weekend app warriors and the Kickstarters--to innovate responsibly, at a price cheaper than clinical trials and a timeframe faster than paperwork?

Pre-order the Heart Monitor here.

[Hat tip: Co.Exist]

MARK WILSON

Mark Wilson is a writer who started Philanthroper.com, a simple way to give back every day. His work has also appeared at Gizmodo, Kotaku, PopMech, PopSci, ... CONTINUED

Global eHealth & Environmental eHealth

I have read some of the work of Dr. Richard Scott from the University of Calgary on Information Communication Technology and Global Health.  I have in my calendar to listen to a webinar that he will give today through COACH.  I didn't know he was leading a program on Environmental eHealth - which is thinking outside the box literally. Had a look through the WHO Global eHealth Bulletin the other day.