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Dr. Richard K. Olney, a leading physician and pioneer in clinical research on amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, died of the disease on Jan. 27 at his home in Corte Madera, Calif. He was 64.

His death was announced by the University of California, San Francisco, where Dr. Olney had been the director of the A.L.S. Treatment and Research Center before learning in 2004 that he himself had the disease.

A.L.S. is a degenerative condition of the nerves in the brain and spinal cord that gradually robs the patient of the ability to use the muscles, trapping the victim in an increasingly unresponsive body.

Many A.L.S. patients die within two years, but Dr. Olney survived more than eight after his diagnosis. In that time he was able to see both of his children get married and to see the birth of his first grandchild, who is named after him.

“That’s why he lived so long: he was fighting to see those important milestones,” said Dr. Catherine Lomen-Hoerth, a neurologist who was trained at the clinic by Dr. Olney, and who took over in 2004 when the illness forced him to retire. She then directed his care.

Nicholas T. Olney, Dr. Olney’s son, said that his father maintained a disciplined and upbeat outlook through the course of his illness. “Once he accepted his diagnosis, he had this attitude that he could make the most of each day,” he recalled. “He didn’t let the next muscle group, the next ability he lost, get him down.”

As he explained in an interview with The New York Times in 2005, Dr. Olney first experienced stiffness in his right leg and loss of coordination in 2003. The initial diagnosis was a herniated disk. He underwent surgery, but his physical slide continued.

By May 2005, he had noticed that his right arm was growing stiff and slow. He then gave himself a common test for A.L.S.: counting the number of times he could tap his fingers in 10 seconds. He knew that he could normally tap 65 times; he had slowed to 55.

“I knew I had A.L.S. then,” Dr. Olney recalled.

A quiet man, Dr. Olney did not seek publicity until he was struck by the disease. When he retired from the clinic, he set up an endowment and agreed to cooperate with journalists in order to build support for the institution. “He wanted to make sure the A.L.S. center would continue after he was gone,” Dr. Lomen-Hoerth said.

In a statement, Lucie Bruijn, chief scientist of the A.L.S. Association, remembered Dr. Olney “not only as a courageous person with A.L.S., but someone who was an outstanding clinician and scientist who made major contributions both for patients and the scientific field.”

Richard Knox Olney was born on Dec. 15, 1947, in Munich, to Lt. Col. Frank and Frances Olney. His family later settled in Norman, Okla. He graduated Phi Beta Kappa from the University of Oklahoma in 1968 with a bachelor’s degree in chemistry, mathematics and zoology, and earned a degree in medicine from Baylor College of Medicine in 1973. He received further medical training at the University of California, Los Angeles, and the University of Oregon Health Sciences Center.

At U.C.S.F. he was known as a hard worker whose hours stunned his colleagues. “He had always told me that the extra time he put in was where he got to do the fun stuff, like research,” said his son, Nick, who is will begin his medical residency in neurology this fall.

In addition to his son, Dr. Olney is survived by his wife of 38 years, the former Paula Louise Zucal; a daughter, Amy Koch Olney Dobbs; his brother, Frank Jr.; and his grandson.

Dr. Olney and his son were working on a research paper together during his final months, focused on the use of nerve responses to predict the likely course of illness in A.L.S. patients. Dr. Lomen-Hoerth will help Nick Olney finish the paper.

Toward the end, Dr. Olney communicated with the world through a computer that responded to his eye movements, with the words appearing on a screen.

Since October, his ability to breathe had gradually diminished. But he continued to send and receive e-mail, and visited the clinic the week before he died to take part in a research project.

As he got ready to leave, Dr. Lomen-Hoerth recalled: “One of the last things he tapped out was, ‘goodbye.’ I think he knew it was his last visit.”

“That,” she added, “was a hard thing to see on the screen.”

Dr. Richard K. Olney,
Felled by the Disease He Studied,
Is Dead at 64,
NYT,
2.2.2012,
https://www.nytimes.com/2012/02/03/
us/dr-richard-k-olney-als-researcher-dies-at-64.html

Wylie Vale Jr.,

Groundbreaking

Endocrinologist,

Dies at 70

January 15, 2012

The New York Times

By NICHOLAS WADE

Wylie W. Vale Jr., an eminent endocrinologist who helped identify the hormones through which the brain governs basic bodily functions and who was involved in a combative race for the Nobel Prize, died on Jan. 3 at his vacation home in Hana, Hawaii. He was 70.

The cause was not yet known, his wife, Mary Elizabeth, said.

Dr. Vale spent most of his career at the Salk Institute in San Diego, where he led efforts to identify the group of hormones involved in bodily functions like growth, reproduction and temperature. Their discovery was a landmark in the history of endocrinology, coming after more than 30 years of bitter competition.

The Nobel Prize went to others, but Dr. Vale “really, in the long run, had the biggest impact in the field,” said Bert O’Malley, an endocrinologist at the Baylor College of Medicine.

The first part of Dr. Vale’s career was spent as the principal scientist in the laboratory run by Roger Guillemin, who was locked in a 20-year race with a rival, Andrew Schally, to identify the hormones first.

The Guillemin-Schally war, described by Dr. Schally as “many years of vicious attacks and bitter retaliation,” ended in a draw in 1977 when the Nobel medicine committee gave each man a quarter share of a prize, the other half going to Dr. Rosalyn Yalow.

But the race was not over. An unexpected second phase erupted when Dr. Vale split from Dr. Guillemin and started competing against his former mentor to find the remaining hormones.

The serene campus of the Salk Institute, a plaza that overlooks the Pacific Ocean, then became the home to two laboratories locked in a race for scientific glory, as Dr. Vale and Dr. Guillemin sought to prove that each could succeed without the other’s help.

“They sharpened their swords and went at it full bore,” said Ronald Evans, a hormone expert at the Salk Institute.

Dr. Vale’s first target was the master hormone known as CRF, or corticotrophin releasing factor, which integrates and controls the body’s response to stress. Dr. Guillemin and Dr. Schally had spent seven years trying to isolate CRF before giving up and moving on to easier targets. Dr. Vale discovered CRF in 1981 and the next year found a second hormone, called the growth hormone releasing factor, or GRF, which had also eluded the older scientists. GRF controls the body’s growth.

Endocrinologists watched in amazement as the battle over the hormones raged. But they let the fight continue, mostly because of the importance of finding the hormones, but also because the dueling labs had acquired expertise in processing hundreds of thousands of sheep, pig and beef brains obtained from slaughterhouses for the research. It was a semi-industrial operation in which few others cared to join.

Despite the pressure of the competition, first with Dr. Schally and then with his own mentor, Dr. Vale maintained his easygoing Texan style and sense of humor. By contrast, Dr. Guillemin, born in Dijon, France, in 1924, brought an immigrant’s intensity to his work. He was also, like his rival Dr. Schally, loath to share credit for his lab’s achievements with his younger colleagues.

Toward the end of the fight with Dr. Schally, Dr. Vale became disenchanted with his mentor’s single-minded quest for scientific renown. During his search for GRF, Dr. Vale wrote the chemical formula for the hormone — it had not yet been published — on a large blackboard, which the members of Dr. Guillemin’s lab could see through the window every morning as they left the Salk parking lot. The formula was a decoy, intended to mislead the rival team. Dr. Vale kept the correct version on a piece of paper in his wallet.

Dr. Guillemin was aghast at the challenge from his scientific “son,” a man whom he had trained for his doctorate. Though he succeeded in finding the CRF and GRF hormones independently, in both cases Dr. Vale’s lab beat him to the punch.

Wylie Walker Vale Jr. was born in Houston on July 3, 1941. He attended Rice University and, after hearing Dr. Guillemin lecture on the releasing factors, as the brain’s hormones are known, joined Dr. Guillemin’s lab at the Baylor College of Medicine, earning his Ph.D. in 1964.

Dr. Vale’s principal task was to detect the releasing factors’ whereabouts in the large volumes of tissue from the sheep hypothalamus, a region at the base of the mammalian brain. He helped Dr. Guillemin to his first success, the identification of TRF, or thyrotropin releasing factor. Like the other releasing factor hormones, TRF is produced in the hypothalamus and reaches its target cells in the pituitary gland, just below the base of the brain. A second hormone, which is released by the pituitary in response to TRF, controls the thyroid gland and the body’s temperature control system.

In 1970, Dr. Guillemin moved his team to the Salk Institute. Over the next three years, Dr. Vale played a central role in the lab’s discovery of LRF, the releasing factor that controls the whole reproductive system, and somatostatin, a releasing factor hormone that inhibits the body’s growth.

Dr. Vale founded two companies to exploit his discoveries. One, Neurocrine Biosciences, is testing drugs that block the action of CRF that may help manage clinical depression. The other, AcceleronPharma, is testing drugs for treating anemia.

He also served as president of the American Endocrine Society and was a member of the National Academy of Sciences.

Besides his wife, who is known as Betty and whom he met in high school in Houston, Dr. Vale is survived by two daughters, Elizabeth Gandhi and Susannah Howieson; his father, Wylie; a brother, Shannon; and a granddaughter.

After Dr. Vale’s competition with Dr. Guillemin ended and the two men had reconciled, Dr. Guillemin recalled how a psychiatrist friend had advised him at the time to reread the Oedipus myth.

At a tribute on Dr. Vale’s 65th birthday, Dr. Guillemin quoted Freud’s analysis of the myth: “Part of any son worth his salt is planning the killing of the father he loves and taking his kingdom.”

Wylie Vale Jr., Groundbreaking Endocrinologist, Dies at 70,
NYT,
15.1.2011,
https://www.nytimes.com/2012/01/16/
science/wylie-vale-jr-groundbreaking-endocrinologist-
dies-at-70.html

Sick leave should be agreed

by independent assessors,

says report

Review to recommend taking agreements
over long-term illness benefits
out of hands of doctors

Saturday 19 November 2011
10.44 GMT
Guardian.co.uk
David Batty
This article was published on guardian.co.uk
at 10.44 GMT on Saturday 19 November 2011.
It was last modified at 11.24 GMT
on Saturday 19 November 2011.

People should be signed off for long-term sick leave by an independent assessor rather than their GP, a government review will recommend.

The independent review, due to be published next week, is also expected to call for businesses to be given tax breaks for hiring patients with continuing and unpredictable conditions.

The welfare minister, Lord Freud, said the reforms could lead to "fewer wasted lives". He said the government wanted to intervene earlier to stop patients drifting into unnecessary ongoing state support.

A job-finding service to match people with long-term illnesses to suitable work is expected to be another recommendation of the government-commissioned review.

People who are signed off sick would also be put on to jobseeker's allowance, rather than employment support allowance, for a period of three months. They would receive less money and have to prove they were looking for work.

Freud said GPs would still have a role in writing sick notes for up to around four weeks leave but after that point an independent assessment of the patient's needs should be carried out.

He told BBC Radio 4's Today programme: "That's the point at which you can get into drift. If you start having no support at all for the next 28 weeks there's a very large proportion of people who then drift of into state support and very long-term support and it's quite unnecessary in many cases."

Freud signalled that the new independent assessment would consider what work someone seeking long-term sick leave could do and not just consider whether they were able to continue their current job.

He said: "GPs are not experts necessarily in occupational health and secondly there's two tests going on – the GP is signing people off for a particular job but actually in the end the assessment will be when they apply for long-term state support. The assessment will be 'can you do any job?'. That difference means that people can fall between the two assessments."

The Independent Review of Sickness Absence, led by Professor Dame Carol Black, the UK's national director for health and work, and the former head of the British chambers of commerce David Frost, is looking at ways of cutting the estimated £60bn cost of working-age ill health.

Black told the BBC: "What the GPs say is they don't have time to do an in-depth functional assessment and nor have they had any training in occupational health so we think it's providing a new unique service that both employers and GPs need."

Frost said when people were off sick for longer than four weeks they started "to lose the will to work".

"What we've got to do is to find a way of actually working with them, encouraging them and providing real, practical help. And that's what the assessment service would do," he told the BBC.

The deputy chair of the British Medical Association's GPs committee, Dr Richard Vautrey, warned that if the reforms turned out to be "a punitive process just to try and save money without the best interests of the patient at the heart of the process then it will fail".

Labour MP Dennis Skinner said: "Last year, the government said GPs should be accountants in charge of the money that is spent in the NHS. This year they want assessors to be GPs. It's crazy. No wonder the country is going to the dogs."

The proposed reforms come as the government is embarking on a major and controversial overhaul of the welfare state. The first independent attempt to quantify the impact of more stringent medical tests and the greater use of means testing warned that the tough welfare reforms will force over half a million people off incapacity benefit and cause widespread poverty in some of Britain's most disadvantaged communities.

Around 600,000 people would disappear from the benefits system altogether under changes to be introduced by 2014 and would often have to rely on family members for financial support, warned researchers from Sheffield Hallam University.

Sick leave should be agreed by independent assessors, says report,
    G,19.11.2011,
    http://www.guardian.co.uk/society/2011/nov/19/
    sick-leave-independent-assessors-report

When Doctors Become Patients

September 2, 2011

The New York Times

By ERIC D. MANHEIMER

FRANK SINATRA’S greatest hits album, filtered through the jet engine noise of the Varian linear accelerator, was not what I felt like hearing at 9 a.m. I made a mental note to bring a Steely Dan CD for my next appointment.

I was strapped to a hard metal sheet, and the technician had just bolted my head down using a black mask that had been heat-molded to the contours of my face. The sheet and I would slide first up and then back in an overhead arc that would send high-energy electrons into my head and neck from computerized data sets outlining my throat cancer and its spread into adjacent lymph nodes.

I wasn’t a doctor anymore. I was a patient.

That was almost three years ago. This spring, the Archives of Internal Medicine published a much-discussed study that showed that doctors might recommend different treatments for their patients than they would for themselves. They were far more likely to prescribe for patients a potentially life-saving treatment with severe side effects than they were to pick that treatment for themselves.

Understandably, people are worried that this means doctors know something they’re not telling their patients. But my own experience with illness taught me a simpler truth: when it comes to their own health, doctors are as irrational as everyone else.

I had squamous cell carcinoma of the throat, a pea-size lesion first, then the cancer spread to my lymph nodes. I knew that this was a bad actor; I’d seen the disease and its consequences many times while wearing a white coat, a stethoscope dangling from my neck, at a patient’s bedside.

At the beginning, I knew intellectually what was in store for me. I allowed myself to be a patient, to trust my doctors and let them lead me through the treatments and complications and side effects that rolled out with alarming regularity. I submitted to a brutal treatment regimen that had not changed in over 40 years. Two thousand units of radiation a day for 35 days, with high doses of platinum chemotherapy, followed, a year later, by a dissection of the right side of my neck to remove the lymph nodes in which the cancer had reappeared.

I soon realized I had no idea what kind of rabbit hole I had fallen into.

For my doctors, it was all about the numbers, the staging of my cancer, my loss of weight and strength. For me, too, it was about the numbers: the six feedings I pushed through the syringe into the plastic tube in my stomach every day; the number of steps I could take by myself; how many hours I had to wait before I could grind up the pill that allowed me to slip into unconsciousness.

But it was also about more: my world progressively shrinking to a small, sterile, asteroidal universe between the interminable nausea and the chemobrain that left my head both empty and feverish, between survival and death.

Survival was a percentage, and not a horrible one — 75 percent if I completed the treatment regimen, by the reckoning of my physicians. But more and more I found myself thinking about what would happen if I was in that 25 percent. If I completed the regimen and the tumor came back, there were no other treatment options. It was morphine and palliative care. I was 58 years old. Death was a 100 percent certainty, eventually. So did it matter?

During one particularly desperate hospitalization, after receiving blood transfusions and a drug to stimulate my white cells, I decided that I had had enough. I refused further radiation and chemotherapy. I lay in my bed and watched the events around me — the distress of my family, the helplessness of my doctors — without anxiety, comfortable that I had made the correct decision.

My doctors couldn’t override it or persuade me to change my mind, but, luckily, my wife, Diana, could and did. From my mental cocoon in the hospital bed, I could sense Diana at my side. “You’re going to finish the treatment,” she said softly. I did not have the energy, or perhaps the will, to disagree. She wheeled me down herself to finish my radiation treatments in the basement of the hospital.

My dreams of dying were not the products of anxious moments of terror. The life force had simply slipped away and made me ready to die. It had also rendered me incapable of making the right decision for myself. My disease was treatable and the odds were favorable. My doctors were professional and gentle but ultimately could not decide for me. When neither doctor nor patient can make the right decision, it is vital to have a caring family — though even here the legal and ethical issues are complicated.

Next week it will be three years since I first noticed the hoarseness that was a symptom of cancer, and I am back to work and a busy life. But my illness has changed me profoundly as a physician. Even having lived through this illness, I’m not sure that I would be any better prepared if I had to relive it again. No amount of doctoring can prepare you for being a patient.

If anything, it’s that recognition of vulnerability as well as expertise that makes me a better doctor today.

Eric D. Manheimer,

the medical director of Bellevue Hospital Center,

is the author of the forthcoming memoir

“Twelve Patients.”

When Doctors Become Patients, NYT, 2.9.2011,
http://www.nytimes.com/2011/09/03/opinion/when-doctors-become-patients.html

The Doctor Will See You Now.

Please Log On

May 28, 2010
The New York Times
By MILT FREUDENHEIM

ONE day last summer, Charlie Martin felt a sharp pain in his lower back. But he couldn’t jump into his car and rush to the doctor’s office or the emergency room: Mr. Martin, a crane operator, was working on an oil rig in the South China Sea off Malaysia.

He could, though, get in touch with a doctor thousands of miles away, via two-way video. Using an electronic stethoscope that a paramedic on the rig held in place, Dr. Oscar W. Boultinghouse, an emergency medicine physician in Houston, listened to Mr. Martin’s heart.

“The extreme pain strongly suggested a kidney stone,” Dr. Boultinghouse said later. A urinalysis on the rig confirmed the diagnosis, and Mr. Martin flew to his home in Mississippi for treatment.

Mr. Martin, 32, is now back at work on the same rig, the Courageous, leased by Shell Oil. He says he is grateful he could discuss his pain by video with the doctor. “It’s a lot better than trying to describe it on a phone,” Mr. Martin says.

Dr. Boultinghouse and two colleagues — Michael J. Davis and Glenn G. Hammack— run NuPhysicia, a start-up company they spun out from the University of Texas in 2007 that specializes in face-to-face telemedicine, connecting doctors and patients by two-way video.

Spurred by health care trends and technological advances, telemedicine is growing into a mainstream industry. A fifth of Americans live in places where primary care physicians are scarce, according to government statistics. That need is converging with advances that include lower costs for video-conferencing equipment, more high-speed communications links by satellite, and greater ability to work securely and dependably over the Internet.

“The technology has improved to the point where the experience of both the doctor and patient are close to the same as in-person visits, and in some cases better,” says Dr. Kaveh Safavi, head of global health care for Cisco Systems, which is supporting trials of its own high-definition video version of telemedicine in California, Colorado and New Mexico.

The interactive telemedicine business has been growing by almost 10 percent annually, to more than $500 million in revenue in North America this year, according to Datamonitor, the market research firm. It is part of the $3.9 billion telemedicine category that includes monitoring devices in homes and hundreds of health care applications for smartphones.

Christine Chang, a health care technology analyst at Datamonitor’s Ovum unit, says telemedicine will allow doctors to take better care of larger numbers of patients. “Some patients will be seen by teleconferencing, some will send questions by e-mail, others will be monitored” using digitized data on symptoms or indicators like glucose levels, she says.

Eventually, she predicts, “one patient a day might come into a doctor’s office, in person.”

Although telemedicine has been around for years, it is gaining traction as never before. Medicare, Medicaid and other government health programs have been reimbursing doctors and hospitals that provide care remotely to rural and underserved areas. Now a growing number of big insurance companies, like the UnitedHealth Group and several Blue Cross plans, are starting to market interactive video to large employers. The new federal health care law provides $1 billion a year to study telemedicine and other innovations.

With the expansion of reimbursement, Americans are on the brink of “a gold rush of new investment in telemedicine,” says Dr. Bernard A. Harris Jr., managing partner at Vesalius Ventures, a venture capital firm based in Houston. He has worked on telemedicine projects since he helped build medical systems for NASA during his days as an astronaut in the 1990s.

Face-to-face telemedicine technology can be as elaborate as a high-definition video system, like Cisco’s, that can cost up to hundreds of thousands of dollars. Or it can be as simple as the Webcams available on many laptops.

NuPhysicia uses equipment in the middle of that range — standard videoconferencing hookups made by Polycom, a video conferencing company based in Pleasanton, Calif. Analysts say the setup may cost $30,000 to $45,000 at the patient’s end — with a suitcase or cart containing scopes and other special equipment — plus a setup for the doctor that costs far less.

Telemedicine has its skeptics. State regulators at the Texas Medical Board have raised concerns that doctors might miss an opportunity to pick up subtle medical indicators when they cannot touch a patient. And while it does not oppose telemedicine, the American Academy of Family Physicians says patients should keep in contact with a primary physician who can keep tabs on their health needs, whether in the virtual or the real world.

“Telemedicine can improve access to care in remote sites and rural areas,” says Dr. Lori J. Heim, the academy’s president. “But not all visits will take place between a patient and their primary-care doctor.”

Dr. Boultinghouse dismisses such concerns. “In today’s world, the physical exam plays less and less of a role,” he says. “We live in the age of imaging.”

ON the rig Courageous, Mr. Martin is part of a crew of 100. Travis G. Fitts Jr., vice president for human resources, health, safety and environment at Scorpion Offshore, which owns the rig, says that examining a worker via two-way video can be far cheaper in a remote location than flying him to a hospital by helicopter at $10,000 a trip.

Some rigs have saved $500,000 or more a year, according to NuPhysicia, which has contracts with 19 oil rigs around the world, including one off Iraq. Dr. Boultinghouse says the Deepwater Horizon drilling disaster in the Gulf of Mexico may slow or block new drilling in United States waters, driving the rigs to more remote locations and adding to demand for telemedicine.

NuPhysicia also offers video medical services to land-based employers with 500 or more workers at a site. The camera connection is an alternative to an employer’s on-site clinics, typically staffed by a nurse or a physician assistant.

Mustang Cat, a Houston-based distributor that sells and services Caterpillar tractors and other earth-moving equipment, signed on with NuPhysicia last year. “We’ve seen the benefit, ” says Kurt Hanson, general counsel at Mustang, a family-owned company. Instead of taking a half-day or more off to consult a doctor, workers can get medical advice on the company’s premises.

NuPhysicia’s business grew out of work that its founders did for the state of Texas. Mr. Hammack, NuPhysicia’s president, is a former assistant vice president of the University of Texas Medical Branch at Galveston, where he led development of the state’s pioneering telemedicine program in state prisons from the mid-1990s to 2007. Dr. Davis is a cardiologist.

Working with Dr. Boultinghouse, Dr. Davis and other university doctors conducted more than 600,000 video visits with inmates. Significant improvement was seen in inmates’ health, including measures of blood pressure and cholesterol, according to a 2004 report on the system in the Journal of the American Medical Association.

In March, California officials released a report they had ordered from NuPhysicia with a plan for making over their state’s prison health care. The makeover would build on the Texas example by expanding existing telemedicine and electronic medical record systems and putting the University of California in charge.

California spends more than $40 a day per inmate for health care, including expenses for guards who accompany them on visits to outside doctors. NuPhysicia says that this cost is more than four times the rate in Texas and Georgia, and almost triple that of New Jersey, where telemedicine is used for mental health care and some medical specialties.

“Telemedicine makes total sense in prisons,” says Christopher Kosseff, a senior vice president and head of correctional health care at the University of Medicine and Dentistry of New Jersey. “It’s a wonderful way of providing ready access to specialty health care while maintaining public safety.”

Georgia state prisons save an average of $500 in transportation costs and officers’ pay each time a prisoner can be treated by telemedicine, says Dr. Edward Bailey, medical director of Georgia correctional health care.

With data supplied by the California Department of Corrections and Rehabilitation, which commissioned the report, NuPhysicia says the recommendations could save the state $1.2 billion a year in prisoners’ health care costs.

Gov. Arnold Schwarzenegger wants the university regents and the State Legislature to approve the prison health makeover. After lawsuits on behalf of inmates, federal courts appointed a receiver in 2006 to run prison medical services. (The state now runs dental and mental health services, with court monitoring.) Officials hope that by putting university doctors in charge of prison health, they can persuade the courts to return control to the state.

“We’re going to use the best technology in the world to solve one of our worst problems — the key is telemedicine,” the governor said.

WITHOUT the blessing of insurers, telemedicine could never gain traction in the broader population. But many of the nation’s biggest insurers are showing growing interest in reimbursing doctors for face-to-face video consulting.

Starting in June, the UnitedHealth Group plans to reimburse doctors at Centura Health, a Colorado hospital system, for using Cisco advanced video to serve UnitedHealth’s members at several clinics. And the insurer plans a national rollout of telemedicine programs, including video-equipped booths in retail clinics in pharmacies and big-box stores, as well as in clinics at large companies.

“The tide is turning on reimbursement,” says Dr. James Woodburn, vice president and medical director for telehealth at UnitedHealth.

Both UnitedHealth and WellPoint, which owns 14 Blue Cross plans, are trying lower-cost Internet Webcam technology, available on many off-the-shelf laptops, as well as advanced video.

UnitedHealth and Blue Cross plans in Hawaii, Minnesota and western New York are using a Webcam service provided by American Well, a company based in Boston. And large self-insured employers like Delta Air Lines and Medtronic, a Blue Cross Blue Shield customer in Minneapolis, are beginning to sign up.

Delta will offer Webcam consultations with UnitedHealth’s doctor network to more than 10,000 Minnesota plan members on July 1, says Lynn Zonakis, Delta’s managing director of health strategy and resources. Within 18 months, Webcam access will be offered nationally to more than 100,000 Delta plan members.

Dr. Roy Schoenberg, C.E.O. of American Well, says his Webcam service is “in a completely different domain” than Cisco’s or Polycom’s. “Over the last two years, we are beginning to see a side branch of telemedicine that some call online care,” he says. “It connects doctors with patients at home or in their workplace.”

Doctors “are not going to pay hundreds of thousands of dollars for equipment, so we have to rely on lower tech,” he adds. The medical records are stored on secure Web servers behind multiple firewalls, and the servers are audited twice a year by I.B.M. and other outside computer security companies, Dr. Schoenberg says.

In Hawaii, more than 2,000 Blue Cross plan members used Webcams to consult doctors last year, says Laura Lott, a spokeswoman for the Hawaii Medical Service Association. Minnesota Blue Cross and Blue Shield started a similar Webcam service across the state last November.

Doctors who use the higher-tech video conferencing technology say that Webcam images are less clear, and that Webcams cannot accommodate electronic scopes or provide the zoom-in features available in video conferencing. “If they are not using commercial-grade video conferencing gear, the quality will be much lower,” says Vanessa L. McLaughlin, a telemedicine consultant in Vancouver, Wash.

Last month, Charlie Martin, the crane operator, was back in the infirmary of the Courageous for an eye checkup. In Houston, his face filled the big screen in NuPhysicia’s office.

After an exchange of greetings, Chris Derrick, the paramedic on the oil rig, attached an ophthalmological scanner to a scope, pointed it at Mr. Martin’s eye, and zoomed in.

“Freeze that,” Dr. Boultinghouse ordered, as a close-up of the eye loomed on the screen. “His eyes have been bothering him. It may be from the wind up there on the crane.”

The Doctor Will See You Now. Please Log On,
NYT,
29.5.2010,
https://www.nytimes.com/2010/05/30/
business/30telemed.html

5 Pioneering Scientists

Win Lasker Medical Prizes

September 14, 2008

The New York Times

By LAWRENCE K. ALTMAN

Akira Endo, a Japanese scientist whose discovery of the first cholesterol-lowering statin drug helped extend the lives of millions of people, is one of five winners of this year’s Lasker Awards for medical research, it was announced Saturday.

An American microbiologist, Stanley Falkow of Stanford University, was honored for greatly expanding knowledge of disease-causing microbes, ranking him as “one of the greatest microbiologists of all time,” the Albert and Mary Lasker Foundation said in making the awards.

A third award went to two Americans and a Briton for their pioneering look into a previously unknown universe of potent molecules, tiny ribonucleic acids known as micro-RNAs. The Americans are Victor R. Ambros, 54, of the University of Massachusetts Medical School in Worcester and Gary B. Ruvkun, 56, of Massachusetts General Hospital in Boston. The Briton is David C. Baulcombe, 56, of the University of Cambridge.

RNA is DNA’s close chemical cousin. These scientists found that snippets of RNA act as genetic regulators governing many activities in animals and plants. Scientists now have implicated micro-RNAs in viral infections, heart failure, cancer, other diseases, and normal functions like muscle action and blood cell specialization.

Dr. Endo, 74, was chosen for ushering in a new era in preventing and treating coronary heart disease, the leading cause of death in the United States and many other countries, said Dr. Joseph L. Goldstein, chairman of the 24-member scientific jury that selects the Lasker recipients.

For two years beginning in 1971, Dr. Endo grew more than 6,000 fungi as a microbiologist working for a Japanese drug company. He was seeking a natural substance that could block a crucial enzyme involved in the body’s production of cholesterol, which occurs largely in the liver. Cholesterol is a crucial component of cells and serves as a raw material for some hormones and nerve sheaths. But it is also a major contributor to coronary artery disease.

At the time, many scientists were skeptical about the safety of lowering the amount of cholesterol because it was an essential body chemical. But by 1980, Dr. Endo’s team found that the statin lowered the LDL, or “bad” cholesterol level, in the blood by 17 percent.

Dr. Endo went on to identify other statins, and his work led the American pharmaceutical company Merck to start a program to develop them as drugs.

Merck manufactured lovastatin (Mevacor), the first statin to be licensed, in 1987. Since then, statins have become among the most widely prescribed drugs in the United States, taken by an estimated 25 million Americans to treat high levels of LDL cholesterol.

Dr. Falkow, 74, was honored for his discoveries that grew out of an extraordinary ability to imagine himself as a bacterium so he could view the world from the microbial perspective.

That talent helped him discover the molecular nature of antibiotic resistance; forge new laboratory tools that revolutionized the way scientists think about how microbes cause disease; and train a number of students who have become scientific leaders in infectious diseases.

Over his 51-year professional career, Dr. Falkow has also developed techniques to help identify disease-causing bacteria that cannot be grown in the laboratory; show how bacteria pass certain traits to one another; pave the way for recombinant DNA technology that has wide use in drug production and in the laboratory; and help untangle mysteries about how bacteria survive and spread.

Dr. Falkow said his research was conducted at the Walter Reed Army Medical Center, Georgetown University, the University of Washington and then Stanford.

The three winners in the basic research category were honored for expanding the versatility of RNA, long regarded as DNA’s poor cousin. Previous scientific convention held that proteins, not RNAs, governed gene activity in animal cells.

“The notion that small RNAs could control gene expression was unheard of,” said Dr. Goldstein, the Lasker jury chairman, who works at the University of Texas Southwestern Medical Center in Dallas.

The scientists’ discovery of micro-RNAs was an accidental finding in research conducted for other reasons.

Dr. Ambros and Dr. Ruvkun were studying how a roundworm, C. elegans, develops from newly hatched larva to adult. The worm serves as a model animal for many geneticists.

Earlier research on flies showed that certain genes instructed embryos where to place wings, legs and other body parts. Suspecting that other genes specified the timing of such developmental events, Dr. Ambros focused on lin-4, a gene that allows immature worms to advance past a particular development stage. Animals with a defective version of lin-4 cannot pass that hurdle.

Dr. Ambros discovered that animals with a different gene, lin-14, skip early steps in development and prematurely acquire characteristics that normally appear later. The two genes exerted opposite effects in worm cells.

Dr. Ambros and Dr. Ruvkun went on to show how the genes collaborated; at an appropriate time, lin-4 blocks lin-14 activity, allowing worms to continue normal development.

In a series of additional steps, the researchers found that they were dealing with very small strands of RNA. At the time, the smallest RNA known to be of importance in cells consisted of 75 nucleotide building blocks. The RNA they found was composed of 22 nucleotides.

Dr. Baulcombe, in a seemingly unrelated line of research in England, expanded the scope of micro-RNAs’ crucial functions by finding that they silenced genes in plants. He called them silencing RNAs and showed that earlier experiments were not intended to find micro-RNAs because their size was much smaller than scientists had imagined.

Now it seems that micro-RNA provides a sophisticated way of adjusting production of amounts of proteins that are needed at one stage of life but must be absent in others.

Recent studies suggest that the human genome contains more than 500 micro-RNAs and that, collectively, they might control a third of all protein-producing genes. Researchers are now trying to develop drugs that work by blocking micro-RNAs.

The winners will received their Lasker Awards at a luncheon on Sept. 26. The prize in each category is $300,000.

5 Pioneering Scientists Win Lasker Medical Prizes,
NYT,
14.9.2008,
https://www.nytimes.com/2008/09/14/
health/14lasker.html

Doctors Wage a Frantic Fight

to Save a Wounded Officer

November 29, 2005

The New York Times

By MICHAEL BRICK

The guarded entrance to Building C of the Kings County Hospital Center in Brooklyn is designed for ambulance traffic, but the green Impala that stopped at its painted curb around 3 a.m. yesterday counted as an emergency vehicle.

There were bullet holes in the doors, and the front-seat passenger, Officer Dillon Stewart, was bleeding from a massive heart injury.

His wound was severe, but there was cause for hope. Just a few hours earlier, surgeons at the hospital had opened the chest of a 17-year-old gunshot victim, saving his life, and now Officer Stewart, 35, was delivering a robust, thick-walled heart into their care. "The heart has a mind of its own," said Dr. Robert S. Kurtz, one of his surgeons, "and his was the heart of a fighter."

The fight to keep Officer Stewart alive, which played out over roughly five hours, was recounted in interviews with Dr. Kurtz and Dr. Patricia O'Neill, the co-directors of trauma surgery and surgical critical care at Kings County.

Officer Stewart was conscious when he arrived in his unmarked cruiser, but a slug had crossed through both his left ventricle, the heart's main pumping chamber, and his left anterior descending coronary artery, which delivers blood to that ventricle.

Doctors call that a double-hit phenomenon: a glancing blow that leaves two injuries from the same hole. "I only know of one patient I've treated who survived it, and that was a knife wound," Dr. O'Neill said. "Bullets do a lot more damage."

There was no exit wound.

Deep inside Officer Stewart's chest, conflicting forces were at work. His pericardium, the rigid sack that surrounds the heart, was filling with blood from the hole in his ventricle. The sack was probably helping keep Officer Stewart from bleeding to death.

But the blood had to go somewhere. As it filled the sack, it pressed on the heart, stifling the muscle's ability to pump. Within minutes, the pressure inside Officer Stewart's chest overwhelmed his cardiac system, and his heart stopped.

Inside the emergency room, the team of doctors and nurses grew to more than a dozen. Their patient was now in full cardiac arrest. Pumping medicines, blood and clotting agents into his veins, they cut open his chest. One of the surgeons, Dr. L. D. George Angus, took Officer Stewart's heart in his hands, rubbing it in a gentle clapping motion until it resumed pumping.

To relieve the pressure on the muscle, surgeons cut open the outer sack. But the bullet wound had to be closed quickly, Dr. Kurtz said, "or he's going to bleed to death right in front of our eyes."

With a long, narrow pair of metal pliers, Dr. Angus gripped a curved needle and drew an inch-and-a-half-long blue, nylon-like suture across Officer Stewart's heart.

Officer Stewart was then taken to a second-floor operating room, where his chest was sealed.

The surgical team performed transfusions to keep up his blood pressure. They wrapped his body in a "bear-hugger," a blanket with circulating heat. They implanted tubes to suck air from his chest.

And their efforts seemed to be working. Their patient's blood pressure was responding to the treatments. The hole in his artery had clotted. His bleeding was stanched. The doctors transferred their patient from his stretcher to a bed in the intensive care unit.

There, Officer Stewart was a room away from his bosses, Mayor Michael R. Bloomberg and Police Commissioner Raymond W. Kelly, who had arrived and were waiting with the officer's wife, Leslyn, and other family members.

But behind the door, Officer Stewart went into cardiac arrest a second time. Surgeons reopened his chest and tried one method after another to restart his heart. "That's a desperation maneuver, to open his heart in bed in the I.C.U.," Dr. Kurtz said.

As Officer Stewart lay there, his heart massaged in a doctor's hands, Mrs. Stewart was called into the room. "She was muted, traumatized," Dr. Kurtz said. By 8:40 a.m., her husband would be pronounced dead in his bed in intensive care.

"She had tears in her eyes," Dr. Kurtz said, "and she kissed him."