Huge Genetic Study May Lead To Arthritis Breakthrough

Osteoarthritisa is a degenerative joint disease in which a joints become damaged, stop moving freely freely, and become painful. It is a complex disease, and more than 20 million Americans suffer from it. Globally, the number is 350 million. Osteoarthritis is a leading cause of disability, and unfortunately, there is no cure. The disease is managed with various medications and injections. In many cases, joints must be replaced. The result is not always perfect. A new study from the Sanger Institute in the U.K. may be a breakthrough.

The Wellcome Sanger Institute and collaborating researchers undertook one of the largest studies of its kind. The hypothesis behind the study was there may be a genetic link between the disease and a person’s DNA. The researchers studied 16.5 million DNA variations from the UK Biobank resource (read last week’s e-brief about biobanks). They analyzed the DNA of more than 30,000 people with osteoarthritis and nearly 300,000 people without osteoarthritis. The study revealed nine new genes associated with osteoarthritis. Five of the genes showed significantly different properties between those with osteoarthritis and those without.

Further research will likely lead to drugs which can have a corrective effect on those genes. The study also found genetic correlations between osteoarthritis and obesity, bone mineral density, type 2 diabetes, and raised blood lipid levels.

See the full story here.

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Biobanks for Population Health

Blood Samples

As millions of consumers and providers add data to patient EHRs, a multitude of data will become available for the greater good. Researchers can anonymize the data and combine it with a large database containing vast amounts of information about the health of the population at a community level, nationally, or globally.

In order to create large databases, providers and state public health organizations must input and share information. To make that happen, the Office of the National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services issued large grants to help states develop health information exchanges for sharing health data among providers, Medicare, Medicaid, and public health agencies. For healthcare providers to receive the incentives, their EHR systems must interface with immunization registries to transmit electronic data public health agencies deem important, electronically record and submit clinical surveillance data and laboratory results, and identify and report cancer and certain other cases to a state cancer registry.

 A thorough understanding of the demographics and medical condition of a population subset could enable hospitals to develop community based preventive care programs and clinics to address the needs of chronically ill patients in the community. The combination of big-data and analytics can enable researchers, public health officials, and healthcare leaders to ask previously difficult to answer questions, and focus on population health. Population health is healthcare of the future and it is unfolding now. 

The next level of population health will be biobanks containing data about the genomes of millions of people. Beginning in 1990, more than 200 scientists collaborated on a $3 billion project to sequence the roughly 3 billion bases of human DNA. Between 2002 and 2008 the cost to perform the sequencing gradually declined from $100 million to $10 million. The introduction of next generation sequencing technology in 2008 led to a plummeting of the cost over the following years until 2015 when I published Health Attitude: Unraveling and Solving the Complexities of Healthcare, when the cost had come down to a few thousand dollars. Now it is less than $500.

Large organizations are jumping on the bandwagon with programs to offer sequencing to millions. The Department of Veterans Affairs has its “Million Veterans” program; Geisinger Health and Kaiser Permanente have enrolled tens of thousands, and this year the National Institutes of Health will begin its “All of Us Program,” aiming to gather genetic and physiologic data on a million volunteers. The “All of Us Program” will extend over ten years and promises to transform healthcare.

At a cost of $1.4 billion, a National Institutes of Health program may help scientists discover links between diseases, genes and lifestyle. The anonymized data will be a huge boost to population health. At a personal level, the impact will also be huge. Medical care will eventually be 100% unique. Every diagnosis, medication, and dietary guideline will be tailored to you and only you. There are many challenges to the biobank idea, especially at a national level where the NIH wants its biobank members to be all inclusive and representative of the American population. This is a laudable goal but one which adds huge amounts of complexity.  The Geisinger Health system returned the Federal grant of $50 million and decided to go it alone to build a biobank of just their members. Earlier this month, Geisinger announced a genetic sequencing will be made available for free for all patients. It will be a routine part of preventive medicine. 

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Bitcoin: Is It For Real?

The following article appeared in the current issue of Sun and Surf Magazine. It was published in Palm Coast, Florida. Meanwhile, the Coindesk Consensus 2018 conference is underway this week in New York City. The interest level for blockchain technology and cryptocurrencies is strong. More than 7,700 attendees showed up to talk about these technologies. Experts and key influencers participated in keynote speeches, more than a dozen panels, and workshops. Some had speculated the enthusiasm of the massive Consensus 2018 conference would increase demand for Bitcoin and other cryptocurrencies. The conference is not over, but so far Bitcoin has declined slightly. As discussed in the article below, volatility is high.

Sun and Surf page 1

Sun and Surf page 2

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Internet Voting With Blockchain

Voting Mobile

Kaya Yurieff, an associate writer focused on consumer technology for CNN Tech, interviewed me in February about Internet voting. Following are the first few paragraphs of her story which appeared online this week.

You can do a lot on a smartphone, from depositing a check to ordering groceries. But here’s one thing you can’t do: vote for elected officials. Some advocates see the potential of a more modernized system amid concerns about US election security and aging voting machines.

A major reason people don’t vote is because they can’t get to the polls, according to John Patrick, author of Election Attitude: How Internet Voting Leads to a Stronger Democracy.”This old system does not accommodate the busy people we are today and the people who are sick, in nursing homes, [or] in the military,” he said. “There are a hundred reasons why people can’t vote.”

But to keep smartphone voting safe, experts are looking toward blockchain technology, a super secure and transparent public ledger with the history of transaction data from anyone who uses a certain service. Although blockchain is most associated with powering cryptocurrencies like bitcoin, it can be applied to other areas, such as health care or voting.

Read the entire article on CNNMoney here.

Kaya did a good job in getting multiple viewpoints on the subject. Unfortunately, the anti-Internet voting activists always get top billing, as though they are the gods of knowledge on whether Internet voting is possible. They compare Internet voting (with or without blockchain) to a perfect system we will never have. They refuse to compare it to the old-fashioned broken system we have. Rather than help specify what is needed to make Internet voting be secure and verifiable, they revert and recommend a paper based system as the only good solution.

Startup companies such as Votem have good voting technology. Competition among them will make Internet voting better. We need more advocates to ask election officials and political leaders whether they think it is important that 100 million could have voted but did not. Instead, we have anti-Internet voting activists criticizing West Virginia and others for being innovative and trying to strengthen our democracy by making it easier to vote. Internet voting is not ready for national elections in 2018 but it could be ready in 2020 if we can muster the political and technological will to make it happen. Lets not forget the 100 million people. We can do better.

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Exoskeletons Are On The Way


As humans, we have a skeleton inside of us which provides us with support. Animals such as insects (grasshoppers and cockroaches) and crustaceans such as crabs and lobsters, have an external skeleton called an exoskeleton. The exoskeletons provide the animals with support and protection. Robotic exoskeletons for humans can do that and much more. As batteries, computer chips, motors, and sensors have gotten smaller and more powerful, robotic exoskeletons have arrived to provide amazing new benefits for humans.

Founded in 2005, Richmond, CA based Ekso Bionics develops and manufactures powered exoskeleton bionic devices that can be strapped on as wearable robots. The sophisticated devices enhance the strength, mobility, and endurance of soldiers and paraplegics and others with physical challenges. The Ekso Bionics’ EksoGT™ is a wearable exoskeleton which can be of great benefit to patients who are debilitated with stroke, spinal cord injury, cerebral palsy, Parkinson’s, or multiple sclerosis. The FDA has cleared the product for use in rehabilitation. Although expensive, the exoskeleton software and motors can supplement a physical therapist where two therapists would otherwise be needed. The software can calculate how much force it needs to provide based on what it senses when the patient moves a foot and then makes an exertion to lift it. Over time, the exoskeleton can help a debilitated patient learn how to walk again.

The robotic exoskeleton straps to a patient’s legs. The onboard computers gather data from the exoskeleton’s sensors and electric motors. Based on data from the hips, knees, and legs, the exoskeleton determines what motion the motors need to provide to move the patient’s legs. The assistance provided is different for a completely paralyzed patient and one which just needs enhanced movement as the leg moves through various cycles of the desired gait.

MDT Machine Design Technology quoted Adam Zoss, lead engineer and staff scientist at Ekso Bionics who said, “The robot doesn’t do everything, but makes up for what the person needs. Not as many sensors and motors are needed because the robot isn’t controlling 100 percent of what is going on,” says  “The person provides situational awareness and decides what they want to do, and the robot leverages the intellectual and physical input.”

Zoss says that exoskeletons with advanced sensors and software can achieve better rehab outcomes providing strength and coordination to help therapists be more productive. The technology can also be less tiresome and safer for the therapist. Helping a patient learn to walk requires the therapist to be bent down or even on the floor. With the exoskeleton, they can stand up and walk behind the patient as shown in the picture above. Zoss said, “Exoskeletons will become an expected standard of care after an injury in rehab settings. But the 50-year vision is clear. They will be used for general mobility improvement for anyone with impaired walking or who needs help in daily life, and as an alternative to a wheelchair.”

The future of robots is not without fear mongering. Some say they will take away all the jobs. Others worry robots will one day be so smart and capable they may decide they no longer have a need for humans. Thousands of people with disabilities such as described in this short article will embrace the robotic exoskeletons as a positive and life changing opportunity.

Read the full story as reported by MDT here.

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