Interview with MannKind’s CEO, Al Mann, and CFO, Matt Pfeffer.

October 23, 2013- Interviewed by Steven E. Greer, MD

The Healthcare Channel interviewed the CEO of MannKind, Al Mann, and the CFO, Matt Pfeffer. Topics discussed include the latest clinical trial data on inhaled insulin Afrezza and the cash situation. We also discuss Mr. Mann’s other company, Second Sight, which has a Medicare and FDA-approved bionic eye to treat diseases that damage the nerves in the retina.

Super rapid acting insulin and inhaled insulin

What Steve Jobs would have invented if he had lived longer

Update January 29, 2014- Apple posted Q4 earnings so big that they are incomprehensible. Read more »

Will IBM’s Watson replace doctors, then be hijacked by industry bias?

February 21, 2013 By Steven E. Greer, MD

The Atlantic article on IBM’s Watson is triggering rebuttals on medical blogs asserting that human doctors cannot be replaced. I hate to break it to internists, but Watson and other computer algorithms will indeed make most functions of the internist obsolete. A nurse with a Watson-type resource can deliver the same care (if not better) as what your internist provides now.

The real question is whether the industry biased “guidelines” for “gold standard” care will become integrated into Watson’s list of recommended therapies and medical diagnostic tests to be ordered. If they are, then Watson will be a menace to society.

Fortunately, we still have wise doctors who know how to ignore the harmful garbage in the medical society guidelines and industry-paid journals, or know how to be prudently cautious “late adopters” of new drugs. The insight that the best doctors have, which cannot be duplicated by computers, is based on the ability of one human brain to decipher the human nature of other brains. They realize, for example, that clinical trials are woefully underpowered to detect real-life adverse events, and are too often based on overseas clinical data of dubious reliability. These wise doctors know that money trumps science and influences journal editors and medical societies, which literally would not exist without drug and device industry funding.

The impressive “medical society guidelines” that seem so official and irrefutable, drafted by doctors who or are often highly paid by the drug and device industries, have caused over history tremendous harm to the population. To list just a few examples:

• Millions of people currently take muscle fatiguing, dementia causing, cholesterol-lowering statin drugs, but they actually do not need them (because they have not had a heart attack and there is no data to support “primary prevention” use)
• Millions of people are taking daily aspirin and, as a result, thousands of them are suffering strokes and GI bleeds caused by the thin blood. Once again, the data do not support that the patients have received a beneficial reduced risk of a heart attack from the aspirin (in patients who have not had a hear attack, or “primary prevention”)
• Millions of people are on antidepressants despite the fact that the drugs cause harm, in the form of suicide, and have very questionable efficacy at reducing suicide.
• Millions of patients receive cardiology related procedures, such as coronary stents, and have suffered unnecessary radiation and vascular complications, while not benefiting from the procedures.
• Millions of patients have received knee arthroscopy, despite the procedures being of no use.
• Millions of people receive cancer-causing CT scans who do not need them.
• Millions of people were placed on the low-fat diet, despite the fact that it was ineffective and harmful.
• ….and so on, and so on

It is quite likely that Watson-type medical algorithm programs will be hijacked by the healthcare industry junk science and guidelines, and therefore be “junk in, junk out”. The best way to prevent this is to eliminate fee-for-service financial incentives.

 

Catherine Lucey, MD: The iPod or iPhone as a medical tool

Produced and interviewed by Steven Greer, MD

Dr. Catherine Lucey, Vice Dean of Education at The Ohio State University College of Medicine discusses their pioneering use of Apple’s iPod and iPhone as a true medical tool. OSU videotapes medical school lectures and makes them available on Podcasts. In the clinical setting, the devices serve as rapid sources of medical and drug information using a variety of special “apps”.

Justin Harper, a fourth year medical student going into plastic surgery, began the program a few years ago. Now, OSU distributes iPods to all of its medical students and residents.

 

Dr. Lucey and Mr. Harper discuss how they set up the program how it functions.

The Thunderbolt: So fast that live streaming video is now possible

March 24, 2011

We recently reviewed the new Samsung Galaxy tablet, based on the Google Android operating system. It was narrow enough to fit into a white doctor coat or business jacket, but it was still a bit too bulky to carry around on a regular basis. As a result, we have been eagerly awaiting the launch of the Verizon/HTC/Android Thunderbolt 4-inch screen phone that might serve as both a small tablet and a phone. It arrived, and we were not disappointed.

Even though the Thunderbolt is the first phone in America to run on true “4G” LTE with super fast download and upload speeds (other carrier’s versions of 4G are misleading and essentially 3G on Ritalin), the Thunderbolt has not been heavily promoted by Verizon. Major press have not been given the phone and the launch was delayed. We are not sure why that is, but can speculate that the hardware of the phone is not radically new, and that there are some software glitches (see below). Also, Verizon recently launch the Apple iPhone, but it is not selling as well as expected. We are only speculating. Who knows why the Thunderbolt has not been acclaimed as a the major advancement that it is.

The LTE 4G, lives up to the hype. The bandwidth pipes are so wide that video can be streamed live and in high quality. For medical applications, one can live broadcast medical Grand Rounds, interviews at medical conferences, interactions with patients using telemedicine, etc.

We used the UStream App that functioned well. What formally would have required a digital camera, tripod, Ethernet cable, laptop, Internet wireless card, and a lot of praying, can now be performed on the Thunderbolt handheld. This is truly revolutionary for medicine. Every medical center media relations teams should have a Thunderbolt STAT.

In our previous review of the iPad 2, we mentioned that the iPad can allow for excellent two-way video conferencing. However, that used Internet Wi-Fi connections which are not always available. The unique thing about the Thunderbolt is that this video transmission quality is sent over the cellular service.

Unfortunately for now, the Skype App does not allow video and one cannot use the web site Skype either. Therefore, the front-facing camera cannot be used for video calls like the Apple FaceTime, but we were told that all of this will be fixed soon.

Walt Mossberg of the WSJ performed some tests and comparisons of the Verizon LTE 4G network. It averaged 12.6 megabits per second download and 4.7 mbps upload. To put that in perspective, those rates were eight times faster than the 3G phone he tested. Other carriers claiming to have “4G” were much slower. Sprint’s EVO Shift and AT&T’s Inspire both delivered only 2 mbps download speed. T-Mobile’s was better with 5.52 mbps down and 1.77 upload, according to Walt.

We prefer the Google Android operating system of the Thunderbolt over the Apple iPhone and iPad systems for several reasons. First, the Google Maps vast database powers several ingenious Apps that we find essential when traveling. Google Navigation (not Verizon Navigation) gives voice activated and spoken turn-by-turn directions as good as, or better than, dedicated units made by Garmin, etc. The Google voice recognition is very accurate and one can speak a destination without typing.

Also, being a more open-platform OS, Android allows the Thunderbolt to function just like a peripheral hard drive and a laptop. One can drag files from their home or work PC onto the Thunderbolt’s generous 30 GB memory capacity that comes with the phone. Of course, using cloud-based storage of files would be another solution, but we are not comfortable putting sensitive patient information, personal photos, etc., on some other entity’s servers.

Another important feature for us is that Google is not trying to put Adobe out of business and “Plays well with others” by allowing Flash videos to play. We also downloaded the FLV player App to run FLV files from Thunderbolt files.

Neat Apps

We will review various medical related Apps in the future. For now, some general use Apps we like are:

Yelp: We like the Yelp service that gives reliable consumer driven ratings of local restaurants, etc. Try the Monocle feature that allows you to hold up the camera, point it in any direction, and superimposed on the real-time image is the names of the local establishments down the road.

Google Goggles: This is still in the works but has awesome potential. One simply snaps a photo of any object, ranging from a tree leaf to a bar code on food, and Google then lists search results for the object. The technology exists now (but Google will never allow this for the public) to use facial recognition and obtain the identity of people. (There are always evil uses for these new technologies.)

Quirks

First, download the full manual here. You will need it. HTC and Google still have some kinks in the Thunderbolt to be sure. Apple products are far and away easier to use right out of the box.

For example, one needs to download HTCSync on the PC in order to connect the Thunderbolt. However, the location of this file is not in the manual or on a CD. After several calls to Verizon, then to HTC customer service in Canada, we found this URL. Because Google wants people to use Gmail systems, they have not placed a high priority on making the HTCSync work well with Microsoft Outlook. Before you sync, be sure to backup your .PST files in Outlook because the software will corrupt your contacts.

The 4G system drains the battery fast even when not searching the Internet or talking. To shut it off, there are several Apps. We cannot recommend one over the other.

The Thunderbolt automatically activates many Apps on start up, and you will activate more on your own. The music player is difficult to full switch off once playing has begun. To turn off all of those features, there are Apps to turn off Apps! Try “Advanced Task Killer”

The iPad2 as a video conference tool for doctors

March 14, 2011

The new iPad2 has two cameras now making video calls possible. The potential uses as a medical tool are numerous. Doctors can video conference patients in the out-patient setting, create on-the-fly TV shows at medical conferences, and attending doctors at home can communicate better with residents on call, to name just a few of the possibilities.

We tested the functionality of the iPad2 video using our desktop Sony Vaio PC (New York), to simulate a patient at home, and neurosurgeon Brian Kopell’s iPad2 (Milwaukee). We used the open-platform Skype, rather than Apple’s proprietary FaceTime. Dr. Kopell used a WiFi connection rather than a cellular tower connection.

This was the first time for Dr. Kopell to attempt any form of video conferencing on his new iPad. He was able to logon to Skype and establish a video connection to us within a few minutes. The video image was pretty clear and not jerky. The audio was not exceptionally delayed or cumbersome.

In summary, the new video conferencing capabilities of the iPad2 are more than adequate to allow doctors to begin a new era of telemedicine. Dr. Kopell joked, “I can strap one of these to my resident’s head and have him round for me.”

The Samsung Galaxy tablet as a medical tool

December 21, 2010

Diabetes expert and Professor of Medicine at Mount Sinai in New York City, Zachary Bloomgarden, MD, reviews the new Samsung Galaxy Android-based tablet. He gives an overview of the general features, then discusses certain medical Apps for the doctor, such as Epocrates, and patient-focused Apps to help with diabetes control.

Blackberry Torch v iPhone: head-to-head comparison

If the video player below does not appear, click here to view the video

Handheld smart phones, iPads, and other devices are rapidly becoming essential medical tools for doctors to retrieve dug prescribing information, electronic medical records, email with patients, alerts from monitors, etc. Blackberry recently released what some call the “iPhone killer” with their Torch that has a full touch screen interface like the iPhone, and also has a slide out real mechanical keyboard for those who find virtual keyboards unacceptable. The people at RIM sent us a Torch to review and we compared it head-to-head against the iPhone.

The physical design of the Torch is well done. The keyboard slides out easily and the buttons on the keyboard have good tactile, or haptic, feedback. The touch screen of the Torch seemed to function as well as the iPhone. Both devices are very close in size and weight.

Critics of the resolution of the Torch screen are misinformed on this point. The complaint is that somehow the experience of viewing movies on a tiny screen will be diminished? First, the Torch screen resolution is just fine. Secondly, the human eye and brain cannot distinguish fairly low-resolution digital moving images from extremely high resolution moving images. It is only with still photos where resolution becomes crucial. (Per conversation with the designer of the first digital movie camera for Industrial Light and Magic, 1999. SE Greer also demonstrated this in a scientific survey before thousands of doctors at the 1999 ASPS meeting.)

The main advantage of the Torch over iPhone is the superior email. Blackberry devices are compatible with corporate America and provide the most secure email. Evidence of this is that some countries, such as Saudi Arabia and India, are now actually complaining to RIM that they cannot break in and spy on Blackberry email. President Obama uses a Blackberry for a reason. In this day and age of rampant theft of your personal information from places like Facebook, Google, most websites, etc, it is refreshing to find a device with security. Blackberry email also “pushes” to the user and does not require constant checking of inboxes as does the iPhone.

In short, Blackberry email is for professionals. iPhone email is for teenagers who primary text message.

For text messaging, the Blackberry messenger, or BBM, is gaining popularity. In a nutshell, it incorporates many of the features of LinkedIn or Facebook by allowing friends to be defined and text-messaged as a group.

For web browsing, the iPhone has the edge. RIM has made a strategic decision to not support Flash. Therefore, many websites do not function on the Torch. In our experience, web sites such as CurrentMedicine.TV with embedded YouTubes, etc, work flawlessly on the iPhone. Another nice feature of the Torch browser is that it uses a full desktop system, and not a browser customized for handhelds.

For those who have a need to have an acceptable camera with them at all times, the camera on the Torch is leaps and bounds better than the ultra-crude iPhone. The real flash on the Torch works well. The video of the Torch is also better than the iPhone. Steve Jobs, for unknown reasons, has made photography a low priority for the iPhone. (The newest iPhones with the double-sided camera allowing for Face Time video conferencing is a feature rather than a camera matter.)

Consistent with the business pedigree of Blackberry, the Torch is almost a tiny laptop in that it allows files such as Word, Excel, PowerPoint, PDF, etc to be transferred between the Torch and the PC. One could make a business presentation by connection a Torch directly to a digital projector. The speakerphone of the Torch is also loud enough to conduct a real business conference call.

The iPhone has an edge over Torch in the number of third-party application programs (Apps) that can be downloaded. However, in our experience, most of these Apps are frivolous junk and not of interest to the professional. Some Apps on the Torch, such as Bloomberg, and the GPS turn-by-turn driving navigation are not available in the same quality on the iPhone.

The new operating system built for the Torch plays media just as well as the iPhone. However, it still crashed on us and required the infamous “Battery boot” familiar to all Blackberry users. The iPhone OS also accrues bugs and requires rebuilding once a month or so, in our experience using a PC with the iPhone.

In the end, the winner of our head-to-head comparison was the Blackberry Torch. Our readers and viewers are professionals who need real email that is secure, and a device with a real keyboard. Google also realizes the importance of the keyboard and the Android-based phones have slide out keyboards much like the Torch. If Steve Jobs stubbornly insists on the all-virtual keyboard, iPhone will be in second or third place in about a year from now. Whatever advantage iPhone might have over Torch in the Apps department or web browsing could not offset its inferior keyboard, camera, email, file transfer ability, and battery life.