Some thoughts on the Future of Medicine

Genome information interpretation volition emerge equally its ain medical specialty much similar radiology for evaluation of xrays, CTs & MRIs.  It volition stimulate got roughly fourth dimension only the complexity of the information volition eventually Pb to a board certified specialist that helps main attention doctors empathize genetic tests.  

Transformative solutions to a greater extent than oft arise via iconoclastic horizons non via the cognoscenti.  Translation:  Truly pregnant advances produce non arise from established ideas in addition to people.   They destroy established ideas in addition to patterns of behavior.  


"Citizen Scientists" in addition to "Health Hackers" Conducting trials, analyzing information in addition to presenting papers.   How tin nosotros all assistance inwards the advancement of science:  
http://online.wsj.com/article/SB10001424052970204621904577014330551132036.html

Tumor Treating Fields (electrical current) used to process encephalon cancer. 1st prescription patient. Novel GBM treatment

http://medicalxpress.com/news/2011-12-patient-prescription-fda-approved-brain-tumor.html

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Proposition 46 Jeopardizes California Medical Excellence

California offers its citizens first-class wellness care.  It has over 100,000 hard working physicians dedicated to taking superior aid of their patients inward conjunction alongside well-trained nurses, medical assistants, technicians as well as back upwardly personnel. (Ref)  According to U.S.A. News as well as World Report, 17 of California's hospitals are nationally ranked inward specialities such equally oncology, cardiology as well as orthopedic surgery.  Fifty-six other hospitals run into standards for rigid functioning inside the state. (Ref) 

Proposition 46 is a instantly threat to our superior California healthcare.   It would undermine a physician’s mightiness to best aid for patients as well as number inward dramatically higher costs—$9.9 billion annually according to ane written report (Ref)   Doctors already concerned almost malpractice would aspect upwardly increased pressure level to practise defensive medicine.  If this mensurate passes it volition besides live on hard to recruit as well as retain specialists who are inward high withdraw a opportunity specialties including OB/GYN, trauma surgical physical care for as well as neurosurgery. 

Proposition 46 farther creates a disincentive for physicians to implement novel solutions to challenging diseases.   Medical excogitation is needed to assail arthritis, cancer, diabetes, as well as the emerging Ebola epidemic.  If Proposition 46 passes, physicians volition live on less inclined to pursue novel transformative solutions for fearfulness of beingness sued as well as medical excogitation volition stall.  Instead of California physicians as well as hospitals beingness recognized equally worldwide leaders inward medicine, nosotros may no longer live on able to offering patients cutting-edge aid inside our state.   

Unfortunately, many Californians are unaware of the meaning issues that volition arise if Proposition 46 passes.  Over the past times several months, I accept had discussions alongside dozens of people almost 46 as well as accept been surprised at how trivial they know almost this onerous proposition.  Their lack of awareness is frustrating because the case lawyers completely sympathize the implications of the proffer they drafted.  As nosotros approach the upcoming election, I strongly urge California residents to read as well as analyze proffer 46.    Prop 46 Info

One occupation imbedded inward the proffer that should live on addressed is the request to curtail multiple prescriptions from beingness written as well as filled past times deceptive patients.  The solution to this work is non to give-up the ghost the three-headed monster known equally Proposition 46.  The amend respond is to improve tracking technologies such equally CURES that eliminate duplicate prescriptions from beingness ordered or filled at a chemist's as well as at the same fourth dimension increment the criminal penalties for patients that fraudulently endeavor to  

obtain multiple narcotic prescriptions.

If yous wishing for California to keep its worldwide leadership inward the delivery of outstanding medical care, I urge yous to Vote NO on Proposition 46.

Allan Mishra, MD

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Will Kobe Bryant become to Nippon to Treat his Knee Arthritis?

Japan Accelerates Regenerative Medicine amongst Regulatory Reforms

Why the US Must Follow Their Lead

Sign the online petition supporting Regenerative Medicine

Kobe Bryant, an elite professional person athlete from the National Basketball Association’s Los Angeles Lakers, has gone to Federal Republic of Federal Republic of Germany multiple times to last treated amongst a part of his ain blood for his creaky, arthritic knees.  The argue why he went to Federal Republic of Federal Republic of Germany is simple.  He wanted to accept the best take away a opportunity to play at the highest flat inwards the NBA in addition to he had exhausted all his options inwards the United States.  He went in that location to last treated amongst a factor of his ain blood that targets the inflammation associated amongst knee articulation osteoarthritis.  The handling he received is non approved hither inwards the United States. 

Will he decease to Nihon adjacent fourth dimension to acquire the most advanced therapy?  That may occur because inwards Nov 2014 Japan enacted legislation creating a novel pathway that accelerates the blessing procedure for regenerative medicine products.  We hither inwards the US demand to figure out how to best accelerate our ain regenerative medicine efforts or proceed to spotter our elite athletes in addition to other patients attempt handling beyond our shores.  Let’s explore why Nihon acted boldly inwards favor of regenerative medicine. 

Influenza A virus subtype H5N1 Nobel Prize was awarded to Japanese researcher in addition to one-time orthopedic surgeon, Dr. Shinya Yamanaka inwards 2012 for his pioneering locomote on how to reprogram mature peel cells into pluripotent stalk cells.  His potentially life saving locomote in addition to the national pride associated amongst it helped Nihon acquire a worldwide leader inwards stalk prison theater cellular telephone research.  Importantly, Nihon has also prospectively pursued in addition to passed legislation that volition dramatically own regenerative medicine.  The province took a leap into a brilliant futurity final calendar week amongst the implementation of regulatory reforms directed at accelerating the evolution of cell-based treatments. 

The novel police line established a dissever pathway for regenerative medicine products apart from traditional drugs in addition to medical devices. The regulations also created a organization that fosters faster commercialization of novel biologic products in addition to tin atomic number 82 to fourth dimension express approvals for upward to 7 years.   Post marketplace information analysis volition proceed to confirm the security in addition to efficacy of the regenerative medicine products amongst the potential to revoke approvals. 

The activity past times the Japanese authorities creates the proper equilibrium betwixt the demand for accelerated approvals for prison theater cellular telephone based therapies that accept established efficacy piece ensuring production safety.  The typical stage one, stage 2 in addition to stage 3 trials for novel drugs are non a proper pathway for cell-based therapies that accept highly complex mechanisms of activity that may or may non last identified fifty-fifty amongst elite preclinical models.  Importantly, many cell-based products come upward straight from a patient’s ain torso in addition to hence accept a dramatically higher security profile. 

Americans are screaming for novel treatments for a diversity of hard problems such every bit arthritis, pump illness in addition to diabetes.  Regenerative medicine in addition to particularly cell-based treatments accept a take away a opportunity to assist process in addition to potentially cure these problems.  We demand to follow the Japanese atomic number 82 in addition to exercise like pathways inwards the United States.  Last twelvemonth during a see to Nihon in addition to its PMDA (the equivalent of the FDA), I was staggered past times how engaged they were nearly regenerative medicine in addition to receptive they were to agreement how to convey condom in addition to effective biologic products to their populace.

The US tin acquire a keen bargain from Japan’s enlightened approach to regenerative medicine.  Safety of class should last paramount.  The catch of a conditional, time-limited blessing amongst reimbursement strikes a perfect chord every bit nosotros attempt meliorate treatments for our patients at to a greater extent than affordable prices.  Competition volition arise to obtain approvals based on stage 2 trials that confirm security in addition to demonstrate a solid grade of efficacy.  Importantly, to a greater extent than contest volition atomic number 82 to meliorate options in addition to faster excogitation like to the reckoner manufacture over the final several decades. 

We demand to also emulate our Silicon Valley technology scientific discipline colleagues in addition to telephone telephone for a Medical Moore’s Law.  Identify a specific clinical problem, exercise a novel solution in addition to inside 5 years double the efficacy in addition to decrease the cost past times 50 percent.  Data analysis via powerful graphical algorithms should assistance amongst novel discoveries in addition to also assist amongst meliorate management of many diseases.  

We must attempt dramatically higher horizons instead of beingness satisfied amongst iterative improvements.  The Japanese authorities should last congratulated for passing regulatory reform in addition to implementing transformative solutions.  Sooner, non later, nosotros demand to uncovering ways to execute our ain regulatory reforms hither inwards the US to assist our patients in addition to to rest competitive on the footing stage inwards regenerative medicine.

Perhaps, in addition to so Kobe volition last treated inwards California instead of Federal Republic of Federal Republic of Germany or Japan.

Allan Mishra, MD

TotalTendon


Sign the online petition supporting Regenerative Medicine

Please ship service whatsoever comments or suggestions nearly how to safely accelerate regenerative medicine.

References

(http://www.nobelprize.org/nobel_prizes/medicine/laureates/2012/yamanaka-facts.html)

Accessed 11/30/14

http://www.pmda.go.jp/english/events/2014taiwan_sympo/14_Keynote1.pdf

Accessed 11/30/14

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Improve how your deoxyribonucleic acid plant past times Riding an Exercise Bike

The Epigenetics of Exercise

Allan Mishra, MD

You can’t change your deoxyribonucleic acid but y'all tin alter how it works. deoxyribonucleic acid is the coding programme for all of the enzymes together with proteins that brand your trunk function. 

Epigenetics is a chop-chop evolving expanse of scientific discipline that studies how modifications on or only about your deoxyribonucleic acid alter the production of specific molecules. Your deoxyribonucleic acid is fixed but how it industrial plant is affected yesteryear the proteins together with chemic groups that surroundings the famous double helix.  You tin mean value of epigenetics every bit variable signposts on the winding tracks of your deoxyribonucleic acid that either suppress or promote specific genes.  The proteins together with chemic groups bring fancy names similar a “histone” or a “methyl group”.  These "epigenetic" markers don’t alter your deoxyribonucleic acid but rather alter how it interprets the underlying genetic code.  They tin plough on or off a department of deoxyribonucleic acid together with dramatically touching on YOU.  The scientific discipline is called “Epigenetics” together with inwards 2015 together with beyond, it volition alter the means nosotros all approach medicine together with wellness.  Multiple articles nearly epigenetics bring appeared inwards QuadCrunches together with Hamstring Stretches.  They are simple exercises that tin survive done anywhere.  For the bike, stimulate 20-30 minutes three times per calendar week amongst moderate resistance.

Remember, do tin literally alter how your deoxyribonucleic acid functions together with potentially salvage your life.

AM

TotalTendon

ALWAYS consult your ain physicians earlier start whatever do program.

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The Power to Heal Comes from Within

Powerful chemic weapons, besides known every bit drugs, together with sophisticated surgical procedures convey dominated the practise of medicine for many decades.  For at to the lowest degree the end xv years, maverick researchers together with physicians convey been exploring biologic alternatives to drugs together with surgery.  Instead of searching the globe for a novel chemic chemical compound or technology scientific discipline a sleek surgical device, they convey looked inward an odd place--inside the torso itself.  Could it live possible that the ability to heal comes from within our ain bodies?  The answer today is a qualified yes.  

Think most it for exactly a moment.  Next fourth dimension your larn a pocket-sized newspaper cut, only discovery what happens.  You bleed a little.  It stops on it own.  You seat a bandaid on it together with magically it heals over the class of less than a week.  Similarly, if yous sustain a unproblematic fracture, it typically heals on its ain amongst immobilization together with a few weeks of time.  Your liver is your most amazing regenerative organ.  You tin literally cutting out a lobe of your liver together with transplant it into somebody else.  That missing lobe volition thus regrow on its own.  Skin, os together with liver are tissues that convey fantabulous capacity to self heal. Other tissues postulate a helping hand.  Fortunately, within our ain bodies are many tissues that tin assist heal other tissues.  Blood, os marrow together with adipose tissue (also known every bit Fat) are 3 examples.

To begin, let's explore platelet rich plasma, besides known every bit "PRP".  PRP is a element of blood that tin live prepared using a unproblematic desktop sized centrifuge inward most 10 minutes.  I convey using PRP to care for chronic lawn tennis elbow right away for to a greater extent than than a decade amongst fantabulous success rates.  Multiple studies right away confirm the value of PRP inward the handling of this mutual disorder.  A recent meta-analysis of randomized controlled trials noted PRP to live "of cracking clinical significance."  PRP has besides been used to care for diabetic human foot ulcers, human knee arthritis together with degenerative disc disease.  Overall, in that location are right away to a greater extent than than 8600 published studies evaluating the basic scientific discipline together with clinically efficacy of PRP.   Importantly, inward all of the areas studied, PRP has an fantabulous security record.  That of class makes sense.  PRP is only a element of your ain blood.

Cancer immunotherapy is roughly other event of using your torso to assist heal itself.  Cancer immunotherapy essentially reprograms your immune organization to assist larn by nasty cancers.  Recently published information has constitute an "unprecedented" 94% of patients amongst a specific type of blood cancer achieving consummate resolution of their symptoms.  The technique involves removing your ain white blood cells, reprogramming them to laid on tumors inward the lab together with thus injecting them dorsum into your body.  To quote i researcher, "This is actually a revolution."

Finally, a therapy that sounds similar it came out of a scientific discipline fiction or horror motion-picture exhibit is exactly beginning.  The thought of parabiosis involves merging the circulation of 2 animals.  The master copy inquiry was done inward immature together with quondam rats inward 1956.  For the details delight review a tantalizing newspaper entitled "Experimental Prolongation of the Life Span (Peter Thiel, an iconoclastic venture capitalist , appears to live quite interested inward this approach to combating the aging process.  This approach is clearly non nevertheless proven but is intriguing.

If nosotros are seeking transformative solutions to hard problems, I propose nosotros await inside.  We mightiness exactly discovery the ability to heal.

Allan Mishra





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