Wednesday, February 24, 2016
NHS
'As I convalesced, I was gobsmacked at the great consequences of free health care and the the potential it offered to improve our society. It was a transformational shift in how we as a country viewed our fellow citizens. The creation of the NHS made us understand that we were in truth our brother's keeper, and that taxation benefits everyone through maintaining not just our roads and sewers but the health of our children, workers and elderly'. Harry Leslie Smith, from 'The Last Stand'.
Tuesday, February 23, 2016
pt's hacking diabetes management
John Costik got the call at the office in 2012. It was his wife, Laura, with terrible news: Their 4-year-old son, Evan, was headed into the emergency room.
His blood sugar reading was sky high, about 535 mg/dl, and doctors had discovered he had Type 1 diabetes. The first three days in the hospital were a blur during which the Costiks, engineers in Rochester, received a crash course in managing the basics of diabetes care.
For starters, they were told to log their son’s numbers on paper forms. It was their first hint that diabetes management did not occupy a place on technology’s bleeding edge. The methods for guesstimating carbohydrate intake also seemed imprecise, Mr. Costik found, and the process generated a lot of wasted data.
“The last thing you want to do is find some form and fill it out,” he said. “You’re really just emotionally trying to cope with it, and that data in that book isn’t necessarily useful to the people with diabetes.”
Several months later, Mr. Costik fitted his son with a Dexcom G4 continuous glucose monitor. A hair-thin sensor under Evan’s skin recorded an exact blood sugar reading at five-minute intervals, 24 hours a day.
But all that data left with Evan every morning when he headed off to day care. Mr. Costik wanted something better: continuous access to his son’s glucose readings.
So he examined the device’s software code and wrote a simple program that transmitted the monitoring data to an online spreadsheet he could view on a Web browser, Android mobile phone or, eventually, his Pebble smartwatch.
“I wanted our lives to be simple,” Mr. Costik said, “and I wanted Evan to live a long time, and diabetes to be a nuisance, not a huge struggle.”
Mr. Costik shared a photograph of his simple hack on Twitter — and discovered a legion of parents who were eager to tailor off-the-shelf devices into homemade solutions. Together, they have set in motion a remarkable, egalitarian push for improved technology to manage diabetes care, rarely seen in the top-down world of medical devices.
In 2014, the last year for which data is available, the Centers for Disease Control and Prevention estimated that 29 million adults were living with diabetes. Of these, 5 to 10 percent had Type 1, which develops when the body’s immune system destroys pancreatic beta cells.
Now, as consumer gadgets weave themselves ever more tightly into everyday life, patients and their families are finding homespun solutions to problems medical-device manufacturers originally did not address. Industry executives say the pace of user-driven innovation was one reason the Food and Drug Administration recently reclassified remote glucose-monitoring devices, hastening approval for new models by big companies like Dexcom and Medtronics.
James Wedding, a civil engineer who lives outside Dallas, saw Mr. Costik’s Twitter post and used his code to set up a remote monitor system for his daughter, Carson, who is now 12.
“Once I got all the pieces together, I remember crying — not quite in sadness, just in utter amazement — the first time I could see her numbers displayed on my computer screen and she was on the other side of the house,” Mr. Wedding said.
“It is such a change in your relationship when the first question out of your mouth when you talk to your son, your daughter, your spouse, your brother, whatever, is no longer, ‘Hey, what’s your number?’ It’s ‘How was math class? How was work? What are you up to today?’”
Lane Desborough, an engineer in California, got in touch with Mr. Costik after seeing his tweet, ultimately creating an open-source system based in part on Mr. Costik’s code. It allows anyone to hack existing glucose monitors so they transmit readings to the cloud, where they can be read by patients and caregivers.
Mr. Desborough called the project Nightscout. The Nightscout group onFacebook, known as CGM in the Cloud, provides free tech support for users trying to improve on monitoring devices.
About two dozen users have even started a project called Open APS, in which they are pairing insulin pumps with glucose monitors in an effort to create an open-source artificial pancreas system. These wearable devices, which automate insulin delivery, are being tested in academic settings, but these early adopters are not waiting for the results of those continuing clinical trials.
Mr. Costik now works at the Center for Clinical Innovation at the University of Rochester, where he works to improve management options for all patients; Mr. Desborough is now the chief engineer at Bigfoot Biomedical, a start-up in Palo Alto, Calif., that plans to create an artificial pancreas.
More recently, the home tinkering projects have buoyed a patient-led initiative to make generic insulin. Anthony Di Franco, a founder of the biotech hacker space Counter Culture Labs in Oakland, Calif., has had diabetes for 10 years. Mr. Di Franco saw what parents with diabetic children were doing with glucose monitoring devices and wondered why, even with insurance coverage, a three-month supply of insulin often totaled hundreds of dollars.
“I was frustrated with the situation,” he said.
With available laboratory tools, and a wealth of available academic literature, he set out to learn whether insulin could be home-brewed on a small scale. After some research, Mr. Di Franco realized, “We can do it, and we can do it now. All of the tools already exist.”
Last year, the Open Insulin Project raised $16,656 in one of the more ambitious efforts to radically transform diabetes care. So far, the small team of researchers has inserted the genes that make proinsulin (the form of insulin produced by the human body) into E. coli bacteria and began culturing the organism on a larger scale.
The intent is not to make insulin at home, or on an industrial scale. Any drug that is injected comes with substantial risks and would face considerable regulatory scrutiny. Rather, the hackers hope to be able to demonstrate the technological feasibility. Within a year or two, Mr. Di Franco said he envisions handing off the protocols and any intellectual property to a generics manufacturer.
“One thing that would make me happy,” he said, “is that if more people who needed insulin got ahold of it by whatever means necessary.”
Dr. Jeremy A. Greene, a physician and historian at Johns Hopkins University, who recently wrote in The New England Journal of Medicine about the lack of generic insulin, said patients with diabetes had a long history of tinkering with existing technology, even in ways that were not officially sanctioned.
Dr. Greene argues that while manufacturers in insulin are making innovations — the newest forms of insulin are substantial improvements over earlier products — they stop producing the older forms once they lose patent protection. Patients and their insurers pay a high price for patented insulin or go without.
Biohackers are attempting to resurrect an older product to address the lack of generic insulin, Dr. Greene said.
“I don’t think that we should be surprised that a population of technologically savvy patients, whose lives are dependent on access to a supply of a biological agent, should be interested in taking means of production into their own hands, especially at time when insulin prices have risen at unpredictably alarming rates.”
Sunday, February 21, 2016
Saturday, February 20, 2016
Aleppo
Back in Jan 2010, I posted a link to this article as a reminder of one of the places I wanted one day to travel to. I could never have foreseen what would come to be 5 years on. The sadness is deep, for all the losses, and inhumanity, the ordinary folk of that region have endured. I hope that things will improve, for hope is all I humbly have.
Tourists Return to an Ancient Crossroads in Syria
TO shouts of “yella-yella” — move along! — the driver of a donkey lugging a wagon overstuffed with pistachios parted the throngs of shoppers in Aleppo’s medieval souk. It was the middle of Ramadan, just hours before the iftar, the evening meal when Muslims break their daily fast, and the market’s serpentine rows of squat stalls were filled with black-veiled women and keffiyeh-clad men, sniffing the handmade olive soaps and stocking up on spices.
But there was another kind of shopper blocking the donkey’s path: Western tourists.
Not that Aleppo is any stranger to outsiders — T. E. Lawrence, Agatha Christie and Charles Lindbergh all made this city in northern Syria their stomping ground at one point.
Yet, as tensions between Damascus and Washington begin to ease, a new wave of visitors is rediscovering this ancient trading center, eager to take advantage of its low prices, spicy cuisine and maze-like bazaar.
In September, tourism in Syria was up by more than a third from the same month a year earlier, and the recent loosening of visa restrictions with Turkey means that Aleppo is being flooded with traders and tourists from across the border.
“The whole infrastructure of tourism is improving dramatically,” said Joshua Landis, an American professor and Mideast expert who runs a popular blog called Syria Comment (joshualandis.com/blog). “The spate of new boutique hotels and restaurants has shown the moneymaking potential of Aleppo’s Old City. But the pitch is to go now, before the masses arrive.”
What makes Aleppo unique is its blend of Ottoman, Armenian, Jewish and French influences, owing to its historic position at the crossroads of empires. Bright-green domed mosques rub shoulders with Armenian cathedrals, Maronite churches and even a synagogue. Its setting amid rolling plains dotted with olive groves and the ruins of dead cities calls to mind a scene out of “One Thousand and One Nights.”
Aleppo may also boast the Arab world’s most impressive souk, a sprawling network of noisy corridors and cramped stalls where, for the past seven centuries, every kind of spice, sweet, soap, silk, dried fruit, carpet, metal, jewelry and water pipe imaginable has been sold. If you’ve ever wondered what a slab of camel meat looks or smells like, just wander through the butcher section. And unlike bazaars in Istanbul or Cairo, Aleppo’s functions as an actual market, not a tourist trap.
The souk is a city unto itself. Old looms turn yarn into splashy-colored textiles, parrots squawk in cages and deific pictures of Presidents Bashar (current) and Hafez (former) al-Assad are everywhere. A buffet of scents — the sweet perfume of smoke, the laurel-like smell of olive soap — follows visitors. Sure, the incessant barking of “Welcome!” and “Where you from?” gets old quickly, but a few shopkeepers at least throw in some humor. “Very expensive. Very bad quality,” one beckoned to me with a wink.
The best time to visit Aleppo’s Old City may be in early morning, when the stalls are shuttered and their inlaid, ornately carved wooden doors become visible. At this hour, the city’s ruddy cobblestone streets go silent, save for the Arabic pop music blaring from a nearby barbershop, and the floral patterns of the enclosed balconies come into focus.
After the obligatory visit to the Grand Mosque, peek into any of the black-and-white stone archways to check out the courtyards of Aleppo’s khans (inns), full of jasmine and citrus trees. Or climb the stone bridge to the citadel, an imposing hilltop fortress completed in the 13th century. Buried within its ruins are a palace, hammam (bathhouse), temple, dungeon and two mosques. But the best reason to visit is the view of Aleppo’s minaret-dotted skyline.
Afterward, men can head to the restored Hammam el Nahasin for a relaxing massage or steam bath. Or, for a nice chaser, swing by the all-night juice stand on Bab al-Faraj square.
The square is mostly noted for its clock tower and the charmless Sheraton Hotel in the middle of it. In a travesty of 1970s-era Soviet-style urban planning, large swaths of the Old City were leveled to make room for wider, car-friendlier avenues. In the mid-1980s, the Syrian government reversed course and invited the German aid agency GTZ to rehabilitate its historic buildings.
The center of town is divided into three main parts: New City, Old City and Al-Jdeida, the old Christian quarter. The least impressive is New City, whose mud-caked modernist apartment blocks topped with rusting satellite dishes resemble those in any drab Arab city (though it does boast some of Aleppo’s best street food).
Guidebooks single out the Baron Hotel, erected in 1911, as the place to drink in New City. While the musty furniture and faded tapestries of its Old World bar and lobby are worth a look — and the moody desk clerk appears as weathered as the interior’s wallpaper — the hotel has lost much of its charm. It is also swarming with loud European tourists.
For a more local crowd, head to Al-Aziziah, a district of New City teeming with crowded bars and cafes. On a Thursday evening last summer, a smartly dressed crowd, most of them students, smoked apple-scented narghiles, or water pipes, their eyes glued to Syrian soap operas playing on big screens.
Or make your way over to Saahat al-Hatab, the main square of Al-Jdeida and maybe the most pleasant section of town. Children kick a ball around the square as old mustachioed men play backgammon late into the night. Some of Aleppo’s finest restaurants are tucked within courtyards along this quarter’s twisting back streets.
Aleppan cuisine reflects the city’s diverse history. It is not uncommon to order a half-dozen dishes in one sitting from as many culinary influences, which might include mezze, or appetizer dishes, of puréed dips with walnuts and hot peppers and main courses of soujouk (peppery sausage) and kibbeh (minced lamb).
And a new wave of Aleppan restaurants is laying claim to rooftops and courtyards across town, while merchants’ houses from the Ottoman era are being converted into trendy boutique hotels.
“Before, you had the government-run hotel on the square, and that was it,” said Thomas Pritzkat, project manager of the Aleppo Urban Development Project. “Now people are buying up old homes and transforming them into hotels and restaurants.”
For tasty tabbouleh salad smothered in parsley on an Oriental-themed rooftop, try Al-Hareer Restaurant. Another Aleppo mainstay is Sissi House, which can feel a bit stuffy — French-only menus, no prices listed — but whose lamb kebob lathered in tangy cherry sauce is worth the visit.
“Aleppo has a rich mix of cultures,” said Karam Artin, 20, an interior design student who was singing at a newly opened karaoke bar bedecked in red velvet. “In a few years, this city will be swarming with tourists, and, hopefully, even more American visitors.”
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