How Florida has made tough calls in Zika fight

When the first cases of local Zika virus transmission were confirmed in South Florida this summer, physicians, public health officials and policy makers had to make difficult decisions on how best to contain spread of the infection linked to birth defects, Guillain-Barre syndrome and other neurological problems. The Sunshine State experience is especially instructive in light of news from Texas of the first case of mosquito-borne Zika infection there.

My lede. The whole shebang.

Catching up on AMA Wire

Last month, I left the College of American Pathologists to rejoin the American Medical Association. Once upon a time, I worked as a reporter for American Medical News, the AMA’s weekly newspaper. And then I didn’t. And then I joined the CAP, which was a lovely place to work.

But now I’m back at the AMA. To wit:

The job principally involves writing for, and editing, AMA Wire. That is an online-only news site that publishes about 500 stories a year. These stories are included an email newsletter that goes to about 250,000 physician subscribers.

Unlike AMNews, Wire is explicitly designed to promote AMA policies, goals and strategic initiatives among practicing physicians, medical students, residents and fellows. So there is an element of marketing communications to the gig, but the main tools used to do that are news-like storytelling and a fair deal of fact-finding and sharing. It is an interesting challenge, and I am enjoying the chance to work with a kind and talented group of people.

I have been so busy getting up to speed on the job that I haven’t made the time to post many links to my articles, as has been my custom. I’ve now created a page here for my AMA Wire stories.  So far, I’ve covered speeches at the AMA’s interim meeting by its president and CEO, team-based care, gun violence, care for LGBT patients, mobile health appshealth care reform, antibiotic stewardship and statin prescribing.

Stay tuned to this website for more, if you are so inclined. Or follow me on Twitter.

Cancer Moonshot has diagnostic thrust

Vice president Joe Biden’s Cancer Moonshot now has a flight plan, drafted by a blue-ribbon panel and published in September. Coming as it does in the final year of president Obama’s term in office, there are doubts about whether the ambitious $1 billion program—aimed at achieving 10 years’ progress in cancer research and treatment in a five-year period—will ever get off the launching pad.

Nonetheless, two pathologists involved with the initiative say it has already spurred creative thinking about how to break down silos within the cancer community and reinforced the central role diagnostics will play in detecting, preventing, and better understanding cancer.

My lede. Read the whole shebang.

6 ways to get your patients immunized this flu season

Influenza sends about 200,000 Americans to the hospital each year, on average, and thousands of patients die of the illness. That morbidity and mortality burden can be greatly reduced by widespread influenza immunization, yet ensuring that each of your patients gets vaccinated is no easy task.

Here are six key steps you can take this flu season to help your patients get the protection afforded by vaccination, according to Capt. Carolyn Bridges, MD, associate director of adult and influenza immunizations in the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases.

My lede. Read the whole shebang.

Yale researchers dig for new kidney biomarkers

An automated immunoassay has been created for symmetric dimethylarginine, or SDMA, a biomarker that can detect chronic kidney disease between 10 to 17 months earlier than creatinine, with 100 percent sensitivity and 91 percent specificity. And, unlike with creatinine, a patient’s muscle mass does not influence the biomarker’s reliability. SDMA has already been incorporated into the kidney-function testing advice that guides clinician ordering worldwide. Since the automated SDMA test was launched in July 2015, 5 million samples have been analyzed and 80 percent of clinicians are aware of the test.

There is a hitch in SDMA’s forward march to a place of prominence in chronic kidney disease testing: It has gone to the dogs—and cats.
The automated SDMA assay is available only from Idexx Laboratories, a Westbrook, Me., company with a 40 percent share of the veterinary lab testing market. In veterinary medicine, the weaknesses of serum creatinine as a CKD biomarker are pronounced because there are no estimated glomerular filtration calculations for laboratories to use and report.

My latest feature article in CAP TODAY. Read the whole shebang.

Project improves rural physician access to subspecialty expertise

The hub-and-spoke model that transformed aviation is being applied to the continuing education of primary care physicians with the aim of enabling access to hard-to-find specialty care in remote areas. In this case, the “hub” is the team of academic subspecialty experts who make themselves available to primary care physicians—the “spokes”—through Web-enabled videoconferencing sessions. They cover dozens of conditions such as chronic pain, HIV, hepatitis C, endocrinology, dementia, autism, addiction and diabetes.

The lede to my first published piece in AMA Wire. Read the whole shebang.

AMP lays out clinical utility standard for molecular Dx

The Association for Molecular Pathology has published a 14-page report its leaders hope will reset the conversation payers, policymakers, and medical guideline panels have when assessing the clinical utility of molecular diagnostics in oncology and inherited diseases. The key to AMP’s approach is to broaden the standard for what is considered a clinically useful molecular diagnostic test.

“We tried to take an inclusive approach and look at patients, providers, and clinicians, and we tried to address clinical utility from all those standpoints,” says Elaine Lyon, PhD, co-chair of the AMP Framework for the Evidence Needed to Demonstrate Clinical Utility Task Force. The panel met for two years to develop the document, “The Spectrum of Clinical Utilities in Molecular Pathology Testing Procedures for Inherited Conditions and Cancer: A Report of the Association for Molecular Pathology” (Joseph L, et al. J Mol Diagn. 2016;18[5]:605–619).

My latest in CAP TODAY’s “Put It on the Board” section. Read the whole shebang.

As diabetic CKD takes toll, work on tests continues

When nephrologist Katherine Tuttle, MD, first saw the photo of two women holding young children, she thought it captured the mother of the boy and girl sitting on a couch with the children’s grandmother.

The younger-looking woman, 33 at the time the photo was taken, works in the clinical research group at Providence Health Care, Spokane, Wash., where Dr. Tuttle is executive director for research. Flashing a smile in the photo, Dr. Tuttle’s colleague held in her arms a baby girl who munched on her toy. Seated next to her was a woman whom diabetologists would recognize as having lost sight in one eye, with a two-year-old boy on her lap. Her face, deeply lined with wrinkles, bore a glum expression.

Contrary to Dr. Tuttle’s first impression, that second woman was no grandmother. She, too, was 33 years old, a cousin of Dr. Tuttle’s colleague and the mother of the two-year-old boy. Diagnosed with type 1 diabetes at 12, she had been on hemodialysis for two years by the point the photo was taken and had lost vascular access. Due to her son’s birth, the woman was highly sensitized and no kidney donor could be found.

“She was dialyzing via a hemodialysis catheter, and if you are a nephrologist you’d say she was probably not receiving very good dialysis based on the way she looked,” Dr. Tuttle said during a talk at the American Association for Clinical Chemistry’s annual meeting in August. “She had been thinking about stopping dialysis, but she didn’t have to make that choice because she was found dead about six weeks after this picture was taken.”

“This is what youth-onset diabetes looks like by the 30s, when people are supposed to be enjoying the prime of life,” she added. “It doesn’t matter if you’re type 1 or 2. It doesn’t matter what color you are. It’s really tragic, and it should be preventable.”

But preventing kidney failure requires new therapies and better biomarkers to help develop, test, and monitor the effect of those treatments. Slashing the rates at which patients with diabetes develop and die of kidney disease also depends on improved clinical use of existing tests and standardization of urine albumin and the cystatin C-based estimate of glomerular filtration rate, said Dr. Tuttle and her co-panelists during the AACC session, “Diabetic Nephropathy: Where Are We Now?”

My latest cover story in CAP TODAY. The whole shebang.

Top court clarifies autopsy’s place in Texas law

The Texas Supreme Court has decided, in the case of Christus Health Gulf Coast v. Carswell, that a hospital-provided autopsy falls under the scope of the state’s medical liability statute. The plaintiff, Linda Cars­well, alleged that professionals at Christus St. Catherine Hospital in Katy, Tex., defrauded her by refusing to request that an autopsy for her husband—who died as a hospital inpatient—be performed by the county medical examiner’s office. The autopsy was instead performed by a hospital-contracted pathology group. Carswell’s attorneys alleged this was done as part of an effort to hide some medical error-related cause of death.

My lede to an item in this month’s “Put It on the Board” section.  The whole shebang.

Missed UTIs? ‘Enhanced cultures’ suggest so

The long-held belief that urine is sterile is facing a serious challenge from new research combining sequencing techniques and an enhanced urine culturing protocol to uncover an array of uropathogens hitherto unseen in microbiology laboratories.

The notion that urine, indeed the entire bladder, is sterile is one medical students are still taught and “it’s a pretty deeply entrenched dogma,” says Linda Brubaker, MD, a urogynecologist and professor of obstetrics and gynecology and urology at Loyola University Chicago Stritch School of Medicine. She and a team of Loyola colleagues have worked for years to learn more about urinary microbiota and in the process demonstrated that currently standard urine culturing techniques fail to spot an alarmingly high proportion of uropathogens that may well be clinically relevant. Their findings were presented in June at the American Society for Microbiology’s Microbe meeting.

“What we’re going to do is replace the dogma that clinical care is based on,” Dr. Brubaker says. “There is a great deal of excitement because this is a vast unknown. It’s like discovering a tribe in the middle of the Amazon. We never knew these people were here, or how they eat, or how they live. We have to understand this [bacterial] community now—how it maintains health, how it deals with perturbations, like when patients are catheterized and a certain number of patients will get infections. Not all of them do. We may learn why some do and some don’t.”

My cover story in the August issue of CAP TODAY. Read the whole shebang.

Structured illumination microscopy used to detect nephrotic kidney disease

Structured illumination microscopy, or SIM, offers an alternative to electron microscopy in viewing details that are below the resolution limit of standard light microscopy. SIM was applied recently to analyze renal podocyte substructure in nephrotic kidney disease, and the findings corresponded with those obtained using electron microscopy (Pullman JM, et al. Biomed Opt Express. 2016;7[2]:302–311).

That is important, says lead author James Pullman, MD, PhD, because electron microscopy, or EM, techniques require specially trained technicians and a time-consuming process of preparing, imaging, and analyzing a single sample using EM. SIM also gives protein localization by immunofluorescence the high resolution of EM.

Also in this month’s “Put It on the Board” section. The whole shebang.