The growing availability of high-speed computing to drug and biomedical researchers has also brought us a step closer to a more effective AIDS drug. The relevance to medicine of the acceleration in supercomputing power and of growing global research collaborations that have access to that power through open-source software was not lost on IBM, which had the vision years ago to see the potential in such a development, and which has had the courage and clout to implement the vision. Its foresight is starting to pay off in the rapid prediction of pandemics and rapid development of vaccines to counter virus mutations.

IBM already has biosurveillance software that links disparate data sources so they can be mined for early warning signs of bio threats. IBM’s foresight, and its self-redefination as a healthcare company, is paying off in hard cash, too: It has signed a nearly half-billion-dollar deal with the University of Pittsburgh Medical Center to revamp UPMC’s IT systems and keep them current, and to co-develop software for hospitals to integrate and mine clinical data records. (In the May edition of the Digest we reported a similar deal between UPMC and Cerner to co-develop and commercialize health IT.)

Other news in HIT:

• The US Food and Drug Administration has decided that its anticipation — expressed in 2004 on the basis of the drug industry’s own confidence — of the common adoption of RFIDby 2007 was premature, though it continues to believe that it will happen “soon.” 

   

• “Sick blogs” and “patient blogs”could ease the uninsured problem by providing access to advice and support. While perhaps contributing to further tension in, or even severance of, the doctor-patient relationship, they might also serve to ameliorate the doctor shortage. They may also be an opportunity for hospitals to bond with their patients. 

   

• A 500 Gigahertz processor has been demonstrated in the lab. By comparison, the fastest PC displayed at the 2005 CeBIT expo had a 5.4 Gigahertz chip.

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The once controversial but now generally respected statistician laureate of medicine, Dr. David Eddy, believes that evidence-based medicine (EBM) is vital to elevating medicine from a hit-or-miss art to a reliable science, but that at least in the case of patients with multiple conditions, the practitioner of medicine is up against a complexity too great for the human brain to handle. So for the past ten years he has led a team developing a computer program that is already helping doctors treat diabetic patients who have multiple other conditions.

Archimedes contains equations representing the actual biology of the body, makes treatment recommendations, and even estimates the cost of alternative treatment. Dr. Richard Kahn, chief scientific officer at the American Diabetes Association, told Business Week‘s John Carey that Archimedes is at least ten times “better than the model we use now, which is called thinking.” Or worse: Intuition. While randomized clinical trials can sort out evidence from intuition, they take years, cost millions of dollars, are not always as valid and reliable as we like to think, and these accelerating days their findings could be rendered irrelevant and worthless by advances in medicine.

Archimedes, funded by Kaiser Permanente, is “a SimCity-like world in silicon, where virtual doctors conduct trials of virtual patients and figure out what treatments work,” writes Carey. In their virtual diabetes world, “each simulated person has a heart, liver, kidneys, blood, and other organs. As in real people, cells in the pancreas make insulin, which regulates the uptake of glucose in other cells. And as in the real disease, key cells can fail to respond to the insulin, causing high blood-sugar levels and a cascade of biological effects. The virtual patients come down with high blood pressure, heart disease, and poor circulation, which can lead to foot ulcers and amputations, blindness, and other ills.” Archimedes was validated by testing it against two dozen real clinical trials. One compared cholesterol-lowering statin drugs to a placebo in diabetics. After 4 1/2 years, the drugs reduced heart attacks by 35 percent. The exact same thing happened in Eddy’s simulated patients. “The Archimedes model is just fabulous in the validation studies,” a University of Michigan expert told Carey.

After validation, the next step was to put Archimedes to work on the “tough, real problem” of how best to treat diabetes in people who also have hypertension, heart disease, depression, or other ailments. Doctors typically assume that keeping blood sugar levels low and consistent is the best way to prevent additional ailments in diabetics. But Archimedes concluded, after running the equivalent of a 30-year clinical trial inivolving thousands of patients, that treating the downstream problems with a trio of generic medicines — aspirin, statin, and ACE inhibitors – saved both lives and money. The benefits far surpassed “what can be achieved with aggressive glucose control.” Carey reports that Kaiser Permanente doctors have switched their standard of care for diabetes as a result, and the early results in real patients are so far following Archimedes‘ prediction. Eddy concedes that Archimedes has a long way to go, likening it to “the Wright brothers’ plane. We’re off the sand and flying to Raleigh.” But it won’t be long, he told Carey, “before we’re offering transcontinental flights, with movies. . . . Our mission is that in 10 years, no one will make an important decision in health care without first asking: `What does Archimedes say?”‘

Supercomputers and Disease

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Small molecule drugs shaped to fit into crevices or cavities in disease proteins and thereby stop the protein from doing its job have not worked well against the HIV protease, whose crevices tend to be too smal for the drug molecules. But using a supercomputer to model how HIV protease switches between two shapes, a US researcher has discovered a new conformation where the cavities open wider. The HIV protease simulations took 20,000 CPU hours on a supercomputer at the US National Centrer for Supercomuting Applications (NCSA). Just a couple of years ago, such computing power was available but generally reserved only for higher priority projects.

Open-Source Global Pandemic Initiative

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Some 20 global health organizations and universities have joined with IBM in an open-source “Global Pandemic Initiative” designed to apply computer technology to respond to infectious disease outbreaks. IBM is contributing software, including a software framework called IHII (Interoperable Healthcare Information Infrastructure) to enable electronic health information to be more easily shared and mined, and software to predict virus mutations. The latter uses supercomputers (including the world’s fastest — IBM’s BlueGene), which are already used to study how proteins fold into complex, three-dimensional shapes.

Scientists at IBM research labs in six countries will serve as focal points for the collaboration, whose steering committee includes the US Agency for International Development, Centers for Disease Control and Prevention, World Health Organization, Scripps Research Institute, and the University of Pittsburgh Medical Center, which is among those working with IBM to develop text-mining technologies to assess what treatment regimens are most appropriate for what patients, as well as in the development of IHII. IBM plans to “expand the role of IHII to include public health issues, responding to global calls for pandemic preparedness by facilitating the sharing of clinical data among medical facilities, laboratories and public health agencies.”

It also plans to build an open-source community around STEM (Spatio-Temporal Epidemiological Modeler) designed to tap into information from IHII and other data sources like roadmaps, transportation infrastructure and animal migration patterns in order quickly to predict the geographical spread of a disease outbreak. Such predictions would help plan vaccine distribution.

Biosurveillance Software from IBM

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In February this year, IBM launched “WebSphere Business Integration for the Healthcare Collaborative Network,” a long name for software to help hospitals and government health agencies to share and analyze clinical data. The software has been tested by US government agencies including the Centers for Disease Control, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services. The Canadian government plans to use the software for biosurveillance, providing early warning of biological threats by analyzing public health data made accessible through the software.

IBM-UPMC HIT Deal

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Over the past five years, the University of Pittsburgh Medical Center (UPMC)s workforce has grown from 29,000 to 39,000, revenue has jumped 104 percent, admissions 27 percent, and the number of hospitals 25 percent. In April of this year, UPMC entered into an eight-year, US$402 million partnership with IBM to overhaul UPMC’s IT infrastructure and help it develop IT solutions both for internal use and for sale to other healthcare facilities. The bulk of the money — $352 million — will be used to rebuild UPMC’s IT infrastructure, which has grown rapidly over the past few years in part through acquisitions that have added disparate IT platforms, making a more efficient and less-expensive-to-maintain integrated IT system impossible to achieve.

As part of the deal, UPMC will replace a third of its hardware every year, and in the process save 15 to 20 percent a year in operating expenses, reduce the operating systems from nine to three, cut the number of servers in its data centers from 786 to 305, and reduce the number of storage arrays from 40 down to just two. UPMC and IBM each have contributed $25 million to kick off the initiative, while projects are considered and a governing body is developed that will ultimately choose which projects to fund.

Possible projects include a biosecurity information initiative to develop technology and tools to help hospitals better handle epidemics and bioterrorist attacks; leveraging current electronic health care records for better patient care and communication among hospital staff; and improving operational efficiency within hospitals. IBM also will donate hardware and technical help to UPMC’s work as part of the National Cancer Institute’s caBIG (cancer bioinformatics grid) project, which is designed to help in the distribution of cancer data and tools.

RFID and Drugs

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In May this year, a US Food and Drug Administration task force on counterfeit drugs decided that its anticipation, expressed in 2004 on the basis of the drug industry’s own belief, of the common adoption of RFID by 2007, was premature, though it continues to believe that it will happen “soon.”

According to an article by Stacy Lawrence in Eweek, citing an IBM exeecutive, “the pharmaceutical industry is still barely even employing the technology; only two drug manufacturers are using RFID and each with a single product line.” “Still,” she continued, “RFID deployment remains a top priority for the FDA and . . . seems likely to soon renew its focus on RFID and push the biopharmaceutical industry into compliance.” In an earlier article, Lawrence noted that “several major states, including Florida and California, have . . . enacted their own ‘pedigree’ laws” [to track drugs as they move through the supply chain] . . . that can be satisfied using already widespread bar code technology.”

Sick Blogs & Patient Blogs

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There is, writes Justin Berton in the San Francisco Chronicle, a growing number of blogs about illnesses, written by people with the illnesses. Some are intended to keep family and friends informed about the blogger’s health, some to share information and anecdotes with fellow sufferers, and some for emotional catharsis. And some, such as carepages.com and caringbridge.org, host more formal, professionaly maintained and content-monitored “patient pages” through hospitals. Sequoia Hospital in Redwood City, California offers its patients accounts on carepages.com, and is installing Wi-Fi in the lobby and cafeteria areas, as well as computer kiosks on patient floors.

Sick blogs and patient pages are extensions of the “new patient” who emerged from the early Internet era to march into the doctor’s office with a printout of research into his or her condition. And they may tauten the tension this created between patient and physician.

Toward Terahertz Silicon Chips

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The world’s fastest silicon-based microchip has been demonstrated by US scientists. The prototype operates at speeds up to 500 gigahertz (GHz), more than 100 times faster than desktop PC chips. Though it could eventually power faster wireless networks and mobile phones, the prototype had to be super-cooled with liquid helium, but even at room temperature it still achieved a whopping 350 GHz, and the researchers believe it is possible to make chips run at 1,000 Ghz, or one Terahertz, at room temperature.