Google Video Chats With Doctors

If you’re one of millions of people who has done a Google search of your symptoms to try to figure out why you’re not feeling well, Google now hopes to be more helpful in getting you an answer. In an attempt to benefit from the extensive searches being done to self diagnose, Google is testing a new program that allows you to video chat with a physician and supposedly receive better information. It is widely claimed that researching symptoms on the web, frequently leads to misdiagnosis. If the false diagnosis is a serious condition, it can elicit unfounded anxiety, a condition that’s been termed “cyberchondria.”

At the present time, only individuals in Massachusetts and California have access to this trial service where Google will pick up the tab for the chat. To help in the launch, Google has teamed up with licensed physicians from Scripps Medical and One Medical. Though similar services exist, Google believes it’s got an edge by allowing the physician to view the individual. If they’re correct, its official launch will likely impact this field.

Although several headwinds to this platform may be cited, my main concern relates to tremendous reliance on sophisticated technology in current medical practice. It’s common today for a physician, despite being fully aware of the medical history and the patient standing before them, to request a series of laboratory tests and/or radio-graphic imaging before proposing a diagnosis.
With this practice playing a part in Google platform’s, aside from the straight forward case, the best a clinician could provide is a list of several possible diagnoses. Will individuals be inclined to open their Google Wallet for a list of conditions? Time will tell.

The way the Google platform now works is fairly straight forward. When doing a search of symptoms, a pop-up icon appears with the message:“Based upon your search query, we think you are trying to understand a medical condition. Here you can find healthcare providers who you can visit with over video chat. All visit costs are covered by Google during this limited trial. Talk with a doctor now.”

Since last year, Google has employed some health video chats in its Google Helpouts platform. Here “providers” schedule a time to teach or offer advise for a predetermined fee. In the US, the health care industry is over $3 trillion in size and in developed economies it regularly makes up 10% of the GNP. If Google is able to succeed with the platform, then even tapping into a fraction of the health care market, could be very beneficial for the company and hopefully patients as well.

Jacob J. Klausner

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Anemia Home Test Shows Promise

 The hemoglobin of our red blood cells carries oxygen to tissues throughout the body and is normally taken for granted until the level drops and anemia results. This may cause mild symptoms such as dizziness, tiredness and weakness or far more serious cardiac symptoms and even permanent cognitive deficits in children.

 It is estimated that as much as one third of the world’s population are at risk of developing anemia. In the U.S., this translates to 85 million people being at risk while 5 million actually are affected. Managing anemia, requires the drawing of blood by a skilled phlebotomist, followed by analysis by a trained laboratory technician. Since all this requires specialized equipment, testing until now has been limited to hospitals, medical offices or laboratories. Further negatives may include the need for blood drawing on a periodic basis, which can sometimes be painful.

 A just published study out of Georgia Institute of Technology and Emory University, reports on an at home, self-administered, inexpensive, disposable, simple plastic device that measures hemoglobin without even needing electricity. The study involved 238 adults and children with various levels of anemia who also underwent standard blood testing for comparison.

 The device draws up a small drop of blood by capillary action, similar to the way a diabetic performs a finger stick. Exactly 5 micro liters of blood is mixed with a precise amount of a reagent solution to produce a characteristic color that is determined by the hemoglobin level. In less than a minute, test results are achieved by matching colors ranging from blue to red. For those who are color-blind or simply color-challenged, an optional smart phone app has been developed which estimates the hemoglobin level and can then transmit the information.

 Individuals who will benefit most from hemoglobin home testing are those who require ongoing management of blood anemias, including sick-cell anemia, aplastic anemia and thalassemia. In addition, cancer patients receiving chemotherapy, individuals with kidney failure and those with chronic inflammatory-immunologic disorders will also benefit.

 The results of the FDA supported study demonstrated that the device has sensitivity levels greater than 90% in individuals with mild and severe anemia. While the device currently costs only half a dollar to produce, it still requires FDA approval and is expected not to make it to market shelves until 2016.


Photo shows the two parts of the anemia test device assembled.

Jacob J. Klausner

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FDA Approves New Colon Cancer Screening Home Test

We first reported this past April on a large scale study of Cologuard, a new multiple target home test for colon cancer. The DNA and blood-based test was shown to be more accurate than any screening test currently on the market. Last week, Exact Sciences, the company behind Cologuard, announced FDA’s decision to approve the test.

 In an unprecedented move, the Centers for Medicare and Medicaid Services (CMS) concurrently proposed that Cologuard be covered nationally by these programs. Normally, CMS begins its evaluation for coverage of new technology, only after the FDA submits their approval. It is anticipated that by November, Cologuard will receive final approval for coverage by other medical insurance programs. Cologuard will be available to patients without insurance at a cost of $599.

 The CMS has proposed that medical insurance companies cover the test for individuals aged 50 to 85 who are of average risk and have no signs or symptoms of colon disease. It still remains to be determined how often the test should be performed, how to deal with false positives or how to correlate it with a colonoscopy procedure.

 Exact Sciences has created the website and is planning to make the test available in select European markets once it receives CE Mark approval. The test which is conveniently performed at home, will be available to patients through their medical providers who will also receive the results. More information about the importance of colon cancer screening can be found on the company’s website, According to the U.S. National Cancer Institute, almost 50,000 people died of colon cancer in the U.S. last year and although it is considered the most preventable cancer, it is also the least prevented due failure in following screening guidelines.

 Jacob J. Klausner

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Lab Tests by Mail

Those who have followed this blog, know that many recent advances in home medical testing have involved developments in the information technology field. But what if you don’t own a smart phone or you’re not especially enamored by medical apps but you’re still interested in basic home laboratory screening.

In most states, you can now receive an assortment of laboratory tests you can perform anytime in the privacy of your own home. For some routine lab tests, there is no longer a need to drive to a medical laboratory and wait in the early morning hours to have your blood drawn. A test requiring that you fast or abstain from your morning coffee will likely further irritate you.

A Chicago medical company, Insight Echo Inc, now provides a service which will allow you to avoid these hassles. When you order an Insight Screenings kit, you will be sent everything required to perform the test. Included are detailed instructions on how to produce blood or saliva samples to ship for complete analysis. The company claims that their results are as accurate as those attained by traditional laboratory testing. Furthermore, if you know what you want and do not reside in New York, Maryland or California, you don’t need a physician’s prescription.

As of now, lab. kits are offered for four common tests as listed.


Home Tests Available

CardioMetabolic ProfileInsulin
Hemoglobin A1C
C-Reactive Protein
Total Cholesterol
Blood $154.95
Male/ Female Hormones Progesterone
Saliva $149.95
Prostate Specific Antigen PSA Blood $35.89
Thyroid Stimulating Hormone TSH Blood $59.95
Vitamin D D2, D3 Blood $64.95


The lab. results with explanations are sent to you within 7-10 days to any address that you’ve requested. You can then choose to share or not share these findings with as many physicians as you wish. If you don’t know physician, Insight Screenings can provide you with some names of those who’ve utilized their services.

Rapid developments in information technology have impacted numerous industries, including the medical laboratory industry. As a result, consumers are being provided with a greater number and more convenient testing options. You need to wonder why such a straight forward and direct service had not arrived on the market sooner.


Jacob J. Klausner

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New App for Pain

Studies have reported that almost 50% of the population suffers from various types of chronic pain conditions. Although most patients get relief with use of over the counter analgesics, there are those who need ongoing professional help to cope with the pain.


The American Pain Society last month met in Tampa, where initial research findings were presented on a newly developed pain app. What this app does is allow for the patient to input their level of pain, mood, physical activity, medication side effects and compliance with management suggestions. Pain experts have recognized for some time that regular monitoring of patients is of benefit in managing their chronic pain. Furthermore, electronic record keeping has been shown to be more effective than paper diaries.

The pain app was developed by Robert Jameson PhD, a pain psychologist at the Brigham & Women’s Hospital in Boston and professor of anesthesia and psychiatry at Harvard Medical School. In addition to monitoring, the app also provides cognitive behavioral therapy and encourages the patient to remain active and to continue developing pain coping skills.

The app requires that patients are asked five questions and answer them on a sliding scale of 1 through 10. Their responses are analyzed relative to baseline measures. When reports are found to be significantly elevated, the patient is advised that their provider will immediately be contacted and will call them. Monitored information is transmitted and becomes part of the patient’s permanent medical record. It’s anticipated that the app will allow pain specialists to more efficiently and economically monitor patients and reduce visits to hospital emergency services by up to half.

The app comes at a time when we are facing an apparent shortage of pain specialists, due mainly to the newness of the speciality. It is estimated that there is only one pain specialist for every 10,000 patients. A major benefit of this app is that it will make it easier for overburdened practitioners to more easily manage their patients. This is especially important with chronic pain patients since they often experience breakthrough pain and significant adverse effects from medications they’ve been prescribed, and then require costly urgent care.

Bottom line. The app should allow pain practitioners to provide their patients better care more easily.


Jacob J Klausner

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Home Sleep Apnea Testing Revisited

The FDA last week approved what is probably the most convenient device currently on the market for sleep apnea testing at home.

 Itamar Medical’s approval of its upgraded WatchPAT technology requires only one finger sensor to measure levels of blood oxygen saturation as well as the integrity of peripheral blood flow. The updated device, called the WatchPAT Unified, greatly simplifies home testing for sleep apnea as it requires the wearing of a single finger sensor which attaches by a short cable to a wristwatch style device. A second optional sensor may be used to assess snoring and body position during sleep.


Itamar Medical, a medical technology firm based in Israel, claims to have centers in all fifty states where the data from the WatchPAT Unified can be assessed and results sent to the physician. Itamar Medical received it’s FDA clearance earlier than was expected and chose to announce it to over 4500 sleep expert physicians, dentists and psychologists gathered at the Annual Meeting of the Associated Professional Sleep Societies in Minneapolis. There reportedly was much enthusiasm among conference attendees for the monitor’s simplicity and comfort.

It was just over two years ago that we first reported on home sleep apnea monitors coming to market and providing a cost-efficient alternative to studies conducted at sleep centers. Although the first generation sleep disorder monitors such as the SleepView Monitor may have been small, they nevertheless took more getting used to as they required wearing a nasal cannula and finger sensors that would attach by cables to a monitor strapped across the chest.

By now, most insurance companies have realized the cost benefits of such devices and usually require home testing before authorizing a sleep center study for milder and more difficult to detect sleep apnea cases. There is the hope that with such technical advances in sleep monitors for the home and simplified dental therapy for sleep apnea, the potential consequences of undiagnosed or untreated sleep breathing disorders will be greatly reduced.


Jacob J Klausner

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Developments in Home Thermometers

Parents generally tend to be somewhat anxious when recording their squirming babies’ rectal temperature. But todays parents can breath a sigh of relief, as recent technical advances have come up with quick, accurate and noninvasive solutions. In fact, as a result of the possibility of injury, many pediatricians no longer suggest that parents record rectal temperature on infants.

Infrared based professional thermometers have been around for several years in hospital and medical settings but only more recently has such technology been made available home use. Although there are many versions on the market, let’s review three of the major brands.

Exergen of Watertown, MA  was one of the the first to incorporate such advanced technology in thermometers for the consumer market. The Exergen Temporal Artery Thermometer requires lightly swiping the forehead and measures the blood temperature of the temporal artery. It has been demonstrated in one study to be accurate to within a fraction of a degree. The thermometer is reported to make 1,000 measurements per second and on instant analysis, displays the most accurate reading. The measurements equate with rectal temperature readings which are considered more precise than oral readings. Selling at local pharmacies and on the internet, the Exergen Temporal Artery Thermometer generally range between $30-50.


By sarang (Own work) [Public domain], via Wikimedia Commons

By sarang (Own work) [Public domain], via Wikimedia Commons

The Italian manufacturer, Tecnimed, has produced the Thermofocus which measures forehead temperature while hovering about an inch above the forehead. It claims to be the first non-contact forehead thermometer in the world, but can also be used at the neck or navel if these areas are more convenient. The readings that result equate in accuracy with rectal temperature measurements. The Thermofocus thermometer is especially effective is mass screenings since no covers or disinfectants are required.

A more recent model on the market, is the Braun Forehead Thermometer put out last spring by Kaz USA Inc. of Southborough, MA. Braun also produces an ear version which measures the heat of the ear drums. Ear temperature readings are generally considered to be more accurate than forehead readings, especially if the child is sweating. But the accuracy of measurements in small and tortuous ear canals is questionable and therefore it is not recommended for use in infants below six months of age. The Braun forehead version is somewhat different in that it equates with oral temperature readings which generally run almost a full degree lower than rectal measurements.

Despite the focus on infants in this piece, realizing the convenience and practicality that an infrared thermometer provides, its purchase should be considered in households of any age group.



  • Readings take only a couple of seconds and can quickly be repeated
  • Measurements do not require a babies’ cooperation.
  • Can be used to measure temperature at various parts of the body
  • Some models do not require disinfection
  • Requires fully charged batteries
  • More costly than traditional digital thermometers


Jacob J Klausner

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New DNA Colorectal Cancer Home Test

Surprise, surprise. Within a day of finishing an update on colorectal home tests in the last blog, the feature article of the New England Journal of Medicine (NEJM) related to a new DNA-based stool test for colon and rectal cancer. It wasn’t that long ago when DNA-based stool colorectal cancer home tests were mostly replaced by what was considered more reliable blood-based fecal immunochemical tests (FITs). Despite this, it was continued to be advised that screening tests for colorectal cancer include DNA markers. The NEJM reports on study of a home test that takes into consideration both blood and DNA markers and claims a level of sensitivity approaching colonoscopy, widely considered the gold standard for colorectal cancer screening.

Developments over the past few years of more sensitive and faster DNA analytic methods, have allowed for production of this novel multiple target test. The test, called Cologuard, is produced by Exact Sciences of Madison, Wisconsin.  Based on the data from the NEJM study, an advisory committee to the Food and Drug Administration (FDA), on March 27, 2014 in a 10 – 0 vote, recommended pre-market approval of the test. The panel considered the noninvasive test to be safe and effective with the benefits outweighing any possible risks.

ScreeningBloodBlood + DNA
Sensitivity - Colorectal cancer74%92%
Sensitivity - Advanced pre-cancers24%42%
Sensitivity - High Grade Polyps46%69%
FDA ApprovalYesLikely
Cost~$15Significantly Higher

The current study involved almost 10,000 individuals of average risk for colorectal cancer in 90 sites throughout the U.S. and Canada. All study participants underwent a colonoscopy and Cologuard and PolyMedco FIT tests. The DNA-based test had a sensitivity of 92%, in that it correctly identified 92% of individuals with colon cancers as well as 69% with high-grade polyps as verified by colonoscopy findings.

Although Exact Sciences had proposed that Cologuard be considered an adjunctive colorectal screening test to FIT, members of the FDA Molecular and Clinical Genetics panel expressed excitement with the study results, with some suggesting that it replace current FITs. Although the Molecular and Clinical Panel’s recommendations still needs to be reviewed by the FDA, approval is widely anticipated.

Jacob J Klausner

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Home Tests Detect Colon Cancers

It’s been over a year since we last covered stool tests for colorectal cancer. As March is colon cancer awareness month in the US, let’s look at some more recent developments in home screening tests.

For several years now, it’s been recommended by the American Cancer Society and the Centers for Disease Control and Prevention that individuals of average risk who are between the age of 50-75 years, have yearly screening tests for colon-rectal cancer. Studies indicate  that 90% of colorectal cancers occur in those over the age of 50. Nevertheless it is advised that Native Americans and African-Americans begin screening at age 45. Studies investigating effectiveness of such tests have reported varying accuracy in detecting hidden or occult blood.

A study just published in the Annals of Internal Medicine, reviewed the quality and results of 19 investigations that had been published in the past 17 years utilizing 8 different fecal immunological tests (FITs). This study concluded that FITs are able to detect about 4 out of 5 patients with colorectal cancers, i.e. they have a sensitivity of 79%. In addition, FITs are 94% accurate in ruling out patients who do not have colorectal cancer.

FITs may be administered at home or at the doctor’s office and are considered to be superior to older fecal occult blood tests (FOBTs). Whereas FOBTs require prior diet and medication modification and multiple specimens to be sent to a laboratory, second generation FITs allow for single samples and provide results in a minutes. As of now, the FDA has approved the test distributed by the Pinnacle BioLabs and which can be purchased directly for $15 as well as some retail pharmacies. The company is also working on having two major retailers distribute the test.

FITs are capable of detecting blood originating from the lower GI versus blood from the stomach or the upper GI. While a positive FIT test could indicate colon or rectal cancer, it may also reflect Crohn’s Disease, irritable bowel disorder, colitis or diverticulitis. A positive FIT test should always be reported to a physician and may require a colonoscopy for a more definitive diagnosis.

Colon and rectal is estimated in 2013 to be the third most common cause of cancer deaths in both men and women in the U.S, following lung cancer and prostate or breast cancer respectively. For this reason, in addition to yearly FIT testing, it is recommended that individuals of average risk in this age group, undergo a colonoscopy every 10 years and an interim lower colon sigmoidoscopy every 5 years. It’s also advised that individuals of increased risk, such as those with either a family history or a past history of polyps, may be screened even earlier and  more frequently.

While most adults are aware of a 10 or 5-year time frame for a colonoscopy, few know that yearly screening is also recommended. More simplified and reliable home tests that entail single samples that do not need to be sent anywhere for results, increase the likelihood that more people will comply with strongly suggested screening recommendations.

Factors Which Increase Risk For Colon Cancer

* Cigarette smoking

* Alcohol usage

*   Lack of exercise

*   Obesity

*   Red meat diet

*   Fatty diet

*   Low fiber diet

*   Prior polyps


Jacob J. Klausner

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Crowd Diagnosing of Medical Illnesses

Internet technology has touched all our lives. Though not all changes are viewed positively, in the area of dissemination of health information, the internet has been without a doubt – revolutionary.

Take for example the San Francisco start-up company CrowdMed launched in the Spring of 2013. Four years in the development and planning stages, this internet site attempts to link individuals with medical conditions that defy clear diagnosis with the opinions of clinicians and non-clinicians throughout the world. In other words, it attempts to employ ‘the wisdom of crowds’ to solve the most difficult medical cases that exist or simply provide a second opinion.

The more common or basic medical ailments can usually be quickly diagnosed and treated by most practitioners. But there are individuals who experience concurrent conditions, rare illnesses, or ailments that are rare to a specific locale and therefore defy easy diagnosis. These and other type of situations can make it very difficult establishing the correct diagnosis and proper treatment. This is especially the case in geographically remote areas where only the most basic medical services are available.

It is has been reported that approximately 8 percent of the world’s population, or a total of 350 million people, experience one of 7,000 rare or very difficult to diagnose conditions. Furthermore, many new conditions are discovered yearly, making it very difficult for most busy clinicians to keep up.

The way CrowdMed works is you first register on line as either a patient or a medical detective (MD). As a patient, information related to symptoms, health history, family health history, medications, lifestyle is posted by opening a case with a $50 refundable payment. In addition, diagnostic laboratory results and imaging findings can be downloaded. Also the patient can be asked further questions or you can discuss the case with other participants. The patient also indicates if and how much they are offering as a cash reward for the best diagnosis. This is decided by the patient or their physician ninety days after the posting or when 50 MDs have provided input, whichever is first. Rewards are distributed to the Medical Detectives based on their point scores for the case.

Medical detectives are enticed to register, as they may view providing feedback, a fun exercise or intellectually challenging. There is also the prospect of entering a competition or a betting contest with the reward being either cash or earned points that leads to a charitable donation on behalf of the most astute MDs. The charitable contribution apparently comes from 10% of the award proceeds retained by CrowdMed.

To date, CrowdMed has raised over $2.3 million in venture capital and claims to has saved an estimated $7.8 million in traditional medical expenses in solved and pending cases. The Medical Detectives of CrowdMed have in the short time since launch, have relieved immeasurable suffering for those patients who have participated and may even have saved some lives.



  • Private beta phase testing with real patients proved to be “stunningly accurate”
  • Utilizes patented diagnoses prediction market technology
  • Accurately lists the most probable diagnoses
  • Provides second opinions easily
  • Potential for curtailing unnecessary diagnostic procedures and treatments
  • Doesn’t require the hassle of another clinician visit
  • Saves time and money in seeing a clinician.
  • Leads to proper treatment sooner
  • Eliminates individual clinician’s bias, lack of knowledge or experience.
  • Addresses privacy concerns.



  • Site is not yet widely known
  • Buy in by clinicians still remains
  • False hope for desperate patients


Jacob J. Klausner

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