Google’s official blog revealed today some details and screenshots of its yet unreleased Google Health project, a web portal for your personal health records (PHR). It appears the site will provide more than just storage space for medical records. Complementary tools may include health information resources and a doctor directory. The two screenshots are only a first look into the new service, and it is likely that more features will be announced in future posts.

Related Post: Google Health Collaborates with Cleveland Clinic

Last month, I wrote an article on the brewing battle between Microsoft and Google to create the de facto portal for your online personal health records (PHR). It seemed that Microsoft’s HealthVault may have had the edge with its earlier deployment and collaboration with the Mayo Clinic.

In a move to equalize the playing field, CNN recently reported that Google Health will work with the Cleveland Clinic to store records of several thousand patient volunteers. Google has been relatively silent about its unreleased project, but I assume it will primarily serve as a portable repository of personal medical information, including demographic data, past medical and surgical histories, current medications, and allergies. It is reasonable to speculate that the web service would also store select test results and discharge summaries from participating hospitals. I doubt that the excruciating details of progress notes or consultations will appear in the near future.

Details about the Google Health project are largely unavailable to the public, but it is clear that both Google and the Clinic have potential to reap great benefits from this symbiotic relationship. Google will instantly acquire a user base in the thousands, while drawing consumers to its brand of products. More importantly, Google would create a working hospital-web service model to market to other health care centers. Hospitals are the natural gold mines of medical records. The web service (e.g., HealthVault or Google Health) that more quickly gains broad acceptance by hospitals will likely dominate the market. The exorbitant costs to develop and maintain an EMR (electronic medical record) infrastructure may prohibit interested hospitals from integrating with multiple web services; that is, it may have to choose one or the other, likely the more popular or widely accepted web service. There is a reason why Windows dominates the desktop OS market (hint: it is not for technological superiority).

As for the Cleveland Clinic, the project benefits the hospital by establishing itself as a leader in health care technology. The association with Google will also boost brand recognition for the Clinic. This is important in a highly competitive health care market where recognition and prestige have tangible effects on patients’ decisions and donors’ pocketbooks.

As I mentioned in my earlier article, there are reasonable privacy concerns with either Google or Microsoft having access to so much personal information. But, the general public has spoken with its money clicks: These are among the most popular web companies in the world. So who’s next in the line-up of PHR marriages … Revolution Health (created by AOL’s co-founder Steve Case) and Johns Hopkins?

On The Wards would like to announce its first article entry (Industry Giants Vie for Your Online Health Records) in the Medicine 2.0 blog carnival. This biweekly collection of blog posts focuses on the application of Internet and related web technologies in health care. The article has been included in the 18th edition.

It was not long ago when mobile phones were considered luxury items or tools reserved for corporate executives. A decade and a half later, every Joe, Jane, and their child now sport a cell phone or some multimedia-capable variant thereof. Fortunately for the general populace and myself, a recent case-control study done in Japan has shown no significant relationship between mobile phone use and brain cancer. There have been many other studies with similar findings, but this is the first to further analyze the spatial relationship between radiofrequency exposure and tumor location.

The case population included 322 patients newly diagnosed with a brain tumor (88 with glioma, 132 with meningioma, and 102 with a pituitary adenoma). They were pooled from neurosurgery departments throughout Tokyo and 25 neighboring cities. The control group comprised of 683 healthy volunteers who were randomly contacted by cell phone. From both groups, the study participants were interviewed on their patterns of cell phone use: type of phone, length of use, average duration per call, frequency of calls, etc. Use of cordless telephones was also considered. The study further analyzed the 3D spatial relationship between source of radiofrequency exposure and location of tumor. These data were used to estimate a specific absorption rate (SAR) within the tumor.

The study did not find a significant increase in the odds (presented as odds ratio with 95% confidence interval) of the three tumor types with typical use of mobile phones. There was no significant difference found in incidence of tumor with increased cumulative time of use. There was also no substantial increase in risk when analyzing subgroups according to mean levels of maximal SAR. The researchers therefore conclude that there was “no increase in overall risk of glioma or meningioma in relation to regular mobile phone use among [their] Japanese subjects“.

It is interesting to note how the general public had embraced mobile phones long before learning of its relative safety. Could this be attributed to our collective state of denial (”it won’t affect me“), the immense utility and convenience of the device overweighing any potential health risks, or the sheer skill of the Sprint-Verizon-Cingular- marketing machine? Fortunately, most research studies have so far dismissed links between mobile phone emissions and brain cancer. But what if they didn’t?

Related Post: Mobile phones are safe in hospitals

• Source
• Takebayashi T, Varsier N, Kikuchi Y, Wake K, Taki M, Watanabe S, Akiba S, Yamaguchi N. Mobile phone use, exposure to radiofrequency electromagnetic field, and brain tumour: a case-control study. Br J Cancer 2008;98:652-9.

We typically characterize hives as an allergic skin reaction manifested with diffuse swelling, itching, and redness. In an unusual case (with accompanying image) recently reported in the New England Journal of Medicine, a woman developed a reaction of blue hives.

The cause is not as much an enigma as it is atypical. The patient was a 77 year-old woman who underwent surgical resection of a carcinoma of her right breast. In such cases, it is standard procedure to inject a colored dye (in this case, isosulfan blue) into the lymphatic system to delineate its drainage pathway. This allows the surgeon to roughly identify which sentinel lymph nodes to excise and biopsy. The patient, unfortunately, was one of the 1.5% of patients who are allergic to the dye. She subsequently developed hives intraoperatively. Although technically the hives is not blue, the presence of dye created this visual impression.

• Source
• O’Sullivan MJ, Morrow M. Images in clinical medicine. N Engl J Med 2008;358:e6.

The FDA (Food and Drug Administration) recently released a public health advisory on Chantix (varenicline), a smoking cessation drug manufactured by Pfizer. This follows an earlier investigation last year on reported behavioral changes associated with use of the drug. The presence of neurologic or psychiatric effects is not completely surprising, considering that Chantix interferes with the brain’s dopamine system. The dysregulation of dopamine has already been implicated in some neuropsychiatric disorders, such as Parkinson’s disease and schizophrenia. Although the drug does not necessarily need to be withdrawn from the market, the FDA cautions both patients and health care providers to be vigilant about past psychiatric conditions and noted mood/behavior changes while on the drug. The FDA adds that use of the drug may interfere with the ability to drive.

Given that lung cancer and heart disease remain among the top killers in the United States, smoking cessation is a key strategy in preventive health. It is hard enough for a smoker to quit. Fortunately there are still several other pharmacologic and non-pharmacologic tools to aid in smoking cessation, including nicotine patches, Wellbutrin (bupropion), and a great coach-physician.