Fortalecer los músculos de la cadera puede reducir el dolor de rodilla

31 10 2011

A team of Canadian researchers published a study showing the corridors with pain in the knee to improve notably if they continue an intensive programme of strengthening of the hip. The researchers subjected to injured riders two simple hip strength exercises, and in three weeks, it was observed that riders had a 40% less pain, less variability of movement between step and step, and more strength to help them manage their movements safely. This study is great news for riders who suffer from chronic knee pain. The Canadian team has been shown to strengthen critical muscles of the hip to help riders to restore a more consistent and predictable pattern of movement and to reduce the pain in the knee.

Summary of strengthening hip exercises carried out by riders who participated in the study.

Puede consultarse en estudio completo en este enlace: [en línea] Calgary (Canada):, 31 October 2011[REF. marzo/abril de 2011] Available on Internet:

The colon tumor cells that make metastasis in the liver become more aggressive in response to the new hostile microenvironment

27 10 2011

Certain healthy liver cells promote an adaptive response in cells of colorectal cancer by inhibiting proliferation and causing his death. The tumor cells that adapt, they change their behavior and morphology, favouring migration.

Researchers of the Institute of Bellvitge biomedical research (IDIBELL) and of the Catalan Oncology Institute (ICO), coordinated by David García Mollevi, the results of this study have been published in the journal Neoplasia.

The cellular microenvironment (called stroma) It has a dual role in the control of normal or malignant cells development: on the one hand, inhibits the growth of abnormal proliferation (neoplasia) in normal tissues while on the other you can enhance growth and tumor invasion in the progression of cancer.

Cancer is a complex tissue where acting different types of cells (the 80% are of a type called fibroblasts) it alongside other cells by creating a particular microenvironment. The balance between these populations: the environment, You can determine the fate of the tumor.

A hostile microenvironment

The objective of the study is to compare the influence of the microenvironment in three different situations: in a colorectal tissue healthy, in a tumor colorectal tumor colorectal which has metastasized to the liver and primary.

In the primary tumor, fibroblasts of the colon increases the proliferation of malignant cells and protect them from programmed cell death (apoptosis). On the other hand, in the situation of metastasis to the liver, tumor cells are found in a hostile environment of hepatic fibroblast, not only reduce their proliferation, but many die. Cells that manage to adapt to this environment change their behavior and morphology to facilitate their migration. These adapted tumor cells are more aggressive.

According to David Garcia Mollevi, the study coordinator, This discovery can be useful in clinical practice because what "open doors to study the mechanism or the factors of liver fibroblasts which produce the death of Colorectal tumor cells to be used in the future as therapeutic tools against metastatic colon tumor".

Changes in colon tumor cells that make the liver metastasis

The article reference

 Mireia Berdiel-Acer, Monika Bohem, Adriana López-Dóriga, August Vidal, Ramon Salazar, Maria Martinez-Iniesta, Cristina Santos, Xavier Sanjuan, Alberto Villanueva and David G. Mollevi. Liver Carcinoma-associated fibroblasts promote an adaptive response in colorectal cancer cells that inhibit proliferation and apoptosis. Neoplasia. Volume 13 Number 10 October 2011 pp. 931946


No Cellphone-Cancer Link in Large Study

24 10 2011

A major study of nearly 360,000 cellphone users in Denmark found no increased risk of brain tumors with long-term use.

Although the data, collected from one of the largest-ever studies of cellphone use, are reassuring, the investigators noted that the design of the study focused on cellphone subscriptions rather than actual use, so it is unlikely to settle the debate about cellphone safety. A small to moderate increase in risk of cancer among heavy users of cellphones for 10 to 15 years or longer still “cannot be ruled out,” the investigators wrote.

The findings, published in the British Medical Journal BMJ as an update of a 2007 report, come nearly five months after a World Health Organization panel concluded that cellphones are “possibly carcinogenic.” Last year, a 13-country study called Interphone also found no overall increased risk but reported that participants with the highest level of cellphone use had a 40 percent higher risk of glioma, an aggressive type of brain tumor. (Even if the elevated risk of glioma is confirmed, the tumors are relatively rare, and thus individual risk remains minimal.)

The Danish study is important because it matches data from a national cancer registry with mobile phone contracts beginning in 1982, the year the phones were introduced in Denmark, until 1995. Because it used a computerized cohort that was tracked through registries and digitized subscriber data, it avoided the need to contact individuals and thus eliminated problems related to selection and recall bias common in other studies.

However, the major weakness of the study is that it counted cellphone subscriptions rather than actual use by individuals, and failed to count people who had corporate subscriptions or who used cellphones without a long-term contract. Those small details could have diluted any association between cellphone use and cancer risk, the investigators conceded.

An accompanying editorial noted that although the results are reassuring, they must be viewed in the context of about 15 previous studies on cellphones and cancer risk, including those that did detect an association between heavy cellphone use and certain brain tumors.

Anders Ahlbom, a professor of epidemiology at the Karolinska Institute in Sweden and an author of the editorial, said in an e-mail that research on the subject should continue.

“Many stones have been lifted, but little has been found,” he wrote. “While there is little reason to expect anything to be found beneath the next stone, some uncertainty remains. We have learned that studies based on historical accounts of cellphone use are prone to bias. So a reasonable way forward seems to be to follow national statistics and prospective cohorts.” [en línea] New York (USA):, 24 October 2011[REF. 20 October of 2011] Available on Internet:

They designed a device that alerts by sms if detected a heart problem

20 10 2011

A group of researchers of the Polytechnic University of Lausanne (EPFL, by its initials in French), in Switzerland, It has designed a small device that attaches to the body and detects abnormalities in the heart rate in real time, whereupon send a text message to the patient and one to your doctor warning of the situation.

The Wireless Body Sensor Network (WBSN) It is a system that constantly monitors the patient's heart and is associated with your mobile phone. "What it does is receive the electrocardiogram information and analyze it in" real time, so if there is some kind of pathology, or hint of pathology, send this information to the mobile, where is shown graphically so the patient can see what is happening. And at the same time it is able to send a message - an sms or an e-mail- "a doctor", explains David Atienza, leader of the team that developed the device.

The appliance, that you can carry in your Pocket (It measures three centimeters high by three of width and thickness), It receives the signals sent by three electrodes attached to the body. What is new on similar devices is that this "is capable of" interpret "the data collected and alert when something goes outside the normal parameters", while others only collect information which is subsequently analyzed.

The system would thus eliminate at least four steps: take a turn to do an electrocardiogram, keep the appointment at the hospital, remove the results and take them to the cardiologist. "The doctor what you" saves is very much expense at hospital level, because it is not necessary for the patient to go to the hospital, or it is going every few minutes, "since the system information sent to the doctor when really detect something", points Atienza.

It is basically intended for chronic cardiac patients, to who the system practised them very specific analysis defined by the specialist (that "it's always who makes the final decision"). You can use all day (even at night) and does not affect normal activities, Since is light and non-invasive. Nor should we be aware of the battery: It has an energy autonomy of about three weeks.

"That proposed is to slightly change the way to deal with this type of diseases that are usually very focused on which the patient go to the hospital", with all the additional cost. This would be a system that is capable of directly working at home "and it is customized for each patient", drew Atienza, an engineer in computer science and electronics that came from Madrid to the EPFL in 2008 and was head of the team of 12 researchers who designed the WSBN. The research was, In addition, with collaboration and supervision of medical advisors.

The prototype already It has been tested with success in 20 patients with heart problems and in some 100 more people. Although "was not intended for a commercial purpose", There are four companies that are interested in producing it and market it. The University is negotiating with them "to see how it would be used", "in what context and under what conditions".

Atienza estimated its market value would be lower to the 100 euros and the validation process that enables its output to the market would take four to five months. [en línea] Buenos Aires (Argentina):, 20 October 2011[REF. 19 October of 2011] Available on Internet:

Transforming Drug Development

17 10 2011

Taking aim at the alarming slowdown in the development of new and lifesaving drugs, Harvard Medical School is launching an Initiative in Systems Pharmacology, a comprehensive strategy to transform drug discovery by convening biologists, chemists, pharmacologists, physicists, computer scientists and clinicians to explore together how drugs work in complex systems.

“With this Initiative in Systems Pharmacology, Harvard Medical School is reframing classical pharmacology and marshaling its unparalleled intellectual resources to take a novel approach to an urgent problem,” said Jeffrey S. Flier, dean of the Faculty of Medicine at Harvard University, “one that has never been tried either in industry or academia.”

Modern drug discovery has focused on the interaction between a candidate drug and its immediate cellular target. That target is part of a vast and complex biological network, but because studying the drug in the context of a living system is profoundly difficult, scientists have largely avoided this approach.

As a result, predicting the effects of a particular candidate drug in humans is currently all but impossible, and many initially promising drugs have been found to lack efficacy or to have unsupportable levels of toxicity—typically at a late stage of a clinical trial, at a cost of years of effort and up to $1 billion.

“Right now in the world of drug discovery, it’s as if we have a map of a highway system that only contains small pieces extending a few miles here and there, without any connectivity on a large scale,” said Marc Kirschner, the John Franklin Enders University Professor of Systems Biology and chairman of the HMS Department of Systems Biology. “If you try to plan a trip on such fragmentary information, you’ll fail. It’s our inability to develop a coherent picture that has stymied drug discovery for so long.”

As drug makers exhaust the most promising candidate areas, the number of new drugs brought to patients has actually decreased in recent years, even as the cost of discovery has soared.

A better understanding of the whole system of biological molecules that controls medically important biological behavior, and the effects of drugs on that system, will help industry identify the best drug targets and biomarkers. This will help to select earlier the most promising drug candidates, ultimately making drug discovery and development faster, cheaper and more effective.

“Through this new initiative, we will develop large-scale models of biological systems and networks which should more accurately predict drug efficacy,” Kirschner added.

The systems approach

The science of analyzing specific biological processes within the context of an entire living system, called systems biology, is relatively new. Harvard Medical School is a world-leader in this area, having established one of the first department-level programs in 2003.

Building on this success, Harvard’s new effort will apply systems biology’s innovative approaches to the understanding and prediction of drug activity, drawing on the vast range of biomedical expertise available at the medical school and its affiliated teaching hospitals and research institutes.

Led by Kirschner and systems biology professors Peter Sorger and Tim Mitchison, the Initiative in Systems Pharmacology will include faculty from a broad array of disciplines: systems biology, cell biology, genetics, immunology, neurobiology, pharmacology, medicine, physics, computer science and mathematics. The initiative will be fueled by a strong and diverse group of existing faculty and new recruits who will be based in several departments, and will be supported by an ambitious fundraising effort.  New approaches could include use of chemical biology to develop probes of biological pathways and failure analysis on unsuccessful drugs, similar to how the aviation industry scrupulously analyzes accidents to learn what went wrong. Such a practice is not common in today’s pharmaceutical industry.

Other projects currently underway at HMS will be expanded through the new initiative.

For example, Sorger and Mitchison collaborate with Ralph Weissleder, HMS professor of radiology and director of the Center for Systems Biology at Massachusetts General Hospital, to probe the mechanism by which anti-cancer drugs kill tumor cells in patients and thereby make the effects of treatment more predictable.  “What’s amazing is how little we know even about many drugs that work,” Sorger said. “A systems approach could help tailor existing treatments to specific patients, and find new uses for therapies we already have.”

And in the lab of systems biology professor Roy Kishony, scientists research the evolutionary forces that shape the emergence of antibiotic-resistant bacteria, seeking strategies for developing combination therapies to slow or reverse the spread of drug resistance.

The initiative will also include a new educational program, one that develops a new generation of students, postdoctoral fellows and physician-scientists. The goal is to train future leaders in academic and industrial efforts in systems pharmacology and therapeutic discovery.

Transforming therapeutics

The Initiative in Systems Pharmacology is a signature component of an HMS Program in Translational Science and Therapeutics. There are two broad goals: first, to increase significantly our knowledge of human disease mechanisms, the nature of heterogeneity of disease expression in different individuals, and how therapeutics act in the human system; and second—based on this knowledge—to provide more effective translation of ideas to our patients, by improving the quality of drug candidates as they enter the clinical testing and regulatory approval process, aiming to increase the number of efficacious diagnostics and therapies reaching patients.

“Systems pharmacology is the first and a key pillar of Translational Science and Therapeutics at Harvard Medical School,” said William Chin, the Bertarelli Professor of Translational Medical Science, executive dean for research at HMS and former head of research for Eli Lilly & Co.

“We intend to harness all the strengths of HMS to gain a deeper understanding of the cause and nature of disease, addressing some of the most vexing questions that continue to impede the development of new drugs,” Chin said. “We will focus our strengths and resources to translating such knowledge into new classes of life-saving medicines.” [en línea] Boston (USA):, 17 October 2011[REF. 17 October of 2011] Available on Internet:

General Electric spent 100 million dollars to innovate in the diagnosis and treatment of breast cancer

13 10 2011

General Electric Healthcare, with the collaboration of several venture capital companies, It has launched the program of financing Healthyimagination Challenge with a budget of 100 million dollars to develop and bring to market innovative ideas in early diagnosis and personalized medicine for breast cancer. During the presentation of the programme, the director-general of the multinational, Jeff Immelt, He stated that they will invest more than one billion dollars over the next five years in r & d in new technologies and solutions for the diagnosis and treatment of cancer.

They are eligible for funding researchers, entrepreneurs and innovative companies in the health sector. The winners, that will be announced during the first quarter of 2012, offered the opportunity to develop a business relationship with General Electric and four venture capital partners (Kleiner Perkins Caufield & Byers, Venrock, MPM Capital and Mohr Davidow ), In addition to receiving financing.

A jury of international experts - including Andrew C. von Eschenbach, former FDA Commissioner and director of the National Cancer Institute in United States, and Michael J.. Harsh Wauwatosa, Vice President and director of technology of General Electric Healthcare - valued innovation, the reliability and impact of the projects submitted.

The period for submitting proposals is to the 20 November of 2011. [en línea] Barcelona (Spain):, 13 de octubre de 2011 [REF. of 13 October of 2011] Available on Internet:

¿Quién mete el bisturí?

10 10 2011

A Spanish physician's visit between nine and ten times a year, a French and a British double. Ingested more medication (especially antibiotics) that any European. Only the 15% is the times you go to an emergency room for a really acute case. And their life expectancy is among the highest in Europe. One might infer that his longevity is the fruit add a healthier lifestyle and a health system that is accessible and quality way. Then nothing should change. Experts do not see as well: they understand that there have been abuses, Spanish health system “have excess fat” and the patient is changing. You must modify the model. But to do so in the midst of an economic crisis forcing a question: Are politicians prepared to make surgeons??

The future is uncertain for many reasons. He announced Albert Jovell, doctor trained in Harvard and President of the Forum Spanish patients: “We need to consider if the system you can pay what is upon you. Each time there will be more patients with various diseases. Approaching us an epidemic of diabetes: a third of the population will suffer it and that will generate problems of heart attacks, transplants, blindness…”. The trend confirmed Eduard Portella, Director of Antares Consulting, a health management company with offices in several countries in Europe: “There is a crisis of model. The offer is very specialized, It is intended for another type of patient, which have more than one disease, anything that has to do with the now. And the problem no longer cure it, but keep it with good quality of life. Like this, a few spend almost everything. And we have a few social services which are a world apart”.

The diagnosis of the health care system shows that it suffers from other problems. The lack of information. The citizen should know that there are hospitals in Spain whose risk of mortality after use of a coronary angioplasty is double with respect to other centres. Or that the mortality rate of certain minor ailments record differences between 2,2 and 4,5 times between areas of health. Data that are unknown to the patients.

When talking about health care in Spain, the public debate has been characterized for years by a sort of electoral practices competition according to which was analysing who promised increased number of hospitals and health centres. He has thought about the equity and universality of access to health care as a conquest that brings us closer to the more advanced countries socially. It is assumed that the system is excellent and cheaper than in other countries of Europe. It is the jewel in the Crown of our welfare State. Agree that there is an abuse in the consumption of drugs and should reduce the price of the pharmaceutical Bill. The time in which the economic crisis placed the autonomous communities (for which health occupies a 40% your budget) in the position of having to make cuts, the debate should be another. May it be more efficient health care at lower cost??

Certain scenes are recurring to a description of problems faced by the Spanish public health system. Patients on waiting list desperate because his illness is not fully settled; emergency services with patients waiting for a diagnosis in a hallway or elderly who must wait, between severe headaches, two months for a diagnostic test; citizens who have suffered the consequences of negligence. Scenes that often accompanied statements of doctors and nurses whiners for a low wage that does not reward many years of study. It is a picture of a health need of more investment.

But there are other problems that are not on the surface, because their knowledge is not within the reach of the citizen. They are discussed at symposia or disseminated in medical journals. For example, hospitalisations avoidable complications of diabetes cases can be 12 veces más frecuentes en un área de salud que en otra. Revenue in hospitals due to affective psychosis can be 28 veces más times more frequent in an area of health than in othere of procedures (for example, Prostatectomy) You can vary up 7,7 times. The increase in the number of Caesarean sections is unjustified and is spreading. These and other data are symptoms of inefficiency and abuse within the system. So two scenes may appear contradictory at a same hospital: We have the patient waiting in a corridor to be entered with the patient entering too many times.

Experts agree a phrase when referring to the Spanish health system: “More spending does not equate to more health”. One phrase: “We have more medical acts than any other OECD country. It is an inflationary system in medical proceedings”.

In the course of the last few weeks there have been several seemingly contradictory facts. The President of Madrid, Esperanza Aguirre, It inaugurated a new hospital very in the style of his later works in the town of Torrejón: a building with design, wide open spaces and good brightness equipped with all services to attend close of 200.000 people living in the vicinity. Almost at the same time, the Government announced new plans of health cuts: at the end of some services and centers of health during the summer, He accompanied an across-the-Board cut in wages (average pay of Christmas) among officials of the health system, without distinguishing between doctors, nursing or administrative staff. These news joined other known during the summer, as the resistance in health centres in the Valencian Community to issue recipes to resident citizens in other communities.

Three circumstances that highlight different ways of managing the health in the middle of the crisis. The news of the inauguration of the hospital from Torrejon has not been accompanied by any information about a remodeling of the services of the Hospital of Alcalá de Henares, just a 10 the newly inaugurated miles, You must now respond to fewer people. Example of the need to review the management of resources.

And not only at the opening of centres. “Is not sustainable and there are hospitals that make certain surgeries in Spain of 9 at 15 h. Been demonstrated that a surgical unit is better as soon as you operate more times: the relationship is direct”, explains Juan del Llano, of the Gaspar Casal Foundation. “The bad fat is not only an economic demand. It is a principle of unethical behavior if you use resources that should not be, If not thoughtful decisions. Here there was a race to open hospitals and health centres. For example, in infant heart surgery it is scientifically proven that the results are associated with the volume of operations. The more operates a doctor, best results have. In this sense, It is not acceptable that the same autonomous community has four units of children's heart surgery”, Go on.

“Surgical productivity of some communities is much higher than others”, ensures Juan Carlos Alvarez, managing partner of Antares Consulting, expert in management of hospitals. “There is oversupply?? The answer would be ‘ not’ because there are waiting lists, But if the question is whether the system is efficient, numbers sing alone: It is surprising how varies between hospitals productivity”. A public hospital of Navarra operates a 80% more than one of the neighboring La Rioja.

The question that arises is to do surgery with health in a totally decentralized system. Where it is necessary to cut and what consequences will bring about the health of our citizens?? Will there be different cuts according to which communities??

Among the catalog of causes which are at the origin of the overweight of the system are two redundant. A, the related staff: the 45,4% the health budget going to staff costs, whose productivity is low compared with their European counterparts (32 hours per week by 39 Germany and United Kingdom or 35 in France) and your absenteeism rate is higher than the Spanish average. Two, oversupply hospital (a hospital by each 860.000 inhabitants, twice as much as other European countries) with a large catalog of services. That cut staff costs so a first temptation, but the problem is how to do it. “Remuneration policies have always punished to making it better. We have a problem of very rigid offer, with many officials. Ask any doctor with who operate. They know, us, not”, ensures Vicente Ortún, researcher of the Center for research in economics and health (CRES).

“Here you can not close coincidentally health centres”, ensures Ricard Meneu, physician and doctor in economic, Vice President of the Foundation Institute for health services research. “The worst is that reduce employment passes to do so where it is possible (interinidades), so you risk losing many motivated and productive professionals. But yes, reduce personal. But we must do so with more head. The worst thing for a stupidly egalitarian system, contrary to reward professionals for their merit, and allergic to make prioritization decisions is to establish tithes as cuts from the 10% spending, of the 5% salaries, the number of beds, in spite of the contribution of each of the affected units”.

“To speak of a coincidence in the diagnosis, I do not have as clear”, ensures Eduard Portella. “Some affect the whole problem in the Pharmacy and I contend that they have taken 22 measures in 10 years on the drug issue. I think that the drug has given Yes all what he could. There are those who think that the solution is the co-payment as a formula for complete financing. Then, those who argue there is need to privatize the model and those who blame the extra cost to the State of the autonomies. I am among those who think that before making another invention must be straining towards the improvement of the management. The problem is that a legislature is not enough”.

Then appears the problem of policy. We are in a system where when changing a Government or a counselor of the same party cease the directors of hospitals, as recognized by José Manuel Freire, of the Instituto Carlos III and Socialist spokesman in the Assembly of Madrid. Vicente Ortún is more explicit on this issue: “Managers paint little. The decisions are still clinics and policies. Managers have a secondary role. There is a problem of transparency. We put the data access for the public. The citizen has the right to know what the best hospitals and centres which are more effective. The day that is known much an appliance in a community and how much in other, will have to give explanations. It is a problem of management which will not improve if no improvement policy”.

The time for cuts, experts lean toward a health Pact, by consensus, to eliminate inefficiency bags that do not adversely affect the health of the patient, even for study cooperation among regional health services. “Desirable would be to apply the reductions in those services where, above a certain threshold, more isn't better”, proposed Meneu. “But that requires surgical fineness. And true value to meet those affected. Something that is not abundant in our policy or our governance, preferring usually drain the bulk, It seems that it generates pissed but not enemies”, Go on.

“You have to be brave”, explains Juan Llano. “And have courage. If the citizen is better informed you can say the things. The information is a crucial issue and this leads to transparency. It's funny because communities have made investments in information systems, but it is not a system connected to central level”, says. Llano it touches a sensitive: each community uses its own system of information. Computer applications in primary care with almost all different: the history of digital health in Andalusia is the program Diraya, Valencia is Abucasis, the dispersion in hospital medical record is even greater.

“I have argued that the health system needs to get rid of fat, though not in muscle”, holds Meneu. “Get rid of fat means to review certain questionable efficiency benefits. It means doing what is not, as having almost multiplied by 17 the costs of management information systems, developing one each autonomy. The lack of transparency is not only a democratic joke, It is also a handicap to the improvement of health, as professional improvement by comparison has been proved that this information encourages. So this behaviour of our health care leaders as well as make them socially unpunished by irresponsible, It makes them harmful to impede improvements from information that already exists, that they manage and have paid all citizens. It is clear that they would take less right decisions by not having an existing information that is unduly limited. If we cannot know who is making it better condemn us to insist on our mistakes”.

In a panel organized in July of 2010 put them in Barcelona to 13 experts in management before 101 possible measures to improve the efficiency of the National health system “keeping clinical outcomes and health for patients and populations”. The most valued measures were those relating to good governance (control of corruption, political patronage, conflict of interest) and transparency.

There are insufficient data to assess each model?, each hospital, the overall effectiveness of the system? The misgivings among the political authorities have prevented the free movement of results to the point of the quality agency, that in its day was the Minister Ana Pastor (PP), It has failed yet the objectives for which it was created. Some communities have been resistant to send information (Madrid on waiting lists has been the dream). Sin embargo, There has been a curious fact, related to the work of the Aragonese Institute of health scientists, directed by Enrique Bernal, in collaboration with other colleagues from Valencia, When it comes to preparing an Atlas of variability, a very interesting tool to evaluate what you are doing in each community. These researchers do receive data, including those in Madrid, the last to join, to change communities to appear as participants in research. Sin embargo, the studies do not identify regions or hospitals. OnHoweverlly speaks of areas of health.

What is the reason?? Some do not want to leave bad unemployed.

Under these conditions, before a patient whose diagnosis is unwilling to make public, ¿cómo actuarán los políticos cuando tengan que hacer cirugía con la sanidad? [en línea] Madrid (Spain):, 10 de octubre de 2011 [REF. of 9 October of 2011] Available on Internet:

Abraham Verghese: A doctor’s touch

6 10 2011

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

Abraham Verghese: Physician and author

Before he finished medical school, Abraham Verghese spent a year on the other end of the medical pecking order, as a hospital orderly. Moving unseen through the wards, he saw the patients with new eyes, as human beings rather than collections of illnesses. The experience has informed his work as a doctor – and as a writer. “Imagining the Patient’s Experience” was the motto of the Center for Medical Humanities & Ethics, which he founded at the University of Texas San Antonio, where he brought a deep-seated empathy. He’s now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns.

He’s also a best-selling writer, with two memoirs and a recent novel, Cutting for Stone, a moving story of two Ethiopian brothers bound by medicine and betrayal.

He says: “I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it’s only at the bedside that I can figure out what is important.”

[ted id=1231] [en línea] New York (USA):, 6 October of 2011, [REF. septiembre de 2011] Available on Internet:

Sra ESCALA: Innovación de garaje en la sanidad española

3 10 2011

Elena scale Sáenz Chief Editor

Microsoft, Apple, HP, Google… All these companies have in common that they were put in place, either literal or metaphorically, in a garage. Is to say projects that sustain them were developed outside of the Establishment, as a voluntary activity, amateur and collaborative. Projects, In addition, in those who has invested much time and effort.

These success stories have made think to some institutions and public administrations to an idea, a garage and a couple of free hours after work enough to innovate in any sector, including the health. Belief that also relies on the idea that Internet and Social Media are the guarantors of the innovation of the 21st century.

Until recently the innovation related almost exclusively to the elite, above all institutional, What was supposed to enter a highly regulated circuit, conservative in thought and resources, rigid and little given the risk and improvisation.

Outside these circles it was very difficult for the healthcare professional to find the technical and strategic resources to innovate. Where do I call?? There is a service of attention to the innovative?? A few yellow pages?? Who helps me to develop my idea??, wondered.

This lack of information and resources has caused the failure of a company on more than one occasion. In fact, more than half of Spanish companies are failing for financial reasons, by errors of calculation; but the percentage of failure attributable to the lack of experience or knowledge in the professional field is very low.

This portrays very well the situation of the health care professional, account with knowledge and an excellent preparation, but it is with problems when developing their ideas either because you don't know the business tools and management, or because you do not know how to obtain resources.

Although making them this traditional circuit of innovation is going flexible little by little, only the Web 2.0 It has been able to produce a substantial change, democratizing the innovation process.

Thanks to Internet and its viral nature an individual, If you already know operate in this complex framework Cyber, You can undertake and innovate outside the usual circuits. Increasingly there are more tools to display, extend, promote and finance their ideas getting their projects to be productive and profitable.

We are even beginning to see the figure of the intraemprendedor in health, the professional still working on behalf of others in a company or institution, use innovation and creativity to develop projects or products originating small start-up that your company, that usually works for which, is the main investor. I.e., the entrepreneur is in your company to his main ally.

So emerging successful telemedicine projects, virtual consultation, management of chronic patients, reduction of bureaucracy, training, social networks for the exchange of knowledge, projects for health promotion…

There is a roadmap of innovation and we do not know what keys that guarantee success. But the truth is that when any of these health garage innovators has success in the development of your idea, the system comes out winning. And however, that effort is not always compensated, recognized or supported by the system.

It is a mistake to pretend that innovation in health is based almost exclusively on innovation in garage, in many small efforts not rewarded or supported.

Projects that health care professionals are launching individually or collaboratively must necessarily be in business agendas, institutional and academic, having a real impact on public health policies.

It is not enough with the will to innovate, and not all Spanish professionals have a garage. Es imprescindible un compromiso serio de todos los agentes que conforman el sector sanitario.