By Sy Mukherjee and Clifton Leaf
February 1, 2017

When an infection takes hold, the symptoms are often immediate and obvious: Our bodies sear and shake with fever and chills, our stomachs churn, we feel so lifeless we can’t lift the TV remote.

But when it comes to the overwhelming bulk of conditions that sicken and kill us mortals, the pathological breakdown is typically slow and stealthy. Cancer—with the exception of pediatric malignancies and a small share of aggressive diseases—is notable in this regard. Ovarian and pancreatic cancers are as silent and deadly as ninjas. Lung and colon cancers are often not caught until they’re in an advanced stage of destruction. The aberrant cells lurk in organs and tissues that are buried in a fortress of skin, muscle and bone.

The human body is awfully good at hiding disease.

Which is why, since time immemorial, medical practitioners have tried to devise methods to identify it early in its symptomless progression. Hippocrates connected changes in the color and odor of urine to an imbalance in the “four humors” that, he believed, underlay health and disease. Galileo invented a crude thermometer. Roentgen had his X-rays. We’ve tried microscopes, stethoscopes, endoscopes, and colonoscopes—and, of course, blood tests galore.

But what if we could diagnose disease from examining human breath? What could be simpler, cheaper, and less invasive? No pin pricks. No smothering CT scans. No brainer.

That’s precisely what a group of researchers at Technion−Israel Institute of Technology and other institutions have reported they can do now—at least with a modest level of specificity and sensitivity. Senior author Hossam Haick says his group created a device that combines an array of carbon nanotubes and tiny gold particles that is able to sense electrochemical signals from tell-tale chemicals (known as volatile organic compounds, or VOCs) in human breath—and that when those signals are analyzed with the help of artificial intelligence, they reveal the unique signatures of more than a dozen diseases.

When Haick and his team tested his AI breathalyzer on 1,404 volunteers known to have one of 17 different conditions, they accurately identified 86% of them, the scientists reported. “Overall,” they wrote with no apparent blushing, “these findings could contribute to one of the most important criteria for successful health intervention in the modern era, viz. easy-to-use, inexpensive (affordable), and miniaturized tools that could also be used for personalized screening, diagnosis, and follow-up of a number of diseases….” (I’ve left an ellipse there because that sentence actually continues.)

Haick and crew are not alone in their enthusiasm. There have been no shortage of reports of similar breath tests diagnosing lung cancer, esophageal cancer (from just five chemicals), lung cancer (again—but this time from breath temperature), colorectal cancer, and more. The European Union is even working on a “SniffPhone,” which would use your smartphone to ID disease when you exhale. (Warning to Mouth Breathers!)

The idea, of course, is a wonderful one—and the technology (and accuracy) does appear to be getting much better over time. But a reminder (and, perhaps, word of caution) to those who hyperventilate over such apparent breakthroughs: Scientists and inventors have been trying to achieve this hack for half a century.

None other than the great Linus Pauling—master chemist, elucidator of the chemical bond, 70-time nominee for the Nobel Prize and recipient of the award in 1954—proposed and tested the idea of diagnosing disease via the VOCs in human breath. He captured the airborne compounds in “a coiled 5-foot by 0.20-inch stainless steel tube cooled in an isopropyl alcohol dry ice bath,” then examined them with a gas chromatograph.

That was in 1971, in the months before Nixon’s War on Cancer began.

More news below.

Clifton Leaf
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

First U.S. community hospital teams up with IBM Watson for Oncology. IBM’s supercomputing unit has struck its first cancer-focused partnership with a community hospital: Florida’s Jupiter Medical Center, a regional nonprofit with 327 patient beds. Jupiter will be able to use Watson’s AI and analytical abilities to support clinical decision-making in oncology by leveraging the plethora of medical journals, clinical trials, textbooks, and other research that Watson has been taught by Memorial Sloan Kettering. That means that Watson will be able to give doctors at Jupiter the most up-to-date treatment options, potential drugs to be used for specific patients, and other critical information in a ranked order. And that’s particularly significant for a community hospital which isn’t part of a massive private health system or university, as Frost and Sullivan analyst Nancy Fabozzi explains. “Keeping up with the pace of change is difficult enough for oncologists at the most sophisticated medical centers—and can be near impossible for those practicing in community settings with fewer resources. Watson for Oncology is fundamentally reshaping how oncologists derive insights that enable the best possible decision making and highest quality patient care,” she said in a statement.

“Smart labs” are on the rise. Nature details how the Internet of Things is finally making its way into research labs, taking an enormous burden off of scientists who have much better things to focus on. Laboratories have begun to incorporate digital sensors and smartphone apps into their facilities, allowing scientists to remotely monitor critical factors like air flow or real-time data from various equipment. Certain “smart labs” are going even further than that. For instance, the smartLAB project in Germany has produced one facility where even the safety goggles are high-tech, and can display information such as chemical safety. The concern with IoT Labs is, of course, the same as with any consumer IoT product: cybersecurity and vulnerability to hacking. (Nature)

athenahealth CEO Jonathan Bush calls for a health IT arms race. athenahealth chief Jonathan Bush has penned an editorial for Healthcare IT News urging the health IT sector to significantly up its game, asserting that the industry needs the type of competitive drive that gave rise to innovative apps and services like Waze and Kayak. The advent of the HITECH Act and regulatory requirements for medical providers to upgrade their systems to electronic ones set the baseline scenario and a minimum threshold of functionality. Now, it’s time to take things to the next level, says Bush. “[A]s reimbursement models, both public and private, shift to demand quality beyond just reporting, so too does the job of health IT,” he writes. “I find it satisfying that the playing field will no longer be defined just by “check the regulatory box” systems, but will become an arms race to determine which health IT partners will play the most meaningful role in driving actual performance. A definite sorting of the wheat from chaff.” (Healthcare IT News)


INDICATIONS

Don’t expect pharma CEOs to fulfill Trump’s wish list. President Donald Trump had a high profile meeting with a who’s who of big pharma CEOs (the chiefs of Eli Lilly, Merck, Johnson & Johnson, Novartis, Amgen, Celgene, and PhRMA were all present). The rendezvous sent all of those companies’ stock prices soaring on the hopes that Trump will actually be friendlier to the industry than once feared. For one, Trump promised to slash corporate taxes and loosen FDA regulations to help speed drug approvals; but he also pressed the pharma chiefs to work to lower drug prices and bring drug production back to the U.S. (In exchange, several of the attendees promised to create more jobs in America.) But, as I argue, Trump’s list of demands is unlikely to come true for a number of reasons: 1) Drug price hikes can still be persistent without being outlandish, and biopharma may increasingly adopt this tactic to avoid a backlash; 2) Companies simply have too much incentive to manufacture overseas, including the lower cost of raw materials/production and the desire to build a footprint in emerging markets where an increasing number of people will become customers; and 3) Trump’s own executive actions could undermine major FDA reform for speeding drug approvals (including implementation of the 21st Century Cures Act) since the president has demanded two regulations be slashed for every new one introduced and a federal hiring freeze that could hamstring an already understaffed FDA. (Fortune)

Eli Lilly’s failed Alzheimer’s med is almost completely dead now. Lilly has abandoned another phase 3 study of solanezumab, its once-promising experimental Alzheimer’s therapy that was hit with a costly late-stage clinical trial failure last year. The Indianapolis-based pharma giant had already wound down one trial in early Alzheimer’s patients; now, it’s also shuttering a phase 3 in patients at the very beginning of their dementia symptoms (i.e., memory loss and haziness but no debilitating loss in cognition), CEO David Ricks announced on Tuesday. The treatment is still being tested in two other Alzheimer’s variations, but those trials haven’t even reached the clinic yet.


THE BIG PICTURE

Obamacare repeal could cost nearly 1.2 million jobs by 2019. On the final day (potentially ever) of Obamacare enrollment, the Economic Policy Institute unveiled a new analysis finding that a repeal of the Affordable Care Act would lead to nearly 1.2 million fewer American jobs within years. The loss in potential jobs would be fueled by widespread benefit cuts that would significantly overshadow the benefits of repeal’s tax cuts, according to author Josh Bivens, a macroeconomics expert and director of research at EPI. And the states that would face the biggest losses in state employment are the ones which benefited most from Obamacare’s Medicaid expansion, which vastly extended the safety net for the working poor and thereby had a macroeconomic stimulative effect on jobs, according to EPI. (Fortune)

Drug resistant malaria rears its head in the U.K. For the first time, a major drug combo used to treat malaria failed to defeat the infectious disease. Four patients in the U.K. treated between October 2015 and February 2016 with an artemether-lumefantrine combination saw a resurgence in infection despite initially responding to treatment (all four had contracted malaria in Africa). Although the patients were all eventually given other medicines; but the fact that the parasite was able to survive raises a red flag about its ability to evolve. Last year, a woman in the U.S. died from a superbug resistant to all 26 different antibiotics available in America. (BBC)

Chemicals in fast food wrappers may be cause for concern. Paper wrapping products that are commonly used to serve fast food staples like fried chicken and french fries may contain fluorinated chemicals that could be harmful to health, according to a new study published in Environmental Science & Technology Letters. According to the study, a third of the examined fast food packaging (which came from 27 chain restaurants) contained these kinds of chemicals. And while their simple presence shouldn’t necessarily be cause for alarm, previous research has shown that the chemicals could eventually leech into the types of hot, greasy food for which the wrappers are used. (The Verge)


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