Category Archives: Healthcare Technology

Setting the record straight: New stool DNA test for Colorectal Cancer Screening (A guest Blog by @DrDeborahFisher)

 

A bit about today’s Blog Post…..

Dr Deborah Fisher is a brilliant Gastroenterologist at Duke University Medical Center.  She is also a fantastic wife and mother.  A Twitter fanatic, Dr Fisher has taken to Social Media to promote issues in Gastroenterology.  Today, she writes about a very controversial subject in GI–Does a New stool DNA test Replace Colonoscopy and is the Media Creating Confusion in the Market? 

Setting the record straight: New stool DNA test for Colorectal Cancer Screening (A guest Blog by @DrDeborahFisher) 

An occupational hazard of being married to a rising media star is that when I expressed my concern and exasperation at the misinformation being circulated about a newly FDA-approved colorectal cancer screening test, his response was “write a guest blog for my blog page”. Another occupational hazard is having the local NBC-affiliate news truck parked in front of our house at 9:30 on a random summer evening. But that is for another blog.

For full disclosure, I am a gastroenterologist and much of my research and clinical focus is colorectal cancer screening. Some of my previous comments on the new stool DNA test, Cologuard, have already been published in the New York Times as well as in a previous issue of @MedPageToday. However, I have recently noticed a number of misleading articles in various newspapers across the country and wanted to address these, likely common, misconceptions about the new test.

First, I want to openly acknowledge the positives about Cologuard. The study in the New England Journal of Medicine examining its ability to find a colon or rectal cancer as a one-time test (compared to colonoscopy as the gold standard) was large, well-designed and well-executed. It showed that as a one-time test Cologuard was 92% sensitive for cancer. It also showed that the false positive rate was about 13%.

The problem has arisen in how the study results are being spun in the media. Here are a couple emerging myths to debunk:

  • Cologuard is for patients who absolutely positively want to avoid colonoscopy.

                                                     FALSE

While colonoscopy is the most common test used in the US to screen for colorectal cancer , it is not the only test. It is not even the “best” test. It is the most accurate test for finding cancers and polyps but that is not the same as the “best” because there are clear downsides including cost, risk of complications, access. A screening strategy of using a non-invasive test first can greatly decrease the need for colonoscopy but does not eliminate colonoscopy because Positive Screening Tests Should Be Followed By a COLONOSCOPY. Therefore, a positive stool DNA test needs to be evaluated with colonoscopy or the point and potential value of screening is lost.

The fecal immunochemical test, aka FIT, is also a non-invasive colorectal cancer screening test. It has been around for decades, and in its current form is a widely available test that is included in all the US colorectal cancer screening guidelines

In fact, I will argue that it is a better test for your patient who is not completely against screening but would prefer to avoid colonoscopy if possible because 1) its false positive rate is 5% vs. 13% for Cologuard. Therefore it carries a lower risk of leading to an unnecessary colonoscopy 2) it is currently covered by all insurance carriers

  • Cologuard will increase colorectal cancer screening rates in the US population

                                                       FALSE

Or perhaps a more accurate response might be “We have no idea” since it is a new test and the only people who have used it were in a research study.

On the other hand, we have compelling data that FIT increases screening rates compared to the older guaiac-based fecal tests and among patients who were previously unscreened.

 

  • Cologuard is the best non-invasive test for colorectal cancer screening

                                                       FALSE

And a bit of a trick question because we really do not have a Best Test at this point. Nonetheless, Exact Science is clearly going after the screening market leftover after colonoscopy takes its lion’s share. In addition to my general case for no “best” test, I would argue that Cologuard has not accumulated enough data to knock FIT off its best non-invasive test perch.

Yes, Cologuard had a higher rate of diagnosing cancer in one-time testing compared to a single FIT product in a single study, but

1) Screening is not a one-time test. FIT is meant to be repeated annually (or biennially in most screening programs outside the US). We have no idea if after 2 or 3 rounds of FIT the higher sensitivity (detecting cancer among individuals with cancer) of Cologuard will remain.

2) The interval of annual FIT testing has a wealth of data support vs. no data whatsoever supporting ANY testing interval for stool DNA tests (currently CMS is considering a 3 year interval

3) In a healthy population, it is important to consider harms and the higher rate of false positives leading to colonoscopy could translate into an increased rate of adverse events.

4) FIT is $25 vs. $600 for Cologuard

 

Now, some might say, “hey colonoscopy is the most expensive, risky option out there”. To which I say touché. Perhaps unfortunately, no headlines are claiming any test is better than colonoscopy. That might be another blog. Poor Dr Campbell is creating a social media monster.

Deborah Fisher, MD, MHS

Associate Professor of Medicine

Duke University Department of Medicine

Division of Gastroenterology

@DrDeborahFisher

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The Dangerous Stranger Lurking in the Dark: Using the AliveCor Device to Identify Asymptomatic Atrial Fibrillation

Surgery has many well defined risks–we perform procedures when the benefits far outweigh the risks.  As healthcare providers, it is our job to carefully discuss the risks and benefits of any medical procedure with our patients prior to the planned procedure and make sure that they understand what we are doing, why we are doing it and what our ultimate goals include.  We often discuss bleeding, infection, and other common post operative risks and then other risks that are specific to the particular procedure being performed.  Now there may be a new perioperative clinical marker–atrial fibrillation–that can identify patients at risk for other complications such as stroke, long after discharge from the hospital.  Atrial fibrillation is the most common heart rhythm problem in the entire world and is associated with stroke in patients who are at risk.

This past week the Journal of the American Medical Association published a new study examining both the incidence of atrial fibrillation after ANY surgery as well as the conferred risk of stroke.  The study involved over 1 million patients and the results were quite alarming–nearly 28K patients had peri-operative atrial fibrillation and of those, almost 14K patients experienced strokes that occurred after discharge.  Even more disturbing was the fact that the rate of atrial fibrillation was even higher in non cardiac surgery patients (as compared to those undergoing cardiac surgery).  Many surgical patients may be discharged without knowing that they have atrial fibrillation or that they are at risk.  Some may present with cryptogenic strokes and suffer life changing devastation.  The data is very clear about the prevention of stroke in atrial fibrillation.  Based on a risk score (known as the CHADS2-vasc) we are able to quickly calculate and assess risk for stroke (based on several common predisposing factors) and appropriately choose an anticoagulant for each patient.  It is also clear that anticoagulation in high risk populations reduce stroke rates significantly.

There is no doubt that atrial fibrillation results in significant morbidity and mortality in the US today.  According to data from Circulation published in 2013, one in every 19 deaths is due to atrial fibrillation related stroke and nearly $37 billion dollars is spent on patient care due to this disease.   Even  more disturbing is the fact that many patients with atrial fibrillation are totally asymptomatic and may not even know they have the arrhythmia at all—many patients’ first presentation with atrial fibrillation is sadly a presentation with a devastating stroke.  The recent article in JAMA further emphasizes the negative impact that silent atrial fibrillation can have on patients.  As clinicians, we remain vigilant for the presence of atrial fibrillation and often we are able to identify and screen those at high risk–however, many patients are missed and preventative therapy with anticoagulation is never prescribed.

What is the Answer?  How can we better screen asymptomatic patients for atrial fibrillation in a cost effective, broad based way?

The Alive Cor iPhone EKG application and device is the first of its kind.  It is an FDA approved device that can record a single lead electrocardiogram directly from your fingertips, display the tracing on the iPhone screen and transmit the tracing to the cloud for review.  The device is now available direct to consumers for purchase and no longer requires a physician prescription.  In May, a clinical trial was published that demonstrated that the Alive Cor device could be used to easily screen large groups of consumers for atrial fibrillation in a cost effective way.  In the study, which was published in May in Thrombosis and Haemostasis, investigators screened 1000 asymptomatic pharmacy customers for atrial fibrillation using the Alive Cor device and found that 1.5% of them actually had atrial fibrillation upon screening.  The cost effectiveness per stroke saved in the US was estimated to be a cost savings of nearly 20%.

Given the high prevalence of both symptomatic and asymptomatic atrial fibrillation worldwide, it is essential that healthcare providers strive to do a better job screening for this sometimes silent disease.  The identification of patients at risk for stroke from atrial fibrillation (and subsequent anticoagulation) is the best way to reduce both the cost and devastating morbidity and mortality associated with the disease.  With technology such as the AliveCor device readily available to both patients and clinicians it is essential that we begin to utilize this device for massive, cost effective screening efforts.  As healthcare reform shifts focus on prevention of costly disease,   we must continue to focus on improving screening and care for those at highest risk.

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What Color is My Pill Doc? Using Technology to Improve Medication Compliance

It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process.  In addition, patient engagement and co-management of their disease has been proven to improve outcomes.  This past month a new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance–when a pill looks differently patients often simply stop taking them as prescribed.  In this study, a change in pill color was associated with a 34% increase in medication discontinuation and a change in pill shape was associated with a 66% increase in medication discontinuation.  In cardiovascular patients in particular, the sudden discontinuation of medications can result in increased hospitalizations for chest pain, congestive heart failure and other more serious acute cardiovascular events. For other disease processes such as diabetes, medication non compliance can be devastating and life threatening as well.

The Challenges of Managing Poly-pharmacy

In general, today’s patients are taking more medications for a multitude of ailments and even for the most astute patients keeping track of doses and regimens can be a challenge.  Add in changes in color and appearance of chronic medications and the task can often be overwhelming for elderly patients with cognitive decline.  According to a study published in the Journal of the American Medical Association in 2008, nearly 81% of adults aged 57-85 took at least one pill and 29% took 5 or more drugs.  In addition, nearly 50% took concomitant over the counter drugs and/or supplements as well.  Side effects, drug-drug interactions and other concerns have led many physicians to attempt to streamline medication use and avoid the dreaded “poly-pharmacy” patient.  However, this serious public health problem is further complicated by patient non-compliance issues.  Many regulators argue for more FDA intervention as well as requiring generic drug makers to conform to non generic shapes and colors when manufacturing generic substitutes.  However, I believe that this data argues for a more comprehensive, patient centered approach to increasing medication compliance.

Leveraging Technology in Seniors

Technology today is ubiquitous in nearly all age groups. According to a Pew Research poll, most seniors utilize the internet and a large majority of these users interact via tablets, computer or other mobile devices.  As we age, we tend to live with more chronic illnesses and seem to require more daily medications.  Given the fact that now seniors are actively engaged on the internet, it makes sense for medical professionals to use these powerful tools to assist patients with management of their disease.  Many EMR systems already incorporate “patient portals” which allow for direct patient access to certain parts of their medical record such as test results, appointments, etc.  In addition, there are websites such as Pill Identifier that allow patients and physicians to search a large database of drug images in order to more accurately identify a medication–this is particularly useful when a patient approaches a visit in an Emergency Room or has a consultation with a new physician.

Based on the newly released study in Annals, it is clear that pill identification (and consistency of appearance) is critical in maintaining patient compliance with chronic medical regimens. Regulatory agencies are slow to act–forcing private generic drug makers to keep the size, shape and color of the generic consistent with the brand name is not realistic.  I believe that we can use tablet technology to quickly address this issue.  What if we create an application (downloadable to mobile phone, tablet and laptop) that is able to quickly identify all shapes colors and sizes of a particular drug? Currently there is a pill identifier app on the market but it requires the user to enter color shape and size in order to identify the correct medication–are there better apps yet to come? Ease of use and accuracy will be key components to any new medical applications aimed at older adults.

What Are Potential Solutions?  What Can WE Do Now?

As healthcare providers, we must do a better job encouraging the use of technology to help identify drugs and promote compliance.  The Annals study is a stark reminder that even though we may prescribe the best, most evidence based regimen to treat disease, it takes very little for our patients to become sidetracked–something as simple as a change in shape or color may result in the discontinuation of an effective, potentially life-saving medical treatment.  As physicians, we sometimes forget the “simple things” such as the importance of consistency and routine for our patients.  The culture of healthcare in the US no longer allows for the extended office visit and frequent follow up in order to ensure that patients are compliant with their treatment plans–we are asked to see more patients, in less time and the documentation requirements have become paramount in practice.  We must look for alternative ways to assist our patients with managing their disease while at home–I believe technology is the answer.  We must provide education and resources for our patients and assist them in the identification and use of medical applications.  With technology, we may be able to extend our reach–and support for our patients–well beyond the walls of our office.

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Privacy in the Era of Mobile Tech and Social Media: Facebook Fallout and New Innovations for Protecting Your Privacy

Did Facebook cross the line when conducting human behavior social experiments last year?  I think so.  When conducting scientific research on human subjects investigators are held to very high standards.  Currently there is global outrage over the experiment and government regulators from several countries are currently looking into the matter a bit more closely.  As I described in my blog a few days ago, Facebook recently published a paper in the Proceedings of the National Academy of Science reporting on a study that they conducted in September 2013.  In this study, researchers purposefully manipulated the News Feeds of randomly selected users in order to determine effects on mood and emotion.  None of the subjects were aware of the experiment and none had provided specific informed consent.

Many academic investigators as well as social media experts from across the globe have taken issue with the lack of specific informed consent and the utilization of subjects without any notification–until the paper was published in a well respected academic journal this last week.  Some groups have petitioned the Federal Trade Commission (FTC) and Facebook has had very little to say–other than “we are sorry…and we are adopting stricter internal review standards for future research.”

How can we avoid situations like this in the future?

Obviously, with the Facebook situation, public outrage and potential regulatory action by governments in many parts of the world may help limit these types of activities by social media platforms in the future.  Currently, several countries including both the US and many throughout Europe are discussing ways to limit privacy incursions such as the Facebook experiment in the future.

Unfortunately, the utilization of data by large social media platforms and organizations may not be the biggest threat to you and your privacy.  Hackers and other criminals are grabbing data from consumers–without their knowledge–from mobile devices such as tablets and smartphones.  These devices are placed in the hands of children, and often lie around the house and are frequently left “on” and unattended.

One inventor from New York City–Michael Sorrentino– has created a new device that can help keep you, your family and your data a little safer.

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Called the iPatch case, this device may change the way you think about your mobile device and its self contained camera.  Hackers and other criminals can actually utilize your own smartphone camera to take pictures of your home or office and can even build a 3D model of your house.  This can result in identity theft, theft of real property or utilizing your images without consent for whatever purpose the criminals deem necessary.  Disguised as a harmless camera application that is often downloaded, these programs can access your camera and obtain images without your knowledge or consent.  Other malware programs have been developed and innocently disguised as harmless games or apps for download.  Software has been developed (and sold by hackers for less than $50 dollars) that can infiltrate your device and control your cameras–stealing sensitive documents, creating models of a home or office or even snapping shots of your children.

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The device–called the iPatch is now in development.  Mr Sorrentino is currently working on the prototype and will be marketing the device once produced.  WIth the iPatch device one flip of a switch will cover and eliminate photo functionality from both the front and back camera of your smartphone.  The device is being developed through crowd-sourcing efforts and is expected to enter production this year.

Mobile technology is changing the way we interact and how we share information.  Issues such as the Facebook “experiment” should give us all pause to consider our safety as we continue to embrace social media, mobile technology and information sharing.  In the future, innovations such as the iPatch are likely to continue to emerge and will ultimately provide us with more options for staying safe while staying engaged and connected in our busy technology driven lives.  Most importantly, as parents, we must set good “mobile behavior” examples for our children and take measures to improve the security of our devices and our information.  Social Media is embedded in the fabric of our lives–and this is a good thing–we must, however, take care to continue to be vigilant and protect ourselves and our families from the new world of cyber-crime.

 

Experimenting with The Emotional Impact of Facebook: New Issues Surrounding Social (Cyber) Studies Without Specific Consent

Facebook, twitter and other social media platforms have become a hotbed of data for marketers, business and product development experts.  In addition, social media has created a new way to observe and investigate some of the intricacies of human behavior and social interaction.  Last week, a study conducted using Facebook users as subjects was published in the Proceedings of the National Academy of Sciences and reported this weekend by the Wall Street Journal as well as the New York Times.  This study, while interesting, has raised a new debate on the ethics of using social media users in social experiments without their consent.  While Facebook claims that they have all rights to perform such experiments under their terms of engagement–that all users sign when they create a Facebook account, many Facebook loyalists are upset and feel as though they have been manipulated and violated.

As an academically trained Cardiologist at Duke University and now faculty at the University of North Carolina, I have had a great deal of experience in medical research throughout my career.  There are basic principles and rules that must be applied when designing and conducting any investigation involving human subjects.  All scientific research on human beings requires informed consent.  In the University setting, we have Institutional Review Boards that provide oversight to any human experimentation–these boards function to protect the rights, safety and privacy of patient subjects.  When researchers manipulate variables and look to examine results, patients can be affected–either positively or negatively.  There has been a great deal of outrage over the recently published Facebook experiment.  Many debate whether or not Facebook has crossed ethical lines by performing a study involving manipulating variables without the consent of the user.  While the attorneys at Facebook will argue that its users give blanket consent to research under their terms of service– I believe that the rules that all of us must follow in any type of human experiment should apply.  Social media and networking is now a part of everyday life and spans all age groups–all of us are affected in some way.

This recent report is no surprise–We have known that Facebook and other social media outlets have gathered data on users for years.  Google and Yahoo have certainly utilized data obtained from individuals search preferences in order to promote advertising of certain goods and services on their homepages.  In fact, Facebook has an entire data science team that is given the job of collecting and analyzing data from nearly 800 million users worldwide.

In the latest investigation, researchers set out to determine if the content of posts on a user’s newsfeed could influence mood.  For one week in January 2012, the accounts of over 600K randomly selected users were manipulated by the research team.  According to Facebook executives,  the identities of the individuals in the study group were blinded and no personal information was shared. What they found was impressive–users whose news feeds were flooded with more negative postings tended to produce more negative content themselves and those users whose newsfeeds were  flooded with positive and inspiring news predominantly produced more positive content themselves.  Previous research in the area of emotional contagion seemed to indicate that in order to pass on a mood or emotion, in person contact and non verbal cues are required.  After conducting the Facebook experiment, the authors concluded that now emotion and mood can be passed on in an online environment without any in person contact at all.  Moreover, emotions shared on social networks can provide a system for large scale spread to millions simply as a result of negative or positive posts by others.   While this information is interesting and potentially quite useful to the both the business and scientific communities, this utilization of human subjects as “emotional guinea pigs” without informed consent has created outrage among many throughout the internet.  Manipulating the emotions of Facebook users within the framework of this experiment has been seen as an abuse of trust by many who are engaged in social networking and calls into questions the ethics of social experimentation via online platforms.

Beyond the ethical considerations that this type of investigation raises, I believe that this study actually may provide a very important message to those of us who utilize social media in medicine.  Social media is a powerful tool that allows us to communicate ideas, describe new technology and treatments and disseminate information.  This communication can be quite broad and the audience can be rather diverse–patients, colleagues and industry leaders.  As physicians, our voices can be heard well beyond our respective institutions and social media allows us to reach broadly.  Because of this reach, and the power of social and involves We must remain positive and hopeful.  Our words can greatly influence the outlook of those who read our blogs, follow us on twitter and check our Facebook postings.  We must inform, discuss and improve awareness.  We must remain positive in order to continue to inspire those who look to us for their care.

The issues raised by the recent Facebook study will need to be addressed.  Going forward, social media users, as well as those that manage major online networks such as facebook, twitter and YouTube (and others) must decide how and when to conduct social networking experiments in a way that provides both useful data and also protects the privacy and rights of those involved in the experiment itself.

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Data is (Em)Power(ment) for Patients: Using Fit Bit to Impact Disease Management

For scientists and researchers who are developing new treatments for disease, Data is power.  For patients, Data can mean empowerment.  Devices that track health indicators are readily available.  These devices can track heart rate, blood pressure, blood sugar and even respiratory rate and body temperature.

This week in the Wall Street Journal, the medical applications of the Fit Bit device are explored.  The Fit Bit is a basic pedometer that tracks movement, steps taken, calories consumed and (in certain models) sleep habits.  This device is commercially available for around 100 dollars and was initially embraced by serious athletes in order to improve performance.  Now, according to researchers, these devices may be able to impact health outcomes–both inside and outside of the hospital or healthcare setting.  These impacts may forever change how physicians and healthcare systems think about managing chronic disease.

As I have mentioned in previous blogs, I firmly believe that smartphone applications for medicine are going to be a part of mainstream medical practice in the coming years.  Providers will prescribe apps just as they do pharmaceuticals.  In the case of the Fit Bit device and others like it, data obtained from physiologic monitoring can be used to assess physical fitness and progress towards obtaining specific health goals.  In several recent studies, researchers at Massachusetts General Hospital in Boston, have found that the Fit Bit users who have diabetes are more likely to have better control of their blood sugars and achieve weight loss related goals better than those who do not use the device.  Many patients with type 2 diabetes can better control their blood sugars through reduction in BMI (body mass index) and the data provided from the Fit Bit device seems to have a positive correlation with weight loss in this particular patient sample.  In the hospital setting, researchers at the Mayo clinic found that in post-operative cardiac surgery patients, the Fit Bit was able to identify patients that needed more physical therapy intervention–by tracking movement in the early post-operative days.  It is likely that by identifying and intervening early in patients who are not progressing after surgery we will be able to prevent many common complications such as deep vein thrombosis (DVT), pneumonia and other morbidities associated with lack of activity after surgery.

At this point, the FDA has no immediate plan for regulation as long as they are not specifically created to treat a particular medical condition or disease process–however, I do expect regulators to act on all types of biomedical data collection devices within the next 5 years.  According to the WSJ, the health monitoring device industry is projected to exceed 5 billion dollars in 2016–largely due to our focus on patient engagement and prevention.  Concerns have been raised as to the security of data and as to the reliability of the data generated by these devices.  As with most new medical innovations, there is still much work to be done.  We must create secure servers where patient’s data can be safely deposited (and HIPAA compliant) and easily accessed by their healthcare providers in order to provide necessary changes to care.  In addition, the patient must be able to access their own data in order to assess progress, adjust goals and optimize their lifestyle changes in order to produce better health outcomes.  Additional concerns have been raised around the legal implications of a large repository of medical and physiologic data—are physicians responsible for every reading and every piece of data in the repository?  Will there be frivolous lawsuits initiated by ambulance chasers (or Fit BIt chasers) in the future?

I contend that more data is better.  Data provides me with the power to make better decisions for my patients.  Data provides my patients with real, meaningful feedback.  When we are sick, we often feel as though we have lost the ability to determine our own destiny and lose any semblance of control.  Data allows patients with chronic illness to actually regain some sense of control—and achieve ownership of their disease with the power to invoke change.

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Making Donald Ross Proud: Erik Compton Overcomes Adversity (and Two Heart Transplants) to Compete in the US Open

This week, the center of the golfing universe is centered on Pinehurst, North Carolina as the United States Open Championships get underway on Thursday.  Designed by Donald Ross and frequented by golf legends such as Bobby Jones, Harvie Ward and Ben Hogan, Pinehurst number 2 is an iconic layout for professionals and amateurs alike.  Golf, in general, takes meticulous preparation, dedication, discipline–and for those who are successful at the highest levels–an uncanny ability to battle and overcome adversity.  As a below average amateur golfer, I certainly have a healthy respect for the abilities of PGA professionals.

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These men and women spend countless hours practicing and perfecting swings and are quickly able to assess their own weaknesses and move to correct them in a timely fashion.  The world of sports can teach us many life lessons and can help better prepare us to do battle in our daily lives.  The traits of successful professional golfers are applicable to medicine in many ways.  Sports figures have always been a source of inspiration for me.  This week, one particular golfer in the US Open field should serve as an inspiration for us all—PGA professional Erik Compton’s daily courage and his willingness to overcome any obstacle can help each of us meet even the fiercest medical or business related challenges and provide better care for our patients.

At age 9, Erik Compton was like any other child.  He was active and loved sports.  However, he became ill with a cold like illness (just like many other kids that age).  Unfortunately, Erik’s cold symptoms lingered.  He began to become very short of breath and was no longer able to keep up with other kids his age.  Eventually he was evaluated by a specialist and found to have viral myocarditis and a significantly reduced left ventricular ejection fraction.  After three years of therapy and worsening congestive heart failure, Mr Compton was listed for a heart transplant and in 1999, he received a new heart.  Through hard work, goal minded behavior and dedication, Erik led a relatively normal life through high school and became one of the top ranked amateur golfers in the United States at the high school level.  He was recruited by many universities and attended the University of Georgia on a full athletic scholarship.  As a college golfer, Mr Compton not only battled the numerous golf courses, bunkers, water hazards and the like, but also battled fatigue and swallowed numerous anti-rejection pills each day. He worked his way onto the Nationwide Tour and eventually earned his PGA card.  Unfortunately, Mr Compton suffered a massive myocardial infarction (MI) in 2007 and was left with another cardiomyopathy in his transplanted heart.  While driving himself to the hospital from the golf course, he called his family to say goodbye.  The goodbyes were not to be–six months later, he received a second heart transplant.

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(Photo adapted from http://www.ErikCompton.com)

At this point, many of us would have simply given up.  “Why me?” we might ask.  Instead, Mr Compton embraced his next life challenge.  Within weeks, he began to walk and exercise regularly and he was determined to play competitive golf once again.

Mr Compton battled back from a second heart transplant and ultimately re-joined the PGA Tour.  Last season, he was awarded the inaugural PGA Tour Courage Award.  Two weeks ago, he sunk a putt in a sudden death playoff in order to qualify for the US Open field.  Mr Compton’s story is compelling for many reasons.  As a golfer and transplant survivor, he exhibits unnatural courage under duress.  For patients and physicians, Mr Compton’s example can provide insight into successfully battling disease and should inspire us all to do better with whatever gifts we are given.  I have never heard Mr Compton complain during an interview–rather, he chooses to focus on the positive–the fact that he is able to once again compete on the PGA Tour and he clearly enjoys EVERY single day, EVERY single minute.

Most importantly, Mr Compton’s story should serve as a call to action for all of us–we must do more to raise awareness for organ donations.  Last year, there were more than 4000 persons on the active transplant waiting list–yet only 2600 heart transplants actually occurred.  Every single year, patients die while waiting for an organ.  Factors such as blood type, body size and other immune system antigen compatibilities often determine how quickly patients are able to receive a heart.  Organ donation is simple–in most states it simply requires answering a question on your driver’s license application.  Organ donors are critical to providing life to those with diseases such as Mr Compton.  Fortunately, through innovation and research we have other therapies that can help patients with end stage cardiomyopathies–Left ventricular assist devices (LVADs) can now serve as destination therapy as well as a bridge to transplant in critically ill patients.  Although the artificial heart has not yet panned out as we would have liked, the advent of 3D printing of organs may hold real promise for the future.  However, until we have other solid alternatives, we must continue to raise awareness for organ donations and work to ensure that more people on the transplant list have organs available to them.  As healthcare workers, we must include questions on organ donation as part of our routine office visits in order to ensure that our patients are at least AWARE of the process and can contemplate decisions with their families while they are young and healthy.

Ultimately, many will die while awaiting organs this year.  Patients and families who have donated during times of tragedy are true heroes–they have provided LIFE for others from the hands of tragic and untimely death.  This week, I continue to be amazed at the ability of PGA golfers to tame the beast that is the historic Pinehurst number 2.  I am even more amazed by the fact that Erik Compton is among the field and walking in the footsteps of Donald Ross, Ben Hogan, Harvie Ward and Bobby Jones.  I think each of these golf legends would be quite proud. In fact, I suspect that Donald Ross himself would enjoy a round with Mr Compton—and would likely invite him to sit in the rockers on the world famous porch at the Pinecrest Inn (a legendary hotel in the village of Pinehurst once owned by Mr Ross) after an afternoon walk on Pinehurst Number 2.

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(Image from my personal collection.  Golfers from all over the world come to Pinehurst for a round of golf and recount the day on the course on the porch at the Pinecrest Inn)