The Expedition Medicine National Conference 201

As one of the world's premiere Expedition Medicine and Wilderness Medicine education companies, we're committed to providing “best of service” CME educational opportunities for medical professionals. Our courses train participants to work in wilderness, extreme, and remote environments, or consult on patients who have returned from these locations.

Attending an ExpedMed event is a refreshing alternative to the typical CME course. Our ExpedMed CME curriculum is based on the textbook entitled Expedition and Wilderness Medicine edited by Drs. Gregory Bledsoe, Michael Manyak, and David Townes. Drawing from a wide range of wilderness medicine and expedition medicine topics — with a particular emphasis on wilderness, tropical, and travel medicine — an ExpedMed CME course will provide you with the information you need on a variety of important topics, all in a concise and practical format.

Go to: ExpedMed.org

What Can I Patent As A Physician? - The Process Patent

You're a physician who thinks you may have a process that you can patent?

The US Patent law specifies 4 things that are patentable:

1. Processes,
2. Machines,
3. Manufactures, and
4. Compositions of matter.

When we think of patents most think of a gadget, which falls under the “machines” classification and is typically referred to as an “apparatus” when writing a patent. We will spend some time later on the apparatus patent but today will focus on the process patent.

First, a story to demonstrate the power of a process patent. In the 1950’s Monsanto produced the compound 3, 4-dichloropropionanilide and secured a patent on this compound. This compound is referred to as “propanil” which is obviously unrelated to the beta-blocker propanolol. In the late 1950’s Rohm & Haas found out that propanil was an excellent herbicide for rice. Monsanto filed suit against Rohm & Haas for patent infringement but the R&H lawyers found a paper from 1902 describing the compound and thus the patent was found invalid.

Note: this was all before the age of Internet search. Nowadays, there is no excuse for spending the money on a patent before an exhaustive (and largely free) search is done for what is called “prior art” in the patent lexicon.

Rohm & Haas then procured a process patent on a “method for applying propanil to inhibit the growth of undesirable plants in areas containing established crops.” Meanwhile Dawson Chemical was selling the compound so R&H sued them.

To the average person, this lawsuit must have seemed ridiculous. After all, R&H did not invent the compound nor were they the first to try to patent it. And, they were just lucky to find out that it was good with rice. What kind of breakthrough was that? Monsanto was long in the seed and herbicide business so clearly they must have thought that this compound could be used as an herbicide. Finally, Dawson was not actually applying the compound to the rice fields — it was the farmers. So, why not sue each individual farmer?

The appeals court ruled against Rohm & Haas but the Supreme Court took up the case. In one of the classic 5-4 decisions, the Supreme Court reversed the appeals court and ruled that:

1. A “repurposing” of an existing compound was worthy of a patent. In an informative paragraph the majority wrote:

“It is, perhaps, noteworthy that holders of "new use" patents on chemical processes were among those designated to Congress as intended beneficiaries of the protection against contributory infringement that § 271 was designed to restore. We have been informed that the characteristics of practical chemical research are such that this form of patent protection is particularly important to inventors in that field. The number of chemicals either known to scientists or disclosed by existing research is vast. It grows constantly, as those engaging in "pure" research publish their discoveries. The number of these chemicals that have known uses of commercial or social value, in contrast, is small. Development of new uses for existing chemicals is thus a major component of practical chemical research.”

2. Dawson was guilty of “contributory” infringement as propanil was not a staple good nor was there another substantial use for it other than as an herbicide. While Dawson did not actually apply the chemical they contributed by selling it when they had to know that it would be used primarily as an herbicide.

The decision can be read at: http://www.law.uconn.edu/homes/swilf/ip/cases/dawson.htm

How does this apply to the physician inventor? Imagine that your were the first to notice that your patients on the diuretic diamox came back from their ski trips mentioning that they now had no problem with altitude sickness? You could get a patent on a process (typically now called a “method” patent) of preventing altitude sickness by taking diamox.

Fine. Now you have a patent. How do you enforce it? Do you sue every skier or mountaineer that takes it? No. However, if a drug manufacturer put that indication in its training or sales material then you could have grounds for a suit. Since this would require an FDA trial, the very study materials and FDA filings would be about all of the evidence that you would need. That alone might be enough for a drug company to approach you for a license. Especially after the off-label prescribing grew to the point that the drug company noticed it.

What could you do if the drug company is content with the off-label prescriptions? Not much unless the other indications (hypertension and glaucoma etc) amounted to a trivial portion of the prescriptions.

Become A Key Opinion Leader & Sought After Speaker

Putting yourself in a postion of opportunity.

Yesterday I was leading a conference call with two physicians, two publicists, a literary agent and an editor. The goal of the call was to launch a new book and raise the profiles of the two physicians. They are already well known in their fields, but with a new book coming out they can reach broader audiences. Their message is honed from months of work, and they are ready to share it. This call was about helping them to do just that.

If you were on the call, you would have heard quite a few "insider secrets" about how physicians can become key opinion leaders. If it was easy, then most doctors would probably be KOLs, because frankly most of them are very intelligent, creative, talented and have wonderful ideas that could really help others. But, it's not so easy to "bump up" and begin speaking at higher levels (for example, to bigger groups or to more senior executives) or having reporters contact you to get your opinion about something.

Here are a few highlights from that call for those of you who are thinking about taking your career to the next level.

1. Prepare an online folder with a new (and nicely done) headshot, updated bio (or two or three if you want to speak to different types of audiences), pdf of the special sales contact information for conference organizers to order bulk quantities of your book (if you have published one; if not, consider coming to the Harvard CME publishing conference www.HarvardWriters.com), a word document with the title of your talk and objectives and a short narrative description (to be used for CME accreditation or for marketing copy).

 2. Give your online reputation a makeover. Keep in mind that you will almost certainly be "googled" by any reporter, conference organizer, etc. So, what does Google say about you? At the Harvard/Discovery Channel conference that I'll be co-directing on October 19-21 in Silver Spring, MD (come join us and learn all this and much more--there's still some slots left http://dryou.discovery.com/) social media experts will be doing "online audits" for all of the attendees to help them figure out what others are seeing about them online and how that is impacting their professional reputation. The goal of the audit is to provide attendees with important strategies to improve their online reputations.

3. You need a TV clip to get on TV. I know it's frustrating, but if you've never been on TV, it's unlikely that you'll be asked to do an interview. Most producers, especially for major news shows, want to see a video clip (or reel) of someone before booking them for a show. At the Harvard/Discovery Channel conference, we will be doing simulated TV interviews -- both live and taped with a teleprompter–and all of the attendees will leave with a video clip so that they'll have something to show producers in the future.

At every conference that I attend (even the ones that I direct), I learn new things. While we always mention the faculty in the conference brochures, the attendees are usually an amazing group of high level physicians and others who become key contacts for future opportunities–especially at conferences like the two that I mention in this blog. This is my final "secret"– you need contacts. Networking is critical, and there's no better place than a conference with like-minded individuals who share your vision and your passion for changing the world!

The 2015 Telemedicine Report - Freelance MD

2015 Telemedicine Report from Freelance MD

The 2015 Telemedicie Report: This report provides an overview of the current sentiment and opinion of telemedicine from the point of view of tens of thousands of clinicians and health care administrators all around the world. This report provides insights into providers’ opinions and the current level of opportunity for telemedicine to have an impact on the delivery of health care.

The Story: Telemedicine is in its infancy but poised to gain wider acceptance and usage as health care providers and markets realize its potential to both scale delivery of services and cut costs (efficiency) and drive greater revenue by removing friction from provider-patient interactions (scalability).

The current view of telemedicine is just beginning to become a topic of mainstream discussions and excitement is growing along with expectations.

There are indications that this is beginning to happen as insurance companies and others see this as a way to provide high-value services at a more reasonable cost while keeping patients healthy and without the need for more expensive intervention treatments. For example, Arches Health Plan recently announced that it will reimburse providers for home-based telemedicine interactions. As this becomes more commonplace the few remaining impediments to adoption will be removed and telemedicine will begin to ramp from the realm of innovators and early adopters and towards the majority of providers.

Market Opportunities

As with all emerging technologies telemedicine is going to disrupt some traditional models and put others out of business. Telemedicine is inherently more efficient, more predictable, and less costly than any current delivery of care. While it cannot replace actual interventional or hands-on care, it solves entire categories of wasteful informational visits and begins to provide a platform where every provider and patient has access to the very best information and care. Early adopters are already realizing this in as evidenced by adoption trends being more pronounced in cosmetic and concierge medicine (direct pay) than family and general practice (third party payer). Those providers who get out ahead of this macro-economic trend be best situated to capitalize on what will inevitably be a commercial marketplace with both winners and losers driven by the availability of big data and consumer choice.

Download the free report above and check out our other free reports for physicians.

Survey: What Do You Think About Telemedicine?

Take our 2 minute survey and share your thoughts and opinions about the future (or lack thereof) of telemedicine!

Telemedicine is gaining at least a toe-hold in health care at both ends of the health care spectrum. For some large hospital groups and insurers it offers an ability to scale with significant cost savings, and on the other end individual physicians like those in concierge practices are using telemedicine to stay in touch with patients and offer services on-demand.

We're asking you for a few minutes of your time to take this survey an answer a couple of simple questions to see what providers are thinking about telemedicine.

We'll aggregate the answers and create a report outlining the sentiment of physicians and other providers around telemedicine.

Here's a direct link to share with your networks: https://storyteller.typeform.com/to/CFMq33

The Non-Traditional Pre-Med Student Effect

Guest post by Christopher A. Perez

Pre-medicine as we currently know it has to change.

I’m not talking about the required courses that have to be completed or the ultra-important MCAT. I’m referring to the notion that pre-med students must carry a full load of classes every semester in order to demonstrate to medical school admissions committees that they can “endure a rigorous schedule of classes”. Commonly, pre-med counselors advise students that they must take 16-18 credits a semester and for many students it’s just not possible.

The traditional student who attends a four-year university directly after high school is not as common anymore. Many students work because they don’t have the financial luxury to only concentrate on school while other students choose to first attend a community college because the cost of tuition is considerably cheaper. Then, there are also career changers. Career changers are students who already have a career but have decided to return to school in hopes of learning a different field then what they have previously studied. According to the National Center for Education Statistics (NCES), nearly three out of four college students are considered non-traditional (Choy). It is the single largest category of college students today. What makes up a non-traditional student? The NCES states that anyone who satisfies one of the following criteria is considered a non-traditional student:

• Delays enrollment (does not enter postsecondary education in the same calendar year that he or she finished high school);
• Attends part-time for at least part of the academic year;
• Works full-time (35 hours or more per week) while enrolled;
• Is considered financially independent for purposes of determining eligibility for financial
• Has dependents other than a spouse (usually children, but may also be caregivers of sick or elderly family members);
• Is a single parent (either not married or married but separated and has dependents), or  
• Does not have a high school diploma (completed high school with a GED or other high school completion certificate or did not finish high school) (Choy).

Getting into medical school is highly competitive and it’s time to level the playing field for all pre-meds, not just the “traditional” students. A student who excels academically whether they attend college part-time or first attended a community college should be placed in the same regard as the “traditional” pre-med student with the same academic statistics. The pre-medical community must remove all negative sentiments of “part-time” and “strength of class” (à la community college versus university courses) and adopt the idea of universal uniformity instead. This will expand the pool of suitable medical school candidates, increasing the competitiveness of getting into medical school which would ultimately benefit medical schools. It will also diversify the profile of matriculating students that are entering medical schools.

Guest post by Christopher A. Perez
Author of Getting into Medical School: A Comprehensive Guide for Non-Traditional Students

Choy, Susan. “Nontraditional Undergraduates.” National Center for Education Statistics. NECS 2002-12. U.S. Department of Education, 2002. Web. 1 Feb. 2014.

The Statistics Of Medicine

Guest post by Aaron Schenone MS IV

As medical students, future residents and physicians we’re used to the statistics. Whether it’s to assess for appropriate screening tools, treatments, or patient outcomes, we have experienced the positive impact evidence based practice has and will continue to have in medicine. But are statistics an absolute in patient care, and if so what are we in jeopardy of leaving behind?

As we move forward in a world with greater chronic disease prevalence, diminishing medical resources, and a financial reimbursement system incentivized by statistical outcomes, do patients always benefit? Of course many statistics provide reassurance. A patient with stage one colon cancer may find some solace in their statistical prognosis, but how should we use statistics with more advanced diseases?   After all, even after confronted with bad news, how many patients are still secretly awaiting a medical miracle?

Dilemmas are something we’re used to in medicine. As soon as we open the door we prepare for the battle between costs, outcomes, and the needs of our patients. In many cases these responsibilities are fairly congruent, but how do we approach when they’re not?

On night call I met an 85 year old man sitting in his chair gasping for breath. He had just had an unstrangulated hernia repair indicated for his refractory pain. However he also heart,  liver, and renal disease. He was lucky to have made it off the table and when confronted with these statistics, he wanted to operate. The pain was just too severe. That night we identified ruptured esophageal varices, and pulled more than a liter of frank blood from his stomach. He was intubated, stabilized and passed the next day.

Weighing our responsibilities to patient needs, while refraining from harming them, is absolutely tantamount to medical practice. However, all too often we find ourselves weighing those responsibilities against our inherent desire to ease suffering. Until statistics create a crystal ball, we will need to enter the patient’s room ready to comfort always, cure sometimes, and weigh our abilities to ease suffering against the potential risks of our care.

About: Aaron Schenone MS IV is presently a fourth year medical student applying to internal medicine residency. He is a consultant with a Biotech Company Histogen Inc. where he applies Oncologic, Biocompatibility, Regenerative Medicine, and Tissue Engineering. He is a Siteman Cancer Summer Scholar Recipient, and have continued with the institute investigating both clinical and basic projects within soft tissue sarcomas. He was also the President of the Dermatology and Oncology Clubs in 2012 and finished Ironman New Zealand in 2002 before starting this whole medical adventure.

Submit a guest post and get the word out.