August 21, 2005
BehindTheMedspeak: World's First Face Transplant is Imminent
Somewhere in greater Cleveland, Ohio right now is a person with severe facial disfigurement.
Somewhere else in the same area a healthy person is going about their business, completely unaware that he or she will donate their face in what will be the world's first attempt at a face transplant.
Dr. Maria Siemionow, director of plastic surgery research at the Cleveland Clinic, after years of heated debate, has received approval to attempt this historic operation.
Her team may already have identified the recipient; the donor must first die — most likely in an accident.
Michael Mason wrote a fascinating article for the July 26 New York Times Science section about the long road to the threshold of a procedure which, from Dubuque to Dubrovnik, will be front page news the instant it occurs.
The story follows.
- A New Face
In an emergency room at a Finnish hospital, a man sprawled unconscious on an operating table as surgeons labored to reattach the hand he had lost hours earlier while chopping wood.
Medical miracles take many forms, but few are as vivid and immediate as this: As the tiny blood vessels were sutured back together, the patient's hand flushed from porcelain to pink.
The delicate tendons of the palm revived, and the skin's granite glaze began to soften.
The man's fortunes had taken a remarkable turn.
So, too, had those of Dr. Maria Siemionow, a surgical resident assisting in the operation.
''That you could restore to people a part of themselves that had been lost, and actually see it become vital again, was miraculous to me,'' said Dr. Siemionow, a native of Poland who trained in Finland and the United States.
''I have never forgotten that day.''
Thirty years later, microsurgery is a commonplace marvel, and as director of plastic surgery research at the Cleveland Clinic, Dr. Siemionow, 55, is a leading practitioner.
But the career that began in a Helsinki hospital has brought her, and her profession, to an extraordinary moment.
A team led by Dr. Siemionow is planning to undertake what may be the most shocking medical procedure to occur in decades: a face transplant.
After years of heated scientific debate over ethics and technical feasibility, the Cleveland Clinic last fall became the first institution to approve this novel surgery.
Already Dr. Siemionow's group is searching for its first patient.
An amateur photographer -- portraits of faces, mostly -- with a talkative, almost merry demeanor, Dr. Siemionow is not the sort one expects to find center stage in a medical danse macabre.
But this is no ordinary procedure, and she is no ordinary scientist.
''This is the single most important area of reconstructive research, and she is carrying the torch,'' said Dr. L. Scott Levin, chief of plastic and reconstructive surgery at the Duke University Medical Center.
''She is incredibly humble but internationally respected, and she has a powerful moral compass. She really wants to help these patients,'' Dr. Levin said.
Dr. Siemionow was raised in Poznan, a city midway between Warsaw and Berlin. Poznan is home to a large medical university that bears a rich academic tradition, with roots in the Renaissance.
She graduated there in 1974.
''Even in my high school you were taught that medicine is a humanistic practice,'' she said.
''Physicians are a part of their patients' lives, and there must be an intimate bond.''
There are few areas of medicine in greater need of a humanistic perspective.
No one knows exactly how many people live with facial disfigurement caused by burns, trauma, disease or birth defects.
But Dr. Siemionow has seen too many cases already -- the woman whose fiancée left after she was burned in a car accident, the lonely shut-in whose face was lost to cancer.
For these patients, there is little doctors can do to restore normal appearance.
Plastic surgeons usually ''resurface'' the damaged face with skin from the victim's back, buttocks or thighs.
Patients may need as many as 50 operations to regain even limited function, and the results are mixed at best.
Normal facial expression, the raised eyebrows and lopsided grins so essential to social interaction, is impossible.
Often the structurally complex eyelids and mouth cannot even be made to open or close properly.
Even after dozens of operations, many disfigured patients must feed themselves through tubes.
And the aesthetic outcome, often likened to a mask or a living quilt, can be so unsettling that some rarely leave their homes.
Chronic depression is not uncommon.
''When you mention a face transplant, people think you are talking about vanity, that someone healthy is going to be walking around with someone else's face,'' Dr. Siemionow said.
''But within the surgical community, we perceive it as a step forward for these traumatized patients.''
The procedure has been a theoretical possibility at least since 1999, when surgeons at the University of Louisville performed the nation's first hand transplant.
That operation has been duplicated some two dozen times now, and the experience has given surgeons like Dr. Siemionow the courage -- hubris, critics say -- to think the unthinkable.
''Have you ever seen someone with severe facial disfiguration? Sometimes I have to force myself to look in a patient's eyes,'' said Dr. John Barker, director of plastic surgery research at the University of Louisville.
''We are social animals, and the face is important to who we are as human beings.''
(With scientists at the Utrecht University, Dr. Barker and colleagues at the University of Louisville also are seeking approval for an experimental face transplant to be performed in the Netherlands. Proposals by surgeons in Britain and France have been denied.)
The medical challenges to face transplantation are formidable.
As Dr. Siemionow envisions it, the series of operations will require rotating teams of specialists who may be deployed in more than one operating theater.
The face to be transplanted will be removed, or ''degloved,'' from a cadaver; it will most likely include the epidermis, along with the underlying fat, nerves and blood vessels, but no musculature.
Surgeons also will remove the patient's own damaged facial tissue, then reattach the clamped blood vessels and nerves to the transplanted face.
The procedures will take 15 hours, perhaps longer.
The months following may be even more harrowing.
Patients receiving transplanted organs must take a lifelong regimen of drugs to suppress their own immune systems and prevent rejection.
The drugs are expensive, often $1,000 per month, and the regimen does not always work.
But even when it does, long-term immunosuppression increases the risk of developing life-threatening infections and cancer.
For every transplant patient, then, doctors must weigh the necessity for a new organ against the possibility of rejection and a shortened life.
Foreign skin provokes a powerful immune response from the body, more so than transplanted livers or kidneys.
So despite reams of research, the risks to Dr. Siemionow's first patients are a cipher, the surgery a step into the void.
While many researchers hail her proposal as a brave leap forward, critics describe it as an alarming case of scientific overreach.
Many medical ethicists believe there are still too many unanswered questions, especially for a procedure that is not lifesaving, only life enhancing. What are the patient's prospects if the new face is rejected?
What are the psychological ramifications for the recipient's family, and the donor's, if the recipient actually comes to resemble the donor?
That is unlikely, but not impossible: though the skulls will never match, there may be some resemblance if the donor's underlying facial musculature also is transplanted.
''This idea needs more evaluation. What we do know either can't be quantified or the risks clearly outweigh the benefits,'' said Karen Maschke, the associate for ethics and science policy at the Hastings Center, a bioethics research institute in Garrison, N.Y. ''Look, a lot of science is boosterism.
''People always think they're going to be cured by new treatments and life will be normal again, but that's usually not the case.''
Dr. Siemionow disputes the notion that facially disfigured patients should not be allowed to decide the risks, asking, ''How can people who are normal decide for burn victims 'This is not right for you'?''
In a series of innovative experiments in laboratory rats, her team has managed to induce long-term tolerance to hind-legtransplants with a drug regimen lasting only seven days.
If similar results can be achieved in humans (many previous efforts along these lines have failed), the advance will alter the calculus behind transplantations, making them feasible for a much greater number of patients, including those with facial disfigurements.
But that day may never come, and for now, the real battle may not even be scientific.
Already, Hollywood, that redoubt of medical humanists, has sunk its teeth into the notion that faces someday may be exchanged.
From the moment Dr. Siemionow first proposed this surgery, she has been hearing about ''Face/Off,'' the 1997 movie starring John Travolta and Nicolas Cage as an F.B.I. agent and a criminal mastermind whose mugs are surgically swapped.
One night, before the first review of her proposal by colleagues at the Cleveland Clinic, she rented the movie to gauge the public's potential reaction to the operation.
''It was O.K., if you like Travolta,'' she shrugged. ''But it was just science fiction.''
Remotely monitor a room from anywhere in the world — for $85
Hawking Technology has come out with a little videocamera (above) that streams live video at up to 30 frames/second.
It has its own I.P. address, which in plain English means that anyone who's online anywhere in the world can see what it sees — if they know the password.
It comes with a WiFi transmitter so it can send its images wirelessly to the internet connection of your choice.
The penny just dropped here re: how to monetize bookofjoe.
So very simple: I sell you the secret password to see what bookofjoeCam sees.
I change it monthly, and you get the new one automatically when your automatic monthly payment flows into my offshore account.
Wait a minute — I don't have an offshore account.
Memo to file: set up offshore account.
Where was I?
Oh, yes, this amazingly affordable technology.
You get the camera, an external antenna and an under–the–cabinet mounting kit.
The camera's very small: 1.6" tall and 5" deep.
"To avoid detection, the camera's four status lights can be turned off by configuring the included software," wrote Andrew Zipern in his piece about the camera, which appeared in the August 18 New York Times.
Is this Version 1.0 of bookofjoeTV?
But don't hold your breath.
If you want to get out there on the bleeding edge you can get one of these nifty devices for $84.84 here.
The size of the web — and other imaginary numbers
My first acquaintance with imaginary numbers in real life came in high school when I learned all about i.
The continuing debate between Yahoo and Google about who indexes more of the web misses the point: both miss most of it.
The stuff search engines find is the tip of the iceberg.
Most of what's out there is known and available only to those who know where to go in the first place.
This past Monday John Markoff, the nonpareil tech reporter for the New York Times, wrote a story about the ongoing Yahoo v. Google "mine is bigger" back–and–forth.
Yahoo two weeks ago announced that its search engine indexes 19.2 billion documents.
Google's latest number is 8.1 billion.
So Yahoo should be far more useful than Google, right?
Well, maybe not.
Sergei Brin, Google's co–founder, said that Yahoo cheats by inflating its numbers with duplicate entries.
Also, Markoff noted that some experts believe that index size may be inversely related to the quality of search results, making smaller better.
Last Sunday researchers at the National Center for Supercomputer Applications had a kind of battle of the search engines and ran a random sample of about 10,000 searches on both Yahoo and Google.
They found that Google returned 166.9% more results than Yahoo.
In only 3% of the 10,000+ searches did Yahoo return more results.
The scientists concluded that the Yahoo claim was "suspicious."
Well, let's look at things from a few other vantage points.
First, the same issue of the Times published a table showing the relative frequency with which various search engines were used during the four weeks between July 10 and August 6.
- The results:
Now let's get a little closer to home: how about a look at which search engines bring people to bookofjoe?
At the top of this post is a representative snapshot and it's quite clear to me that Google is overwhelmingly the search vehicle of choice.
Even if you discount the Google image search numbers it's still 292 v. 49: that's nearly a 6:1 preference, even more dominant for Google than the survey above from the Times.
Finally, when I try searches on both Yahoo and Google, as I do from time to time, it's always a clear win for Google — by a mile.
Richard Griot, the guy who puts out the catalog where I found this, wrote about it: "One of the most useful items I have in my 'bag of tricks.'"
There are times when I want to have my screwdriver magnetized so that I don't drop a precious fastener down to where I can't reach it.
I also like to magnetize my files so that iron filings don't get into places they're not supposed to (oil lines, etc.)!
Magnetize and demagnetize screwdriver blades, tweezers, etc.
Made in Germany.
No moving parts.
At least, none that you'll be able to see — Earthling.
Machinima — Spawn of a 'Halo' voice–over
Two weeks ago today Clive Thompson's story, "The Xbox Auteurs," appeared in the New York Times magazine.
I've been thinking about it off and on almost every day since.
Because what Thompson wrote about — making a mashup of a videogame and an amateur voice–over to create an animated movie — is the opening salvo of what I believe will become an avalanche, a [virtual] tsunami of new media with unimaginable consequences.
The price of admission to virtual reality just dropped to the cost of a game of "Halo."
Michael Burns worked at a dead–end job in Austin, Texas.
He loved playing videogames.
" 'Halo is like crack,' Burns recalls thinking. 'I could play it until I die,'" wrote Thompson.
Burns liked to sit around with a bunch of other guys like him at his company talking about video games.
For laughs Burns used to make voice–overs and attach them to particularly cool stunts he and his friends discovered inside "Halo."
Then he'd post the videos on a website.
One day the penny dropped: he realized the videos he was making were essentially computer–animated movies.
He wondered if he could create an actual movie or TV series.
So he and his buds did just that, then posted their comedy series, "Red vs. Blue," on their website (surreptitiously hosted on their company's servers.)
They thought maybe a few hundred people would take a look.
They figured wrong: in one day 20,000 people downloaded the file and crashed the server.
The dead end jobs are now history and Burns et al run a company called Rooster Teeth that makes such machinima.
Thompson's kept the electronic rights to his story (good move, Clive) and has posted it on his website, collisiondetection.net, for anyone on the planet to read in its entirety for free.
The Times, which hasn't yet twigged to the fact that in the 21st–century easy access creates value, continues to sequester the article on its painfully outdated website.
There, you first go through a torturous registration process so that you can then go through another registration process to buy the right to read Thompson's article for $2.50.
I hope the Times wakes up before the clue train completely leaves the station.
Considering they don't even seem to be able to attach email addresses to their reporters' stories, I don't hold out a whole lot of hope for the staggering, witless old–media dinosaur.
Oh, sure, the Times provides a syndicated link where you can read the article but it's more or less secret and if someone like myself or Thompson doesn't give it to you you're essentially out of luck.
Hey — not my problem.
And isn't "machinima" a wonderful word?
Motion Sensor Projection Clock
A lot going on here besides the time.
When I first looked at the display on the clock's face (above) I thought for a second I was at the controls of a 747.
- From the website:
1) The Italian–designed nightstand clock includes a separate motion sensor (below)
"so you can monitor foot traffic by day or curfews by night."
When the sensor detects motion the clock gives an alert signal.
2) The clock is radio–controlled for accuracy
3) The time is projected on a wall
4) Displays indoor temperature and date
5) Features dual melody alarm with snooze function
6) Any of six gentle nature sounds (birdcalls; wind; river; raindrops; waterfall; waves) may be used for the alarm
Plug–in AC adapter included.
Measures 10.5"W x 8.5"H.
A somewhat different approach to waking up than previously featured here earlier this week but I believe there is room for discussion.
The floor is now open.
Beware of the door.
'Masters of Deception'
Al Seckel wrote the above–titled book, whose subtitle is "Escher, Dali & the Artists of Illusion."
- From his website:
There are a number of incredible artistic works featured in "Masters of Deception," which require movement to appreciate their full impact.
Additionally, I had in my possession various interviews with some of the book's featured artists that I wanted to share with my readership.
Unfortunately, the publisher was unwilling to produce a CD to accompany the book.
I have created this web site, therefore, to augment and enhance the reader's experience by presenting those works and interviews that I could not present in book form.
Inside/Outside Measuring Cup
What a great idea: put the measurements inside the cup where you're pouring and looking.
It seems obvious once you see it.
Whenever I measure something with a cup that's not clear but is instead made of metal or plastic I have to look at the outside for the mark I want and then inside to see if I'm there yet, usually ending up with a good guess.
This solves that problem.
2–cup capacity; stoneware.