Alzheimer's Disease-from bad to worse

I read today that drugs commonly used to treat some Alzheimer's Disease (AD) patients do not do any good, and may even do some harm. The BBC reported on their website that the neuroleptic drugs that are sometimes given to AD patients to control behavior, can also compromise verbal skills in patients with only mild cognitive impairment. These drugs were originally developed to treat psychosis in schizophrenic patients but are often given to elderly patients with dementia because they can control the aggression that comes with the progression of AD. This latter indication is an off-label indication since the FDA has not approved it for such use, nor has it been tested widely in the elderly. Olanzapine (trade name, Zyprexa) made by Lilly) has come under particular fire lately for inappropriate advertising and administration for off-label indications.

In 2004 the Committee on the Safety of Medicines in the UK issued a warning that Zyprexa could cause strokes in patients with dementia and recommended it not be used for that purpose. In 2004 my father died from the effects of Zyprexa while under the care of a nursing home in my home town of Newark, UK.
My father had been deteriorating from the effects of Lewy Body Disease (a type of dementia that has features of AD as well as Parkinson's like shuffling) and was taking Zyprexa daily to control aggression. I remember the day the hospital doctor told me it was his only hope. He would sit on the floor and refuse to get up, strike out occasionally and wander in the streets at night. It was explained to me that Zyprexa was his last chance to retain some some semblance of manageability as his dementia continued to progress. That same doctor told me that he 'was not in there' when he went through a phase of not talking, but of course, his family knew differently. He was there all along, but he just couldn't always show us. After he had been in the nursing home for a couple of years, the doctor decided to increase his dose of Zyprexa. He was too lively it seemed. Not for long. The day nurse increased his dose. The night nurse increased his dose. The result was a fatal overdose. The day he got the double dose, he immediately spike a fever. My mum relayed to me that his face was very flushed and he was silent. He seemed to be in pain and his urine was very dark. He had taken to his bed and could not get up. The research I was doing at the time while at Pfizer led me to the web where my suspicions were confirmed. He was suffering a rare (but is it that rare?) side effect of some anti-psychotic medications, Neuroleptic Malignant Syndrome. The high temperature brought on my the drug caused his muscle tissue to break down giving rise to the tell-tale dark brown urine color of rhabdomyolysis or muscle toxicity. He never got out of bed again and 4 months later, passed away. His medicine records were never found and my mum would not consent to a postmortem so it looked as though he just slipped away from advanced dementia. There are so many things wrong with the picture I just painted but I want to raise one that has nothing to do with the use of anti-psychotics in the elderly and everything to do with how we view dementia in the first place. A new book I am reading called The Myth of Alzheimer's questions our categorization of the disease and suggests that we over-focus on the disease labels and unnecessary treatments, and under focus on the social aspect of caring for our elderly as they progress through old age and is challenges. In his book, Dr Peter Whitehouse suggests that AD is little more than a convenient marketing empire that distracts us from the core issues with the disease which are, that we do not know what causes it, or whether it merely represents a 'normal' aging of the brain that occurs at different times in different people (a bit like some people get aching bones earlier than others perhaps...).
The book makes me wonder about my own experience with a loved one with dementia. The drugs, the quick proclamation that 'he's not in there any more' when he clearly was very much 'in there', and the fear and denial associated with his daily delusions (he was usually happy with his hallucinations, it was us that were not). Perhaps we need to learn to be more gracious with the demented. Perhaps our social systems should be more geared towards support of the elderly rather than condemnation to a disease state that strikes fear into the hearts of all of us. My dad had a good life and retained his character until the end but in a changed form. His 'disease' created another version of himself that was as fascinating as it was sad. He didn't lose himself as much as found a new self. If we had been able to grasp that at the time, we may have been better company for him in his last years.

(Hyper?) Active kids

Children are a delight and a worry. The only time I am completely happy is when they are asleep in bed. And even then I wonder whether the blankets are occluding their breathing and the CO2 giving them brain damage. When my youngest was a baby, I was convinced he was growing asymmetrically. It didn't help that our pediatrician was new to the job and tended to validate all my concerns before referring him to other more experienced doctors who reassured me that he was quite normal every time.

Now they are older (soon-to-be 15, and 12) and they worry me no less. The older one for obvious reasons, but both of them because this is the time in their life when they are developing a sense for what they might want to be when they grow up. It was with great surprise then, when my 12 year old asked me to talk to his teachers about him intending to be a musician when he grows up, and asking for their help in getting his grades up so he could get to college. The music bit was not a surprise-the boy creates new songs every day- but the link to good grades and college was.

I did meet with his teachers to talk about his academic progress (or lack of it in some areas) after his home room teacher suggested I needed to come in. I was nervous, because earlier in the year, the school counselor had called and asked if they could assess my son for attention problems. I said yes, feeling like I would have been a bad mom if I said no. But then when my part of the paperwork came home, I did not fill it out, instead opting to get advice from a friend who is a child psychologist. He suggested that if an investigation was warranted that I go to a professional outside of the school system as they tend to look at all potential issues rather than just ADHD. Good advice and I chose not to follow up with the school assessment at that time.

My son is not unable to focus, or to hold concentration. He is just easily distracted by one or two things; Friends, and the opportunity for an audience. Given his aspirations to be a musician perhaps at least the latter is not such a bad thing.
So, when I entered the room and saw his teachers sitting in waiting I felt some trepidation. I felt for sure, this was it. Time to confront the ADHD issue. But, it didn't go that way. All of his teachers appeared to recognize that they had a talent on their hands. They understood the tragedy of suppressing the spirit in artistic kids, and they offered suggestions to help my son improve his grades without compromising his dreams or his social life. Small organizational tips, and gentle reminders that there us a time and a place for everything now seem to be keeping him on track. How many other kids are so lucky to have teachers like that? How many others would have been pushed into medications rather than viewed as unique spirits on their way to their own special destiny? A 2007 review in the American Journal of Psychiatry found that there is a worldwide prevalence of ADHD/HD of 5.29% and the US is similar. The use of stimulant drugs to treat ADHD is necessary in severe cases but the risk of over-prescribing and mis-use of medications is a concern for parents, teachers and doctors alike. It is estimated that about 1 in 8 children in the US take a stimulant such as Ritalin, or Dexidrine, in order to control their ADD or ADHD.
A Time Magazine article way back in '03 (http://www.time.com/time/magazine/article/0,9171,1101031103-526331,00.html) highlighted the dilemma of having pills that work to focus and calm anxious middle schoolers, versus the unknowns associated with such medical practices, mainly regarding effects of artificially modifying the emotional and behavioral control mechanisms that are still underdeveloped in kids of that age. We don't know much more now about the use of stimulants in kids than we did in 2003. If you learn to cope chemically in those formative years, does it compromise your ability to cope without the chemicals later on? It's a balance between doing well enough to stay in the game (with or without medication) and developing the life skills for a successful adulthood without reliance on those same medications. In 2008, it is emerging that teenagers are abusing stimulants to stay awake longer during crunch time for exams. The pill takers are raising the game. Reminds me of the steroid problems that athletes face. If one does it, the baseline is elevated and if you snooze you lose.
The pharmaceutical trade group PhRMA have suggested that up to 10% of American children suffer from some mental illness. I offer the notion that perhaps we are too eager to classify the considerable angst of teenager-hood as bipolar, ADHD, depression or any number of other maladies that can now be ameliorated with non-street versions of uppers and downers. The FDA also worries. But don't misunderstand me. I am not for or against these therapies, just very strongly in favor of a thoughtful process on a child by child basis before jumping to a label and a drug to fix it.

In the case of my son, I am still open minded regarding a diagnosis for his oddball characteristics. If is has troubles with his peers, or with authority figures, or with himself, that he can't deal with, I will take him in. At the moment, we (his teachers, myself and my son) accept that he has an unusually creative and sociable side that he must reign in at certain times, such as the classroom. They tell me he thinks beyond his years. He is not weird, doesn't need medications, nor therapy, and is doing quite well at school with the gentle nudges and organizational tools we are helping him develop. I am proud of his creativeness and his ambitions to become a professional musician. Luckily, his teachers are too.

Socially networked out

I'm exhausted from all my socializing, most of which I do from this very spot. Face to face with a 17" screen, I chat, play, work, sing (yes-I have sung to my computer and with the wonders of Logic Pro I can make myself sound like Celine Dion on steroids with a mere tap of a key), laugh and even sometimes, cry. I heard yesterday that about 10% of Americans are addicted to the internet and I understand why. The web has it going on.

Rather than talk about what's wrong with that (and there is much), I'm going to talk about the upside. Being connected is a fundamental human need. Being without a community is a bad for your health as giving up smoking is good (Bowling Alone by Robert Putnam--great book). Two days ago a far away friend mentioned how discomforting it had been to be 2 weeks without home internet when his system threw a wobbly. He felt like he'd been missing a friend, he said. Another friend in a far place asked me today if I had figured out what the point of Facebook might be. I had to think, because it wasn't immediately apparent. I have LinkedIn for serious work networking, I have YouTube for a laugh and to keep track of my musically prolific son, Plaxo Pluse for keeping in touch with old friends, and I have zaadz.com for the weird side of me that still believes in fairies. So what is Facebook for? It must be good for something. Sheryl Sandberg, Google's (ex) VP of global online sales defected to Facebook to become COO this week. I pondered my recent experience with it. Why, just in the last three days I was poked by two people I have never met, sent a leprechaun by someone I care a great deal about but rarely see, and turned into a vampire by one of the smartest and successful people I know, who should know better. Oh, and I threw some beads at a couple of folks as part of a bizarre on-line Mardi Gras party that seems to go on forever. Add to that the two games of Scrabble I'm currently playing with remote friends, it seems like Facebook might just be for plain fun.

All of these sites allow me to feel like I am part of the Universe as it moves along in time. I am part of the ebb and flow of my friends' lives in an unobtrusive but slightly voyeuristic way. It feels good to be connected, although I can't fully rationalize the value in a purely logical way. One thing I realized in all my pondering: Facebook does have a purpose. It is to remind us not to take life and ourselves so seriously, that there is no shame is getting of the perch of progress and regressing occasionally. So go on. Sign in and throw a few beads. You'll feel better for it, and so will those that receive.

FDA looks to 'broaden drug use'

According to the New York Time (Feb 16th FDA seeks to broaden the use of drugs) the FDA is considering allowing pharma companies to give doctors articles on off-label use of their approved drugs.  Docs have always been able to use their discretion to prescribe the drugs they see most fitting for a disease whether the drug is approved fro that indication or not.  However, the FDA has come down pretty hard on companies that actively promote their drugs for such off-label uses (A few years ago Pfizer had to pay up almost half a billion dollars for promoting an epilepsy drug for non approved indications that they themselves had data that showed it did not work for). Now the FDA is saying companies can give docs articles that show or suggest utility for indications other than currently approved, in the hope that 'life-saving' treatments can be more easily apparent to docs in deciding what to prescribe for their patients.

Off-label prescribing is usually good for pharma but not always.  A drug for macular degeneration, Genetech's Lucentis, suffered from same-company poaching when the same company's cancer drug Avastin was adopted by retina specialists as a cheaper alternative to Lucentis.  In most other cases off-label prescribing leads to more prescriptions written and higher sales for a given medicine.  If it benefits the patient, what is the problem with off-label prescribing and what the FDA is proposing?  Well, for starters, off-label prescribing is inherently risky.  The drugs in question have not been tested for safety issues in any group apart from the approved-for population and their proposed efficacy also does not have rigorous data behind it.  A second issue with allowing pharma companies to give articles to docs is that the companies can be selective about what they give, choosing to distribute only the supportive articles and not the detractors.   Rarely is data cut and dried and there is usually plenty of evidence to support a contrary view to the one that supports an alternate indication.  A third issue is that pharma companies often sponsor trials to show their drugs are useful for additional diseases. None of these points automatically mean it is unethical for anyone to show a doctor an article on anything that is out there in the public domain.  We know for sure that is is unlikely most docs get much time to go through the literature and develop a balanced view on what is out there.

So, where does this leave the issue?  Here are the 'facts':

1) Drugs often have uses beyond their current approved indication.  

2) Doctors are in a unique position to see their patient as a whole, and to prescribe what they feel is best for each individual

3) Pharma companies are often more aware of off-label experiments that most, and even sponsor a number of them

4) Doctors and health professionals do not have time for a regular detailed review of the literature

5) Pharma usually gains from encouraging off-label drug use 

6) Patients should be able to get access to the best drug for their disease, approved or not

The latter point speaks to an earlier argument where patients are not allowed access to truly potentially life-saving options because the drugs are in trial stage and not approved for anything yet.  If the patients do not fit the trial criteria (set to optimize the chance of success of a drug)  then they cannot get access to their experimental medicines. To my mind, this is where the most action by the FDA is required.  For many, these experimental drugs are a genuine last hope and I believe if patients are willing to assume the risk they should be allowed to take the meds.  

So this brings us to patients and what they are prepared to risk.  Since an off-label indication is risky, then shouldn't the patient also have a say?  I don't believe it is enough to 'educate' the physician with the articles as suggested by the FDA. Shouldn't materials also be provide for the patient?  Perhaps a balanced view of what is known and what is not, and a statement about potential risks acknowledging rigorous studies have not been done?  I think balance is the key for both docs and patients.  Give them the info, sure, but be sure all aspects are represented--then the doc and the patient can have the discussion and make the choice.  Seems obvious to me but I'd be interested in what others think.

Some predictions...

• Targeted medicines for all diseases. Few side effects, few efficacy failures--we get it right first time!
• We understand how to help the body help itself. We fight off disease and destruction every day without realizing it. In the future we will know how we do it and be able to coax our body to heal itself at will
• The era of over dosing on prescriptions drugs is coming to an end. We are beginning to know too much to be fooled by simplistic treatment regimes that pile on one med after another. Holistic, gentler approaches will come into vogue in the next 10 years. In the meantime, there will be a public backlash against high priced medicines that we are told we must take. Anti-infectives will be the exception, and the most lucrative area in the near future for pharma and biotech
  
• Big Pharma is definitely dying. The model cannot withstand the shift to targeted medicines and increased generic use. As we understand our disease states better, we will be better able to create personal medicine approaches using old and/or new meds. There will be less demand for sexy new meds that cost millions. No more big houses for pharma execs and fancy off-site meetings in the sun...:(
  
• Biologics will be seen as a flash in the pan. A red herring. This is a wild suggestion, but it's an intuition. Biologics are fraught with problems and horrendously difficult to make. We thought we understood proteins once before when we were into macromolecules... The future is somewhere else
  

Physiologists-come back-all is forgiven

Google this story.....Diabetes Study Partially Halted After Deaths

Published: February 7, 2008 New York Times

...and you will be amazed. Apparently lowering blood sugar in Type II diabetics (90% of the diabetic population have Type II) increases your chance of dying. It was supposed to be the other way around. This is a quick post so I'll get to the point. Perhaps the physiology of the diabetic patient is fundamentally different to that of a non-diabetic? This is not a radical statement, nor a novel one, but the pharmaceutical profession do tend to think of a diseased individual as a person having 'normal' physiology with an 'abnormal' disease superimposed on it. So, we just add drugs, or drug cocktails, to 'fix' all the abnormal bits (for eg the high sugar, or the high cholesterol). Most drugs are assessed by their effects on receptors and organs rather than whole systems as they go through drug development. They are marketing in the same manner. No wonder we tend to pile up the meds to counter all the deviant aspects of a person's physiology rather than stepping back to assess the overall picture. The 'overall picture' is a scary concept. Modern medicine doesn't give us the tools to assess nor treat it.
In the current age of high profile drug cocktail-related deaths such as the recent passing of Heath Ledger, and Ann Nicole Smith, perhaps it is time for those of us in the health professions to think of how we can begin to see the human as an ever evolving system over the years, that becomes fundamentally changed as we reach the tipping point for various disease states (diabetes is only one--dementia, autoimmune disorders, depression, anxiety etc, etc are others). When we do become diabetic, depressed, etc, our baselines have changed. And, because we are an interconnected mess of tissues and cells, these baselines affect every aspect of our being from our response to drugs to our mental view of the world. We can't just keep throwing on more meds until the blood sugar is low enough, or we feel calm and serene enough to get back to work. It's time we spent more time looking at the heart of our diseases and the dynamic physiology that underpins them; that complex backdrop that determines our unique response to everything that interacts with us, natural or imposed.

Homework

http://www.nytimes.com/2008/01/03/garden/03nooffice.html?pagewanted=1&WT.mc_id=BU-D-I-NYT-MOD-MOD-M013-ROS-0108-L2&WT.mc_ev=click&ei=5087&en=6ddbcb438579327d&ex=1216875600&mkt=BU-D-I-NYT-MOD-MOD-M013-ROS-0108-L2

Apologies for the very long URL but it's a good one from today's New York Times. The article is concerned with the the ups and downs of working at home. This is a topic I can speak with authority on since I've spent over a year now firmly planted in my home office in the back yard. My office, or the 'Little House', sits all by itself about 10 steps from the 'Big House' as me and my dog have come to call the place where we all live. I spend most of my working days in there and have heating, cooling, technology and scented candles. With windows all around, I feel like I am actually in the garden.

So what does this have to do with future health trends? Well, according the NYT article, there are more and more people working from home and a good portion of these folks feel at increased risk of social isolation (obvious) and depression (less obvious). Personally, I have experienced neither in my year at home but then I've always liked being by myself. I do the odd lunch to keep in touch with friends and ex-colleagues, and I network on line like a mad woman. I miss certain old friends of course, but not enough to consider going back to the office environment.

A second issue for homies, is that they have trouble organizing their day without the enforced rules of the corporate office. Now this I identify with. There are some days when I cannot seem to get anything done and others where I work like there is no tomorrow (sometimes, there isn't....deadlines being what they are). However, I do find this work easier than any I have ever had to face in the past. Probably because it is my choice to do it for the most part, and also because I actually enjoy it. The hours in meetings at my previous work places, while neat and well-scheduled, were often tedious and non-productive in a real-world sense. Now, I do feel guilty when I am not working sometimes, perhaps because somebody else did not sanction it. It can be hard to justify a day off, or even an hour off, when there is work to do and no boss to say--go ahead, relax, you deserve it. Such is our conditioning that we feel we must work an 8-hour day no matter what (see 'The 4-hour workweek' by Timothy Ferris-an excellent read on this topic).

The home-office worker has to be disciplined but the self-employed have to play many roles themselves. Deciding how to structure the day is a challenge I did not see coming when I left the corporate office. I actually missed the structure at first. I think I grieved for it a bit. It was like an old friend providing security and easy gratification. If all else failed, I knew I had to be there at x o'clock, ready for the next strategy meeting/performance review/IT meeting/etc/etc. Just being there on time and prepared garnered a sense of achievement that I didn't recognize as such at the time. Now I have to be the meeting organizer, the confidante (no, I'm not schizophrenic and I don't have multiple personalities (although some might beg to differ on the latter), but I do have to talk to myself, if only to get to the truth of what I am feeling), the sanctioner of 'off-time', the patter of the back when things go well, as well as the actual decision maker on what to do. It's a lot to fit into a day.

So back to the future of health. There are some downsides to working at home and the article referenced above articulates them well. I've thought of a couple of others too. What happens if you have a heart attack in your home office and there is no-one to revive you? Worse still, if you live alone, it may be days, nay, weeks, before you are missed! Add that to the depression that can go with isolation, and the stress of having to make your own plans every day-and stick to them- then working at home does come with potential health issues. As more of us do it, will we get better at dealing with them? Support groups for the lonely home worker anyone? Government subsidized work conclaves so people can cheaply rent communal office space to get their social fix a couple of times a week without losing work time? Or maybe the three day weekend (that should surely be just around the corner for an advanced civilization such as ours) will take care of it when it gets here.

In the meantime, I will continue my occasional morning coffee/lunch with friends, and make sure if I'm having any chest pain, that I leave the office and hang out in the front garden until it goes away. Just in case...

Family doctors, or cyber health?

Several friends of mine have, or have had, cancer.  Some of them are freshly diagnosed while others are old hands.  One recently died.  All these friends have something in common, besides their cancer.  They struggle for answers.  What does my diagnosis mean? What should I do about it? Should I take the surgery right away? I feel like I've been hit with a sledgehammer-do I have time to step back and think?  Who is the best doctor for what I've got.  What have I got anyway?

Some of my friends come to me with these questions.  They know I am a net maven, and they know I'm something to do with the medical field, if not an MD.  Many folks can find information, but they have a hard time sifting through it to find what's relevant.  The stories I hear are amazing.  One doctor says one thing, another says something else, and the web tells a whole different story.  With a little context I can often offer some clarity, but it's also a matter of what people are ready to hear.  They know it's not a good situation when they hear the C word, and sometimes they like to take things a step at a time.  Is there room then, in the future, for a better way to help patients make sense of health information, whether it is preventative care, tending to a kid's bruised up knees, or the decisions that need to be made after the big C diagnosis.  Can our questions be shaped in such a way that the answers are more immediately relevant?  Can our data retrieval systems be such that the solutions coming back actually make sense without having to find a friend who is the the trade, so to speak, to help us understand what the doctor and the internet could not? Can we get better answers by just pushing the right buttons?

The answer, I think, is no.  The singularity is near, Ray Kurzweil tells us in a recent book of his. The time when machines become smart enough to replicate themselves in smarter versions that humans themselves.  If that were true then, for these entities, the interpretation of such complex factors as a medical diagnosis in the setting of our own unique contexts would be child's play.  It would be just a matter of engaging the right algorithms and acting on what comes out the other end.  I think Ray is off the mark though.  Machines can only deal will attributes and relationships that we put into them.  They are no good at predicting the future of an action any more than they are any good at feeling an emotion.  It is only through predicting the future that we can act in circumstances that have never been encountered before.  We can't search our memories for this exact moment because it hasn't happened yet.  However, we can search for similar moments and approximate our response based on that.  This requires a prediction of what might happen if we do 'x' so that we can engage the appropriate action for the situation.  This is one of the research topics at the Redwood Institute in California and suggests that artificial intelligence is not so intelligent after all.  At least, not yet.

So, the future of medicine, probably does not include replacing doctors with artificial diagnostic intelligence, and bedside robots at least for the moment.  My cardiologist and I discussed recently the phenomenon of a doctor's intuition.  We agreed it is hard to explain and even harder to teach.  This is an element of medical practice that all those cancer patients I talked about could really use; an empathic doctor who will use his intuition to engage with the patient and work through the data with them to find the truths they seek.  Often, there are gaps. Always, there are uncertainties.  But what patients need most of all at times like these, is a trusted individual to tell them what they need to know.   Someone to validate their fears, and guide them through the options for treatment and beyond.  In other words, an old fashioned family doctor.  

Perhaps the future will see a return to the past with the family doc acting not just as the first person to go to with symptoms, but as a sympathetic infomediary that interprets and guides in the midst of all those specialists. An internet whiz who can seamlessly bob and weave through the paper and the ether to give us the confidence that while we may not know how it's all going to end up, we can make the best of what we've got given what's known.

Mac Magicians

Not exactly the future of health, but it could be.  Who knows when the fingerprint pulse-ox widget will become available and allow us to check our oxygen saturation on our iphone?

They have done it again. The Mac Air was unveiled yesterday and I want one. It is geared for light, wireless working anywhere and everywhere. While not exactly sorcery, it may as well be to me. I don't know what goes on under the keyboard and contrary to my husband who builds his own computers and scoffs at Macs, I don't care. All I know is, I want a light, portable, durable, connected machine and the Air looks like it is it. At almost 2K I'll have to wait though. As if revealing the Air was not enough, I also discovered the latest iphone update today. It lets me customize my home screen among other things, as well as pin my home address to my maps for ready directions anywhere I want to go. The iphone is remarkable. I don't know how anyone will catch up. Then there is the iTunes latest that allows movie rentals for 30 days after which they miraculously disappear to free up hard drive space and make way for the next batch. I love it all. To me it's sorcery and science in perfect synergy

Dem old bones

Shortness is related to arthritis, the latest news tells us. Too tall, or too short, it seems we are at risk of osteoarthritis if we are anything other than average when it comes to height. The reasons are not clear but this news is quite exciting to researchers as there are so few genes for osteoarthritis, whereas there are a great many for height. Careful digging into the genetic and environmental causes of both may shed light on the increased risk. If short people get arthritis, what does this mean from an evolutionary perspective? Often, a genetic disadvantage in this day and age, may have been a significant advantage in years gone by.

I'm short, so I should perhaps be concerned. Or maybe not. I could have a gene test; a gene for Growth Differentiation Factor 5, or GDF5, has been associated with the development of cartilage, and also with arthritis susceptibility in Europeans and Asians. If I have the risk variant, what would I do about it? Nothing, because there is really nothing that can be done. I have no family history, although my son does appear to have somewhat mobile joints. Perhaps I passed a dicky gene on? To understand my genetic risk is becoming easier for bones and lots of other pending problems. Gene testing is relatively cheap and beginning to offer significant information, albeit un-validated for the most part. The HapMap, a complete map of human genetic variation, is about to be released in the journal Nature Genetics (online, Jan 13th 08). For sure, as these types of sweeping tests become more popular, doctors, diagnostics companies and drug companies will have to start coming up with ethical responses to the questions that will arise when folks begin to see they have genes rendering them susceptible to dementia, cancer and the like. How will we deal with the knowledge of the risk, with no preventatives to soothe us while we wait for the inevitable? Dangerous and heady times are ahead. But what an amazing time to be alive, and what a great opportunity for those of a business mind-set.

Welcome to the Future Health Trends Blog

Our health environment is changing as information becomes more available about diseases, treatments and the effects of our own body's characteristics on the effects of both.  There is so much information out there, in fact, that we can get bogged down answering even the simplest of questions when we turn to the internet, the TV or media.  The problem with the ubiquity of information is that not all information is relevant to each one of us, and the trick is to understand what is meaningful in our own context, and what is not.

Science and technology has been quite reductionist for a while. For several centuries in fact.  Now, however, we are recognizing that the power of science and technology can only be increased by integrating with the arts and the humanities. It is at the intersections of art and science that true discoveries are often made. This blog is intended to explore the future of health and medicine from the perspective that integrative approaches to health and wellness are better than linear, discipline based approaches.  We will also report on key developments that stand to improve access and effectiveness of diagnostics and treatments based on the understanding of individual physiological, psychological and socioeconomic characteristics.