Schizophrenia- a perspective.

Schizophrenia is a frightening disease for anyone, but until the recent attention on dementia, it was always the neurological disorder I feared the most.  I read about schizophrenia when I was in my early teens through the writings of RD Laing who believed the disease was a result of poor parenting. I reasoned that if it was just bad parenting, then it could be prevented and was therefore slightly less scary. However try as I might, I couldn't quite buy into his theory. While I agreed that parents could certainly drive one mad, it seemed as thought there would be a great many more schizophrenic individuals around if parenting was the cause.  I imagined back then that the brain may be lying in wait for some trigger to set it off down the schizophrenic path, which put me in a vulnerable position.  Did I have the madness in me or not? I was adopted and do not know my family history but in my teens, I didn't make the connection between genes and risk.  It was all I could bear to think my brain might be waiting to betray me at any moment.  (I had similar feelings about multiple sclerosis after I read a book on it when I was 16, but bodily dysfunction paled in comparison to mental decline in my young eyes).
If it was due to some underlying predisposition, I reasoned there would be true cause for concern.  Some rogue genetic defect that lies in wait until the bearer unwittingly triggers it, I imagined I was one such unfortunate soul and that surely, it was a matter of time.
An argument with a colleague a few years later narrowed the argument a bit- the disease was either something that could happen to anyone, or something that could only happen to certain people.  We now know that both could be true but that the latter is the more likely.

While I have always been interested in the disease, a new book reminded me of the broader ramifications of our current treatment of it.  I don't mean just the pharmacological approach- that is complex enough- but also the treatment of schizophrenic individuals.  In the early 80s many of the mental institutions that housed people afflicted with this and other diseases, were closed in favor of 'community based care' that basically never happened.  As the institutions closed, residents had nowhere to go and many schizophrenics ended up on the streets.  Once colorful character in St Louis, (where I hung my hat for a while) sat on street corners and drew what he saw.  Day after day, he created fantastically detailed pencil drawings of building, people, parks, transport.  He lived in a shelter during the night hours but had nowhere to go in the day.  He wore no shoes, even in the depths of a Missouri Winter.  One day, we heard he had been hit and killed by a car.  A tragic waste of life and a talent that would be sadly missed by all who watched him as he drew.

'Henry's Demons' by journalist Patrick Cockburn, is a remarkable account of his son's experiences with schizophrenia, and he shares the writing with his son to give the reader a first-hand view of what the disease is like.  Henry also didn't like to wear shoes, and he did not believe he was ill for much of the time.  The onset of disease was in his early 20s, which is typical, and appeared to have been triggered by marijuana use.  I was surprised to read that this is quite common with marijuana (I will post on this in more detail eventually- I am researching it now...).  Henry and his family's struggle is vividly described in the book and one wonders how many similar stories are out there. Patrick speaks about the need for institutions for those that cannot exist without such a structure, particularly when they are deep into their illness.  I wondered how people in the US coped with the costs of the treatment and care and then I remembered. Many of our schizophrenics are homeless and penniless.  I have met them while working at my local food bank.  They can appear normal for a while, but not long enough to hold down a job.  They can't just pull themselves together because they are confused about who they themselves are.  They see the world from a unique perspective and Henry and Patrick's story is a remarkable insight into that perspective.  I recommend it.

Is this chemical making you fat?

Hormones are necessary chemicals that circulate in the bloodstream to keep our bodies running smoothly.  They regulate all bodily functions including sleep, sex-drive, moods and appetite although the precise mechanisms of their actions is imprecisely understood, and becomes perhaps more so as we gain more knowledge of all the moving parts.  In recent years,  the hormone leptin acquired a certain mystique for its potential role in the regulation of appetite.  Leptin reduces appetite but its effects are complex and people who are overweight or obese may become resistance to its actions.  The hopes of drugs to modify leptin have been somewhat confounded by the complexity of the system but new hope has arisen since the discovery of ghrelin, a hormone that acts as leptin's counterpart by stimulating appetite under certain conditions.  Ghrelin is considered to be the first circulating hormone that stimulates hunger.  It is increased before a meal and decreased during the meal so that as a person becomes full, the hormone levels drop and appetite is suppressed. 

Ghrelin's action is also very complex but a study released today by the Journal of Neuroscience (April 13th issue) provides an interesting new piece of data. It seems that ghrelin enhances the sense of smell, causing rats to sniff more often and smell more intensely. The investigators suggest that this may be an important mechanism to help animals find food when they are hungry.  When humans were given ghrelin in the same study, they inhaled air tainted with various 'flavors' more deeply than without ghrelin.  There was no difference, however, in how much they like the smells after ghrelin.  It seems ghrelin may make us more aware of potential foods around us but the effects of its evolutionary advantage in over-fed humans is not well understood. Evidence does suggest that ghrelin plays a key role in appetite regulation along with the other hormones, insulin and leptin. The big questions that may help us understand how to use these data to address the current obesity epidemic revolve around how to seperate our physiological drives to eat from the psychological ones.  David Kessler, former FDA commissioner, has suggested that the Western diet itself alters our body's ability to regulate our appetite and our food intake and these hormone likely have a critical role.  Once we get into the vicious cycle, it takes heroic efforts to break out of it.  With high calorie, processed food being cheaper and more accessible than more nutritious fare, it seems the odds are stacked against us.
As we understand more about the effects of particular foods on our responses to these 'hunger' hormones, perhaps we will find the evidence we need to regulate food production more appropriately so nutritious foods are more widely available at reasonable cost.  In the meantime, yet another study has shown that sniffing a certain food can actually decrease our appetite.  In women, just the smell of dark chocolate suppresses appetite and interestingly, it appears to be accompanied (or preceded?) by a change in circulating ghrelin in these subjects. 

Even with all the uncertainties of the system, it does seem that exercise and a reduction in calorie intake both work together to move the regulatory effects of leptin, insulin and ghrelin in a favorable direction.  So in other words, we can't go wrong if we walk a little more, eat a little less, and take a whiff of dark chocolate now and again.

To lose weight- be kind to yourself?

I remember reading about a study a number of years ago where two groups of women were given the same diet and told they could eat as much as thy wanted of it.  One group also received massages and spa treatments throughout the study.  At the end of the study, the pampered ladies had lost weight whereas the other group's weight had remained stable or even increased slightly.  The story resonated with me because like many folks I tend to eat more when I am upset about something.  During times when I feel optimistic and successful, I eat less.  When I'm sad I comfort myself with junk, when I am happy I reward myself with healthy food.  For me, there is a huge difference between comfort and reward when it comes to food. A recent blog from Tara Parker-Pope at the New York Times reports on work that supports those early findings and my own experiences.  Dr Kristen Neff suggests that some people, who can be quite compassionate to others, have a difficult time applying the same compassion to themselves due to a fear of overindulgence.  These folks are over-critical of themselves when work doesn't go well, or when they gain weight, lose their temper, or offend a friend.  That sounds like me.  An eating study in 2007 showed that when women were asked to test candies, those that were told not to feel bad about eating the candies at less of them.  The other women who were not given the same pep-talk to encourage self-compassion, ate more and felt worse about it.  A preloading donut given to eat during a TV introduction to the study (to simulate mindless easting in front of the TV perhaps) made the situation worse for those that did not receive the subsequent encouragement towards self-compassion and mindful eating. However, the negative effect of a doughnut preload was reversed in the self-compassion group.  So just a few of the right words can shift our attitudes about ourselves, and change our attitude to eating.  Interesting stuff. (As I write this I hear my male friends muttering, 'meh, whatever').  
Perhaps this all plays a role in the current obesity epidemic in the US and across the globe.  Too much cheap junk, a culture of self-blame, and unprecedented levels of depression may predispose us to overeat.  Low self-esteem, particularly in those who have lost jobs, are low-income, or recently become divorced may contribute to a disproportionate incidence of overweight and obesity in those populations.  The notion of being ind to oneself intrigues me and the relationship to food is irresistible. A colleague and I are embarking on a writing a book about how people eat and how people think about food especially in these current times of economics insecurity.  We'll be digging in to how eating habits change when money gets tight, and especially how the diet of children in the home might change.  We hope to challenge some assumptions about food insecurity, obesity, personal choice in foods, conditioned eating in children and mindfulness about eating at all ages.  Self-compassion also needs o be a focus.  We will set up a website and we will blog about our progress once we are on track with our first chapter.  More later...

And this is why....

...we study tumor size and not metastasis... Tumor size is relatively easy to measure in experimental models and even in real patients. Prevention or inhibition of metastasis however, is very difficult to measure.  It is mainly for this reason (in my view) that we continue to plough most research funding into reducing tumor size rather than preventing migration of the cancer cells to new locations around the body. This is a great article (Why Scientists are so often wrong: the streetlight effect) on why science is often wrong. We look at end-points we can easily measure which may give us, at best, only a small piece of the picture and at worst, irrelevant findings. If we measure the measurable (and it is perfectly understandable why we would want to), then we must remember to re-insert the findings back onto the larger context. This is the value of the systems approach, which we have torn apart over the past 200 years in the name of Enlightenment. An over-emphasis on what we call things has led to an inappropriate level of categorization of data and terms which forces us to place something in one category when it might really belong in two or three or even in none. Medical diagnostic codes are a good example of this forced boxing which is done to allow communication between healthcare providers and insurers. The previous blog about cancer also illustrates the problem to some degree. We say a person has died from breast cancer when in actual fact they died from metastatic liver cancer for example. I have a friend whose disease sadly took this path. We remember her, and walk in her honor, to benefit all victims of breast cancer, but the liver and brain cancer that finally took her life is never mentioned.
Another example is appearing in the medical community at large. The pay-for-performance paradigm for doctors and hospitals depends on care professionals reporting certain elements that they are asked to report. Rewarding certain behaviors will ensure that they are reported more. It doesn't necessary follow that the patients are any healthier for it. For a balanced view of the implementation of 'quality' programs for health care see here. The author calls the programs 'garbage in, garbage out' or in other words, you get what you pay/ask for.  The whole system is forcing certain categorization that can make health data fairly meaningless.  For scientists and physicians alike, this should be cause for concern although, I must admit, there are no easy answers given that the system has evolved this way due to human nature.  Few are comfortable with ambiguities if a more concrete alternative is available, and the system does not allow the time for it anyway.  Perhaps in the future, it will.

My name is cancer and I like to travel.

As Elizabeth Edwards succumbed to cancer today, an article in Science News heralded the discovery of a switch that appears to be central to the ability of cancer cells to move or remain still.  Researchers at the University of Georgia say the misregulation of this switch may play an important role in the processes that allow cancer cells set forth on their malevolent journey around the body to find new places to spawn.  Cancer in situ, that is to say in a particular place, often remains fairly innocuous until it either grows large enough to disturb organ function, or acquires the ability to move and settle elsewhere.  Once it has spread its wings and become metastatic, it is very difficult to control and often leads to the rapid demise of its host. 

Today's new discovery could  lead to a better understanding of how and why cancer cells move and in the longer term, yield new approaches to treatment. Could it be possible that in some distant future we may be able to prevent metastasis altogether and come to view cancer as somewhat of an inconvenience rather than a fatal disease? 

Targeting cancer cells that are getting ready to move, or already on their way to some other place, is one approach but what about trying to understand what makes the new location they settle into so appealing?  Maybe we can make the environment around the body unwelcoming to the invading cells.  There are current approaches to preventing colonization of the cancer cells at the distant location.  Therapies are in development that disrupt the local signalling that is required for the cells to invade and colonize the tissues.  Studies look promising but the problem is far from solved.  Clinical studies with smart combinations will likely be required due to the complex nature of the cellular interactions and there is no better time to jump into these.  All of us have lost friends, family and colleagues to cancer.  In my case, every cancer death I have known to date has been due to metastatic disease. I would vote to divert the majority of funding for cancer research from limiting tumor growth to preventing effective metastasis. Maybe it's heading in that direction already. Any comments welcome...

Airport odyssey reveals how awful and annoying we are - CNN.com

Airport odyssey reveals how awful and annoying we are - CNN.com

This article speaks for itself. While not entirely about airport security, it does speak to our attitudes to mass travel and security as we pass through. The author traveled over 5000 miles observing passenger and security staff and collecting numerous eye-opening stories about how we travel. Kudos to the staff that have to put up with all this day in, day out.
In the debate about airline security, the media is reporting that the TSA may change screening methods in response to the outcry. I hope they don't back down. There is also talk about privatizing airport security. For those that still think the TSA are the bad guys, imaging you are about to board a plan to St Louis for instance. The guy in front of you is traveling alone, has a large bag, refuses to go through the scanner and is sweating a little. It's not hot in here you think, but you trust that if he's hiding somethimg, security will catch him during the pat down. The guys is uncomfortable with the first security officer who comes over for the pat down, and requests another. A second guy appears but seems to not conduct a proper pat down- what you don't know is that this private firm is rated on customer satisfaction and he doesn't want to upset anyone. How would you feel about getting on the same plane with a guy who refused the scanner, got a good deal on the pat down and looks sweaty and nervous? Training, accountability, security and regulation are all threatened with that model. It would also be incredibly expensive. Some activities are best kept with the government I think.

Brain Tumors Grow Their Own Blood Supply - ScienceNOW

Brain Tumors Grow Their Own Blood Supply - ScienceNOW

A quickie....this is an interesting new snippet on the science of cancer. Many types of cancer develop a new blood supply to bring nutrients in and take metabolic products out. Drugs to prevent the development of the networks of blood vessels that support this blood supply can be effective at reducing tumor size. These drugs are called anti-angiogenic drugs and they also work to prevent new blood vessel growth at the back of the eye in macular degeneration, the leading cause of blindness in the over 60's. It has always been assumed that the new blood vessels grow from the outside of a tumor and invade the tissues to provide the blood supply. The study above, just published in Science Journal, suggest some brain tumors, called glioblastomas, can generate some of their own blood supply that appear be able to avoid the effects of the traditional angiogenic drugs. It seems at least some of the endothelium that lines the new blood vessels is differentiated from stem cells inside the tumor. New drug treatments could be aimed selectively at these unique endothelial cells, or could work further upstream to prevent the differentiation of the stem cells altogether.

The weight of health information

Lately I've been speaking with several folks who are in possession of large amounts of health information for one reason or another.  They all believe their data is valuable and are looking for ways to leverage it to make a business or to advance medical understanding, or both.  Noble ambitions indeed but a question struck me as I listened to the the most recent of them this last week.  Could it be that the weight of all that information is actually crushing innovation rather than stimulating it?  It seems to me that we have a plethora of data looking for a problem to solve.  If we recall the old proverb, 'Neccessity is the Mother of Invention', and then consider that some of our most recent enduring inventions were developed locally and ground-up with little intellectualization at the start (some of the more successful social media forums for eg) we might conclude tha Nike may have it right in their newer proverb, 'Just Do It'.  Serve a local, immediate and acknowledged need; if it works scale it.  This avoids the political nightmares of having to first make a business case to those who don't believe there is one.  The latter is a very difficult way to start a business but we do it all the time.

If we start from the ground up, we all want better health but what does that really mean?  Here are some possibilities:  Better ways to know if we are sick, or going to get sick; better treatments to prevent or cure at costs we can afford; more control over our general health; less hassle in managing health for ourselves and those we care for; a more peaceful existence.  To me, the latter is perhaps the most important of all and to some degree relies on success in the former four.

There are numerous elements to each of the outcomes but it seems like the last place to start in attempting solutions might be in collecting the data.  There's no harm in it per se, provide one doesn't expect the answers to then simply reveal themselves.  We must exert some energy up front if we are to make sense of the problem and move toward solutions in a short time frame and at reasonable cost. However, given that my colleagues have started with the data,  let's look at the process from the data-first perspective.  We are forced to ask questions in the following way: 1) what data do you have and where does the data comes from 2) what problems can you apply it to 3) who might have a vested interest in either the data or a solution.  Very time consuming and like put the cake ingredients into a bowl and then asking what we might make with it.  If we think nationally or globally then the problem is magnified and can be prone to costly red herrings.

If we look at the problem first, then understanding what to do with the data becomes that much easier because the need is already understood. To further simplify, solving a problem locally first allows one to talk directly with those that have the problem rather than having to resort to assertions or assumptions about the population as a whole.  Locally, trial and error can be conducted at low cost and low risk.  Even for those that already have large data sets, perhaps as a side effect of another part of their business (pharmacies or drug companies for instance), this approach is a sensible way to determine how the data might be leveraged more broadly.

Starting with a large amount of data and a set of assumptions means starting with a muddy board.  The danger of solving the wrong problem is great, provided you can get out from under the weight of all that data.   Starting with a white board and a diverse group of passionate individuals with first-hand knowledge of the problem is an innovation waiting to happen.

So.....

1. Identify the problems before you collect/look at the data
2. Become a local hero first.

Anyone have anything to add?

Airport scanning- how much is too much?

One way or another, for me to get on a plane, I need to be assured that the best attempt has been made to check my fellow passengers for weapons, malicious intent, or materials that can be used for no good.  I see folks being sniffed by beagles or going through puffer machines to detect explosives, getting the pat down by surly but not unpleasant security staff, and occasionally being asked to step aside for further questioning because of a red flag somewhere along the way.  For years we have been trolling through the standard metal detectors and until 9/11 we figured it was not enough. Since then, the US has been spending quite a bit of cash to improve the means to catch the bad guys.  We focus on the person and the carriage of harmful agents; other countries such as Israel also throw in passenger profiling.  We have a system in the works to do that too. People will be profiled to identify their risk status- none, unknown, elevated or high, and this will be achieved by more intensive questioning at the time of booking the flight.  This week, a young passenger felt his civil liberty was violated by the TSA's invitation to step into the whole body scanner where the device would digitally strip him to identify any weapons or harmful objects about his person.  The traveler was even more upset with the pat down he had to undergo as a result of refusing the scanner.  He recorded the whole episode on his cell phone and by now it is viral on YouTube and the guy has been on every talk show under the American sun.  Recording in an airport security area is an offense so it will be interesting if his fine is as widely reported.  The incident triggered a firestorm, with many Americans declaring a revolt against the perceived inhumanity of it all.  Some have vowed to refuse the scanner and furthermore to wear a kilt for maximum harassment of security personnel during the required pat down.  I wonder, really, what folks are afraid of. Which is worse- being seen 'naked' by a security guard (who will see thousands of other 'naked' forms throughout his day), or having to jump an errant passenger in-flight because they are brandishing a box cutter or conspiring with a fellow passenger to put together an explosive?

I can understand the knee-jerk reaction to being 'violated' in this way but what should we really be concerned about?  I think there are a couple of questions, 1) Does it indeed violate civil liberties; 2) is it effective; and 3) is it safe.

In my view the civil liberty issue is a bit of a non-starter.  The good of the many outweigh the needs of the few.  I'd gladly submit to the scan, lumpy thighs and all, to contribute to better safety for all passengers.  The safety issue is the more interesting to me, as well as the overall effects of using the scanners on airport dynamics and travel times.  Here is what I have found out.  On the safety side, the scanners emit very much less radiation (0.005 milllrads per scan) than normal background (300 millirads). To reach the equivalent of background radiation one would have to go through the machines over 100 times a day.  Dr Brenner from the University of Columbia fears the official reports of radiation emitted by the units is underestimated by about 20 times. Even if this is true the radiation is still far less than background.   It seems the scanners are pretty safe, even for very frequent travelers. In terms of effectiveness, they can certainly detect weapons.  Whether there is a reduction in terrorist-like events we may never know.  Most potential incidents do not reach the news. So what about the affect of using the units on travel per se? According to several reports I found the use of a scanner takes about 25 seconds whereas a traditional pat-down takes 2 minutes.  If everyone used the scanner, then transit time through security should be faster.  A person can keep coats, belts etc on too.  Overall, it seems the scanners are a positive move.  In the UK, such scanners have been in use for over a year and, after initial controversy over privacy, 95% of the public now approve. A recent blog suggested that there might also be an anti-obesity side effect.  Image conscious travelers might want to drop a few pounds before stepping into the machine. 

There are murmurings of even more advanced systems that can detect liquid explosives, as well as the aforementioned passenger profiling systems that can identify a possible high-risk passenger based on additional questions asked at check-in.  And then there are biometrics methods that determine whether the person's face or eyes matches the person it is supposed to represent.  Whole body scanning is just the beginning so we had better come to terms with it.  Or just drive.

Bad behavior for Navigenics and 23andMe according to government report - San Jose Mercury News

Navigenics, 23andMe slammed in government report - San Jose Mercury News

First let me say that I am not opposed to genetic testing, and to the use of the resulting data to target medicines for better outcomes and fewer side effects. I'm also not opposed to using genetic data as a reason to modify one's behavior if, for example, genes were found to indicate a particular risk of heart disease. A better diet and a little more exercise wouldn't be such a bad thing. However, one bad outcome of personal genetic testing is that the consumer who pays for, and receives, genetic data, is mislead into thinking their genes are predictive for a disease when there is little or no data to support it.  This is especially troublesome when the disease in question cannot be prevented by known means, and is currently incurable; Alzheimer's disease for example.  If the company goes further to offer them additional products that can help them stave off the said disease, then in my view, this is unethical and possibly dangerous. I have heard of this anecdotally from an employer of a local health food shop. This lady paid for her profile and then was sold an additional package of supplements and dietary aids intended to reduce her risk for a variety of diseases that her genes were supposedly pointing her towards.  To me, this is free-market opportunism at its most insidious.

In the news story above, a couple of personal gene testing companies are in trouble with the government because of their interpretations of the gene patterns to the customer.  Few genes can be definitively associated with disease risk and with the current state of knowledge regarding prevention of disease, there is little to be done with the genetic information.  The most useful application is to let patients know whether they will respond to a particular medicine, or be at risk of a certain side effect.  Genetic ancestry is also a popular use of genetic tests at present but this also carries ethical implications if misinterpreted.

By misleading the public into thinking the data mean more than they, do, Navigenics and 23andMe are doing a disservice not only to the consumer, but to their industry.  The government is already considering regulations for direct-to-consumer gene tests and hopefully these will be sensible and not too restrictive.  Research needs to continue on the meaning of genetic information and when the data is clear on a particular finding, patients and physicians should have access to tests. But companies must act responsibly with the data and the information they pass back to the consumer.  Genetic information must be accompanied with the caveat that the implications of the data are not well understood and that association of a gene with a disease does not imply causation. Systems biology scientists are working on algorithms that can take into account environmental factors and the influences of genes on genes, but we have a very long way to go before we can say a gene or genetic pattern actually increases risk in a definitive way. 

Honey as an antibiotic: Scientists identify a secret ingredient in honey that kills bacteria

Honey as an antibiotic: Scientists identify a secret ingredient in honey that kills bacteria

Scraped knees and elbows is a common hazard of the young and I was no exception. I liked to ride my bike fast, and scooter my scooter faster. I was always in some state of injury and my dad was always there with the honey. A small scoop of granulated, crunchy honey placed on a would and covered with a band- aid was always sure to bring rapid relief and healing. I hated that it was sticky and was often irritated at the inevitability of the solution but it always worked. Finally science has caught up with my dad. The protein responsible is defensin-1 that prevents the bacteria taking hold at an infection site by working with the body's own defenses. The method is particularly appropriate for resistant bacteria which is important; the more antibiotics we use, the more bacteria develop resistance against them as a rule. There are cases now, where patients are dying because they have resistance infections that cannot be treated with known antibiotics. The researchers used medical grade honey which differs from food grade honey a little in that the medical grade contains less bacteria. Table grade seems to possess fewer antibacterial qualities according to research but the rough honey of my youth seemed to do the trick.
For minor scrapes, maybe a little honey rather than neomycin, might be the way to go?

Reference:
P. H. S. Kwakman, A. A. te Velde, L. de Boer, D. Speijer, C. M. J. E. Vandenbroucke-Grauls, S. A. J. Zaat. How honey kills bacteria. The FASEB Journal, 2010; DOI: 10.1096/fj.09-150789.
Cooper et al, 2009: http://www.woundsresearch.com/content/a-comparison-between-medical-grade-honey-and-table-honeys-relation-antimicrobial-efficacy

Loneliness, poor health appear to be linked

University of Arizona (2010, June 21). Loneliness, poor health appear to be linked. ScienceDaily. Retrieved June 23, 2010, from Science Daily. Two studies have found that hoarding friends doesn't necessarily diminish forlorn feelings and that loneliness is a matter of perception. Superficial relationships, researchers say, can not only result in feelings of detachment, but also contribute to certain health-related problems.

Remember Robert Putnam's book several years ago, Bowling Alone.  He made a startling statement in that book, the lack of social connectedness was worse for your life expectancy than smoking.  If he was correct, and the current studies from the University of Arizona support his hypothesis, then what is to become of all the folks who sit at home alone playing computer games?  Do on-line social networks count?  I'd be interested to see what the researchers think about that.  As more of us develop our virtual friendships, how does the quality of those connections compare with real-life?  The Arizona studies found that quality of relationships was more important than quantity.

I like my social networks and find them comforting.  It's validating to put thoughts out there and have folks comment on them, whether the comments are for or against.  I find other humans fascinating so I like it when I see some posts that people are doing their laundry, preparing to paint the living room, or returning from vacation. I even like reading what people eat.  Personally, I love the virtual world but I wouldn't swap it for real life friends.

Living with all life's joys and burdens is a pleasure for sure. Without someone to share it all, it loses its flavor.  It's easy to see why daily stresses can build over time and threaten a person's well-being.  Too much adrenaline suppresses the immune system.  The effect is so pronounced that certain military units have had to curb the the rigors of their training, because soldiers were becoming sick with opportunistic infections.  Adrenaline is also given to patients whose immune system is over-reacting in the acute and serious allergic reaction known as anaphylaxis.  Consider a person who is lonely and stressed and whose adrenaline perhaps never gets a break.  It is easy to see how chronic feelings of isolation might suppress our immune systems and make us sick over time.

Loneliness is a terrible thing and it seems our bodies don't like it any more than our minds.

McDonald's faces lawsuit over Happy Meals - latimes.com

McDonald's faces lawsuit over Happy Meals - latimes.com
This article suggests McDonald's is negligent for attracting young and impressionable toddlers with a cute toy in their Happy Meal. Since when does the toddler in the house make the decisions about what he or she will eat? I understand the wailing kid in the back seat blubbering that everyone else has that toy except him and now he'll be left out... blah, blah. I went through this with my kids. They can be VERY persuasive but at the end of the day, parents are the ones who should be saying no if they don't like the idea of the Happy Meal.

McDonald's built a business on fast, unhealthy food that sells to millions and millions. We all know the deal. Perhaps the problem with McDonald's is not the enticing Happy Meal toys, but rather the disgracefully cheap dollar deals that let you feed a family of five for about ten bucks. This seems to be a more criminal aspect in my view. Try driving around with a car full of hungry teens and a meager $20 left in your pocket to feed them. The dollar menu calls. It's fast, easy and filling but of course lacking in significant nutrient value.

Should we picket Micky D's to take away the dollar menu, withdraw the Happy Meal toys, or better still, shut their doors altogether? In my opinion it is none of these. Fast fat food is everywhere. It's just cheaper at Micky D's and the like. A walk around the supermarket will tell you that our whole diet has degenerated into an artificial, sugary mess. Even yogurts are stuffed full of sugar and we tend to put those in the health category. The latest Dannon yogurt I ate had 23 grams of sugar!!

So, let McDonald's advertise the toys. And parents out there... teach your children to resist early. It doesn't get any easier as we get older. As big business continues to push the calories, it is up to us to say no and the earlier we learn that life skill the better. No-one will do it for us.

Now what did I do with that Twinkie.....

Hospital acquired infections

On a trip to England last year, I saw hand washing stations outside each hospital ward, and surprisingly, most people were using them before they visited their loved ones. I remember, more than 20 years ago, the hoopla about MRSA in the hospital I worked in in London. We practiced barrier methods to keep the bugs from spreading and washed our hands relentlessly. People generally came to hospital to get rid of their infections, not pick them up. That’s how I remember it anyway.
Today, the chances of getting an infection while in hospital appears to be staggeringly high. The World Health Association estimates that any any given time, 1.4 million people worldwide are suffering from infections they got while in a healthcare establishment. Healthcare- associated infections (HAI) costs the US alone almost $7 billion each year. What is worse, some of these infections can be quite difficult to treat. The levels of antibiotic resistance is increasing and along with it our chances of having to take a more risky antibiotic to treat our infections. Unbelievable as it sounds in this day and age, people can and do die of infections that cannot be treated with known antibiotics. Antibiotic resistance makes hospital visits that much more scary. Imagine you go in for a life-saving procedure, for a burst appendix perhaps, and come out without your appendix but with a HAI that takes you weeks to recover from. Or imagine that you go in for a little liposuction and endure months of prolonged pain as a result of something you became infected with while in the hospital. These scenarios are becoming more common and with it, an increased reticence about going in for that operation in the first place.

Hospital acquired infections would be much less worrisome if many of them were not drug resistant. There are many efforts across the globe to better understand antibiotic resistance and to ensure we have drugs available for emerging resistance strains. Some bugs of concern, so-called Gram negatives, including the particularly nasty Acinetobacter are difficult to treat to begin with. WIth resistance accelerating to even newer antibiotics, there are few drugs in the pharmaceutical pipeline to keep up with resistance. MRSA still remains a problem even though it tends to stay out of the headlines these days. Once a hospital-acquired infection, MRSA is now just as likely to be contracted in the community. Infection control for some microorganisms has been improved in many hospitals. However, some centers still have a way to go. Just this week the Journal of the American Medical Association (JAMA) published an article that suggests lax infection practices may plague the nation's more than 5,000 outpatient centers. Patients coming in for day surgeries are leaving with more than they signed up for in more and more hospitals. U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement that her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers.
Reporting infections is important and in general, is on the increase although some doctors still fail to report incidences at their hospital.

In the future it is conceivable that minor operations may not be widely accessible due t the high risks of acquired infections in the hospital. Patients may have to think twice about procedures we now take for granted such as C-sections, joint replacement surgeries and cosmetic procedures for example. With the risk of HAI growing, the future of medicine may see a very limited list of surgical options for patients in non-life-threatening situations.

For people interested in learning more about HAIs, there are a couple of places to go. The first is a website put together by Kimberly-Clark at www.haiwatch.com. Folks can sign up for newsletter and browse around for general information particularly on two of the most common HAIs; ventilator- associated pneumonia and surgical skin infections (SSI). The CDC also provides more information at http://www.cdc.gov/ncidod/dhqp/healthDis.html

TED video on a new way to get around the web: MUST SEE

Pretty cool way to explore the web

Scheduling babies

News reported in the New York Times today says Caesarian births (C-sections) are at an all time high in the US and now comprise the most common surgical procedure over here.  I read the headline and had three questions on why this might be: 1) Are US pregnant mothers less healthy than other country counterparts (maybe due to lack of good healthcare?); 2) Do US mothers choose C-sections more often as elective surgeries?; 3) How does this affect the health of the baby?
The article answered these questions reasonably well and also gave me some surprises.  It seems that C-sections are going up in all countries but the US and China appear to be among the biggest fans. China's rate is approaching 50% (!) and there is a suggestion that a major driver is increased income for doctors who perform the surgeries. Here in the US it seems the causes of C-sections are many-fold. The main reasons however, appear to be elective procedures called for in the name of convenience, and fear of liability issues on the part of the doctors.  Caesarians are about twice as expensive as normal deliveries and, unless there is a specific risk to the mother and/or child, the babies are not healthier.  In addition the risks of the surgery include abnormalities of the placenta and as with any surgical procedure, the risk of infection.  The latter may be of particular concern as hospital acquired infections that are resistant to antibiotics seems to be on the rise too.
In other news it appears the trying to get weight under control in school aged children may be too late to off-set the increased risk of obesity later on.  Chubby babies may be cute, but so-called baby fat may not be as innocuous as once thought, leading to obesity in adults and increased incidence of type 2 diabetes.   An additional report from the LA Times suggests that women can prevent the normal 1-2lbs of body weight gain that occurs per year between the ages of 25 and 50 by simply exercising for 1 hour per day.  Sounds delightful--but who has time?  I think we probably all do if we prioritize the activity but then again....Those are also the child-bearing years and this factors in in more ways than one.  Pregnancy related weight gain and the the complete lack of time for anything but baby and work for working moms makes a whole 60 mins of me-time out of the question for most.  Still, its a nice ideal and something to aspire to.

Three snippets:
Cool position advertised:
Head of McGovern Family Center for Venture at Cornell.  Wish I loved closer to Ithaca, NY.

Cool organization found:
Bravewell consortium for integration medicine I would love to work with these guys somehow.

It's World Water Week!
Unicef's tapproject.org

Eyes, brains and sea squirts

In 2005 scientists discovered a way to predict who is at risk of Alzheimer's by looking at the lens inside their eye.  As we age our lenses get cloudy over time leading to the formation of cataracts which we can replace with an artificial lens when things get too murky.  There is another type of cloudiness, however, that is caused by the deposition of the same proteins that are believed to play a major role in the development of Alzheimer's disease (AZ). A special ophthalmoscope is needed to identify the amyloid deposits.  Yet another way to get a hint of the pain to come but what of potential new treatments?

Firstly, the humble sea squirt (Ciona intestinalis) offers a possible model for screening new compounds that might inhibit the formation of plaques and tangles that characterize AZ as we know it.  The marine creatures are likely our closest non-vertebrate relatives and share 80% of our genes  (don't get too excited - we share about 98% with chimps). Sea squirt tadpoles share all the known genes for the formation of plaques and tangles and can be stimulated, with the introduction of a mutant protein, to form not only plaques and tangles in one day, but also behavioral defects that can be reversed with an experimental anti-plaque forming drug.  This novel method, development by Bob Zeller and Mike Verata at the San Diego State University, is one of the most interesting and promising steps forward in the quest for AZ drugs.  I wonder if the little guys (the sea squirt tadpoles that is), can help model Lewy Body Disease too?

In other news, a potential new treatment for Alzheimer's made by Pfizer was nixed today by the FDA. The drug, Dimebon (that sounds  a bit like time-bomb if I am pronouncing it correctly) did not show improved cognition or overall functioning in early- to mid-stage AZ patients.  Analysts had been mixed on their expectations, with The Day article citing anticipated ROI ranging from $1.5 billion to zero. Pfizer was disappointed with the results but not as disappointed as all those folks with the inappropriately cloudy lenses that are now anxiously awaiting news of a cure for their impending AZ...

Technology and medicine- future directions?

I couldn't pass up an opportunity to comment on a recent article in the latest issues of the Economist.  Basically there is a 3-D bio printer machine on the horizon that can be programmed to create cell lines and eventually whole organs.  Researchers are starting simply with skin, muscle and blood vasculature but hope to progress to larger patches of cells that are grown on artificial scaffolds in the shape of particular organs.  Researchers have created ex vivo bladders this way but not using a machine approach. My feeling is that a bladder is one thing, but a functioning organ such as a kidney will be a great deal more complex. Human biology being what it is, I think it unlikely that a machine primed with recipes for 'baking body parts' will become a reality any time soon, if ever.  I do applaud the effort however.  There is certainly no progress in any field without imagination.

It's obvious that our current healthcare system is unsustainable and this piece from the New York Times sums it up nicely. In addition to speculating on the future collapse of the system he talks about his son's recent wrestling injury which I must admit distracted me from the meat of the message, having a young wrestler myself (see pic).  Regardless, if you are thinking healthcare reform is unnecessary, you should take a look at what he has to say.  We spend the most but are way down the list when it comes to outcomes such as life expectancy and infant mortality.  For those worried about tax increases to pay for universal access, would you rather pay a few hundred more each month for health insurance with higher deductibles and more procedures not covered, or a bit more tax for higher coverage for all.  The the country as a whole, the latter makes so much more sense.

I don't hear much about this yet but it's eye opening how much 'high-tech' doctors are earning these days.  Even taking into consideration their malpractice insurance, these salaries are likely to come under scrutiny as health reform progresses (yes, it is progressing, albeit very slowly).   When physicians earn up to half a million per year and patients are going bankrupt to afford the services, something is out of balance.  Even for those who are adequately insured (a rapidly decreasing segment of the US population), increases in insurance premiums and decreases in covered services will bring the actual costs of medicine and everything it encompasses further under the microscope.  It's hard to figure how this will re-balance, given the costs of med school and malpractice, but re-balance it must.

This posts brings up a related question: High tech means high cost; how much technology in medicine is too much? And who makes that determination?  Ultimately, it must be you and I, the consumer.  Are we prepared?

Bedtime browsing to start the day

I turned on the TV this morning and saw some old news. Senator Chris Dodd is retiring. To NBC this was 'Breaking News' and yes, he only announced it early this morning, but to me it was old news. You see, I get all the stuff that I need to know before I get out of bed. My iPhone alarm sounds and I reach for the phone to turn it to snooze. After one or two snooze cycles, I click the AP news button, and a quick glance tells me the major news, some saucy snippets from Hollywood and what I can expect from the weather today (COLD!). From my early morning bedtime browsing, I also know that England was blanketed in snow last night, that UK talk show host, Jonathan Ross (or Wossy to his Tweeter-buds) couldn't start his car today and fed the birds in his yard before taking a taxi to work, that there is a nasty virus attached to a particular Facebook group and that I had no urgent e-mails to worry me. All this took about 5 minutes, maybe less, and provided me with a working view of my environment for the day, whether it will really affect me or not.
So, do we need NBC? or CBS, or any TV news station, any more? I do like the recipe sections on the morning editions, and the interviews are interesting at times. For news, however, they have to offer something spectacular for me to be able to watch. There has to be something I couldn't find in a headline on my iPhone. US news channels use a rapid fire approach so that all the major news is over within the first 3 minutes. To survive, maybe US news should take a cue from the BBC. Each item gets thorough coverage with news and in-depth contextual background. WE can get a taste of it with BBC America over here. When I first came to the States I was shocked at the almost dismissive nature of the 5 o'clock news. Now I am used to it but find there are better ways to get 3 minutes of whiz bang breaking news--on my iPhone before I even get up.
There are elements of my environment that my iPhone cannot tell me about. There is the mood of my family members first thing in the morning (dubious at best) but then again, if one should ever get up before me, they would likely post their status on FB and so I would have that too. Imagine if I could get a read out of how I am doing healthwise. I see a future where we have a tiny implanted chip that records what we eat during the day, and how our bodies respond to it. Maybe one morning, I will add to my browsing list, the details of my previous day's health status. Maybe it will say something that might translate to this, 'take it steady today, you ate twice as many calories as you need and went way overboard on the fat with that giant bag of potato chips. Oh, and your serotonin is a little low so be on the lookout for depressive thoughts, and try to walk a bit more, lardy.' We could get used to our personal baselines, and then bit by bit, try to do better each day until we are making a real impact on our longer term outcomes. Maybe it would help us learn to connect our lifestyle choices more closely with the health impacts. Just thinking about it makes me want to eat an apple. See, it's working already.
PS: the picture is of a couple of puff pastry mince pies- just one of the items my in situ health monitoring chip would tell me to avoid like the plague...

The sad state of health insurance in the US

Today a report announced that about 20% of Americans went without health insurance for some or all of last year. By contrast, in almost every other developed nation in the world, 0% went without health insurance in the same time period.
The report suggests, not surprisingly, that lack of insurance was more common amongst the unemployed. I have found myself in this situation recently, having lost a job unexpectedly and being unable to afford the premiums for a private plan once my corporate benefits ended. Most plans cost in excess of $1000 per month for a family of 4, and still have deductibles that run into the thousands. For those without regular income, this is laughable, and insurance of any kind only becomes more thinkable if one's family income is at poverty levels so you can at least get the kids signed up with Husky. Husky appears to be a comprehensive and admirable way to spend our tax dollars. Almost 40%of our children are covered with a Husky plan according to today's report with only 8% left without insurance at all. Personally, I had no idea so many children were taking advantage of government health insurance. I find it reassuring that the program is there.
For parents, life without a job is difficult. Life without health insurance, is terrifying. That's why we need health reform. Bring it on.