Staying sane in the world today

Fish House play against a moving back wall at The Workshop in Mystic, CT

After reading this in Fast Company I think I may be a Genfluxer.   I usually dislike labels but I"m happy to adopt this one.  Genfluxers are comfortable with ambiguity, recognize that the future is inherently unstable, and wallow in chaos like pigs in muck.  That describes me pretty well and according to the article I am in good company.  Pete Cashmore, who runs Mashable is in there- he is a hero of mine.  Beth Comstock and Susan Peters  are shaking it up at GE. Baratunde Thurston is digital editor at The Onion and is a quintessential GenFluxer according to the article.   Social media and the Internet have created a fast-changing world that challenges many traditional notions of how work gets done. Knowledge Management (KM) was a discipline of sorts that grew up in the same time frame of Fast Company magazine and as I read the article I reflected on what it means to know what you need to know in the current environment.   Never before has it been so easy to gather information.  Just typing in a term into a search engine will get you a plethora of hits and comprehensive overview of your topic.  Some have suggested that the ease of information gathering has a down side in that you get what you ask for. And little else.  Serendipity is more elusive when you look for something directly, versus scanning through a magazine shelf and happening upon an interesting snippet that sheds new light on a particular problem.  A recent article in Intelligent Life magazine on the loss of serendipity in the digital sums it up nicely. Knowing what we know and don't know has perhaps never been easier, but the challenge now lies in asking the right questions and in not being too comfortable with your answers.  What seems right one day, may indeed be quite wrong on another depending on context.  Being open-minded and ready to shift perception based on emerging information is critical in today's environment.  For better or worse, we can no longer sit back and feel accomplished in our understanding.  I, for one, am comfortable with that although sometimes it feels easy to get left behind. Really, though, it may not be being left behind that is important thing to worry about. Rather, being too caught up with every changing view and losing sight of the big picture may be the greater danger.  That seems to me to be a recipe for burnout.  For individuals and companies wishing to keep their footing in the rapidly swirling environment, it seems that cultivating an open mind, getting comfortable with ambiguity, and being somewhat brave, may be the best approach to staying sane and, with luck (yes luck), finding success.

In 2012 I will be thin.... or will I?

The end is nigh.  Or so it seemed a year or two ago.  Now, it seems that the end of the world has gone off the boil and the race for the 2012 Republican nomination is eclipsing all talk of Armageddon.  As we begin this new year, millions of people are starting to act on new year's resolutions that will involve eating better, exercising more and possibly being nicer.  Working harder may factor in, and earning more is a no-brainer.  All of these will last at most a month or two and by Valentine's day the gyms will be empty and the larders stocked once again.   We humans are so predictable.  We love new beginnings but we are terrible at sustaining behavior change, especially if involves some effort, and getting fitter surely does.  Today on NPR, I heard Tara Parker-Pope (try saying that 10 times after a few beers) talking about her struggle with weight.  Tara is a health writer so for her to admit to weight issues is big and brave but the personal touch she brings to this story makes it convincing.  Her story, The Fat Trap, in this week's New York Times magazine and a telling  Q&A about it on line today, reports from the scientific literature on the memory of fat cells and their quest to keep themselves full.  She discusses the evidence that once a person becomes fat, their body will always try to maintain that weight despite all efforts to become slim.  A slim person who has once been fat will gain weight much more easily than someone of the same weight who has never been fat.  If this is true (and the article is compelling), then perhaps we should be less judgmental about people who start the fitness resolutions and then seem to give up so soon.

Researchers have shown that when women lost a significant amount of weight, even one year later, their levels of certain hormones were abnormal- ghrelin that stimulates hunger was unusually high, and peptide YY that usually suppresses hunger was below normal.  The cards were stacked against thee women even after they were no longer overweight.  A 2010 study found a number of gene variants that correlate with higher body-mass index.  One variant, known as FTO is carried in about 65% of Europeans and Africans, and up to 44% of Asians.  Whether we have one or two copies of this gene appears to correlate with weight and it seems that it may play a role in how we eat.  Genes, however, are likely only part of the problem.  Food cues are another.  We live in an environment that is saturated with food messages, images and cues to eat high fat, high sugar foods.   For people who have lost weight, their emotional response to food may be greater than slim non-dieters.  They also burn less energy than their non dieting counterparts for a given amount of exercise.

From all the data, it seems it's a hopeless situation, but Ms Parker-Pope feels it's better that she knows what she is up against and I feel the same way.  One of the surest ways to fall off the wagon is to have one day's blowout and then feel so bad you never get back on it.  Knowing that there are forces at work that your thin friend may never have to deal with, might actually strengthen the resolve to stick with the diet or the exercise plan.  Most importantly though, it seems we should not become overweight to begin with.  This underscores the value in educating children about balanced eating.  We need all the help we can get to maintain a healthy focus on food, diet, and exercise in the current world of information overload and dietary excess.  It's difficult enough to know what to eat and how much as an adult.  To teach our children to eat when they are hungry and to exercise as much as they can seems the responsible thing to do as a parent even though it's difficult with every other ad on TV being for some sugary or greasy snack.  For all of us, eating to satisfy hunger and getting out there and walking to work when we can, is a healthy prescription that we shouldn't sweat over, but just do our best whatever our biological odds.

Dreams are real

When I was young I had a recurring dream that I was in a small town in a desert and I had lost my parents.  The town was a colorful collage of dusty roads, bright tents and intense citizens cloaked in veils and robes, their faces hidden from me at all times.  I somehow knew it was a dream but was powerless to change the direction. I was always lost, always without parents, and never able to escape the desert.  Lack of control in dreams is the norm for most of us but not for a small number of people who can experience lucid dreams.  Whilst in the dream state, as recorded by brain activity showing Rapid Eye Movement phase (REM sleep- the phase that is associated with dreaming), lucid dreamers can respond to external commands and can direct the course of their dreams.  This is a learned skill that has recently been put to use to determine whether brain activity in dreamers correlates with movement in non-dreamers.  German scientists at the Max Planck Institute in Leipzig, in collaboration with scientists from the Charite hospital in Berlin, put sleepers into a magnetic resonance scanner and asked them to indicate when they were in a lucid dream state via eye movement.  The lucid dreamers were then asked to dream themselves clenching a fist while the researchers monitored their brain activity.  It seems the brain lit up in the same way as when the dreamers were awake and actually clenching a fist.

The major difference between dreaming and acting while awake seems to be the physical paralysis that accompanies the dream state that stops us from us from acting out the dream.  In some people this mechanism appears to be defective though.  People that develop Parkinson's Disease or a form of dementia called Lewy Body disease, sometimes suffer from sleep disorders where they appear to be acting out their dreams long before the actual disease appears.   These disturbed sleepers are usually unaware of their nighttime antics which can cause harm to their bed partners through punching and kicking. Violent nights that leave the sleeper oblivious can go on for up to 50 years before the Parkinson's or dementia reveals itself and occur in 60-80% of patients.  My own father who I have blogged about often, would throw himself out of bed or hit my mother with force during his sleep for about 10 years before he received his diagnosis of Lewy Body.   She would retreat to another room as an act of self-preservation on those nights where he was active, and complain to me that he was 'at it again.'  Never once did either of them mention it to the doctor, and I didn't know there was a connection with brain disease until much later, when other symptoms had started to appear. 

Now, the question of why this occurs in this at-risk population is a hot topic for research.  One has to wonder whether the sleep disorder is cause or effect of the final disease.   A quick review of the literature finds the jury out on the actual mechanism of the disorder but in the meantime, any regular violent night time behavior, particularly where the sleeper is unaware of the problem, warrants a check up at the very least.

Reference: Max-Planck-Gesellschaft. "Scientists measure dream content for the first time: Dreams activate the brain in a similar way to real actions." ScienceDaily, 28 Oct. 2011. Web. 30 Oct. 2011.

Hey, We're Number ... Uh ... 36! | Truthout

Hey, We're Number ... Uh ... 36! | Truthout

Genes, diet, and most of all access to good healthcare all contribute to the poor ranking of the US in life expectancy- number 36 according the United Nations, and number 50 from CIA factbook estimations. We spend far more than any other country on healthcare but there is so much disparity in quality and access that one person may die of a highly treatable condition while another exists for years on rounds and round of expensive cancer therapies with a very low quality of life. How we let this stand is an interesting question and perhaps relates to the 'haves' being the ones with the voice, but not realizing the plight of the 'have-nots'. Any comments on why we are not up in arms about these statistics?

Thanks Irene.

I am electrified. Literally.  We have power at our house for the first time in a week. Hurricane Irene meandered up the coast, taking her own sweet time and reeking havoc everywhere she went, until finally arriving on our doorstep last Saturday evening.  Within two hours of the start of what would be about a 10 hour process, a tree was already down in the back yard and we had lost power.  We were under-prepared for some reason; warnings that she was coming our way were posted well in advance of her arrival but it seemed uncool to panic too soon so we didn't panic at all.  It turned out our generator was broken and our power was lost right at the start of the storm, as if God was saying, "you should've listened to Bob," (cheers Bob Maxim, NBC30 weatherman extraordinaire).  At least we had filled the bathtub with water since we couldn't pump from the well with no power.

As a dark day and an even darker night passed, batteries became depleted, non-perishable food was rapidly devoured (I under-purchased on that front too), so we began to seek comfort in the outside, namely Hamburger Hill.  This famous strip in Groton serves burgers upon burgers from Wendy's, Burger King, MacDonalds and the like, and surely would be back up and running in no time.  Hallelujah-Wendy's was open.... and had a line about half a mile long outside.  We heard rumor that a Dunkin Donuts was open and evidently so did everyone else.  There was a flock of people down the street waiting for coffee too.  I opted for Dunkin and amazingly found an outlet to recharge my phone.  Sitting, sipping, waiting, I watched the masses file in and out with varying degrees of relief to have finally found some caffeine (even though, in truth, it had been less than 24 hours for most).  Occasionally, someone I thought I knew came in. A glance and a nod told me I was right but where did I know them from?  Some might walk over and say hello and we reconnected as if we were old friends, reminiscing about some event where we had crossed paths.  Others just nodded and moved on with their day.

A few days later, still in the dark and powerless, I met a friend in Starbucks at about 8pm, a time that is usually quiet and winding down for the evening.  Not that night.  Teams of people were jostling for seats and outlets, some with irritation and some with philosophical resignation that they would just have to wait.  The mood overall was jolly.   I saw acquaintances exchanging pleasantries and some sitting down together for a more solid engagement.  Outlets were stuffed full at all times; PCs and Macs, phones, notebooks flashing in the background. Yes, in the background.  Whilst many had come it to try to get some work done or check their Facebook, virtually everyone ended up closing their laptops and talking to another person in the flesh.    The irony did not escape me.  The desperation of dead batteries and no virtual connection, led all these people to the Starbucks charging stations where they found real life conversation.  At 10pm, Starbucks began to move us out, offering free tea to go.  There was a reluctance to leave even though all gadgets were by now, up and raring to go.   Some said they would be sad when the power came back and I knew what they meant.  The sense of shared fate and camaraderie in the cafe that night was palpable and the buzz of conversation had never been more alive. This is what coffee shops were meant for I thought as I walked out; connecting and sharing.  I wondered why we have to have a little disaster for us to get back to that.  Maybe because virtual is just so easy.

Our power has been back for almost two days now.  At first we turned on few lights, and didn't even look towards the TV let alone turn it on.  No games on the computer, little sound except for Kyle and Jake on electric guitars.  I began to wonder if somehow we might be permanently changed.  But then reality crept back.  Washing machine fully cranked, gaming back in full swing, computers buzzing all around, TV still not on but it won't be long... 

Remembering Dad. Catching up with Alzheimer's.

I am interested in the mental machinery that keeps us sane (or not) but have always been somewhat afraid of being taken over by unwanted demons in the head.  I know nothing of my genetic heritage since I was adopted as a baby but a part of me wonders if my birth mother or birth father, if still living, are mad yet.  My adoptive father did succumb to dementia as I've written about in earlier blogs and experiencing him disappear was at once terrifying and fascinating.  As a daughter, it was hard to watch but the scientist in my could not look away. 

In the early days, each strange statement, or out-of-character emotion, led me further into the rabbit hole of madness and I was consumed with understanding this terrible disease and the human response to it that was evident all around me; my mother's denial, my father's hope, my own morbid curiosity about the devious neuronal aberrations.  As time went on of course, it became starkly obvious that he was over the edge, never to return as the father I loved for his quick, intensely inquisitive mind, and seemingly endless well of knowledge about the most obscure topics.  While there were glimpses of his old self, in an impish grin or a half-told joke (he could never remember where he was in relation to the punch line, or even that one was expected, closer to the end), my dad was now someone different and my memory of him was all that existed of that former self.  We were able to talk sometimes, but rarely to hold a whole conversation. Often, these talks were about things I couldn't see; the boys playing football in the courtyard of the nursing home; the red lights of the signals ahead as the train approached; the car he had just taken into the shop for a repair he thinks he could have done better himself; his mother calling him for tea in the distance.  He was living a full life, but not one he could share or that anyone else would believe.

This week, several news items came up about Alzheimer's Disease. This one from ABC laments the lack of preventatives or treatments for the growing number of Baby Boomers who are entering the early stages of the disease. Here, Medical News Today describes a couple of studies that show patients with signs of Alzheimer's on a brain scan but without any symptoms fall more often than people with no brain signs,  while another study showed that retinal scans can indicate which patients might be at risk of the disease. Yet another study shows certain brain proteins predict disease progression in patients with mild cognitive impairment.  Plenty of research findings that may help determine who of us is just forgetful and who might be on the slippery slope from which there is no return.

This still all leaves me a little cold.  Research is good. Science is good. But for those who have seen the disease take those we love, the fear of knowing what's ahead without any credible way to forestall it is almost cruel.  It presents a dilemma for me as a scientist because I understand the value in identifying the predictors and prognosticators associated with a disease; it's one of the surest paths to eventual prevention and treatment.  However, my emotional side tells me we shouldn't know.  Like watching my dad, I have to get comfortable with seeing it from both sides.  Even so,  the tests are not for me. Yet.

Guest blog by Kristy Dawson: Cancer patients embrace holistic methods

A recent turn in hospitals has allowed cancer patients and others dealing with illness to sometimes shy away from using conventional methods of treatment such as chemo and radiation. Specifically with cancer patients, an increasing number are turning to complementary and alternative methods of healing that are often based in holistic therapy options such as yoga, chiropractic care, and acupuncture among others.

Yoga has gained major popularity as an exercise option in the past few decades, but recently cancer patients have adopted it as one of the most used types of complementary/alternative therapy sessions. The use of yoga has allowed for those participating in conventional therapy sessions to cut down on common side effects such as nausea and dizziness. Some have adopted it as one of their alternative methods of therapy, as yoga can often be used to help improve range of motion, flexibility, and ease body pain.

Acupuncture has also been used as a way to reduce side effects of chemotherapy and radiation such as vomiting and nausea. Most of the patients who undertake acupuncture as an alternative or complementary therapy are suffering from major bouts with body pain. Acupuncture works to relieve the pain in the back area, as well as numerous other parts of the body.

Using meditation, hypnosis and other mind therapies are often critical to cancer patients. Mind and body connecting methods allow patients to alleviate some problems that are usually hard to counter act such as anxiety and stress. Meditation allows for the chance to free up time from schedules that often overflow with treatment and tests. Hypnotherapy allows patients the opportunity to alter behavior and emotions, while cutting down on stress and anxiety. This form can be crucial for patients who are having a very rough time dealing with their emotions following diagnosis.

The proof is in the stories of use for complementary and alternative methods of treatment. A great example of the impact these are having involves mesothelioma survivor Paul Kraus. This is a type of cancer in the lungs that evolves from asbestos exposure. Kraus has used a combination of strict dieting along with numerous alternative therapy methods such as yoga and meditation to defy expectations. Average life expectancy for the disease is usually between eight and 14 months, but Kraus is living today 14 years after what was expected.

Looking toward the future, alternative and complementary methods are likely to gain heavy popularity. As more and more doctors add in these methods as complements for routine therapy, their importance will take off in the medical community. 

Thank you to my guest blogger, Kristy Dawson! Kristy is a recent college graduate and aspiring writer from Florida. As a Health and Safety Advocate, she shares a strong passion for the wellness of others in her community. Kristy uses her writings to spread awareness of such issues to help others live the healthiest lifestyles possible.  If you want to contact Kristy, please e-mail me at spiral5@mac.com.

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.....