The Fountain of Youth Available Now – Side Benefits Included

It is no big surprise to see the results of a recent study of a long running study of primates that shows significant value in a low calorie diet. This article reported on MedPage here in July 2009. The headline here:

researchers have shown that restricting calories in primates maintains their youth and prevents age-related disease

Let me state that again:

researchers have shown that restricting calories in primates maintains their youth and prevents age-related disease

The research is exciting since this represents a real way to reduce disease and extend high quality life. Unfortunately the nature of society today makes for an interesting slant on this information and so the the researchers are interested in the possible short cut that this research might help develop:

open the door to drugs that would mimic so-called caloric restriction

Sigh……..so much better to actually use the information to drive healthy behavior.

The effect has been know for many years in other animal models and a peak into other research papers reveals similar findings. The Annals of New York Academy of Sciences 25 Jan 2006: Caloric Restrictions in Primates demonstrated caloric restriction (CR – the fancy term for low calorie dieting) has significant benefits:

that reproducibly extends mean and maximal life span in short-lived mammalian species. This nutritional intervention also delays the onset, or slows the progression, of many age-related disease processes. The diverse effects of CR have been demonstrated many hundreds of times in laboratory rodents and other short-lived species, such as rotifers, water fleas, fish, spiders, and hamsters. Until recently, the effects of CR in longer-lived species, more closely related to humans, remained unknown. Long-term studies of aging in nonhuman primates undergoing CR have been underway at the National Institute on Aging (NIA) and the University of Wisconsin-Madison (UW) for over a decade. A number of reports from the NIA and UW colonies have shown that monkeys on CR exhibit nearly identical physiological responses as reported in laboratory rodents. Studies of various markers related to age-related diseases suggest that CR will prevent or delay the onset of cardiovascular disease, diabetes, and perhaps cancer, and preliminary data indicate that mortality due to these and other age-associated diseases may also be reduced in monkeys on CR, compared to controls

But the latest research linking this finding to human’s is more recent (though in all honesty is this surprising to anyone!). But the news is even more exciting. The low calorie group had some additional side effects:

• Zero incidence of Diabetes in the CR group (compared to 30% in the other group)
• A reduction in incidence of Cancer of 50% in the CR group
• 50% reduction in Cardiovascular Disease in the CR Group

Do you need anymore incentive on healthy living? I know I don’t! Reduce your calories now – your body needs you to!
Technorati Tags: Calorie Restriction, Low Calorie Diet, Fountain of Youth

The Food Industry – New Tobacco

Its a radical idea but a recent article in the NY Times (How Food Makers Captured Our Brains) lends some credence to the idea that the food industry is behaving much like the tobacco industry was some years back (and probably still today). They engineer their food and the contents to make it as addictive as possible. This is done with no regard to health or health consequences. Their desire is to hook us to their product making us want more. Dr Kessler (Pediatrician that has served two presidents in his role at the FDA) has recently published a book: The End of Overeating: Taking Control of the Insatiable American Appetite)

My original supposition that I have shared with others was centered on sugar as the key ingredient akin to Nicotine – addicting and the reason why my kids have always preferred <INSERT: name of Fast Food Chain> Hamburger when compared to a home cooked Hamburger. But it is likely more about the combination of foods that is achieving this level of addiction:

food companies certainly understand human behavior, taste preferences and desire. In fact, he offers descriptions of how restaurants and food makers manipulate ingredients to reach the aptly named “bliss point.” Foods that contain too little or too much sugar, fat or salt are either bland or overwhelming. But food scientists work hard to reach the precise point at which we derive the greatest pleasure from fat, sugar and salt. The result is that chain restaurants like Chili’s cook up “hyper-palatable food that requires little chewing and goes down easily

The Snickers bar, for instance, is “extraordinarily well engineered.” As we chew it, the sugar dissolves, the fat melts and the caramel traps the peanuts so the entire combination of flavors is blissfully experienced in the mouth at the same time.

As he points out much of this is not about will power but the daily challenge we face in the over stimulated world of food. Knowing your own triggers (good and bad) is a great place to start. I know my own personal bad trigger is in the evening…I’ve been good all day and want to sit back and unwind and have big urge to head for anything sweet. My strategy is to deflect to an alternative in my case some type of herbal tea. This works well int he winter but is not as easy in the hot summer months when hot tea is less attractive. As with many things this is a journey not a destination. Who knows someone might have a good suggestion for an alternative that suits me – let me know I’ll share any that I receive.

There are no quick fixes and we and our children face this challenge on a daily basis but understanding what is affecting us and developing coping mechanisms can be a great start.
Technorati Tags: Fast Food, Healthy Eating, Tobacco Industry

Aspirin Use in Primary Prevention – Meta Analysis

Aspirin has long been seen as a wonder drug with a low incidence of side effects and some significant positive effects on health. In particular the potential to reduce incidence of heart disease. SO much so tat Bayer and other manufacturer’s offer a low dose version of Aspirin that is targetted to the general public for heart disease prevention. But recent meta analysis of multiple data sets by Dr Colin Baigent from Oxford University suggests that the data does not support the general use of Aspirin in otherwise health individuals and  catch all prevention for heart disease. The material was published in the Lancet (subscription required) and reviewed on Medscape (free membership required) – as Dr Baigent put it:

We have shown for the first time that the very same people at higher risk of heart disease are also at higher bleeding risk with aspirin, which is a very important piece of information and should influence the way in which aspirin is used.

So what to do given the latest evidence. There are many strategies and tools to use and no one size fits all. In fact based on the evidence in the meta analysis:

Medicine has moved on in recent years, and we now know that we can safely reduce risk of heart disease by lowering cholesterol and blood pressure, and the drugs used to lower these risk factors are probably safer than aspirin. A person wanting to lower their risk might well consider taking a statin or an antihypertensive first and only after that add in a less safe drug like aspirin.

The guidelines have not been changed and no doubt the guideline committees will review the latest data to determine if the guidelines need to be changed but int he meantime reviewin individual circumstances, family history and your own tolerance and experience with the various choices will influence decisions.

The major increased risk shown with Aspirin therapy was that of “major bleeds” which increased from 0.07 to 0.10% per year (absolute of 0.03% increase). These increases did not depend on other risk factors, age etc. And there appeared to be no “significant” trend in the positive effects of Aspirin in people at very low, low and moderate risk. There was an accompanying editorial from a clinical group out of Utrecht in the Netherlands that tried to provide some guidance on the relative risk and who should take Aspirin but the data and advice was disputed by Dr Baigent .

So review the choices, understand the risk and make your own choices based on consultation with your doctor and reviewing the updated findings and material

We the Patient Want to be Included in Meaningful Use

There is a great post on THCB “Bringing Patients into the Health IT COnversation About ‘Meanaingful Use‘” by David Kibbe. We are looking at $34 billion of our money being used over the next several years to improve our health

After all, we, the taxpayers, will pay for all this hardware, software, and associated
training. There are many more consumers of health care than doctors or health care professionals. Shouldn’t we have a say in what matters – in what is meaningful – to us?

As is often the case the end user is forgotten. Clinicians often complain they are forgotten in the design and build of EMR’s. The same is true of the HITECH and ARRA investments for patients. Their voice is hard to hear if not completely absent. But as the article clearly points out we are already using technology and find much of what we need online without recourse or even the desire to contact our local healthcare provider. When we do the process is archaic at best and fails miserably to provide the necessary information in a form we can use. In a recent discussion in a medical office I asked the question what clinical system the office used…..they had no idea. So it was not a great surprise when I asked for my records in digital form that they looked at me with blank stares akin to the deer in headlights! I have yet to have a reasonable response to this simple request.
The suggested included elements to cater to patients for meaningful use were:

• Prevention and screening reminders. As appropriate, these should be shared along with a personal health plan and full access to one’s records.
• Patient decision aids for major surgery and procedures. This might include messaging pre-and post-surgery to help avoid waits and delays.
• Patient instructions for acute and chronic conditions. What to do at home; what signs of problems or improvements to look for; when to call if symptoms develop or improvements don’t occur as expected.
• Guided self-management messaging for chronic conditions.  Instructions in self monitoring, lifestyle, medications management, action plans, etc.
• Visit preparation for scheduled visits.  This could include questions to ask the doctor or provider and biometric instructions, e.g. the need to fast before a test.

A great start but still a long way to go since it does not guide the interoperability issues and the need of the patient to have the data in a form they can use (paper or any proprietary format just doesn’t count). You can bet we will start down this track with the usual suspects producing their proprietary system that you have to log in and set up an account for each and every office and facility you visit. None talking tot he other or sharing he information in a way that allows other systems to use. Reminds me of the status with ATM’s when you had to find your bank’s ATM since cards only worked in that ATM. It was also a non connected network (this particular fact worked in favor of an old medical school friend who used this to extract cash from his empty account after midnight when the machine was unable to check his balance and therefore had to allow him access to cash!)

Meanwhile we the consumer must fight tooth and nail with these systems and facilities that are focused on their profits and keeping their patient’s – god forbid they made it easy for a patient to select another doctor or facility by providing information that was portable. Until the incentives and the money lines up behind this it seems unlikely that things  will change dramatically.Meanwhile there is a big lobby of interested parties focused on keeping control and the information (seen as power) out of the hands of the consumer.

Healthcare Historical Solutions

Unfortunately history does not bode well for our ability to solve the current healthcare crisis and while it seems the accepted norm to find blame in all manner of elements and contributors it turns out that we have tried much of this in the past and as this chart shows
Over the last 35 years we have seen all manner of attempts but none have managed to curb costs and expenditure……Health Affairs featured a short piece titled “The Sad History of Health Care Cost Containment” which makes sobering reading. Interesting in the Carter years there was a similar sequence of events with the government flexing its muscles and the health care industry quick to offer

what it called the “Voluntary Effort.” The rate of increase in per capita private-sector health spending fell rapidly but then bounced back within a few years

Sound familiar….? Same old story same old special interests. At some point the we the consumer will have to take control over our own destiny and apply market pressures and economics. Get ready to take control of your own healthcare and become an e-patient as described in this white Paper: e-Patient’s and the focus of the e-patients.net site

Rally in support of those imprisoned for expression

Freedom of Speech – One of Our Great Liberties. I join others who are part of the blog rally for bloggers that are dying – it started here for Roxana Saberi – the NPR reporter incarcerated in Tehran.

The Universal Declaration of Human Rights states, “Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference, and impart information and ideas through any media regardless of frontiers.”

Journalist Roxana Saberi has been incarcerated in Tehran’s Evin Prison, where she is spending her birthday on a hunger strike. Around the world, people continue to face similar violations of their rights to freedom of expression, free speech, and a free press. Let’s show the international community that we won’t be silenced by intimidation and tyranny – that we won’t stop believing in and fighting for these rights.

Freedom of the press is not a luxury. It lies at the heart of making this world healthier and more just. People without a voice and without a clear line of sight into the things that would threaten or corrupt their societies cannot hope for equitable growth and meaningful change.

A group of bloggers is holding a blog rally in support of journalists, bloggers, students, and writers who have dared to express their thoughts freely and have been imprisoned, abused, or killed.

Please consider “wearing” a blue ribbon online this week on your blogs, websites, and facebook / myspace / twitter pages, and invite others to do the same. Get the discussion going, and keep it going!

Benign Paroxysmal Positional Vertigo (BPPV) – or Dizziness

Dizziness that’s entirely treatable condition for 20% of sufferers where the condition is due to Benign Paroxysmal Positional Vertigo (BPPV). In a recent NPR story – Rock Slides Lead to Vertigo it was fascinating to hear that this was

really a success story in medicine. We’ve figured out the cause of this condition — and we’ve figured out how to treat it

It runs out that it is due to loose crystals or rocks (the proper name for these is otoconia) which are small crystals of calcium carbonate that are derived from an inner ear structure called the utricle:

What causes this is the dislodging of these “rocks” which can be caused by head injury, links to migraines and old age degeneration of the vestibular system. Viruses and other infections can also cause the rocks to dislodge.

The good news for suffers is that it is easily treatable with simple physical maneuvers that get the rocks back into place. The Epely maneuver is the main stay of treatment:

And there are others – you can find out more at this site
Simple care to treat dizziness.

Mapping Your Genome

There are increasing numbers of genome mapping services for $399 at 23 and me (this has come down significantly form the original $1,000) and now the new kid on the block is the oddly named Knome (know thyself) that is approaching this opportunity with what they see as a more complete strategy that includes personalized services that is personalized, includes discussion and consultation and makes specific reference to the need for privacy. The privacy is especially important given the potential for insurance denial and rate increases upon the identification of proven (or even ravenously linked) genomic related conditions.

In fact the company is offering the service through eBay (an odd perhaps marketing driven idea) with bidding starting at $68,000 (anything below $99,000 is a bargain as this is the rack rate direct currently)

The NY Times featured a review of this recently in a piece “Mapping the Human Genome via an eBay Auction”.  As they point out the cost of these services will inevitably come down:

Scientists envision that in a few years it will cost only $1,000 to determine the sequence of virtually all 6 billion chemical units of DNA in a person’s 46 chromosomes. Someday, such personal genetic blueprints could be used to predict people’s risk of disease and what drugs might work best for them.

But there is still a question as to the value of this service even at the bargain basement price of $68,000. It is not clear the additional value offered at Knome since the New England journal cited in the NY Times piece states there is still limited knowledge and understanding of genetic traits of disease and how that contributes to the disease process. In fact in a recent presentation that ePatient Dave featured on his blog and I found riveting from the TED group (Ideas worth Spreading) on how Bacteria communicate is just scratching the surface on the complex interactions that we are still trying to understand

So should you take this on, is it worth the money. As is often the case that depends……. If you have a family history that is significant (significant can mean many things but this is not just the occurrence of a clinical condition but an unusual incidence that occurs earlier than expected adjusted for age, sex etc) then this may be worthwhile.

For the average individual this coud be an interesting exercise but is statistically unlikely to reveal  any earth shattering news. Anybody that has used it and wants to comment on the usefulness, the process or other aspects of these services (are there others) please fire away and leave your comments below

Patients and Doctors Need to Reform Too

There is much discussion and commentary on the Healthcare Reform, new clinical systems and the investments being made through the stimulus package. But not so much has been written about Patient reform. The NY Times piece A Hurdle for Health Reform: Patients and Their Doctors focused on the issue of patient and physician behavior and the all to frequent insistence on treatment can be a poor choice. It is a poor choice for economic reasons – why pay for a treatment that has little or no effect. And why start using a drug that has no demonstrable improvement in outcomes vs an older well tried and tested drug. Apart from the fact that we already pay 77% more for comparable drugs – in no small part due to the effective lobbying and marketing drug industry machine. But we also find our treatments based on Physician Pillows (they reflect the most recent impression left on them – often by drug companies) for a newer supposedly better drug but:

when it comes to comparative effectiveness, the track record of the American public and their doctors is not encouraging. Even when such comparisons are available, we tend to ignore them. In 2002, for example, one of the largest government-financed clinical trials ever found that generic pills for high blood pressure worked better than newer drugs that were up to 20 times as expensive. But most hypertension patients still use costlier drugs marketed by pharmaceutical companies

Of and by the way – the side effects for these newer drugs are by the very nature of their recent introduction as yet undiscovered, so the American public is providing a great service to other countries and their patients testing out new drugs on their behalf! If you’d like to read more I can recommend this book by Marcia Angell, a senior lecturer at Harvard Medical School “The Truth About the Drug Companies: How They Deceive Us and What to Do About It“. Shocking insights into the industry that is there to make money. The first recommendation on Amazon is pretty compelling

I should start with a disclaimer. I’m a Vice President within one of the largest drug companies in the world and I have spent close to twenty years marketing drugs. So I guess I’m not supposed to like this book. But the truth is I thought it was fantastic. First, for those of you who are not familiar with the healthcare industry, you should know that Ms. Angell is better capable of writing this masterpiece than any other author. She used to be Editor-in-Chief of The New England Journal of Medicine, which is considered the most prestigious medical journal in the world.

But this volume is much more than simple entertainment. It is quite possibly one of the best analyses of the state of the U.S. drug industry today, complete with footnotes backing up every statement the author makes. You will learn not only that in 2002 the top ten drug companies made a higher profit than the other 490 businesses together on the Fortune 500 list. You will also understand how the drug industry has been able to achieve such a business success and how this success, as is often the case throughout history, will likely be their downfall

Yikes – and this from a Drug Company employee!

So what to do – start with more education, include and understanding of what works and what does not and above all else, don’t take the treatment you receive as gospel. Would you pay for “Synthetic” oil for an oil change that is more expensive without understanding why it is worth spending that extra money – if indeed it is. I hope not. The same should be true for your health and with the availability of information, support groups and tools to analyze healthcare will be a much more inclusive process involving the patient and the whole team in making decisions than it has in the past.

Do you have your own experience of good or bad choices;  if so please share them and let me know what you think f the current state of healthcare today

Vaccination – Essential part of Child Healthcare

It is in the words of Victor Meldrew (don’t know who he he is here’s a link to this famous BBC British Comedy character and the series One Foot in the Grave) “unbelievable” that Time magazine would give ink to the delusional rantings (Autism and Vaccines) of an individual who appears hell bent on a mission to return our countries childhood back to the dark ages of killer measles epidemics and chicken pox for the masses. But wait, she used to be a Playboy model so this obviously provides the essential scientific background to debate the pros and cons of vaccination….or could it be a simple eye candy decision for the photo cover. Whatever it is I agree with Orac in his post “I really wish this were an April Fools Joke” where as he highlights

Jenny thinks it’s acceptable that infectious diseases will return because of her efforts and those of her fellow antivaccinationists

Her unscientific belief that vaccines cause autism – there are numerous studies (here, here and here for example and this Hollywood Mom Amanda Peet and her support of vaccinateyourbaby.org public service campaign ) showing no, repeat NO epidemiological evidence for a causal association of vaccinations and autism. Correlation does not equal causation (simple statistics) and promoting this as science is like the snake oil salesmen in the wild west…. marketing hype). This is someone who can’t even remove expletives from her conversation with a journalist……

If the vaccine companies are not listening to us, it’s their f___ing fault that the diseases are coming back

Right! As Orac says

No matter how many studies exonerate vaccines as a cause of autism, you don’t believe them

And if science disproves your latest hair brained idea you’ll find something else to blame as in the Toxin gambit as we moved off Mercury as a cause. This is no longer about  science or science- and evidence-based medicine this is McCarthgeddon and reminds me a lot of the McCarthy from the 1950’s and his hunt now seen through the clarity of history as a modern day witch hunt….interesting they share the same name.

If you were wondering – get your kids vaccinated….for everything. Follow the science.