Tuesday, January 18, 2011

Fitness Goals: Run. Race. Beat the Boyfriend.

Philip Lee Harvey/Getty Images

When I look at a fresh calendar and start penciling in races, a lot of things factor into what makes the cut. Did I run the race last year? Do I want to tackle a challenging new course? Is it close to home, or somewhere I want to travel to? What’s the fee? Does it have a cool medal or T-shirt?

Throw in one more criterion this year: Will it give me more race miles than my boyfriend? My boyfriend, the one who says, “I’m not a real runner, I just do this to stay in shape,” beat me by 0.03 miles in 2010. There’s no way I’m letting him accumulate more mileage than me in 2011.

When we met last June, he and I were taking time off from our respective amateur sports — soccer for him, running for me. I was recovering from a hip injury, and most of our exercise seemed to consist of lingering at outdoor cafes, lying on the beach or walking to a bar that was more than a block away.

The start of his soccer season in August coincided with the beginning of my half-marathon training. I said I’d watch his games, and he offered to go with me on my first few long runs. I’d planned them for Saturdays, starting at four miles and ending at 10 in October.

Fine, I thought. I was rehabbing an injury and needed to do those long runs at an easy pace. I welcomed having a novice along, someone who only occasionally ran a 5K, to slow me down, at least at the start of training. He swore he would stop when the runs hit six miles.

Six miles became seven, then eight. The loping 10-minute-per-mile pace I envisioned dropped to 9:30, then 9. Despite his claims, up until my last week of training, that he was not running the actual half-marathon, there he was in front of me on race day, crossing the finish line 30 seconds before I did.

And then I did the math. Earlier in the year, before meeting me, he had run a five-miler, on the same weekend I ran an 8K. Eight kilometers equals 4.97 miles. He was 0.03 miles ahead of me.

I told him I was going to hop into a Turkey Trot, a 5K race in a nearby town, on a day I knew he couldn’t run. “No problem,” he said. He switched his schedule to run the race with me. And beat me. Again.

In December, we went on vacation, then shuffled back and forth between our families for the holidays. I considered jumping into a midnight 5K being run a few miles from his house late in the year. “Sorry, babe, I just have to walk the dog. Don’t mind that I’m carrying a gym bag or that I won’t be back for a couple of hours.” I didn’t think he’d buy it.

So how was it possible that he’d beaten me? I was the runner in the relationship. He started running with me to get to know me better, figuring that long stretches on the road would forge some sort of communication path between us.

It did. We talked about everything, even topics that made us uncomfortable, like his brief marriage and my alcoholic ex-boyfriend. Those long runs forced us to talk, and formed the foundation for our relationship.

But those .03 miles still burn, so I’m plotting. He’ll be playing in soccer tournaments in the spring, so I’ve added an April half-marathon. He’s scheming too, making commitments to summer races, which he knows I hate. I registered for the New York City Marathon lottery; he didn’t. If I’m picked, there’s no way he can make up those 26.2 race miles that I’ll be running without him.

But if I do get in to the marathon, it means I’ll be doing many more Saturday long runs — and, because of his soccer commitments, they’ll most likely be on my own. There will be no one I can tease for complaining that it’s too cold. No one to agree that the driver in the big S.U.V. that almost hit me was definitely in the wrong. And no one to talk me through those last painful miles on a bad training run.

Before I met him, I craved the solitude of those long, lonely runs. Now I want his wry companionship next to me for every mile.

Well, almost every mile.

Jen A. Miller is the author of “The Jersey Shore: Atlantic City to Cape May.”

Remedies: Garlic for Athlete's Foot

Tony Cenicola/The New York Times What alternative remedies belong in your home medicine cabinet?

More than a third of American adults use some form of complementary or alternative medicine, according to a government report. Natural remedies have an obvious appeal, but how do you know which ones to choose and whether the claims are backed by science? In this occasional series, Anahad O’Connor, the New York Times “Really?” columnist, explores the claims and the science behind alternative remedies that you may want to consider for your family medicine cabinet.

The Remedy: Garlic.

The Claim: It can treat athlete’s foot.

The Science: You don’t have to be much of an athlete to contract athlete’s foot. All it takes is a step on a moist floor or a moment in a gym locker room to end up with the pesky and widespread fungus, which causes flaking and tiny cracks between the toes that sting as much as paper cuts.

Treating tinea pedis, as it is known scientifically, can be just as irritating. Those who have it often experiment with all sorts of creams, sprays, gels and prescription drugs that have varying success rates. And the condition has a notorious habit of returning, in part because the fungus often lingers even after symptoms subside, causing many people to end their treatments before the fungus has been completely extinguished.

But one alternative remedy that a small number of studies support is garlic, widely used throughout history for its antimicrobial properties. In particular, studies have looked at a compound in garlic known as “ajoene,” which gets its name from “ajo,” the word for garlic in Spanish. The compound seems to be especially effective against the fungus that causes athlete’s foot.

“Garlic has long been considered a powerful natural antifungal,” said Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at Hackensack University Medical Center in New Jersey and a pediatrician at the Whole Child Center in nearby Oradell. Dr. Rosen pointed out that studies have found garlic effective against a number of fungal infections, including those caused by Candida and other common pathogens.

Tinea pedis seems to be just as vulnerable. In 2000, one team of researchers published a study in The Journal of the American Academy of Dermatology that compared a week of twice-daily applications of mild garlic solutions with topical applications of the popular drug Lamisil in about 50 people with diagnoses of athlete’s foot. Two months later, the scientists found that a garlic solution that contained about 1 percent ajoene had a 100 percent cure rate, compared with a 94 percent cure rate for 1 percent Lamisil. Other studies have found similar results.

Ajoene creams and solutions are not available commercially. But some experts recommend simply adding a few finely crushed cloves of garlic to a foot bath and soaking the affected foot for 30 minutes, or mincing a few garlic cloves, mixing the minced garlic with olive oil, and then using a cotton ball to rub some of the solution on the affected area.

The Risks: According to the American Academy of Family Physicians, side effects of garlic are generally mild and uncommon. But some people can develop allergic rashes or blisters with topical use.

Quinoa: The New Superfood?

Quinoa is healthy and delicious. Up until now, I’ve only enjoyed it as a side dish at fancy restaurants, usually paired with duck, lamb, or veal.

But it turns out that quinoa may actually be the next “superfood.” It may also be quite effective for losing weight (more details below).

But first, here’s a quick video on how to prepare quinoa at home:

Now, if you’re looking to lose weight, and you’ve struggled with other diets, then quinoa may be especially appealing to you.

First of all, it’s 100% gluten-free. If you are allergic to wheat or if you’ve been diagnosed gluten-intolerant, then quinoa is an ideal substitute.

Secondly, this South American grain is high in protein, essential amino acids, and iron. In fact, it contains 14 grams of protein for every 100-gram serving.

And thirdly, quinoa has been used to control weight loss since pre-Columbian days. The Incas even considered it to be a “sacred grain.”

In fact, it was recently called “one of the world’s superfoods” by the United Nations. Unlike its extremely popular friend from Brazil, the Acai berry, quinoa has no sugar and still tastes great, which makes it perfect for diabetics (or anybody else who’s trying to cut back on sugar).

Want to learn more? Then check out the Quinoa Super Diet.

It’s the first diet of its kind that utilizes this amazing grain to supercharge your diet, help you hit your weight loss goals, and possibly even give you the slim body you’ve been dreaming of.

The Quinoa Super diet is packed with health facts, dietary tips, and tasty recipes that are easy to understand, easy to make, and easy to add into your daily life. More importantly, it could be the “missing link” you’ve been looking for to help you lose weight.

Click here to learn more about The Quinoa Super Diet


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Monday, January 17, 2011

How to Haggle With Your Doctor

Dr. Jeffrey Kullgren, an internist and clinical scholar at the University of Pennsylvania.Laura Pedrick for The New York Times Dr. Jeffrey Kullgren, an internist and clinical scholar at the University of Pennsylvania.

In this week’s Patient Money column, Walecia Konrad asks Dr. Jeffrey Kullgren, an internist at the University of Pennsylvania who researches consumer-driven health care, for advice on how to negotiate with a doctor or other medical provider. “Your physician may be just as uncomfortable with these conversations as you are,” he said. “That’s because — and I can tell you firsthand — doctors are simply not trained for this. I was trained to give the very best care for my patients, regardless of cost.”

Among Dr. Kullgren’s tips:

I would advise not waiting until the last minute to bring up finances. It helps to bring it up early in the visit so you have enough time to talk about it.

Billing people work on getting those services paid for….They are not the ones who can offer alternative treatments that may cost less — say, generic medicines instead of brand-name, for example. Only your doctor can do that, which is why he or she needs to know your situation.

Ask your doctor how he or she feels about the specific test you are about to undergo and if shopping around for a lab with the lowest price is an option.

To learn more, read the full article, “A Talk With the Doctor May Help Trim Fees,” then please share your thoughts in the Comments section below.

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Is a Medical Resident a Student or Employee? Supreme Court Has an Answer.

What, exactly, is a medical resident?

That question isn’t intended to provoke existential angst; it was the center of a Supreme Court decision handed down today. The case pitted the IRS, which said residents were employees and thus subject to Social Security taxes, against the Mayo Clinic, which said they were students and therefore not subject to the tax.

As the WSJ reports, today the Supreme Court ruled unanimously in favor of the government. Here’s the earlier WSJ story on the oral arguments in the case, which were heard in November. Mayo’s lawyer argued that the IRS rule was arbitrary, and said residents are primarily in their positions to learn.

An opinion by Chief Justice John Roberts, however, said that the IRS “did not act irrationally” in concluding residents were subject to Social Security taxes. The IRS rule went into effect in April 2005, and last year the agency said residents were entitled to refunds on taxes paid before then.

Here’s info on the case from Scotusblog.

The decision means both residents and teaching hospitals will have to split the tax, which is 12.4% of wages. Taxes will bring in about $700 million in revenue annually, the WSJ says. In a statement, Mayo says it is “disappointed” by the decision but that its own medical residents won’t see any changes, since they’ve been paying Social Security taxes as the case has progressed through the courts.

Update: Updates with comment from Mayo Clinic.

Image: iStockphoto

Don’t be fooled by the towel-folding robot video

Robots in motion are a mesmerising sight, even if they are doing a chore that would be very boring if carried out by a human. So it’s not surprising that one of the week’s most viewed videos on YouTube shows a Californian robot picking up towels from a pile of laundry and neatly folding them.

Views shouldn’t be fooled, though, into thinking that robotic deliverance from domestic chores is at hand.

For a start, the robot (made by a company called Willow Garage and programmed at the University of California, Berkeley) is very slow. The YouTube video is speeded up 50-fold, so what the machine appears to be doing in 30 seconds actually took 25 minutes.

Not only is the robotic housemaid maddeningly slow, it is also far from versatile. Can it iron? Sort very similar black socks into pairs from a pile of laundry? Stuff a duvet into its cover? No.

If you want the full academic paper, it’s here, with the splendid title: “Cloth Grasp Point Detection based on Multiple-View Geometric Cues with Application to Robotic Towel Folding”.

Robot researchers are always optimistic, and Berkeley team have been talking about producing useful household robots within five years. Don’t believe it.

The Doctor and the Kidney Stone

Getty Images

Must doctors follow their own advice?

The issue often comes up when the obese doctor or the doctor who smokes advises a patient to lose weight or stop smoking. But I recently got to ponder the issue more personally when the severe pain of a kidney stone hit. Despite the extreme discomfort, I continued to work. But would I advise my patients to do the same?

The pain of kidney stones is distinctive because it is excruciating yet intermittent. A mixture of salts and minerals, stones form in the kidneys of susceptible individuals and often stay put, causing no symptoms. But they can cause severe pain — as severe as that associated with childbirth — when the body decides to send them out of the kidney and into the long, thin ureters that connect with the bladder.

As is often the case, the first sign I had a stone was blood in my urine. Within hours, though, I was having “10 out of 10” pain in my left flank area. I went to an emergency room, where doctors gave me intravenous fluids and increasing doses of pain medications. A CT scan revealed, as I suspected, a stone stuck in the middle of the left ureter.

It was very small, only three millimeters in diameter. This was good news. The stone would most likely pass by itself, and I would not need extracorporeal shock wave lithotripsy, a technology that uses high-energy sound waves to break up larger stones, say five to 10 millimeters in diameter, that won’t move.

But there is a downside to waiting. Even when patients drink lots of fluids, smaller stones may not pass for quite a while. In the meantime, periodic bouts of severe pain are likely to return.

This is exactly what happened to me over the next four days. Out of the blue, my flank would begin to hurt again. Although I immediately took pain pills, they took a while to start working. In the meantime, I would be moaning in agony, writhing on the floor, trying desperately to find a comfortable position.

My family was perplexed and, it should be said, a little irritated at my decision to stay the course. “Why don’t you just get it taken care of?” my wife asked.

I had my reasons. Being a physician, I always first think, “Do no harm.” I knew that as long as I did not develop a complication from the stone — most likely an infection above the obstruction — I was in no great danger. And while lithotripsy is well established and largely safe, it nevertheless has side effects, most notably bleeding, infection or, should the stone shards that are left come to obstruct the ureter, more pain. Nevertheless, I consulted with a family friend and urologist, who was willing to do the lithotripsy – just in case.

I also continued to work. Between bouts of pain, I felt totally fine and very productive. Fortunately, the pain hit only once when I was seeing a patient, and it was toward the end of the session. And on two other occasions I was able to close the door to my administrative office until the pain subsided.

I experienced my last bout of pain six days after the episode began. It was mild and in my groin, suggesting that the stone was moving down the ureter into the bladder. When I saw what looked like grains of sand in my urine, most likely the remnants of a stone that had broken up by itself, I knew the episode was over.

So was it crazy for me to go about my work and pretend to lead a normal life, when I could have gotten rid of the stone much sooner? I don’t think so. After all, 80 percent to 90 percent of kidney stones pass by themselves. In the end, I judged that avoiding lithotripsy was a huge success.

But I’m not so sure I would realistically recommend to my own patients that they wait it out and continue to work. Pain medications can dull one’s ability to think, and though I never saw patients after taking them, not everyone has a job in which it is possible to take pills, shut the door and even take a quick nap. The pain, along with the medications, can also make it dangerous to drive to and from work.

I would advise my patients with kidney stones to find a good urologist, one who is skilled at lithotripsy and surgery, but not too eager to use them. And I continue to keep myself well hydrated in the hope of avoiding a recurrence. But should another stone develop, I may again end up being another doctor telling his patients to do what he says — but not what he does.

Barron H. Lerner, M.D., a physician and historian at Columbia University Medical Center, is the author, most recently, of “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.”

For more information, see The Times Health Guide: Kidney Stones.

Sunday, January 16, 2011

Putting Profits Before Patients

Wendell PotterEmily Potter Wendell Potter

The inherent conflict of interest in a health care system anchored by for-profit insurers lurks unspoken behind nearly every debate over reform. Few politicians dare to openly address the issue; but over the last year and a half, one unlikely individual has consistently reminded us of this moral dilemma: Wendell Potter.

In articles, interviews and testimony before Congress, Mr. Potter has described the dark underbelly of the health care insurance industry — broken promises of care, canceled coverage of those who fall ill and behind-the-scenes campaigns designed to discredit individuals and snuff out any attempts at reform that might adversely affect profits. And he has the street cred to do so. For 20 years, he was the head of corporate communications at two major insurers, first at Humana and then at Cigna.

Now Mr. Potter has written a fascinating new book, “Deadly Spin” (Bloomsbury, 2010). As I write in today’s Doctor and Patient column, the book details the methods he and his colleagues used to manipulate public opinion and describes his transformation from the idealistic son of working class parents in eastern Tennessee to top insurance company executive, to vocal critic and industry watchdog.

To learn more about “Deadly Spin,” Wendell Potter and the 17-year-old patient whose death affected Mr. Potter so profoundly he left corporate public relations for good, read the full column, “When Insurers Put Profits Between Doctors and Patients,” then please join the discussion below.

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JP Morgan Healthcare: Google’s Schmidt on Open Source and Health IT

Current health-care information technology systems don’t work well with one another. And that’s a big obstacle to the creation of a truly universal electronic-medical record system, which proponents say could theoretically lead to more efficient care and allow for data mining to see trends, measure outcomes and show the comparative effectiveness of different treatments.

One solution to the problem may be to take the electronic-medical record architecture out of the hands of the corporate world, suggested Google CEO Eric Schmidt at the JP Morgan Healthcare Conference last night.

“If I were not doing what I’m doing and I wanted to do something in health care … I would go to all of the research universities and would try to figure out where the best, interesting IT software is that can be open-sourced,” he said at a health-IT panel discussion. “My guess is that a platform like that would be remarkably different from the platforms that we are using today,” he said.

Schmidt said that using such an open-source strategy — giving programmers the freedom to modify and distribute software — is a proven way to fix disparate software architectures. It’s the same development strategy that brought about the modern internet and “all the other technologies that you use every day.” Such an endeavor wouldn’t be designed to be profitable, he said, but there would be money made from the companies that eventually support or work with the basic system.

Part of the problem in designing and discussing a new standard is that the current focus is on the companies involved rather than the patients.

“The ideal scenario would be to have a patient-centered outcome here where the patient was so excited about something that they would then drive that behavior into the rest of the system,” Schmidt said. “A simple rule about my business is if enough consumers do something, the industry will figure out a way to do it.”

In other words, he said: “Figure out a way to get the consumers to love the product.”

Photo: European Pressphoto Agency

JP Morgan Healthcare: Lilly and Boehringer Team Up on Diabetes

It may not be coincidence that Lilly announced a diabetes-therapy development partnership with Boehringer Ingleheim on the same day it’s scheduled to present at the pharma industry’s premier deal-making conference.

The companies will jointly share the development and marketing costs of at least four diabetes treatments currently in mid- or late-stage trials. Under the terms of the agreement, Lilly agreed to pay 300 million euros (about $388 million) up front and to pay Boehringer another 625 million euros if the German company’s two oral diabetes medications meet certain regulatory milestones.

Meantime, Lilly could receive up to $650 million from Boehringer if Lilly’s experimental insulin products meet their own regulatory milestones. Boehringer can also opt to co-develop and co-market a fifth Lilly compound, in which case it would pay Lilly another $525 million if the treatment meets certain benchmarks.

Diabetes is a key focus at Lilly, the maker of the Byetta treatment. About 17 percent of company revenue comes from diabetes, according to Bernstein analyst Tim Anderson.

But the company’s longstanding primacy in the space is under threat. New drugs, particularly Novo Nordisk’s Victoza, are gaining ground. Lilly and development partners Amylin Pharmaceuticals and Alkermes suffered a surprising setback last year, when the FDA delayed a decision on Bydureon, the companies’ answer to Victoza.

That delay left Lilly, with one of the industry’s steepest patent cliffs, even more dependent on deals like today’s to fill its product portfolio until — and if — its pipeline pays off.

In an interview yesterday at the JP Morgan Healthcare conference in San Francisco, Lilly CEO John Lechleiter told the Health Blog this so-called in-licensing is “just becoming more and more” important. It gives Lilly access to promising science outside its own labs, he said, and also makes sense for “lots of good business reasons.”

“I increasingly believe the distinction between what happens in our lab and what happens in someone else’s lab” is dissolving, he said. In other words: let’s make a deal.

Photo: Bloomberg News

A.M. Vitals: Abortion Rate Edged Up 1% in 2008

Abortion Rate Up: The U.S. abortion rate, which has been dropping over the last decade or so, edged up 1% in 2008, to 19.6 abortions per 1,000 women of child-bearing age from 19.4 in 2005, the WSJ reports. A researcher at the Guttmacher Institute, which produced the report, says factors including the recession and an end to falling teenage pregnancy rates likely contributed to the increase.

Achoo!: Remember those reports that some Zicam anti-cold products blunted the sense of smell in some users? The Supreme Court weighed their significance yesterday in a case about what constitutes material information that must be disclosed by a company, the New York Times reports. Zicam’s manufacturer, Matrixx Initiatives, claims it had no duty to inform investors about a statistically insignificant number of reports of the problem, but justices seemed skeptical of that argument, the NYT says.

Enzyme Effectiveness: In briefing documents ahead of an FDA advisory panel meeting tomorrow, agency staffers ask whether liprotamase — acquired by Lilly through its purchase of Alnara Pharmaceuticals — is as effective as other pancreatic enzyme replacement products, the WSJ reports. Alnara says liprotamase, which unlike competing products doesn’t include enzymes derived from pigs, is “a safe, reliable and consistent source of enzyme replacement therapy.”

Exchange Rules: The independent Institute of Medicine will this week discuss the specifics of what benefits must be covered by insurers participating in the insurance exchanges that were created by the health-care overhaul law, Kaiser Health News reports. Their recommendations will be considered by HHS as it draws up the requirements for policies sold on the exchanges, which go into effect in 2014.

Image: iStockphoto

Saturday, January 15, 2011

The Benefits of Fever

Katherine Streeter

A child sick with fever is cause for concern for any parent. Confusion about what constitutes a “dangerous” body temperature and the proper dosing of fever medicines only adds to the anxiety. But as Dr. Perri Klass, a pediatrician, writes in this week’s “18 and Under” column:

Fever can indeed be scary, and any fever in an infant younger than 3 months is cause for major concern because of the risk of serious bacterial infections. But in general, in older children who do not look very distressed, fever is positive evidence of an active immune system, revved up and helping an array of immunological processes work more effectively.

To learn more about the role of fever in illness, and when to worry — or when not to — read the column, “Lifting a Veil of Fear to See a Few Benefits of Fever.” Then please join the discussion below.

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Pasta and Seafood, Inspired by Italy

Andrew Scrivani for The New York Times

“Mediterranean cooks have a knack for making meals from small amounts of animal protein,” writes Martha Rose Shulman in this week’s Recipes for Health. “Italians often accomplish this by combining pasta and seafood.”

Ms. Shulman offers five simple dishes that combine fish or shellfish, rich in omega-3s, with pasta and vegetables for a light and easy one-dish meal.

Linguine With Red Clam Sauce: A classic dish that has been popular in Italian-American restaurants for decades, made over with a light hand.

Pasta With Beet Greens and Tuna: An adaptation of a wonderful recipe for orecchiette with beet greens, tuna and olives from the cookbook author Clifford A. Wright’s impressive Web site.

Penne With Arugula and Clams: In Apulia, in southeastern Italy, arugula is cooked like a green as well as eaten raw in salads.

Penne With Swordfish or Tuna and Tomato Sauce: The sauce here is a sort of fish ragù common throughout Sicily and Southern Italy.

Spaghetti With Mussels and Peas: When you think you have no vegetables in the house for dinner, remember those peas buried deep in your freezer.

If you want to know more about screening….

this set of modules is rather good: and Angela Raffle, the public health consultant narrating, has a lovely voice. Quite impressive that it was sponsored by the NHS – if only the same common sense would filter into the actual screening programmes. And here’s another thing of interest to people who are sceptical about screening – a paper co-authored by UK surgeon Mike Baum on the possible hazards of surgery for breast abnormalities. This paper is interesting for a number of reasons. It explores a potential harm that may not have been known, or thought about, when screening programmes were being set up for breast cancer. What makes a good scientist I think has something to do with careful observation, and then challenging oneself and others when the results are unexpected or unexplained.

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Friday, January 14, 2011

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Drinking Fluids to Conquer a Cold

Christoph Niemann

One common piece of advice for treating a cold is to drink plenty of fluids. But as Anahad O’Connor writes in this week’s “Really?” column, it isn’t clear whether drowning a cold in water or juice really helps.

Theoretically, taking in extra beverages like water and juice helps replace fluids lost from fever and respiratory tract evaporation, and it helps loosen mucus. But when a team of scientists at the University of Queensland in Australia set out to determine whether this was indeed the case, they found a surprising dearth of data in the medical literature.

For their report, published in the journal BMJ in 2004, “we examined references of relevant papers and contacted experts in the subject,” they wrote, yet were unable to find even a single clinical trial in the last four decades that specifically studied whether increased fluid intake reduced the severity of an infection.

To learn more, read the full column, “The Claim: Drink Plenty of Fluids to Beat a Cold.” Then please join the discussion below. What helps most when you have a cold?

Patients on the internet

I do love the internet: at home and also at work, where I can find things faster, often, than searching through a textbook (filing not being my strong point.)

The pros and cons of using the internet for diagnosis have been noted and an interesting recent perspective in the New England Journal of Medicine  – Untangling the Web – Patients, Doctors, and the Internet – makes the point well. Information has to be good.

But what about getting a bit more personal? I’ve discussed before my unease about the (lack of) evidence and harms of “doctor rating” websites – I don’t think that being able to search online for a doctor is all the UK government cracks it up to be. But what about doctors searching online for information about patients? The thought had never occurred to me. But an article in the  Harvard Review of Psychiatry: Patient-Targeted Googling: The Ethics of Searching Online for Patient Information  suggests that it is commonplace in the US, and comments that it might be a bit intrusive to google for information about patients.

I can’t think of a better word to describe it than “creepy”. Sure, the information on Facebook or whatever is in the public domain – but who is to say whether it is accurate. The authors say that consent should be obtained from patients to allow doctors to search…but should they really search in the fist place? Surely not.

Is There Really a Link Between Violence and Mental Illness?

If Jared Lee Loughner is mentally ill — as some say videos he posted online suggest — did his condition play a role in his decision to shoot Rep. Gabrielle Giffords and others?

Psychiatric exerts tell the Health Blog that the behaviors that Loughner exhibited on his YouTube videos are consistent with that of a person with a severe mental illness like schizophrenia, but caution that a thorough and direct examination would be necessary to diagnose him with that or any condition.

In general, people with schizophrenia often have trouble organizing their thoughts, hold beliefs that are out of touch with reality, such as that they have great powers or that someone is out to get them, and may see or hear things that aren?t real.

Though schizophrenia is often thought to be linked with violent behavior, the vast majority — more than 90% — of people with severe mental illness won?t become violent, says Jeffrey Swanson, a professor at Duke University who has conducted studies on schizophrenia and violence.

In fact, the question of whether people with the illness are actually any more likely to be violent than those without it is a controversial one.

One national study conducted by Swanson and his colleagues showed that people with schizophrenia are relatively more likely to commit a violent act compared to people without a mental illness, though the percentages for both were low: 2.3% of people without a mental illness in the sample had committed a violent act in the last year vs. 7% of those with schizophrenia.

But another, more recent study showed that people with schizophrenia are no more likely to commit violence than those without mental illness. That research did find an increased risk of violence among those with schizophrenia who are also using drugs or alcohol.

Complicating things is that even if someone with schizophrenia commits a violent act, the illness isn’t necessary the reason for the behavior, say experts. With regard to Loughner, “my concern is that people immediately leap to the explanation that [the mental illness is] the master answer to why he committed this crime,” says Swanson. “It?s much more complicated than that.”

Other variables, such as being young, male or a drug user are much better predictors of violence than mental illness, says Eric Elbogen, a forensic psychologist at the University of North Carolina, Chapel Hill.

Image: iStockphoto

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Thursday, January 13, 2011

Message about the FT health and science blog

This blog will be closing at the end of this week but will remain accessible as an archive.

Margaret McCartney will continue blogging from:

http://www.margaretmccartney.com/blog/

You will also now be able to add comments to her weekly columns at:

http://www.ft.com/comment/columnists/margaretmccartney

You can also follow the FT’s science coverage at:

http://www.ft.com/businesslife/science

Thank you for reading and contributing to the discussion on the blog

Reprieve for Royal Institution’s board

In the end it wasn’t even close. At a special general meeting last night, members of the Royal Institution voted 512 to 121 against a move to oust the board and bring in a new group of trustees.

The sad saga of the RI has fascinated scientific London since December when its charismatic director, Susan Greenfield, was made redundant in the midst of a financial crisis at the 211-year-old institution.

A high-powered group of dissident RI members – including Julian Hunt, former head of the Met Office, and Lisa Jardine, historian of science and chair of the Human Fertilisation and Embryology Authority -  triggered the SGM. They felt that the 12-member board of trustees had unfairly made Greenfield the scapegoat for a crisis that was their collective responsibility.

But at last night’s meeting – attended by around 650 of the RI’s 2,400 members, who spilled out of the historic Faraday lecture theatre into libraries and galleries – the dissidents were strangely inarticulate.

They failed to make a convincing case to support a move that would have been unprecedented at a British charity: to sack all the trustees simultaneously. Members who spoke from the floor made clear that they were not prepared for such a revolution, whatever the rights and wrongs of the case.

Nor did the dissidents make clear whether their primary motivation was to improve the RI’s governance or to reinstate Greenfield, who is suing the institution for sex discrimination and unfair dismissal.

Another important factor was the evidently strong feeling of RI staff that the present board should remain in place and Greenfield should not return.

After this vote of confidence by the membership, there are two priorities for the board and management.

Firstly, with losses running at £100,000 a month, the RI urgently needs new funds. Adrian de Ferranti, the chairman, said four donors had offered £8.75m in interest-free loans that might be convertible into gifts.

Secondly, the RI must recruit a top scientist (who is also a good communicator) to a leadership position. The current trustees and staff include no well-known scientists – which is clearly unacceptable in an institution that aims to be a world-class promoter of science.

Phys Ed: Does Exercising Make You Drink More Alcohol?

Steve Bronstein/Getty Images

Can regular exercise avert or undo some of the harm associated with binge drinking? Perhaps even better, could exercising beforehand pre-emptively reduce your urge to overindulge in alcohol later? Or does exercising actually drive you to drink? Those questions, relevant to any of us whose memories of New Year’s Eve are fuzzy, have been the subject of a growing number of studies recently, with thought-provoking results.

Phys Ed

One of the more telling new studies examined the issue of whether being fit and exercising reduces the urge to drink. For the experiment, researchers used adult male rats with an inbred taste for alcohol. Half of the rats were given access to running wheels for three weeks. The others were kept in cages without wheels. After three weeks, the running wheels were removed, and half of the animals from each group were allowed unlimited access to alcohol for 21 days. Earlier studies by other researchers found that animals given equal access to exercise and alcohol — they were allowed to sip booze while on a running wheel — chose to drink less than animals not exercising. Based on those results, “we had anticipated that exercise would reduce” the rats’ drive to drink, said J. Leigh Leasure, an associate professor in the department of psychology at the University of Houston and senior author of the study, which was presented in November at the 2010 annual meeting of the Society for Neuroscience in San Diego. Instead, the exercising animals turned to alcohol with significantly more enthusiasm than the sedentary rats, mainly during the first week of the experiment. “It was a bit of surprise,” Dr. Leasure said.

But the findings are right in line with those from a recent, large-scale national survey of human subjects published in The American Journal of Health Promotion. Bluntly titled, “Do Alcohol Consumers Exercise More?” it answers its own query with a resounding if counterintuitive yes. In fact, the data show, the more people drink, the more they exercise. The study, based on replies from an annual telephone survey of hundreds of thousands of American adults about their health habits, found that “drinking is associated with a 10.1 percentage point increase in the probability of exercising vigorously,” the authors write. More specifically, “heavy drinkers exercise about 10 more minutes per week than current moderate drinkers and about 20 more minutes per week than current abstainers.” Meanwhile, the authors continue, “an extra episode of binge drinking increases the number of minutes of total and vigorous physical activity per week for both women and men.”

Why would drinking increase exercise time? The authors don’t have a definitive answer. The survey results do not “follow expected patterns,” they admit, in which people who indulge in one unhealthy habit tend to indulge in others and vice versa. Smokers, for instance, statistically are less likely than average to exercise regularly and eat well. But this is not the case when it comes to drinking and exercise.  Maybe, the authors speculate, some of the drinkers are drawn to a “sensation-taking lifestyle” that includes adventurous, extreme styles of exercise. Alternatively, imbibers could be “socializing and drinking after participating in organized group sports.” Or they might be trying “to compensate for the extra calories gained through drinking or to counterbalance the negative health effects of drinking.”

Dr. Leasure suspects that alterations in the brain circuitry of drinkers and exercisers may also play a role. Drinking and exercising both preferentially alter activity in “the mesocorticolimbic neural circuitry,” she said, a portion of the brain associated with reward. Brain activity patterns there suggest that, for rats and presumably for people, exercise and drinking are rewarding activities; we enjoy doing them (although, in the case of exercise, it may be that we “enjoy having done it,” Dr. Leasure said, since the exercise itself sometimes feels like drudgery). When the exercising rats were deprived of their running wheels and the accompanying rewards, they may have sought a replacement in booze, which lights up the same brain centers.

Finally, it may be that exercising allows you to become a little less stupid as a result of binge drinking. Binge drinking does, as you may have heard, kill brain cells. Repeated animal studies have shown that even one episode of serious binge drinking leads to a slaughter of brain cells, particularly in the dentate gyrus, a portion of the brain associated with memory and emotion. But a study by Dr. Leasure and her colleagues published last year showed that when rats exercised for two weeks before being allowed to binge drink, they lost fewer cells due to cell death in their dentate gyrus. They also, however, had less growth of new brain cells than might have been expected; exercise should provoke a wild burst of neurogenesis in the dentate gyrus, and that response seems to have been blunted by the alcohol binging. So the drinking exercisers did not benefit as much from their exercising as if they hadn’t indulged, but they didn’t lose as many brain cells, in aggregate, as they otherwise would have. To some degree, the exercising had offered “neuroprotection.”

Which does not mean that you should heedlessly indulge. All of the binging rats experienced cell death in portions of their brains outside the dentate gyrus, and most of those were not reduced by exercise. It’s also not clear yet how the reward issues involved in drinking and exercise intermingle. Would rats with ongoing access to running wheels in their cages choose to drink more or less outside those cages than sedentary rats when they’re given the chance? “We’d like to find out,” Dr. Leasure said.

For now, it might be encouraging to know that if you did overimbibe during the holidays, the decision-making portions of your brain should still be functioning adequately enough to tell you to get out and, as you know you should, exercise.

Nutrition Advice From the China Study

books

Six years ago a small Texas publisher released an obscure book written by a father-son research team. The work, based on a series of studies conducted in rural China and Taiwan, challenged the conventional wisdom about health and nutrition by espousing the benefits of a plant-based diet.

T. Colin Campbell T. Colin Campbell, Ph.D.

To everyone’s surprise, the book, called “The China Study,” has since sold 500,000 copies, making it one of the country’s best-selling nutrition titles. The book focuses on the knowledge gained from the China Study, a 20-year partnership of Cornell University, Oxford University and the Chinese Academy of Preventive Medicine that showed high consumption of animal-based foods is associated with more chronic disease, while those who ate primarily a plant-based diet were the healthiest.

Last fall, former President Bill Clinton even cited the book in explaining how he lost 24 pounds by converting to a plant-based diet in hopes of improving his heart health. The president gave up dairy, switching to almond milk, and says he lives primarily on beans and other legumes, vegetables and fruit, although he will, on rare occasions, eat fish.

Recently, I spoke with T. Colin Campbell, a co-author of the book and professor emeritus at Cornell University, about the success of the book, the research behind it, and why he thinks the nation’s health woes can be solved by plant-based eating. Here’s our conversation.

How did you end up writing this book?

I have been in the field for a long time and had a major research program at Cornell. We published a lot of research over the years. My program had a good reputation. I’d finally gotten to a point where we’d discovered a lot of things that were very exciting, things that were provocative. Finally I sat down to write the book, to tell my story.

What was so unusual about your story?

In the beginning of my career I was teaching nutrition in a very classical sense. Nutrient by nutrient. That’s the way we did research, that’s the way I taught it. I came to believe, after doing the work we did in the Philippines and China, that there was a very different world of understanding nutrition. I ended up with a view now that is almost diametrically opposed to what I had when I started my career.

How have your views changed?

I was raised on a dairy farm. I milked cows. I went away to graduate school at Cornell University, and I thought the good old American diet is the best there is. The more dairy, meat and eggs we consumed, the better. The early part of my career was focused on protein, protein, protein. It was supposed to solve the world’s ills. But when we started doing our research, we found that when we start consuming protein in excess of the amount we need, it elevates blood cholesterol and atherosclerosis and creates other problems.

The problem is that we study one nutrient out of context. That’s the way we did research — one vitamin at a time, one mineral, one fat. It was always in a reductionist, narrowly focused way. But I learned that protein is not quite what we thought it was. We’ve distorted our diet seriously through the ages, and we have all the problems we have because of that distortion.

What loomed large for me was that we shouldn’t be thinking in a linear way that A causes B. We should be thinking about how things work together. It’s a very complex biological system. The body is always trying to restore health every microsecond of our lives. How do we furnish the resources for the body to use? In order to try to understand that, we shouldn’t be giving ourselves individual nutrient supplements. We shouldn’t be trying to discover which gene causes what. But those two areas have become the major focus of research over the years.

So how should we be eating?

I don’t use the word “vegan” or “vegetarian.” I don’t like those words. People who chose to eat that way chose to because of ideological reasons. I don’t want to denigrate their reasons for doing so, but I want people to talk about plant-based nutrition and to think about these ideas in a very empirical scientific sense, and not with an ideological bent to it.

The idea is that we should be consuming whole foods. We should not be relying on the idea that genes are determinants of our health. We should not be relying on the idea that nutrient supplementation is the way to get nutrition, because it’s not. I’m talking about whole, plant-based foods. The effect it produces is broad for treatment and prevention of a wide variety of ailments, from cancer to heart disease to diabetes.

Do you advocate a 100 percent plant-based diet?

We eat that way, meaning my family, our five grown children and five grandchildren. We all eat this way now. I say the closer we get to a plant-based diet the healthier we are going to be.

It’s not because we have data to show that 100 percent plant-based eating is better than 95 percent. But if someone has been diagnosed with cancer or heart disease, it’s smart to go ahead and do the whole thing. If I start saying you can have a little of this, a little of that, it allows them to deviate off course. Our taste preferences change. We tend to choose the foods we become accustomed to, and in part because we become addicted to them, dietary fat in particular.

If we go to a plant-based diet, at first it might be difficult, but it turns out after a month or two our taste preferences change and we discover new tastes and feel a lot better, and we don’t want to go back. It’s not a religion with me, it’s just that the closer we get to a 100 percent plant-based diet, the better off we’re going to be.

Have you been surprised by the success of your book?

I have been a little surprised. When I finished writing the book with my son, who had just finished medical school, I didn’t know how well it was going to do. We had an agent who shopped the manuscript around, and the publishers all wanted 60 to 70 percent of the pages to be recipes. I said, “That’s not my shtick.” They wanted me to dumb it down.

I went to a small publisher in Texas who let us do what we wanted to do. I didn’t want to proselytize and preach. I didn’t want to write a book that says, “This is the way it has to be.” It’s a chronology. Here’s how I learned it, and let the reader decide. I say, “If you don’t believe me, just try it.” They do, and they get results. And then they tell everybody else.

Chlamydia screening: messier and murkier

Over the past couple of decades, chlamydia screening has been discussed, started, changed, discussed, evaluated, disagreed with, and discussed again.

One thing I think has been missing is large scale Randomised Controlled Trials performed early on, and used to make cost-effective decisions.

Instead decisions have been made on trials that have now been decided as flawed, and last year the National Audit Office - Chlamydia testing ‘wasting money’ – concluded that millions have been wasted.

And this week the BMJ reports that screening for chlamydia with a single test doesn’t prevent pelvic inflammatory disease.  – Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial

Obtaining more information will be nearly impossible – now that screening kits in GP surgeries are endemic, any more “pure” trials – where people are either screened as part of a study, or aren’t screened as part of a study, are going to be much harder to do.

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Wednesday, January 12, 2011

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Throw out your broccoli, chuck out your tomatoes…

Shall we? The vegetable tide is turning. For those of us forcing vegetables into our children in the belief that they are essential to health, the news, from the Journal of the National Cancer Institute: Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition reporting a very large study, is that vegetables don’t cut the risk of cancer in the way some analyses had found: Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence

All those UK Department of Health ’5 a day’ campaigns, and attempts to wean us off chocolate bars and onto bananas may have wasted their efforts.

The NCI study examined almost half a million Europeans for over 7 years. The found a small protective effect  against cancer from a high fruit and vegetable intake – but of about a four per cent reduction. The rates of cancer were 7.1 per 1000 for women and 7.9 per 1000 for men. So the reduction overall is not large.

This is a monster of a study, in relative terms – many smaller retrospective analyses have been done and shown the opposite – many came out during the 90s saying that a 50% reduction in cancer would be possible through eating lots of vegetables.

But we can’t fully dismiss the theory that fruit and veg are good for health. The study found that heavy drinkers had an extra benefit from this kind of diet – but only a benefit in reducing cancers caused by alcohol.

Further, evidence remains - Fruit and Vegetable Consumption and Risk of Coronary Heart Disease: A Meta-Analysis of Cohort Studies – that risk of cardiovascular disease – strokes, heart attacks – is reduced by a veg-rich diet. The other issue is that of the role of fruit and vegetables in preventing or reducing obesity: we probably shouldn’t wave good bye to the fresh produce aisle just yet.

Health Blog Q&A: Seth Mnookin, Author of ‘The Panic Virus’

Author photo by Sara James.

In his new book “The Panic Virus,” out today, journalist Seth Mnookin digs into the claims about the link between childhood vaccines and autism — and why people believe them. (Here’s a WSJ review of the book.)

Here are edited excerpts from our recent conversation with Mnookin:

You write that this book was an extremely taxing project. Why?

On an intellectual level, I felt an incredible responsibility to understand the science — and there was a lot of science. I needed to get a comprehensive grasp of things like virology and neurology. On an emotional level, I found it extremely difficult. I met a lot of developmentally disabled kids and their families, and found out that they really don’t get enough support. Regardless of? whether we have the same views on the vaccine issue, there are a lot of parents dealing with those difficult situations and also a lot of parents whose kids got incredibly sick or died from [vaccine-preventable] diseases. And there was no splitting the difference on this issue, so [now that the book takes a stand] some of the people I spoke with are now very angry with me.

What mistakes did physicians and public-health officials in the years after the publication of the small study — now discredited — claiming a relationship between the measles, mumps and rubella vaccine and autism?

When that study first came out, there was a sense that the public would ignore the media reports. [As the scare picked up steam] the medical community made very little effort to address the issue with parents. It’s not accurate to say there is never a risk from vaccination, just like it’s not accurate to say there’s no risk in wearing a seat belt — there’s some tiny number of cases where someone has their chest crushed. If doctors had said, “I understand your concerns, and here’s the evidence we have regarding vaccine safety and here are the risks of not vaccinating your child,” I think that would have gone a long way to nip the situation in the bud.

Why is this an issue in this day and age?

Vaccines are perpetually victims of their own success.? With the seat belt example, it’s clear what the consequences of not wearing one is. But the downside — getting these [vaccine-preventable] diseases — is totally notional; people in our generation never knew anyone in an iron lung, for example.

Vaccine opponents often point to awards made by the federal vaccine court as evidence of harm.

That court is set up to be generous — the burden of proof is much, much lower [than in a regular court]. In one of the rulings, a judge referred to it as “50% plus a feather.” But in the omnibus cases finding no link between vaccines and autism, a series of judges working independently agreed this wasn’t even a close case.

Do you see any hope that the current conversation about vaccination will change?

For people who have watched their children go through painful, difficult experiences that happened after they were vaccinated, the dynamic isn’t going to change. But the overall dynamic — how people think about this issue — can change. The media can help.

Speaking of the media, how did it fall down in reporting this story?

We would never have the type of reporting about business that we do about science. You wouldn’t see a story on the front page that Apple was going to declare bankruptcy based on the opinion of one person — even if he had a business degree. We have to take a greater responsibility to train reporters and editors in the topics they cover.

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