Wednesday, August 23, 2017

The Case for a Breakfast Feast - The New York Times

Many of us grab coffee and a quick bite in the morning and eat more as the day goes on, with a medium-size lunch and the largest meal of the day in the evening. But a growing body of research on weight and health suggests we may be doing it all backward.

A recent review of the dietary patterns of 50,000 adults who are Seventh Day Adventists over seven years provides the latest evidence suggesting that we should front-load our calories early in the day to jump-start our metabolisms and prevent obesity, starting with a robust breakfast and tapering off to a smaller lunch and light supper, or no supper at all.

More research is needed, but a series of experiments in animals and some small trials in humans have pointed in the same direction, suggesting that watching the clock, and not just the calories, may play a more important role in weight control than previously acknowledged.

And doctors' groups are taking note. This year, the American Heart Association endorsed the principle that the timing of meals may help reduce risk factors for heart disease, like high blood pressure and high cholesterol. The group issued a scientific statement emphasizing that skipping breakfast — which 20 to 30 percent of American adults do regularly — is linked to a higher risk of obesity and impaired glucose metabolism or diabetes, even though there is no proof of a causal relationship. The heart association's statement also noted that occasional fasting is associated with weight loss, at least in the short term.

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https://www.nytimes.com/2017/08/21/well/eat/the-case-for-a-breakfast-feast.html?

More Young People Are Dying of Colon Cancer - The New York Times

When researchers reported earlier this year that colorectal cancer rates were rising in adults as young as their 20s and 30s, some scientists were skeptical. The spike in figures, they suggested, might not reflect a real increase in disease incidence but earlier detection, which can be a good thing.

Now a sobering new study has found that younger Americans aren't just getting cancer diagnoses earlier. They are dying of colorectal cancer at slightly higher rates than in previous decades, and no one really knows why.

"This is real," said Rebecca L. Siegel, an epidemiologist with the American Cancer Society and the lead author of the current study, published as a research letter in JAMA, as well as of the earlier report. "It's a small increase, and it is a trend that emerged only in the past decade, but I don't think it's a blip. The burden of disease is shifting to younger people."

The study found that even though the risk of dying from colon and rectal cancers has been declining in the population over all, death rates among adults aged 20 to 54 had increased slightly, to 4.3 deaths per 100,000 people in 2014, up from 3.9 per 100,000 in 2004.

"This is not merely a phenomenon of picking up more small cancers," said Dr.Thomas Weber, who was not involved in the study but is a member of the steering committee of the National Colorectal Cancer Roundtable. "There is something else going on that's truly important."

No one knows what underlying lifestyle, environmental or genetic factors may be driving the rise in cases.

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https://www.nytimes.com/2017/08/22/well/live/more-young-people-are-dying-of-colon-cancer.html?

Sunday, August 20, 2017

Women are flocking to wellness because modern medicine still doesn’t take them seriously - Quartz

The wellness movement is having a moment. The more luxurious aspects of it were on full display last weekend at the inaugural summitof Gwyneth Paltrow's lifestyle brand Goop, from crystal therapy to $66 jade eggs meant to be worn in the vagina. Meanwhile, juice cleanses, "clean eating," and hand-carved lamps made of pink Himalayan salthave all gone decidedly mainstream. I myself will cop to having participated in a sound bath—basically meditating for 90 minutes in a dark room while listening to gongs and singing bowls. (I felt amazingly weird afterward, in the best possible way.)

It seems that privileged women in the US have created their own alternative health-care system—with few of its treatments having been tested for efficacy, or even basic safety. It's easy to laugh at the dubious claims of the wellness industrial complex, and reasonable to worry about the health risks involved. But the forces behind the rise of oxygen bars and detox diets are worth taking seriously—because the success of the wellness industry is a direct response to a mainstream medical establishment that frequently dismisses and dehumanizes women.

To be fair, the American health-care system is generally unpleasant for everyone: impersonal, harried, and incredibly expensive. "The doctor-patient relationship has been slowly eroding, not only with specialization and the fact that people now see panels of doctors, but because emergency rooms are slammed, there are insurance-coverage problems, et cetera," Travis A. Weisse, a science historian at the University of Wisconsin, told Taffy Brodesser-Akner in an article for Outside magazine. "It can make a patient feel devalued."

The medical system is even more terrible for women, whose experience of pain is routinely minimized by health practitioners. In the emergency room, women routinely wait longer than men to receive medication for acute pain. At the gynecologist's office, severe period-related pain is often dismissed or underestimated. Ingrained sexism means that doctors may regard women as either earth mothers or hypochondriacs; that is, either women possess deep wellspring of internal pain control that they ought to be able to channel during childbirth, or their pain is psychological in nature—a symptom of hysteria.

Conditions that affect women at higher rates than men, including depression and autoimmune diseases like fibromyalgia, are much more likely to be dismissed as having a psychological rather than a physiological source. Chronic fatigue syndrome sufferers are still instructed to rely on exercise and positive thinking, despite research that indicates these measures do not cure the condition. Many women with autoimmune diseases, endometriosis, or even multiple sclerosis go undiagnosed for years, despite multiple trips to doctors and specialists—all the while being told that their symptoms could just be stress.

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https://qz.com/1006387/women-are-flocking-to-wellness-because-traditional-medicine-still-doesnt-take-them-seriously/

Saturday, August 19, 2017

The Appointment Ends. Now the Patient Is Listening. - The New York Times

The next time you see your cardiologist or internist, what would happen if you took out your smartphone or a digital recorder and said you'd like to record your appointment?

The doctor might be startled, might bridle, might have visions of a supposedly confidential discussion showing up on YouTube — or in a malpractice lawyer's files.

Or the doctor might think more like Dr. James Ryan, a family practitioner in Ludington, Mich.

With his patients' approval, Dr. Ryan routinely records appointments, then uploads the audio to a secure web platform so that patients can listen whenever they need to recall what they discussed with him. They can give family members access to the recordings as well.

Sheri Piper, who has seen Dr. Ryan almost monthly for a host of medical problems — gout, high blood pressure, hypothyroidism, anxiety and depression — has come to rely on this system.

"As aging continues, it's harder to not be overwhelmed by what you hear in a doctor's office," said Ms. Piper, 63, a retired administrative assistant.

An extended round of hospitalizations and operations in 2013 affected her memory, she said, so "you can tell me something today and I won't remember tomorrow."

Thus, last month, straining to recall what Dr. Ryan had said about how often to take allopurinol for gout, she turned to the recording (annotated so that patients can easily locate specific topics of conversation) for clarification.

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https://www.nytimes.com/2017/08/18/health/recording-your-doctors-appointment.html

Thursday, August 17, 2017

A Start-Up Suggests a Fix to the Health Care Morass - The New York Times

WINFIELD, Kan. — If you watched the drama in Washington last month, you may have come away with the impression that the American health care system is a hopeless mess.

In Congress, a doomed plan to repeal the Affordable Care Act, President Obama's health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.

So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.

Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump's son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.

But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.

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https://www.nytimes.com/2017/08/16/technology/a-start-up-suggests-a-fix-to-the-health-care-morass.html?

Wednesday, August 16, 2017

Teen Drug Overdoses Doubled From 1999 to 2015, CDC Reveals - NBC News

From 1999 to 2015, while America was grappling with wars in Iraq and Afghanistan, and the worst economic crisis since the Depression, another tragedy quietly unfolded — the death rate of teenagers overdosing on drugs more than doubled.

In 2015 alone, there were 772 drug overdose deaths for adolescents ages 15 through 19 and they died at a rate of 3.7 per 100,000, according to figures newly released Wednesday from the federal Centers for Disease Control and Prevention.

By contrast, the death rate was 1.6 per 100,000 in 1999.

"For both male and female adolescents, the majority of drug overdose deaths in 2015 were unintentional," the CDC report states.

And the chief culprits that year were the same drugs that the National Institute on Drug Abuse say killed a total 35,000 Americans of all ages across the country — opiods, specifically heroin.

"Drug deaths are rising very rapidly for this group (although not as fast as at slightly older ages) and opioid analgesics and particularly heroin and fentanyl are the most important contributors," Dr. Christopher Ruhm, author of a recent University of Virginia study which found the national overdose crisis may be even worse than reported, wrote in an email to NBC News.

Ruhm said he expects the death toll for 15- to 19-year-olds will likely be higher after the CDC compiles its figures for 2016 and 2017.

"Not, primarily, because of opioid analgesics but rather because of rapid growth in deaths due to heroin and (often unintentionally) fentanyl use," he wrote. "Prescription opioids have played a role in all of this earlier, particularly in establishing patterns that led to increased heroin use."

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http://www.nbcnews.com/storyline/americas-heroin-epidemic/teen-drug-overdoses-doubled-1999-2015-cdc-reveals-n793006

10 Things My Chronic Illness Taught My Children - The New York Times

My children have a mother with a chronic illness. They live with my rheumatoid arthritis just as much as I do. I was given my diagnosis when all three of them were young, and since then I've spent a lot of time worrying about what the daily uncertainty of my condition would mean to them, and whether it would affect their development.

They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here's how.

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https://www.nytimes.com/2017/08/16/opinion/chronic-rheumatoid-arthritis-children.html?

Monday, August 14, 2017

IBM Watson Makes a Treatment Plan for Brain-Cancer Patient in 10 Minutes; Doctors Take 160 Hours - IEEE Spectrum

A new study, in which IBM Watson took just 10 minutes to analyze a brain-cancer patient's genome and suggest a treatment plan, demonstrates the potential of artificially intelligent medicine to improve patient care. But although human experts took 160 hours to make a comparable plan, the study's results weren't a total victory of machine over humans.

The patient in question was a 76-year-old man who went to his doctor complaining of a headache and difficulty walking. A brain scan revealed a nasty glioblastoma tumor, which surgeons quickly operated on; the man then got three weeks of radiation therapy and started on a long course of chemotherapy. Despite the best care, he was dead within a year. While both Watson and the doctors analyzed the patient's genome to suggest a treatment plan, by the time tissue samples from his surgery had been sequenced the patient had declined too far.

IBM has been outfitting Watson, its "cognitive computing" platform, to tackle multiple challenges in health care, including an effort to speed up drug discovery and several ways to help doctors with patient care. In this study, a collaboration with the New York Genome Center (NYGC), researchers employed a beta version of IBM Watson for Genomics.

IBM Watson's key feature is its natural-language-processing abilities. This means Watson for Genomics can go through the 23 million journal articles currently in the medical literature, government listings of clinical trials, and other existing data sources without requiring someone to reformat the information and make it digestible. Other Watson initiatives have also given the system access to patients' electronic health records, but those records weren't included in this study.

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http://spectrum.ieee.org/the-human-os/biomedical/diagnostics/ibm-watson-makes-treatment-plan-for-brain-cancer-patient-in-10-minutes-doctors-take-160-hours

Sunday, August 13, 2017

Forever Yesterday: Peering Inside My Mom’s Fading Mind

Every time I talk to my mom on the phone, just as I'm getting ready to say goodbye, she slips in an abrupt update about her parents — my grandparents. Sometimes they're in Switzerland. Sometimes they're in Loma, Montana. Sometimes they've gotten "mixed up with bad people." Sometimes they've completely disappeared or died mysteriously. Sometimes it sounds like a government conspiracy — a murder plot. At first, I didn't know what to say in return. I'd ask how they died or what they were doing in Switzerland. In more recent conversations, I tried to place her back in reality. I'd say, "Mom, your parents have been dead for forty years." I'd ask her how old they were and she would say 60, 70, or 75. She's not sure. She says that all the time: I'm not sure. "How old are you?" I ask, and she laughs and says, "Oh, I think I'm about 25." Once she said she was 18. She's actually 88 years old.

For about two years now, my mother has been fighting with Alzheimer's and the dementia that comes from that disease. She's had years of struggle with diabetes and epilepsy — but her mental condition was always sharp. A lifelong democrat and the mother of six, Patsy loved sewing, making quilts, reading mystery novels, and watching Seattle Mariners baseball while enjoying a Pepsi (never Coke). I am her youngest son.

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https://longreads.com/2017/08/11/forever-yesterday-peering-inside-my-moms-fading-mind/?

The Symptoms of Dying - The New York Times

You and I, one day we'll die from the same thing. We'll call it different names: cancer, diabetes, heart failure, stroke.

One organ will fail, then another. Or maybe all at once. We'll become more similar to each other than to people who continue living with your original diagnosis or mine.

Dying has its own biology and symptoms. It's a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.

Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren't usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain.

While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what to expect.

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https://www.nytimes.com/2017/06/20/well/live/the-symptoms-of-dying.html?smprod=nytcore-ipad&smid=nytcore-ipad-share