Tuesday, November 24, 2015

Brawn and Brains - The New York Times

Sturdy legs could mean healthy brains, according to a new study of British twins.

As I frequently have written in this column, exercise may cause robust improvements in brain health and slow age-related declinesin memory and thinking. Study after study has shown correlations between physical activity, muscular health and mental acuity, even among people who are quite old.

But these studies have limitations and one of them is that some people may be luckier than others. They may have been born to have a more robust brain than someone else. Their genes and early home environment might have influenced their brain health as much as or more than their exercise habits. Their genes and early home environment also might have influenced those exercise habits, as well as how their bodies and brains responded to exercise.

In other words, genes and environment can seriously confound experimental results.

That problem makes twins so valuable for scientific purposes. (Full disclosure, I am a twin, although not an identical one.) Twins typically share the same early home environment and many of the same genes, and if they are identical, all their genes are the same.

So if one twin's body, brain and thinking abilities begin to differ substantially over the years from the other's, the cause is less likely to be solely genetic or the early environment, and more likely to be attributable to lifestyle, including exercise habits.

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Sunday, November 22, 2015

This diet study upends everything we thought we knew about ‘healthy’ food - The Washington Post

If you've ever tried out the latest diet fad only to find yourself gaining weight and feeling awful and wondered what you were doing wrong, scientists now have an explanation for you.

Israeli researchers, writing in the journal Cell this week, have found that different people's bodies respond to eating the same meal very differently — which means that a diet that may work wonders for your best friend may not have the same impact on you.

Lead authors Eran Segal and Eran Elinav of the Weizmann Institute of Science focused on one key component used in creating balanced diet plans like Atkins, Zone or South Beach. Known as the glycemic index or GI for short, it was developed decades ago as a measure of how certain foods impact blood sugar level and has been assumed to be a fixed number.

But it's not. It turns out that it varies widely depending on the individual.

The researchers recruited 800 healthy and pre-diabetic volunteers ages 18 to 70 and collected data through health questionnaires, body measurements, blood tests, glucose monitoring and stool samples. They also had the participants input lifestyle and food intake information into a mobile app that ended up collecting information on a total of 46,898 meals they had.

Each person was asked to eat a standardized breakfast that included things like bread each morning.

They found that age and body mass index, as expected, appeared to impact blood glucose level after meals, but so did something else. Different individuals showed vastly different responses to the same food, even though their own responses remained the same day to day.

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NYTimes: Are Good Doctors Bad for Your Health?

Pretty regularly, I receive an urgent call from a distraught friend or friend of a brother. "Zeke, Mom was at home and her heart stopped. The E.M.T.s are rushing her to XYZ hospital in Miami. Can you help me find the best cardiologist there for her?"

"Get me the best cardiologist" is our natural response to any heart problem. Unfortunately, it is probably wrong. Surprisingly, the right question is almost its exact opposite: At which hospital are all the famous, senior cardiologists away?

One of the more surprising — and genuinely scary — research papers published recently appeared in JAMA Internal Medicine. It examined 10 years of data involving tens of thousands of hospital admissions. It found that patients with acute, life-threatening cardiac conditions did better when the senior cardiologists were out of town. And this was at the best hospitals in the United States, our academic teaching hospitals. As the article concludes, high-risk patients with heart failure and cardiac arrest, hospitalized in teaching hospitals, had lower 30-day mortality when cardiologists were away from the hospital attending national cardiology meetings. And the differences were not trivial — mortality decreased by about a third for some patients when those top doctors were away.

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Saturday, November 21, 2015

Protect Doctor-Patient Confidentiality - The New York Times

When should a doctor betray a patient's confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship.

In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby's favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment.

But last November an appeals court reversed that judgment, asserting that doctors could be required to warn "all foreseeable victims" of potentially dangerous patients in their care. Whether the attack on the Schierings was foreseeable, the court said, should be decided by a jury.

Though the murder of innocents is obviously a tragedy, the Washington State Supreme Court should overturn the appeals court's decision. Not only does that judgment greatly expand the circumstances in which psychiatrists would be required to violate patients' confidentiality; those violations in the end would also not serve the purpose for which they were intended.

Throughout history, doctor-patient confidentiality has been a cornerstone of Western medical practice. The duty to keep patients' information private is written into the codes of ethics of medical organizations, and is even in the Hippocratic oath: "What I may see or hear in the course of treatment," it says, "I will keep to myself."

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Thursday, November 19, 2015

Federal privacy law lags far behind personal-health technologies - The Washington Post

Jacqueline Stokes spotted the home paternity test at her local drugstore in Florida and knew she had to try it. She had no doubts for her own family, but as a cybersecurity consultant with an interest in genetics, she couldn't resist the latest advance.

At home, she carefully followed the instructions, swabbing inside the mouths of her husband and her daughter, placing the samples in the pouch provided and mailing them to a lab.

Days later, Stokes went online to get the results. Part of the lab's Web site address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of some 6,000 other people.

The site was taken down after Stokes complained on Twitter. But when she contacted the Department of Health and Human Services about the seemingly obvious violation of patient privacy, she got a surprising response: Officials couldn't do anything about the breach.

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Wednesday, November 18, 2015

Single course of antibiotics can mess up the gut microbiome for a year | Ars Technica

In a battle against an infection, antibiotics can bring victory over enemy germs. Yet that war-winning aid can come with significant collateral damage; microbial allies and innocents are killed off, too. Such casualties may be unavoidable in some cases, but a lot of people take antibiotics when they're not necessary or appropriate. And the toll of antibiotics on a healthy microbiome can, in some places, be serious, a new study suggests.

In two randomized, placebo-controlled trials of healthy people, a single course of oral antibiotics altered the composition and diversity of the gut microbiome for months, and in some cases up to a year. Such shifts could clear the way for pathogens, including the deadly Clostridium difficile. Those community changes can also alter microbiome activities, including interacting with the immune system and helping with digestion. Overall, the data, published Tuesday in the journal mBio, suggests that antibiotics may have more side effects than previously thought—at least in the gut.

In the mouth, on the other hand, researchers found that microbial communities fared much better, rebounding in weeks after antibiotic treatments. The finding raises the question of why the oral microbiome is less disturbed by drugs. It could simply be because of the way that antibiotics, taken orally, circulate through the body. Or, it could imply that oral microbiomes are innately more resilient, a quality that would be useful to replicate in microbial communities all over the body.

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Using a weight-loss app? One created for millennials doesn't help much, study finds - The Orange County Register

Young American adults own smartphones at a higher rate than any other age group. And researchers from Duke University wanted to see if capitalizing on that smartphone usage with a low-cost weight-loss app might help the 35 percent of young adults in the U.S. who are overweight or obese.

If you're rooting for smartphones to solve all our health problems, you're not going to like what the researchers found. The smartphone app didn't help young adults lose any more weight than if they hadn't been using the app at all.

The study, published in the journal Obesity, looked at 365 young adults ages 18-35. A third of the participants used an Android app specifically created for the study, which not only tracked their calories, weight and exercise but also offered interactive features such as goal setting, games and social support.

Another third of the participants received six weekly personal coaching sessions, followed by monthly phone follow-ups. Plus, this personal coaching group was also encouraged to track their weight, calories and exercise via smartphone.

The last third of the participants were given three handouts on healthy eating and exercise – nothing else.

Researchers tracked the young adults' progress after six months, one year and two years. The personal coaching group had lost more weight than the other two groups after six months, but that lead vanished at the one- and two-year follow-ups.

As for the group using the smartphone app, their average weight loss was never more than the other two groups.

Lead author Dr. Laura Svetkey said she and her colleagues were both surprised and disappointed at the results.

"Given the seeming power of cellphone apps and frankly the popularity of these health and fitness apps in the commercial world, we thought this might be a really good strategy to provide effective intervention very broadly and potentially at low cost," said Svetkey, a professor of medicine at Duke University School of Medicine.

Yet, Svetkey says, it's difficult to get the same level of intensity in an app that you might get through personal coaching, and people have the tendency to stop using weight-loss apps after a while.

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NYTimes: Early Prostate Cancer Cases Fall Along With Screening

Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in The Journal of the American Medical Association.
The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.

The declines in both screening and incidence "could have significant public health implications," the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.

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Diary of a Food Tracker - The New York Times

Research shows that people who keep track of what they eat and weigh on a regular basis are more likely to succeed at losing weight and keeping it off. But as the food diary of Steve Lochner shows, food tracking and weight loss is far from simple.

In February of 2012, he weighed a high of 337 pounds. But then he started tracking his eating habits using the Lose It food tracking app. Soon he became a "Super Tracker," detailing virtually every bite of food — good and bad — that he ate over a three-year period, losing more than 100 pounds. Here's how he did it.

Tuesday, November 17, 2015

'War on drugs means millions are dying in pain' - CNN.com

Ruth Dreifuss is former President of Switzerland and Minister of Home Affairs. Anand Grover is former U.N. special rapporteur on the Right to Health, India. Michel Kazatchkine is former executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria. The opinions expressed in this commentary are theirs.

Millions of people are dying in pain because of the repressive stance the world has taken on drugs. That's because states are obsessed by the fear that people will use controlled medicines such as morphine as recreational drugs, thereby neglecting their important medical uses. 

Where you live determines whether you will be able to access to controlled medicines, particularly opiates, when confronting an acute terminal, chronic or painful illness. Ninety-two per cent of the world's morphine is consumed by only 17% of the world's population, primarily the United States and Europe. Seventy--five percent of the world's people in need do not have access to pain relieving medicine. 

In other words, most of the global population, outside the affluent countries in the North, dying in pain, including from terminal cancers, do so in the absence of dignified palliative care. 

This is a horrendous situation for millions of patients and families. Essential medicines such as morphine, taken for granted as the standard relief of severe pain in the global North, do not enjoy the same status in the global South. Quite the opposite. Chances are, if a person living in any developing country ends up with an illness associated with extreme and avoidable pain, they will endure the pain simply because their government has created obstacles to morphine use in hospitals.

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