February 25, 2012

Tiny medical device can propel itself through bloodstream

For fifty years, scientists had searched for the secret to making tiny implantable devices that could travel through the bloodstream. Engineers at Stanford have demonstrated a wirelessly powered device that just may make the dream a reality.
By Andrew Myers
Someday, your doctor may turn to you and say, “Take two surgeons and call me in the morning.” If that day arrives, you may just have Ada Poon to thank.
Yesterday, at the International Solid-State Circuits Conference (ISSCC) before an audience of her peers, electrical engineer Poon demonstrated a tiny, wirelessly powered, self-propelled medical device capable of controlled motion through a fluid—blood more specifically. The era of swallow-the-surgeon medical care may no longer be the stuff of science fiction.Poon is an assistant professor at the Stanford School of Engineering. She is developing a new class of medical devices that can be implanted or injected into the human body and powered wirelessly using electromagnetic radio waves. No batteries to wear out. No cables to provide power.
“Such devices could revolutionize medical technology,” said Poon. “Applications include everything from diagnostics to minimally invasive surgeries.”
Certain of these new devices, like heart probes, chemical and pressure sensors, cochlear implants, pacemakers, and drug pumps, would be stationary within the body. Others, like Poon’s most recent creations, could travel through the bloodstream to deliver drugs, perform analyses, and perhaps even zap blood clots or removing plaque from sclerotic arteries.
Challenged by power
The idea of implantable medical devices is not new, but most of today’s implements are challenged by power, namely the size of their batteries, which are large, heavy and must be replaced periodically. Fully half the volume of most of these devices is consumed by battery.
“While we have gotten very good at shrinking electronic and mechanical components of implants, energy storage has lagged in the move to miniaturize,” said co-author Teresa Meng, a professor of electrical engineering and of computer science at Stanford. “This hinders us in where we can place implants within the body, but also creates the risk of corrosion or broken wires, not to mention replacing aging batteries.”
Poon’s devices are different. They consist of a radio transmitter outside the body sending signals to an independent device inside the body that picks up the signal with an antenna of coiled wire. The transmitter and the antenna are magnetically coupled such that any change in current flow in the transmitter produces a voltage in the coiled wire — or, more accurately, it induces a voltage. The power is transferred wirelessly. The electricity  runs electronics on the device and propels it through the bloodstream, if so desired.
Upending convention
It sounds easy, but it is not. Poon had to first upend some long-held assumptions about the delivery of wireless power inside the human body.
For fifty years, scientists have been working on wireless electromagnetic powering of implantable devices, but they ran up against mathematics. According to the models, high-frequency radio waves dissipate quickly in human tissue, fading exponentially the deeper they go.
Low-frequency signals, on the other hand, penetrate well, but require antennae a few centimeters in diameter to generate enough power for the device, far too large to fit through all but the biggest arteries. In essence, because the math said it could not be done, the engineers never tried.
Then a curious thing happened. Poon started to look more closely at the models. She realized that scientists were approaching the problem incorrectly. In their models, they assumed that human muscle, fat and bone were generally good conductors of electricity, and therefore governed by a specific subset of the mathematical principles known as Maxwell’s equations — the “quasi-static approximation” to be exact.
Poon took a different tack, choosing instead to model tissue as a dielectric — a type of insulator. As it turns out human tissue is a poor conductor of electricity. But, radio waves can still move through them. In a dielectric, the signal is conveyed as waves of shifting polarization of atoms within cells. Even better, Poon also discovered that human tissue is a “low-loss” dielectric — that is to say little of the signal gets lost along the way.
She recalculated and made a surprising find: Using new equations she learned high-frequency radio waves \ travel much farther in human tissue than originally thought.
“When we extended things to higher frequencies using a simple model of tissue we realized that the optimal frequency for wireless powering is actually around one gigahertz,” said Poon, “about 100 times higher than previously thought.”
More significantly, however, her revelation meant that antennae inside the body could be 100 times smaller and yet deliver the same power.
Poon was not so much in search of a new technology; she was in search of a new math. The antenna on the device Poon demonstrated at the conference yesterday is just two millimeters square; small enough to travel through the bloodstream.
She has developed two types of self-propelled devices. One drives electrical current directly through the fluid to create a directional force that pushes the device forward. This type of device is capable of moving at just over half-a-centimeter per second. The second type switches current back-and-forth in a wire loop to produce swishing motion similar to the motion a kayaker makes to paddle upstream.
“There is considerable room for improvement and much work remains before these devices are ready for medical applications,” said Poon. “But for the first time in decades the possibility seems closer than ever.”
Stanford doctoral candidates Daniel Pivonka and Anatoly Yakovlev contributed to this research.
Ada Poon’s research was made possible by the support of C2S2 Focus Center, Olympus Corporation, and Taiwan Semiconductor Manufacturing Company.
Andrew Myers is associate director of communications for the Stanford School of Engineering.

February 24, 2012

Monitoring Your Health With Mobile Devices

A medical camera from Firefly Global shows a child's eardrum on a screen.

Dr. Eric Topol is only half joking when he says the smartphone is the future of medicine — because most of his patients already seem “surgically connected” to one.
A blood glucose monitor from AgaMatrix works with an iPhone app.
A blood pressure cuff from Withings works with an iPhone or iPad to track blood pressure over time and can send the data to a Web site.
But he says in all seriousness that the smartphone will be a sensor that will help people take better control of their health by tracking it with increasing precision. His book, “The Creative Destruction of Medicine,” lays out his vision for how people will start running common medical tests, skipping office visits and sharing their data with people other than their physicians.
Dr. Topol, a cardiologist and director of Scripps Translational Science Institute in La Jolla, Calif., is already seeing signs of this as companies find ways to hook medical devices to the computing power of smartphones. Devices to measure blood pressure, monitor blood sugar, hear heartbeats and chart heart activity are already in the hands of patients. More are coming.
He acknowledges that some doctors are skeptical of these devices. “Of course, the medical profession doesn’t like D.I.Y. anything,” he said. “There are some really progressive digital doctors who are recognizing the opportunities here for better care and prevention, but most are resistant to change.”
Dr. Topol may be right about the caution in the industry, but he is far from the only person with this vision. Apple was promoting the iPhone as a platform for medical devices in 2009. An entire marketplace is evolving that marries the can-do attitude of hacking devices with the fervor of the wellness movement.
Smartphones make taking care of yourself more of a game, Dr. Topol said. “I recommend these devices because it makes it more fun and I get more readings than if I ask them to do it manually.”
The enthusiasm for this vision of do-it-yourself medicine with a smartphone, though, must be balanced with the cold reality that all of the experimenters should consult with their physicians.
Some of the attempts to turn the iPhone into a medical device are little more than toys. The 99-cent iStethoscope Pro app warns, “This app is intended to be used for entertainment purposes.” Those who have bought it have given it uniformly poor reviews.
The equally poorly reviewed iStethoscope Expert 2012, also 99 cents, offers a $24 bell to enhance the sound.
I experimented with a homemade otoscope, the device doctors use to look into the ears, connected to a smartphone so I could take pictures of a family member’s eardrums. My son has had infections in his Eustachian tube and the doctor likes to take a look. I figured that if I could take a picture or a video of the eardrum, I could save the trouble of him missing school to visit the doctor.
With the help of a little duct tape, I attached the phone to a small home otoscope from a company called Dr. Mom Otoscopes. It is just a lens, a light source and a plastic sleeve and sells for $27. To improve the image, I inserted a $20 close-up lens I had bought fromPhotojojo.com.
The biggest problem was in the software of the smartphone. The Apple camera app balanced the light and dark over the entire image, washing out the center so the eardrum was just a sea of white. The Android camera app offered the option of using spot metering so the light balance was better.
Despite all this fiddling with the optics and the software, the result was never very good. Better results require more than duct tape.
Firefly Global in Belmont, Mass., makes a medical camera and sells it directly to doctors who want to share the images with patients and save them for the future. Its line includes cameras for dentists, dermatologists and ophthalmologists. Unfortunately, the $180 to $350 cameras connect to a computer, not a smartphone.
The most prevalent diseases and the biggest markets are getting the tools first. Devices to monitor heart disease are already available.
A French start-up, Withings, has created a blood pressure cuff for $129 that connects to an iPad or an iPhone. The cuff will automatically inflate, deflate and then record the pulse rate and the blood pressure. The app will graph the pressure over time, making trends easier to see.
Withings also includes a connection to its Web site so users can share their data with their doctors either directly through their password-protected pages or through third-party sites like digifit.com.
The growing incidence of diabetes is by many estimates the biggest public health challenge today, so companies are developing tools to help people with the disease manage their blood sugar.
Tom Xu, the founder of SkyHealth in El Cerrito, Calif., created the Web siteglucosebuddy.com to help people keep track of the sugar in their blood. The numbers must be entered manually. The site works with an app for the iPhone to gather the blood glucose level and some information about when it was taken. “Our main goal of glucosebuddy is not to just record numbers. That’s the boring part,” he said. “Once you know how your diet affects your blood sugar, you take your health more seriously.”
Other companies are beginning to integrate the hardware and software. AgaMatrix, a company that makes a blood glucose monitor, iBGStar, that attaches to the iPhone, worked with Sanofi, the pharmaceutical giant, to develop the tool. In December, the Food and Drug Administration approved the device for sale in the United States.
“When patients are dealing with chronic conditions, you might see a doctor every six weeks or two months,“ said Joseph Flaherty, the senior vice president for marketing at AgaMatrix. “For people to have real command over these diseases, we need to close the feedback loop and give people the information they need to make smarter decisions in real time.“
Its tool, like many other pocket meters, measures the amount of glucose in the blood, but it also transfers the data to the smartphone, which helps patients to track their glucose levels over time. It is not much different from a piece of paper and a pen, but it is faster and cleaner, and it is easy to share these values with doctors and friends.
Johnson & Johnson has also spoken publicly about developing a similar device. The ultimate goal is replicating the full-body diagnostic “tricorder” from the “Star Trek” TV show, a goal that is being encouraged by a $10 million prize put up by Qualcomm, the smartphone chip maker, through the X-Prize Foundation.
Apps that simulate the lights and sound of the TV show prop are available from app stores.

February 23, 2012

Mammograms Benefit Women in their 40s, Study Shows:

A great debate about early detection via mammography screening and the costs. It looks like from our friends at TIME, early detection for women is very important.

Mammograms catch tumors earlier, result in less invasive treatment and increase women's chances of survival. So, why shouldn't younger women be screened?

Amidst the continuing debate over the age at which women should begin screening routinely for breast cancer, researchers report fresh evidence that women in their 40s whose cancers were picked up by mammograms need less treatment and live longer than cancer patients who were not screened.
The results focus on the very group — 40- to 49-year-olds — who were excluded in 2009 by the U.S. Preventive Services Task Force’s (USPSTF) revised breast-cancer screening recommendations. The expert panel, having weighed the life-saving benefits of routine mammography against its potential risks — including anxiety and unnecessary testing following false positive results and complications from unneeded biopsies and other procedures — concluded that routine breast cancer screening should begin at age 50 for most women. In younger women, the panel said, mammograms did more harm than good.
But based on the new data, researchers Judith Malmgren, Dr. Henry Kaplan and their colleagues at the Swedish Cancer Institute in Seattle argue that the USPSTF’s conclusions fail to consider key benefits of mammography: less invasive treatment and better outcomes for women whose cancers are detected early.
Image by Juan Silva / Getty Images

Malmgren’s group studied 1,977 breast cancer patients aged 40 to 49, stratifying them by the stage of their disease, how their disease was diagnosed (by mammography or self- or physician-based exams), how it was treated and whether the cancer recurred. Over the 18-year study period, the percentage of breast cancers detected by mammography increased, from 28% in 1990 to 58% in 2008, due to increased screening. Over that same time period, the percentage of early stage tumors caught by mammograms increased as well — the number of Stage 0 cancers detected by screening jumped by 66%, while the number of more advanced Stage 3 cancers dropped by 66% as well.
When tumors were identified earlier, women were able to undergo less invasive treatments, with more using lumpectomy, or partial removal of breast tissue, and fewer having to resort to radical mastectomy, the removal of entire breasts. These early treatments translated into improved survival, with 4% of women whose cancers were detected by mammography dying of breast cancer compared with 11% whose cancers were not picked up by the screenings.
“Women are getting diagnosed earlier, when the cancer is at a more treatable phase,” says Malmgren. That might translate into a greater benefit for mammography than previous studies have shown. In the USPSTF’s analysis of screening’s benefits, Malmgren says the panel focused only on the number of lives saved by routine mammography. She argues that perhaps the panel should have also included benefits like less invasive treatment. Such benefits can be weighed more accurately against the risks of routine screening, including anxiety over false positive results and medical complications from unnecessary procedures.

“The USPSTF says the harms outweigh the benefit, but if they don’t have all the benefits in the equation, then I don’t think it’s an accurate depiction of the situation,” Malmgren says.
She acknowledges that her study is an observational analysis, and cannot be used to recommend routine mammograms starting at age 40. But the findings justify that the definition of “benefits” should be broadened when balancing the pros and cons of regular breast-cancer screening in women aged 40 and 49. “I don’t think it’s prudent to throw the baby out with the bath water,” she says about the exclusion of this age group in national guidelines for routine screening. “We need to keep working out the issues.”

Eric Topol at TEDMED: Consumer Mobile Healthcare is Here...


Items to remove from your kitchen / home:

1. Plastic Bottles and plastic containers: Plastics are known endocrine disruptors, which means they interact with hormone receptors, possibly making a person more susceptible to precocious puberty or hormone related cancers. Food and liquid stored in plastic can absorb plastics during the heating process, which can occur when they are heated in a microwave oven or if they become hot in a car or storage container. Instead, store food and liquids in glass or ceramic containers. If you must use plastic, choose the ones with recycle numbers – 1, 2, 4 and 5

2. Aluminum or Teflon cookware: Aluminum is a metal that can leach into food during cooking. Aluminum has been associated with neurodegenerative conditions. Also, Teflon cookware is made from a Fluoride containing toxic chemical called polytetrafluoroethylene (PTFE) that can leach into food when the surface is scratched. Consider cooking with cast iron, pyrex or stainless steel instead.
3. Canned Tuna: Tuna is a large predatory fish that is known to bio-accumulate mercury in its fat. Mercury is a known neurotoxin and causes autoimmune reactions. Replace tuna or canned tuna with canned Alaskan salmon.
4. Antibacterial soap: The main ingredient in antibacterial soap is triclosan, an endocrine disruptor and pesticide. Prolonged use of these soaps has been implicated in causing drug resistant bacteria and adding to hormone related health problems. Use glycerin or castile soap, both of which clean our skin very well.
5. Cool Mist humidifier: During the winter, ambient air humidity is low leading to a variety of irritating health conditions such as dry skin, dry sinuses and increased susceptibility to colds. Adding humidity to the air can be very helpful to prevent these conditions. Rather than using a cool mist humidifier, which is susceptible to mold, and bacterial growth, instead boil water or use a warm mist humidifier.

Items to add to your home:

1. Broad Leaf Plants: Plants are natural air purifiers and make attractive home decorations. Choose plants with the best air filtering affects, such as: peace lily, rubber plant, Boston fern, and weeping fig.
2. Water Filter: It is well known that New York City has very clean water at its source. By the time that water gets to your tap it has picked up sediment and heavy metals from pipes, as well as bacteria and parasites. Chlorine is added to the city water to kill the bacteria and parasites. An under sink or counter top water charcoal filter can help to remove a great deal of this unwanted contaminants.

Debunking nutrition myths:

1. Beef is bad for you? It is well known in nutritional science that when cows eat grains, which are not natural in their diet, the beef has very high levels of the inflammatory chemicals called arachidonic acid, which can contribute to heart disease. When cows are raised eating only grass, which is their natural diet, the beef has very low levels of arachidonic acid and levels of Omega-3 fatty acids that rivals Alaskan salmon. Grass fed beef can be a healthy part of your diet.
2. Egg Yolks are unhealthy? Chickens that are raised on grains, which are not in their natural diet, produce egg yolks high in arachidonic acid, which causes inflammation in our bodies. When chickens eat a diet that consists of seeds, bugs and even green plants, their eggs yolks are high in DHA, which is an omega-3 fatty acid and anti-inflammatory. You can tell a healthy egg yolk by its deep orange color and creamy taste.
3. Milk is essential for strong bones? While it is true that milk contains a good amount of calcium, about 250mg per cup, some adults and children are on a milk free diet due to dairy allergy. There are many other options to get calcium for people looking for non-dairy options. Some examples include: almonds, about 400mg per cup; Salmon, 360mg per 6 oz; dried figs, about 270mg per 10; and broccoli, about 178 mg per cup. Milk has been implicated in causing food allergies and rashes in children, so they do have non-dairy options to get their calcium.

February 22, 2012

Mobile Technology and Healthcare Looking Ahead...

Mobile Health, or “mHealth”, offers benefits throughout the healthcare industry. For clinicians, mHealth is a method to remotely monitor a patient’s health and improve the quality care rendered. For patients, mHealth provides a way to monitor their own health more easily and reduces the cost of care by decreasing the amount of time spend at a doctor’s office or hospital. For payers, it is a way to determine what type of support they need to offer their members.
While the advantages of mHealth technologies are hard to ignore, these technologies also produce a new set of privacy concerns. Because mHealth increases the amount of data collected (think of a glucose test versus a glucose test every two minutes), the amount of data subject to a privacy breach is alarming. Since the majority of mHealth technologies require that the captured information be stored in some type of electronic medical record (EMR) or personal health record (PHR), it is reasonable to be concerned about security and privacy.
According to the National Committee for Vital and Health Statistics (NCVHS), an advisory committee to the US Department of Health and Human Services (HHS), “privacy is an individual’s right to control the acquisition, uses, or disclosures of his or her identifiable health data.” Security is defined as the “physical, technological, or administrative safeguards or tools used to protect identifiable health data from unwarranted access or disclosure”. So the question is – can mobile devices such as patient-centered devices, clinician communication devices, medical equipment, telemedicine devices and inventory devices maintain patient privacy and securely manage patient data? If so, then why all the concern? If not, then do the benefits outweigh the risks and are their measures that can be taken to increase security and minimize privacy concerns?
In my humble opinion the technology is out there to both serve the public and their privacy concerns. Technology is moving exponentially. By looking at the last few years, we can see how technology has helped our lives in other aspects. Why not on the healthcare frontier where we need the most help. For example the site Healthtap.com has grown from 5,000 to 10,000 US physicians in just 4 months answering people's medical questions for free. With this rapid change in technology, we are really at a paradigm moment of true change. I'm committed to excellence in my patients' care and therefore want to give them the best ways to access me as their concierge physician. Healthtap.com and other emerging technologies like Twitter are already bridging the gap.



ACAM member and guest blogger, Dr. Scott Greenberg, of the Magaziner Center for Wellness in Cherry Hill, NJ is easing joint pain for his patients with a new therapy using the patients' own stem cells.

February 21, 2012

East meets West: Chinese delegation visited UCLA to discusses traditional Chinese Medicine

As most Angelinos know, the UCLA Health System is on the cutting edge of healthcare; however, many are not aware of its interest in traditional Chinese medicine (TCM). On June 10, 2010, Vice Minister Wang Guoqiang of the Chinese Ministry of Health and a six-person delegation visited UCLA to learn how TCM and integrative medicine are practiced in the United States as a new healthcare model. Integrative medicine is a concept that explores new ways to concurrently treat the mind, body, and spirit. In essence, integrative medicine is a holistic approach that treats the whole person. TCM includes a variety of traditional practices practiced in China dating back thousands of years; it includes herbal medicine, dietary therapy, acupuncture, and massage. Traditional Chinese medicine is completely different from Western medicine in both theory and practice; it differs from Western Medicine in how the human body functions, what causes an illness, and how the illness should be treated. Currently TCM is used to treat more than 25% of the world’s population. The early Chinese physicians were philosophers; their medical treatments were influenced by the way they viewed the world and man’s role in it. TCM advocates moderation in all things––living in harmony with nature and striving to attain balance in all things. Prevention is emphasized in TCM; a strong emphasis is placed on educating the patient to live responsibly.
The Chinese coalition visited with Dr. Ka-Kit Hui and his team at the UCLA Center for East-West Medicine; the center is collaborating with China to develop a virtual library of integrative medicine information. Other projects of the Center for East-West Medicine include the creation of an Internet-based multimedia resource for clinicians, educators and consumers, and research comparing the effectiveness of TCM and integrative medicine on healthcare. The Chinese delegation also met with faculty from the UCLA Collaborative Centers for Integrative Medicine, the UCLA Division of General Internal Medicine and Health Services Research, and Dr. Eugene A. Washington, vice chancellor for health sciences and dean of the David Geffen School of Medicine at UCLA.


Superbugs from space offer new source of Electricity

Bacteria normally found 30km above the earth have been identified as highly efficient generators of electricity.

Bacillus stratosphericus – a microbe commonly found in high concentrations in the stratosphere orbiting the earth with the satellites – is a key component of a new 'super' biofilm that has been engineered by a team of scientists from Newcastle University.
Isolating 75 different species of bacteria from the Wear Estuary, Country Durham, UK, the team tested the power-generation of each one using a Microbial Fuel Cell (MFC).
By selecting the best species of bacteria, a kind of microbial "pick and mix" they were able to create an artificial biofilm, doubling the electrical output of the MFC from 105 Watts per cubic metre to 200 Watts per cubic metre.
While still relatively low, this would be enough power to run an electric light and could provide a much needed power source in parts of the world without.
Among the 'super' bugs was B. Stratosphericus, a microbe normally found in the atmosphere but brought down to earth as a result of atmospheric cycling processes and isolated by the team from the bed of the River Wear.
Publishing their findings today in the American Chemical Society's Journal of Environmental Science and Technology, Grant Burgess, Professor of Marine Biotechnology at Newcastle University, said the research demonstrated the "potential power of the technique."
"What we have done is deliberately manipulate the microbial mix to engineer a biofilm that is more efficient at generating electricity," he explains.
"This is the first time individual microbes have been studied and selected in this way. Finding B.altitudinis was quite a surprise but what it demonstrates is the potential of this technique for the future – there are billions of microbes out there with the potential to generate power."
The use of microbes to generate electricity is not a new concept and has been used in the treatment of waste water and sewage plants.
Microbial Fuel Cells, which work in a similar way to a battery, use bacteria to convert organic compounds directly into electricity by a process known as bio-catalytic oxidation.
A biofilm – or 'slime' – coats the carbon electrodes of the MFC and as the feed, they produce electrons which pass into the electrodes and generate electricity.
Until now, the biofilm has been allowed to grow un-checked but this new study shows for the first time that by manipulating the biofilm you can significantly increase the electrical output of the fuel cell.
As well as B. Stratosphericus, other electricity-generating bugs in the mix were Bacillus altitudinis – another bug from the upper atmosphere – and a new member of the phylum Bacteroidetes.
Newcastle University is recognised as a world-leader in fuel cell technology. Led by Professor Keith Scott, in the University's School of Chemical Engineering and Advanced Materials, the team played a key role in the development of a new lithium/air powered battery two years ago.
Professor Scott says this latest  research can take the development of MFC's to a new level.

What are Telomeres?

  •  Could telomeres provide an answer to questions like “How long will I live?” or “Will I get cancer?”

What are telomeres?

Telomeres are structures at the ends of chromosomes  that contain repetitive stretches of DNA. They “seal” chromosomes at the tips, preventing them from unraveling or sticking together. Telomeres also protect a chromosome’s DNA sequence as it is being copied during cell division. Because the enzymes that copy DNA aren’t able to continue to the very end of the sequence, a bit of DNA is lost each time the chromosome is copied. Telomeres provide a buffer that grows shorter every time a cell divides. 
   Over time, telomeres become so short that cell division stops and the cell dies. This mechanism is thought to restrict the lifespan of cells to a limited number of divisions, making telomere length a measure of aging at the cellular level.

Telomeres and stress

Environmental stress can accelerate telomere shortening. Studies have implicated cigarette smoking, radiation, poor diet, and even psychological stress as causes. A newly published studyExternal Web Site Icon.  reported that children who spent a large proportion of their early lives in institutions had shorter telomeres on average than children who received high-quality foster care as part of an intervention study. Previous studies have found telomere shortening in adults who were maltreated as children.  

Telomeres and disease

Chromosomes that have lost their telomeres can rearrange or fuse together; these abnormal chromosomes are often observed in cancer cells. In some families, inheritance of exceptionally short telomeres is linked to specific diseases, such as pulmonary fibrosis or bone marrow failure.
Several epidemiologic studies have found that shorter telomeres tend to be associated with diseases that become more frequent with age, including heart disease and cancer.  Telomere shortening and chronic diseases could be caused by the same cell-damaging processes, such as oxidative stress and inflammation.    

Telomeres and aging

Is telomere length a biomarker for aging? According to a systematic reviewExternal Web Site Icon. published last year, the evidence is equivocal. On average, older people have shorter telomeres; however, there is a great deal of variation among individuals. It isn’t clear whether shorter telomeres are just a sign of aging, or whether they contribute to it.    
Studies of telomere length and mortality have found mixed results. Very few studies have actually followed people over time to see how changes in telomere length correlated with survival. Several such studies now underway should shed more light on this question.

Telomeres and immortality

Germ cells (eggs and sperm) and stem cells contain an enzyme, telomerase, that restores telomere length. Although it is normally inactive in most other cells in the body, telomerase is activated in cancer cells, making them “immortal.” Although activating telomerase to immortalize normal cells is a theoretical possibility, its feasibility isn’t known. 

Testing for telomeres

Research on telomeres is still at an early stage but some entrepreneurs see human curiosity as an untapped market. A company in the UK announced that it would soon be offering a test of “biological age” based on telomere length to the public. 

Mindfulness and Weight Loss

Mindfulness is bringing one’s complete attention to the present experience on a moment-to-moment basis.  Along with successfully treating anxiety and stress, it can also be helpful in the treatment for weight loss.  Dr. Mary Connors explains how:

Overconsumption, increased stress, and resulting weight gain often propel individuals to a wish for change, such as making a New Year’s resolution to get control of eating and to lose weight. Unfortunately, many people make the same New Year’s resolutions year after year because goals such as “lose 75 pounds” or “get up at 5 a.m. daily to run” are typically not achievable or sustainable. A large amount of psychological research also underscores the importance of selecting goals that are realistic and moderate rather than extreme. An “all or nothing” radical change program frequently results in “nothing” because it’s not possible to maintain a 500 calorie a day “cleanse” without binge eating in response to an overly depriving diet.

Sadly, even if we are being more moderate about weight goals, more research is finding that, as millions of people have experienced for themselves, it is very difficult to lose weight and to maintain the loss (see this article in the New York Times). We have known for some time that only a minority of individuals manage to sustain significant weight loss, but now we understand more about how and why this is so difficult. Humans evolved in a “feast or famine” environment, and our bodies developed numerous mechanisms designed to ensure our survival. We seem to be hard wired to prefer sweets, fat, and lots of variety, all of which were adaptive in our ancestral environment. Diets tend to be viewed by the body as alarming indicators of potential starvation that must be abated by a metabolic drop, and actual weight loss seems to result in ongoing secretion of chemicals designed to increase food intake and restore the lost weight.

Does this mean it’s hopeless to try to lose weight? Not at all; I know many people who have done it and maintained their loss. Individuals who binge eat and respond to negative emotions by overeating can frequently change these patterns and gradually lose weight. Also, stress is a significant contributor to weight gain; stress results in the secretion of cortisol, which promote abdominal weight gain. Research is demonstrating that mindfulness based interventions can be very helpful with such issues. Dalen et al. (2010)conducted a six week mindfulness class that showed numerous beneficial outcomes on eating variables as well as emotional factors. Participants reported weight loss, reductions in binge eating, increases in feelings of control around food, and improvements in their levels of stress and depression. Daubenmier et al. (2011) conducted a four month mindfulness based program for stress eating. Obese treatment participants showed large decreases in cortisol secretion. Although they did not lose weight over the course of the study, they maintained their weight, whereas control group participants gained weight and showed no changes in cortisol. Finally, a one day mindfulness and acceptance workshop (Lillis et al., 2011) was found to decrease self reported binge eating in a three month follow up.

Mindfulness based interventions enable individuals to become more accepting of internal experiences rather than avoidant. Being able calmly and compassionately to sit with a painful feeling and to recognize it as a transient mental event lessens the urge to self-medicate with food. Becoming more aware of what hunger and satiety feel like promotes more attuned responses to these signals from the self.  Such attunement fosters the development of an sensible eating program that may result in weight loss.

February 20, 2012

What is Concierge Medicine?

From our friends at balancedmag.com, an explanation of concierge services:

Out of America’s growing healthcare dysfunction emerges a new, healthier trend – Concierge Medicine. Also known as boutique medicine, this fast-growing concept requires that patients pay an annual retainer, or fee, similar to those that attorneys charge clients. Concierge physicians limit the number of patients they see greatly reducing overall caseload and allowing them to spend more personal time with patients. Those who advocate this healthcare model feel it benefits both the physician and patient by facilitating a more satisfying and thorough appointment experience for patients.

What’s in it for the average patient?

In exchange for the annual fee, patients enjoy same-day appointments with no more long hours in waiting rooms full of others doing the same. Doctors actually know their patients by name and don’t flinch when ordering numerous preventive health screening tests. Patients have access to their personal physicians 24 hours a day, 7 days a week and aren’t burdened by calling a central line with recorded instructions. Some concierge physicians actually give patients a direct number where they can be reached.

A carefully selected, well-trained medical staff works along with each patient and the doctor to ensure patients experience customized, personal healthcare at each visit. Concierge medicine breathes new life into the trusting doctor-patient relationship of yesteryear. Patient amenities include:

  • Physician house calls and emergency home visits
  • Low physician/patient ratios (averaging one-fifth of the patient load per physician seen in most prevailing practice models)
  • Customized healthcare plans
  • Comprehensive preventive testing
  • On-site diagnostic tests
  • Staff scheduling of appointments with referred specialists
  • Treatment and diagnostic test scheduling
  • Curbside transportation service when necessary
  • Staff handles all correspondence with patient insurance plans, when available (some of these practices do not accept insurance), and advocates for the patient regarding approval of services, disputes, etc.