By John Pranger
“The medical establishment has become the major threat to health.”
— Ivan Illich in Limits to Medicine: Medical Nemesis, the Expropriation of Health, 1976
Animals are used by pharmaceutical and chemical companies to test the toxicity of drugs and other substances, including cosmetics, household cleaners, and pesticides—and tobacco. This practice has been regularly criticized by doctors and scientists who maintain that animal testing is unscientific, erroneous, and a danger to human health. It merely performs an alibi function for corporations and governments, who hope to protect themselves thereby from legal liability.
This alibi function was confirmed by James D. Gallagher, then director of medical research for Lederle Laboratories, who complained in the Journal of the American Medical Association in 1964: “Another basic problem which we share as a result of the regulations and the things that prompted them is an unscientific preoccupation with animal studies. Animal studies are done for legal reasons and not for scientific reasons. The predictive value of such studies for man is meaningless—which means our research may be meaningless.”
See also
Abolitionists in animal rights movement push for vegan society
Peter Fricker: Mountain View centre must be accountable for welfare of captive animals
The biological variations between species make the results of experiments done on one species inapplicable to any other species, including humans. In addition to this, the various diseases which plague human beings either do not occur naturally in non-humans or they take on a very different form. Put simply, animals can never have human disease due to the basic biological fact that they are not human.
Cigarette smoking is a factor in many diseases, causing an estimated 443,000 deaths each year in the U.S. alone. Why are cigarettes still legal when they are proven harmful? Epidemiology has shown, for instance, that persons who smoke are far more likely to die of lung cancer than persons who do not smoke. Numerous large population studies have been undertaken, and there is not a single retrospective or prospective controlled study that has failed to show that cigarette smoking causes human lung cancer.
In stark contrast to the consistently positive findings linking cigarette smoking to lung cancer in humans, the results of decades of animal experiments are highly contradictory. Most animal studies have failed to show that cigarettes cause cancer.
Perversely, denying medical facts, researchers are forcing animals to inhale cigarette smoke to this day, no scientists having yet succeeded in causing the human type of lung cancer in animals. In 1975’s The Unseen Fight Against Cancer, Dr. Thelma Brumfield Dunn writes: “the induction of lung cancer by tobacco smoking has not been achieved. Almost every conceivable experiment has been devised to induce lung cancers in animals that would duplicate the lung cancers found in man. Chickens and dogs were made to smoke and to inhale, but no convincing lung cancers developed. Hundreds of mice spent a lifetime in smoke-filled rooms yet no increase in lung cancer was found.”
Because of animal studies’ failure to show that cigarette smoking causes cancer, wider and speedy acceptance of the cigarette-lung cancer theory has been seriously retarded, although it is firmly based on studies of actual human populations. Tobacco companies have used the legal alibi of animal testing to keep their products on the market and to frustrate all attempts at instituting meaningful regulation and public health measures. In 1993, the New York Times quoted sworn testimony of William Campbell, then president and CEO of cigarette manufacturer Phillip Morris USA:
Q: “Does cigarette smoking cause cancer?”
A: “To my knowledge, it’s not been proven that cigarette smoking causes cancer.”
Q: “What do you base that on?”
A: “I base that on the fact that traditionally, there is, you know, in scientific terms, there are hurdles related to causation, and at this time there is no evidence that -- they have not been able to reproduce cancer in animals from cigarette smoking.”
Animal studies are almost unbelievably contrived and crude. Dogs with erections (don’t ask how) were forced to inhale cigarette smoke. Most of the dogs failed to maintain an erection after the smoke was inhaled. In the Journal of Urology in 1987, researchers said this observation lent support to the clinical observation that smoking interfered with a man’s ability to maintain an erection.
Laughable or worrying? Why do we have to give our money to people who conjure up such mad science behind locked doors? Why does government continue funding animal experiments with our taxes in spite of their proven inability to cure or prevent disease?
Nearly a century of tormenting animals with cigarette smoke and what’s the upshot? 5.4 million Canadians are addicted to cigarettes—the leading cause of preventable death—and 45,000 Canadians die from smoking each year and that number is growing. When will the “scientists” be satisfied that smoking is unhealthy and that we don’t need their “confirmation” to know this?
John Pranger is the director of communications for the Animal Defense & Anti-Vivisection Society of British Columbia.
Tuesday, February 2, 2010
Monday, November 16, 2009
Vitamin D and Endurance Exercise
Nutrition
November 16 2009
Comments
Low vitamin D levels are very likely limiting your running performance, and may compromise your health.
Written by: Reyana Ewing, MPH, RD, CLE
As runners we want to do everything possible to perform well and have a great season. We are meticulous about our training schedules, hydration, sleeping habits, etc. Yet many times we fall short when it comes to nutrition.
My Story
In the summer of 2008 I started to feel rather lethargic during workouts and I struggled to maintain my normal training paces. My recovery from my harder efforts and long runs took longer than usual. I immediately and incorrectly assumed I had low serum ferritin levels indicating iron deficiency anemia.
One colleague to whom I lamented about my chronic fatigue asked me if I had checked my vitamin D levels. “Vitamin D levels?” I exclaimed. I live in California, it is summer, and I am outside way more than the recommended 20 to 30 minutes a day. There is no way I could be vitamin D deficient, especially since in addition to being exposed to sun most days, I eat a very balanced diet that includes a daily multivitamin supplement. However, a visit to my doctor confirmed that my serum 25–hydroxy-vitamin D (25(OH)D) value was dangerously low (18 ng/ml). Normal levels are between 40-70 ng/ml. And for those with chronic diseases such as cancer, heart disease, diabetes, and multiple sclerosis, normal blood levels should be between 55-70 ng/ml. I was shocked.
I immediately started daily supplementation with 1000 IU of vitamin D (Vitamin D3). After 8 weeks, my 25(OH)D level had improved somewhat (28 ng/ml). I did feel slightly better, but I wanted to recover completely, so I upped my dosage to 2000 IU daily. A few weeks later my levels were within the normal range (56 ng/ml). I felt noticeably stronger and was able to hit my usual paces during training. And in October 2008, I set a half marathon personal record.
Deficiency
This was my very first experience with vitamin D deficiency and I have since learned that vitamin D deficiency is becoming an epidemic worldwide, not only in geographic regions where sun exposure is limited. And my discussions with fellow dietitians working with college runners and professional athletes in generally sunny states (Texas and Florida) confirmed the alarming prevalence of vitamin D deficiency across ethnicity and gender.
Athletes who live in northern latitudes (north of 35 degrees), or use sunscreen consistently, perform their sport indoors, or keep their skin covered are at the greatest risk. Melanin affects the production of vitamin D. So those with more melanin or darker skin produce less vitamin D. Since vitamin D is a fat-soluble vitamin, athletes with fat malabsorption problems such as cystic fibrosis, Crohn’s disease, and celiac disease are at risk for deficiency. Those who have normal levels typically (around 50 ng/ml) live in sub-equatorial Africa and work outdoors for most of the summer.
Once thought of as being primarily involved in bone development, activated vitamin D (calcitriol), a steroid hormone, is responsible for regulating more than 1000 human genes. Almost every cell in the human body has receptors for vitamin D. Recent research shows that vitamin D deficiency increases the risk of different types of cancer (such as breast cancer and prostate cancer), as well as heart disease, diabetes, depression, autoimmune diseases, hypertension, obesity, gum disease, chronic pain, muscle wasting, inflammation, birth defects, osteoporosis, influenza and colds, etc.
Importance for Endurance Athletes
We are only just beginning to understand the complexity and importance of vitamin D in relation to health. Of importance to athletes is the function of vitamin D as it relates to overall health, bone density, innate immunity, muscle wasting, and exercise-related inflammation and immunity. To train and race optimally, an athlete should not have any nutrient deficiencies.
Bone Health:
Deena Kastor, Olympic Marathoner, broke her foot in Beijing during the 2008 Olympic Marathon. It was discovered that her calcium levels were normal, but her 25(OH)D levels were reported to be around 15 ng/ml. And Kastor lives in sunny California. Because of an early scare with skin cancer, she is known to apply sunscreen for all of her outdoor runs, thus limiting her ability to manufacture vitamin D from sun exposure. Even with the extensive research to show vitamin D and calcium’s role in preventing osteoporosis, elite, college, and high school athletes continue to be deficient in one or both nutrient(s). Stress fractures are quite prevalent in runners and yet so preventable.
Increased VO2 max:
German research studies dating back to the 1950s show that athletes exposed to vitamin D-producing ultraviolet light had improved athletic performance. Other studies showed that athletic performance peaked at the end of the summer. Peak performance was also associated with 25(OH)D levels around 50 ng/ml. In addition, maximal oxygen uptake was found to drop when less ultraviolet rays reached the earth, for example, in the late fall. This is particularly a problem for marathoners training through the summer for fall marathons.
Reduced Inflammation:
After intense exercise, endurance athletes experience inflammation due to elevated levels of pro-inflammatory cytokines. Vitamin D reduces the production of these cytokines while increasing the production of anti-inflammatory cytokines, thereby speeding the recovery process between hard workouts.
Improved Immunity:
In a February 2009 study published in the Archives of Internal Medicine, vitamin D3 levels were tested in 19, 000 Americans. Those with low levels of vitamin D had the highest incidence of colds and influenza. This is important information for endurance athletes who strive to balance heavy training loads and staying healthy.
What can be done?
Check 25(OH)D levels regularly and supplement as needed.
Check for total 25(OH)D and not 1, 25(OH)D, which will tell you nothing about your blood stores. Total 25(OH)D reflects all sources of vitamin D – from food, UV energy (photo-production), and supplementation.
Deficient athletes measuring less than 30 ng/ml should supplement with 20,000 IU to
50, 000 IU of vitamin D3 per week for 8 weeks andrecheck serum 25(OH)D until normal values are attained.
Get regular, safe, twice-daily (5-30 minutes) exposure to sun between the hours of 10 am and 3 pm. Note that sunscreen and glass (being indoors) reduce or block UV energy.
Supplement with 1000 IU to 2000 IU of vitamin D3 to maintain normal levels.
For those living or competing in northern latitudes (north of Atlanta, GA) little to no vitamin D production will occur, so consumption of fortified foods and supplements is a necessity.
Food Sources of vitamin D
There aren’t many naturally occurring foods that contain vitamin D. Most of the foods containing vitamin D have been fortified, for example milk and certain juices.
Table 1. Food Sources of Vitamin D FOOD Serving IU per serving *
Fish liver oils (cod liver oil) 1TBSP 1360
Herring, cooked 3 oz 1383
Wild salmon, cooked 3.5 oz 981
Farm salmon, cooked 3.5 oz 249
Tuna, canned in oil 3.5 oz 200
Milk, non fat, reduced fat, whole (fortified) 8 oz 100
Margarine, fortified 1 TBSP 60
Egg 1 whole 18
Beef, liver 3.5 oz 15
Cheese 1 oz 12
*IU = International Units
Dietary Supplement Fact Sheet. National Institute of Health (2007)
Caution
High intakes of vitamin D can cause nausea, vomiting, poor appetite, weakness, and constipation. Current safe upper limits are set at 2000 IU by the National Institute of Health, but there are newer data supporting upper limits as high as 10,000 IU per day.
***
Reyana Ewing. Photo courtesy: Fuel to Move.
Reyana Ewing, MPH, RD, CLE is a registered dietitian, sports dietitian and runner based in Santa Rosa, Calif. Find our more about her at www.fueltomove.com
November 16 2009
Comments
Low vitamin D levels are very likely limiting your running performance, and may compromise your health.
Written by: Reyana Ewing, MPH, RD, CLE
As runners we want to do everything possible to perform well and have a great season. We are meticulous about our training schedules, hydration, sleeping habits, etc. Yet many times we fall short when it comes to nutrition.
My Story
In the summer of 2008 I started to feel rather lethargic during workouts and I struggled to maintain my normal training paces. My recovery from my harder efforts and long runs took longer than usual. I immediately and incorrectly assumed I had low serum ferritin levels indicating iron deficiency anemia.
One colleague to whom I lamented about my chronic fatigue asked me if I had checked my vitamin D levels. “Vitamin D levels?” I exclaimed. I live in California, it is summer, and I am outside way more than the recommended 20 to 30 minutes a day. There is no way I could be vitamin D deficient, especially since in addition to being exposed to sun most days, I eat a very balanced diet that includes a daily multivitamin supplement. However, a visit to my doctor confirmed that my serum 25–hydroxy-vitamin D (25(OH)D) value was dangerously low (18 ng/ml). Normal levels are between 40-70 ng/ml. And for those with chronic diseases such as cancer, heart disease, diabetes, and multiple sclerosis, normal blood levels should be between 55-70 ng/ml. I was shocked.
I immediately started daily supplementation with 1000 IU of vitamin D (Vitamin D3). After 8 weeks, my 25(OH)D level had improved somewhat (28 ng/ml). I did feel slightly better, but I wanted to recover completely, so I upped my dosage to 2000 IU daily. A few weeks later my levels were within the normal range (56 ng/ml). I felt noticeably stronger and was able to hit my usual paces during training. And in October 2008, I set a half marathon personal record.
Deficiency
This was my very first experience with vitamin D deficiency and I have since learned that vitamin D deficiency is becoming an epidemic worldwide, not only in geographic regions where sun exposure is limited. And my discussions with fellow dietitians working with college runners and professional athletes in generally sunny states (Texas and Florida) confirmed the alarming prevalence of vitamin D deficiency across ethnicity and gender.
Athletes who live in northern latitudes (north of 35 degrees), or use sunscreen consistently, perform their sport indoors, or keep their skin covered are at the greatest risk. Melanin affects the production of vitamin D. So those with more melanin or darker skin produce less vitamin D. Since vitamin D is a fat-soluble vitamin, athletes with fat malabsorption problems such as cystic fibrosis, Crohn’s disease, and celiac disease are at risk for deficiency. Those who have normal levels typically (around 50 ng/ml) live in sub-equatorial Africa and work outdoors for most of the summer.
Once thought of as being primarily involved in bone development, activated vitamin D (calcitriol), a steroid hormone, is responsible for regulating more than 1000 human genes. Almost every cell in the human body has receptors for vitamin D. Recent research shows that vitamin D deficiency increases the risk of different types of cancer (such as breast cancer and prostate cancer), as well as heart disease, diabetes, depression, autoimmune diseases, hypertension, obesity, gum disease, chronic pain, muscle wasting, inflammation, birth defects, osteoporosis, influenza and colds, etc.
Importance for Endurance Athletes
We are only just beginning to understand the complexity and importance of vitamin D in relation to health. Of importance to athletes is the function of vitamin D as it relates to overall health, bone density, innate immunity, muscle wasting, and exercise-related inflammation and immunity. To train and race optimally, an athlete should not have any nutrient deficiencies.
Bone Health:
Deena Kastor, Olympic Marathoner, broke her foot in Beijing during the 2008 Olympic Marathon. It was discovered that her calcium levels were normal, but her 25(OH)D levels were reported to be around 15 ng/ml. And Kastor lives in sunny California. Because of an early scare with skin cancer, she is known to apply sunscreen for all of her outdoor runs, thus limiting her ability to manufacture vitamin D from sun exposure. Even with the extensive research to show vitamin D and calcium’s role in preventing osteoporosis, elite, college, and high school athletes continue to be deficient in one or both nutrient(s). Stress fractures are quite prevalent in runners and yet so preventable.
Increased VO2 max:
German research studies dating back to the 1950s show that athletes exposed to vitamin D-producing ultraviolet light had improved athletic performance. Other studies showed that athletic performance peaked at the end of the summer. Peak performance was also associated with 25(OH)D levels around 50 ng/ml. In addition, maximal oxygen uptake was found to drop when less ultraviolet rays reached the earth, for example, in the late fall. This is particularly a problem for marathoners training through the summer for fall marathons.
Reduced Inflammation:
After intense exercise, endurance athletes experience inflammation due to elevated levels of pro-inflammatory cytokines. Vitamin D reduces the production of these cytokines while increasing the production of anti-inflammatory cytokines, thereby speeding the recovery process between hard workouts.
Improved Immunity:
In a February 2009 study published in the Archives of Internal Medicine, vitamin D3 levels were tested in 19, 000 Americans. Those with low levels of vitamin D had the highest incidence of colds and influenza. This is important information for endurance athletes who strive to balance heavy training loads and staying healthy.
What can be done?
Check 25(OH)D levels regularly and supplement as needed.
Check for total 25(OH)D and not 1, 25(OH)D, which will tell you nothing about your blood stores. Total 25(OH)D reflects all sources of vitamin D – from food, UV energy (photo-production), and supplementation.
Deficient athletes measuring less than 30 ng/ml should supplement with 20,000 IU to
50, 000 IU of vitamin D3 per week for 8 weeks andrecheck serum 25(OH)D until normal values are attained.
Get regular, safe, twice-daily (5-30 minutes) exposure to sun between the hours of 10 am and 3 pm. Note that sunscreen and glass (being indoors) reduce or block UV energy.
Supplement with 1000 IU to 2000 IU of vitamin D3 to maintain normal levels.
For those living or competing in northern latitudes (north of Atlanta, GA) little to no vitamin D production will occur, so consumption of fortified foods and supplements is a necessity.
Food Sources of vitamin D
There aren’t many naturally occurring foods that contain vitamin D. Most of the foods containing vitamin D have been fortified, for example milk and certain juices.
Table 1. Food Sources of Vitamin D FOOD Serving IU per serving *
Fish liver oils (cod liver oil) 1TBSP 1360
Herring, cooked 3 oz 1383
Wild salmon, cooked 3.5 oz 981
Farm salmon, cooked 3.5 oz 249
Tuna, canned in oil 3.5 oz 200
Milk, non fat, reduced fat, whole (fortified) 8 oz 100
Margarine, fortified 1 TBSP 60
Egg 1 whole 18
Beef, liver 3.5 oz 15
Cheese 1 oz 12
*IU = International Units
Dietary Supplement Fact Sheet. National Institute of Health (2007)
Caution
High intakes of vitamin D can cause nausea, vomiting, poor appetite, weakness, and constipation. Current safe upper limits are set at 2000 IU by the National Institute of Health, but there are newer data supporting upper limits as high as 10,000 IU per day.
***
Reyana Ewing. Photo courtesy: Fuel to Move.
Reyana Ewing, MPH, RD, CLE is a registered dietitian, sports dietitian and runner based in Santa Rosa, Calif. Find our more about her at www.fueltomove.com
Sunday, May 24, 2009
Brain Power - At the Bridge Table, Clues to a Lucid Old Age
May 22, 2009
By BENEDICT CAREY
LAGUNA WOODS, Calif. — The ladies in the card room are playing bridge, and at their age the game is no hobby. It is a way of life, a daily comfort and challenge, the last communal campfire before all goes dark.
“We play for blood,” says Ruth Cummins, 92, before taking a sip of Red Bull at a recent game.
“It’s what keeps us going,” adds Georgia Scott, 99. “It’s where our closest friends are.”
In recent years scientists have become intensely interested in what could be called a super memory club — the fewer than one in 200 of us who, like Ms. Scott and Ms. Cummins, have lived past 90 without a trace of dementia. It is a group that, for the first time, is large enough to provide a glimpse into the lucid brain at the furthest reach of human life, and to help researchers tease apart what, exactly, is essential in preserving mental sharpness to the end.
“These are the most successful agers on earth, and they’re only just beginning to teach us what’s important, in their genes, in their routines, in their lives,” said Dr. Claudia Kawas, a neurologist at the University of California, Irvine. “We think, for example, that it’s very important to use your brain, to keep challenging your mind, but all mental activities may not be equal. We’re seeing some evidence that a social component may be crucial.”
Laguna Woods, a sprawling retirement community of 20,000 south of Los Angeles, is at the center of the world’s largest decades-long study of health and mental acuity in the elderly. Begun by University of Southern California researchers in 1981 and called the 90+ Study, it has included more than 14,000 people aged 65 and older, and more than 1,000 aged 90 or older.
Such studies can take years to bear fruit, and the results of this study are starting to alter the way scientists understand the aging brain. The evidence suggests that people who spend long stretches of their days, three hours and more, engrossed in some mental activities like cards may be at reduced risk of developing dementia. Researchers are trying to tease apart cause from effect: Are they active because they are sharp, or sharp because they are active?
The researchers have also demonstrated that the percentage of people with dementia after 90 does not plateau or taper off, as some experts had suspected. It continues to increase, so that for the one in 600 people who make it to 95, nearly 40 percent of the men and 60 percent of the women qualify for a diagnosis of dementia.
At the same time, findings from this and other continuing studies of the very old have provided hints that some genes may help people remain lucid even with brains that show all the biological ravages of Alzheimer’s disease. In the 90+ Study here, now a joint project run by U.S.C. and the University of California, Irvine, researchers regularly run genetic tests, test residents’ memory, track their activities, take blood samples, and in some cases do postmortem analyses of their brains. Researchers at Irvine maintain a brain bank of more than 100 specimens.
To move into the gated village of Laguna Woods, a tidy array of bungalows and condominiums that blends easily into southern Orange County, people must meet several requirements, one of which is that they do not need full-time care. Their minds are sharp when they arrive, whether they are 65 or 95.
They begin a new life here. Make new friends. Perhaps connect with new romantic partners. Try new activities, at one of the community’s fitness centers; or new hobbies, in the more than 400 residents’ clubs. They are as busy as arriving freshmen at a new campus, with one large difference: they are less interested in the future, or in the past.
“We live for the day,” said Dr. Leon Manheimer, a longtime resident who is in his 90s.
Yet it is precisely that ability to form new memories of the day, the present, that usually goes first in dementia cases, studies in Laguna Woods and elsewhere have found.
The very old who live among their peers know this intimately, and have developed their own expertise, their own laboratory. They diagnose each other, based on careful observation. And they have learned to distinguish among different kinds of memory loss, which are manageable and which ominous.
A Seat at the Table
Here at Laguna Woods, many residents make such delicate calculations in one place: the bridge table.
Contract bridge requires a strong memory. It involves four players, paired off, and each player must read his or her partner’s strategy by closely following what is played. Good players remember every card played and its significance for the team. Forget a card, or fall behind, and it can cost the team — and the social connection — dearly.
“When a partner starts to slip, you can’t trust them,” said Julie Davis, 89, a regular player living in Laguna Woods. “That’s what it comes down to. It’s terrible to say it that way, and worse to watch it happen. But other players get very annoyed. You can’t help yourself.”
At the Friday afternoon bridge game, Ms. Cummins and Ms. Scott sit with two other players, both women in their 90s. Gossip flows freely between hands, about residents whose talk is bigger than their game, about a 100-year-old man who collapsed and died that week in an exercise class.
But the women are all business during play.
“What was that you played, a spade was it?” a partner asks Ms. Cummins.
“Yes, a spade,” says Ms. Cummins, with some irritation. “It was a spade.”
Later, the partner stares uncertainly at the cards on the table. “Is that ——”
“We played that trick already,” Ms. Cummins says. “You’re a trick behind.”
Most regular players at Laguna Woods know of at least one player who, embarrassed by lapses, bowed out of the regular game. “A friend of mine, a very good player, when she thought she couldn’t keep up, she automatically dropped out,” Ms. Cummins said. “That’s usually what happens.”
Yet it is part of the tragedy of dementia that, in many cases, the condition quickly robs people of self-awareness. They will not voluntarily abandon the one thing that, perhaps more than any other, defines their daily existence.
“And then it’s really tough,” Ms. Davis said. “I mean, what do you do? These are your friends.”
Staying in the Game
So far, scientists here have found little evidence that diet or exercise affects the risk of dementia in people over 90. But some researchers argue that mental engagement — doing crossword puzzles, reading books — may delay the arrival of symptoms. And social connections, including interaction with friends, may be very important, some suspect. In isolation, a healthy human mind can go blank and quickly become disoriented, psychologists have found.
“There is quite a bit of evidence now suggesting that the more people you have contact with, in your own home or outside, the better you do” mentally and physically, Dr. Kawas said. “Interacting with people regularly, even strangers, uses easily as much brain power as doing puzzles, and it wouldn’t surprise me if this is what it’s all about.”
And bridge, she added, provides both kinds of stimulation.
The unstated rule at Laguna Woods is to support a friend who is slipping, to act as a kind of memory supplement. “We’re all afraid to lose memory; we’re all at risk of that,” said one regular player in her 90s, who asked not to be named.
Woody Bowersock, 96, a former school principal, helped a teammate on a swim team at Laguna Woods to race even as dementia stole the man’s ability to form almost any new memory.
“You’d have to put him up on the platform just before the race, just walk him over there,” Mr. Bowersock said. “But if the whistle didn’t blow right away, he’d wander off. I tell you, I’d sometimes have to stand there with him until he was in the water. Then he was fine. A very good swimmer. Freestyle.”
Bridge is a different kind of challenge, but some residents here swear that the very good players can play by instinct even when their memory is dissolving.
“I know a man who’s 95, he is starting with dementia and plays bridge, and he forgets hands,” said Marilyn Ruekberg, who lives in Laguna Woods. “I bring him in as a partner anyway, and by the end we do exceedingly well. I don’t know how he does it, but he has lots of experience in the game.”
Scientists suspect that some people with deep experience in a game like bridge may be able to draw on reserves to buffer against memory lapses. But there is not enough evidence one way or the other to know.
Ms. Ruekberg said she cared less about that than about her friend: “I just want to give him something more during the day than his four walls.”
Drawing the Line
In studies of the very old, researchers in California, New York, Boston and elsewhere have found clues to that good fortune. For instance, Dr. Kawas’s group has found that some people who are lucid until the end of a very long life have brains that appear riddled with Alzheimer’s disease. In a study released last month, the researchers report that many of them carry a gene variant called APOE2, which may help them maintain mental sharpness.
Dr. Nir Barzilai of the Albert Einstein College of Medicine has found that lucid Ashkenazi Jewish centenarians are three times more likely to carry a gene called CETP, which appears to increase the size and amount of so-called good cholesterol particles, than peers who succumbed to dementia.
“We don’t know how this could be protective, but it’s very strongly correlated with good cognitive function at this late age,” Dr. Barzilai said. “And at least it gives us a target for future treatments.”
For those in the super-memory club, that future is too far off to be meaningful. What matters most is continued independence. And that means that, at some point, they have to let go of close friends.
“The first thing you always want to do is run and help them,” Ms. Davis said. “But after a while you end up asking yourself: ‘What is my role here? Am I now the caregiver?’ You have to decide how far you’ll go, when you have your own life to live.”
In this world, as in high school, it is all but impossible to take back an invitation to the party. Some players decide to break up their game, at least for a time, only to reform it with another player. Or, they might suggest that a player drop down a level, from a serious game to a more casual one. No player can stand to hear that. Every day in card rooms around the world, some of them will.
“You don’t play with them, period,” Ms. Cummins said. “You’re not cruel. You’re just busy.”
The rhythm of bidding and taking tricks, the easy conversation between hands, the daily game — after almost a century, even for the luckiest in the genetic lottery, it finally ends.
“People stop playing,” said Norma Koskoff, another regular player here, “and very often when they stop playing, they don’t live much longer.”
By BENEDICT CAREY
LAGUNA WOODS, Calif. — The ladies in the card room are playing bridge, and at their age the game is no hobby. It is a way of life, a daily comfort and challenge, the last communal campfire before all goes dark.
“We play for blood,” says Ruth Cummins, 92, before taking a sip of Red Bull at a recent game.
“It’s what keeps us going,” adds Georgia Scott, 99. “It’s where our closest friends are.”
In recent years scientists have become intensely interested in what could be called a super memory club — the fewer than one in 200 of us who, like Ms. Scott and Ms. Cummins, have lived past 90 without a trace of dementia. It is a group that, for the first time, is large enough to provide a glimpse into the lucid brain at the furthest reach of human life, and to help researchers tease apart what, exactly, is essential in preserving mental sharpness to the end.
“These are the most successful agers on earth, and they’re only just beginning to teach us what’s important, in their genes, in their routines, in their lives,” said Dr. Claudia Kawas, a neurologist at the University of California, Irvine. “We think, for example, that it’s very important to use your brain, to keep challenging your mind, but all mental activities may not be equal. We’re seeing some evidence that a social component may be crucial.”
Laguna Woods, a sprawling retirement community of 20,000 south of Los Angeles, is at the center of the world’s largest decades-long study of health and mental acuity in the elderly. Begun by University of Southern California researchers in 1981 and called the 90+ Study, it has included more than 14,000 people aged 65 and older, and more than 1,000 aged 90 or older.
Such studies can take years to bear fruit, and the results of this study are starting to alter the way scientists understand the aging brain. The evidence suggests that people who spend long stretches of their days, three hours and more, engrossed in some mental activities like cards may be at reduced risk of developing dementia. Researchers are trying to tease apart cause from effect: Are they active because they are sharp, or sharp because they are active?
The researchers have also demonstrated that the percentage of people with dementia after 90 does not plateau or taper off, as some experts had suspected. It continues to increase, so that for the one in 600 people who make it to 95, nearly 40 percent of the men and 60 percent of the women qualify for a diagnosis of dementia.
At the same time, findings from this and other continuing studies of the very old have provided hints that some genes may help people remain lucid even with brains that show all the biological ravages of Alzheimer’s disease. In the 90+ Study here, now a joint project run by U.S.C. and the University of California, Irvine, researchers regularly run genetic tests, test residents’ memory, track their activities, take blood samples, and in some cases do postmortem analyses of their brains. Researchers at Irvine maintain a brain bank of more than 100 specimens.
To move into the gated village of Laguna Woods, a tidy array of bungalows and condominiums that blends easily into southern Orange County, people must meet several requirements, one of which is that they do not need full-time care. Their minds are sharp when they arrive, whether they are 65 or 95.
They begin a new life here. Make new friends. Perhaps connect with new romantic partners. Try new activities, at one of the community’s fitness centers; or new hobbies, in the more than 400 residents’ clubs. They are as busy as arriving freshmen at a new campus, with one large difference: they are less interested in the future, or in the past.
“We live for the day,” said Dr. Leon Manheimer, a longtime resident who is in his 90s.
Yet it is precisely that ability to form new memories of the day, the present, that usually goes first in dementia cases, studies in Laguna Woods and elsewhere have found.
The very old who live among their peers know this intimately, and have developed their own expertise, their own laboratory. They diagnose each other, based on careful observation. And they have learned to distinguish among different kinds of memory loss, which are manageable and which ominous.
A Seat at the Table
Here at Laguna Woods, many residents make such delicate calculations in one place: the bridge table.
Contract bridge requires a strong memory. It involves four players, paired off, and each player must read his or her partner’s strategy by closely following what is played. Good players remember every card played and its significance for the team. Forget a card, or fall behind, and it can cost the team — and the social connection — dearly.
“When a partner starts to slip, you can’t trust them,” said Julie Davis, 89, a regular player living in Laguna Woods. “That’s what it comes down to. It’s terrible to say it that way, and worse to watch it happen. But other players get very annoyed. You can’t help yourself.”
At the Friday afternoon bridge game, Ms. Cummins and Ms. Scott sit with two other players, both women in their 90s. Gossip flows freely between hands, about residents whose talk is bigger than their game, about a 100-year-old man who collapsed and died that week in an exercise class.
But the women are all business during play.
“What was that you played, a spade was it?” a partner asks Ms. Cummins.
“Yes, a spade,” says Ms. Cummins, with some irritation. “It was a spade.”
Later, the partner stares uncertainly at the cards on the table. “Is that ——”
“We played that trick already,” Ms. Cummins says. “You’re a trick behind.”
Most regular players at Laguna Woods know of at least one player who, embarrassed by lapses, bowed out of the regular game. “A friend of mine, a very good player, when she thought she couldn’t keep up, she automatically dropped out,” Ms. Cummins said. “That’s usually what happens.”
Yet it is part of the tragedy of dementia that, in many cases, the condition quickly robs people of self-awareness. They will not voluntarily abandon the one thing that, perhaps more than any other, defines their daily existence.
“And then it’s really tough,” Ms. Davis said. “I mean, what do you do? These are your friends.”
Staying in the Game
So far, scientists here have found little evidence that diet or exercise affects the risk of dementia in people over 90. But some researchers argue that mental engagement — doing crossword puzzles, reading books — may delay the arrival of symptoms. And social connections, including interaction with friends, may be very important, some suspect. In isolation, a healthy human mind can go blank and quickly become disoriented, psychologists have found.
“There is quite a bit of evidence now suggesting that the more people you have contact with, in your own home or outside, the better you do” mentally and physically, Dr. Kawas said. “Interacting with people regularly, even strangers, uses easily as much brain power as doing puzzles, and it wouldn’t surprise me if this is what it’s all about.”
And bridge, she added, provides both kinds of stimulation.
The unstated rule at Laguna Woods is to support a friend who is slipping, to act as a kind of memory supplement. “We’re all afraid to lose memory; we’re all at risk of that,” said one regular player in her 90s, who asked not to be named.
Woody Bowersock, 96, a former school principal, helped a teammate on a swim team at Laguna Woods to race even as dementia stole the man’s ability to form almost any new memory.
“You’d have to put him up on the platform just before the race, just walk him over there,” Mr. Bowersock said. “But if the whistle didn’t blow right away, he’d wander off. I tell you, I’d sometimes have to stand there with him until he was in the water. Then he was fine. A very good swimmer. Freestyle.”
Bridge is a different kind of challenge, but some residents here swear that the very good players can play by instinct even when their memory is dissolving.
“I know a man who’s 95, he is starting with dementia and plays bridge, and he forgets hands,” said Marilyn Ruekberg, who lives in Laguna Woods. “I bring him in as a partner anyway, and by the end we do exceedingly well. I don’t know how he does it, but he has lots of experience in the game.”
Scientists suspect that some people with deep experience in a game like bridge may be able to draw on reserves to buffer against memory lapses. But there is not enough evidence one way or the other to know.
Ms. Ruekberg said she cared less about that than about her friend: “I just want to give him something more during the day than his four walls.”
Drawing the Line
In studies of the very old, researchers in California, New York, Boston and elsewhere have found clues to that good fortune. For instance, Dr. Kawas’s group has found that some people who are lucid until the end of a very long life have brains that appear riddled with Alzheimer’s disease. In a study released last month, the researchers report that many of them carry a gene variant called APOE2, which may help them maintain mental sharpness.
Dr. Nir Barzilai of the Albert Einstein College of Medicine has found that lucid Ashkenazi Jewish centenarians are three times more likely to carry a gene called CETP, which appears to increase the size and amount of so-called good cholesterol particles, than peers who succumbed to dementia.
“We don’t know how this could be protective, but it’s very strongly correlated with good cognitive function at this late age,” Dr. Barzilai said. “And at least it gives us a target for future treatments.”
For those in the super-memory club, that future is too far off to be meaningful. What matters most is continued independence. And that means that, at some point, they have to let go of close friends.
“The first thing you always want to do is run and help them,” Ms. Davis said. “But after a while you end up asking yourself: ‘What is my role here? Am I now the caregiver?’ You have to decide how far you’ll go, when you have your own life to live.”
In this world, as in high school, it is all but impossible to take back an invitation to the party. Some players decide to break up their game, at least for a time, only to reform it with another player. Or, they might suggest that a player drop down a level, from a serious game to a more casual one. No player can stand to hear that. Every day in card rooms around the world, some of them will.
“You don’t play with them, period,” Ms. Cummins said. “You’re not cruel. You’re just busy.”
The rhythm of bidding and taking tricks, the easy conversation between hands, the daily game — after almost a century, even for the luckiest in the genetic lottery, it finally ends.
“People stop playing,” said Norma Koskoff, another regular player here, “and very often when they stop playing, they don’t live much longer.”
Friday, April 3, 2009
CUTTING SALT ISN'T THE ONLY WAY TO REDUCE BLOOD PRESSURE
Study Suggests Boosting Potassium is also Effective
MAYWOOD, Ill. -- Most people know that too much sodium from foods can increase blood pressure.
A new study suggests that people trying to lower their blood pressure should also boost their intake of potassium, which has the opposite effect to sodium.
Researchers found that the ratio of sodium-to-potassium in subjects' urine was a much stronger predictor of cardiovascular disease than sodium or potassium alone.
"There isn't as much focus on potassium, but potassium seems to be effective in lowering blood pressure and the combination of a higher intake of potassium and lower consumption of sodium seems to be more effective than either on its own in reducing the risk of cardiovascular disease," said Dr. Paul Whelton, senior author of the study in the January 2009 issue of the Archives of Internal Medicine. Whelton is an epidemiologist and president and CEO of Loyola University Health System.
Researchers determined average sodium and potassium intake during two phases of a study known as the Trials of Hypertension Prevention. They collected 24-hour urine samples intermittently during an 18-month period in one trial and during a 36-month period in a second trial. The 2,974 study participants initially aged 30-to-54 and with blood pressure readings just under levels considered high, were followed for 10-15 years to see if they would develop cardiovascular disease. Whelton was national chair of the Trials of Hypertension Prevention.
Those with the highest sodium levels in their urine were 20 percent more likely to suffer strokes, heart attacks or other forms of cardiovascular disease compared with their counterparts with the lowest sodium levels. However this link was not strong enough to be considered statistically significant.
By contrast, participants with the highest sodium-to-potassium ratio in urine were 50 percent more likely to experience cardiovascular disease than those with the lowest sodium-to-potassium ratios. This link was statistically significant.
Most previous studies of the relationship between sodium or potassium and cardiovascular disease have had to rely on people's recall or record of what foods they eat to estimate their level of sodium consumption. This is a less precise measure of sodium intake than urine samples. In addition, many have been cross-sectional rather than follow-up studies.
The new study "is a quantum leap in the quality of the data compared to what we have had before," Whelton said.
Whelton was a member of a recent Institute of Medicine panel that set dietary recommendations for salt and potassium. The panel said healthy 19-to-50 year-old adults should consume no more than 2,300 milligrams of sodium per day -- equivalent to one teaspoon of table salt. More than 95 percent of American men and 75 percent of American women in this age range exceed this amount.
To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake. Most American adults aged 31-to-50 consume only about half as much as recommended in the Institute of Medicine report. Changes in diet and physical activity should be under the supervision of a health care professional.
Good potassium sources include fruits, vegetables, dairy foods and fish. Foods that are especially rich in potassium include potatoes and sweet potatoes, fat-free milk and yogurt, tuna, lima beans, bananas, tomato sauce and orange juice. Potassium also is available in supplements.
Whelton is among the nation's top experts on high blood pressure. He has published more than 400 papers on the subject, and has been the principal investigator on more than $100 million of studies funded by the National Institutes of Health.
Co-authors of the Archives study include Nancy Cook (first author), Julie Buring and Dr. Kathryn Rexrode of Brigham and Women's Hospital; Eva Obarzanek and Dr. Jeffrey Cutler of the National Heart, Lung and Blood Institute; Dr. Lawrence Appel of Johns Hopkins University and Shiriki Kumanyika of the University of Pennsylvania.
###
MAYWOOD, Ill. -- Most people know that too much sodium from foods can increase blood pressure.
A new study suggests that people trying to lower their blood pressure should also boost their intake of potassium, which has the opposite effect to sodium.
Researchers found that the ratio of sodium-to-potassium in subjects' urine was a much stronger predictor of cardiovascular disease than sodium or potassium alone.
"There isn't as much focus on potassium, but potassium seems to be effective in lowering blood pressure and the combination of a higher intake of potassium and lower consumption of sodium seems to be more effective than either on its own in reducing the risk of cardiovascular disease," said Dr. Paul Whelton, senior author of the study in the January 2009 issue of the Archives of Internal Medicine. Whelton is an epidemiologist and president and CEO of Loyola University Health System.
Researchers determined average sodium and potassium intake during two phases of a study known as the Trials of Hypertension Prevention. They collected 24-hour urine samples intermittently during an 18-month period in one trial and during a 36-month period in a second trial. The 2,974 study participants initially aged 30-to-54 and with blood pressure readings just under levels considered high, were followed for 10-15 years to see if they would develop cardiovascular disease. Whelton was national chair of the Trials of Hypertension Prevention.
Those with the highest sodium levels in their urine were 20 percent more likely to suffer strokes, heart attacks or other forms of cardiovascular disease compared with their counterparts with the lowest sodium levels. However this link was not strong enough to be considered statistically significant.
By contrast, participants with the highest sodium-to-potassium ratio in urine were 50 percent more likely to experience cardiovascular disease than those with the lowest sodium-to-potassium ratios. This link was statistically significant.
Most previous studies of the relationship between sodium or potassium and cardiovascular disease have had to rely on people's recall or record of what foods they eat to estimate their level of sodium consumption. This is a less precise measure of sodium intake than urine samples. In addition, many have been cross-sectional rather than follow-up studies.
The new study "is a quantum leap in the quality of the data compared to what we have had before," Whelton said.
Whelton was a member of a recent Institute of Medicine panel that set dietary recommendations for salt and potassium. The panel said healthy 19-to-50 year-old adults should consume no more than 2,300 milligrams of sodium per day -- equivalent to one teaspoon of table salt. More than 95 percent of American men and 75 percent of American women in this age range exceed this amount.
To lower blood pressure and blunt the effects of salt, adults should consume 4.7 grams of potassium per day unless they have a clinical condition or medication need that is a contraindication to increased potassium intake. Most American adults aged 31-to-50 consume only about half as much as recommended in the Institute of Medicine report. Changes in diet and physical activity should be under the supervision of a health care professional.
Good potassium sources include fruits, vegetables, dairy foods and fish. Foods that are especially rich in potassium include potatoes and sweet potatoes, fat-free milk and yogurt, tuna, lima beans, bananas, tomato sauce and orange juice. Potassium also is available in supplements.
Whelton is among the nation's top experts on high blood pressure. He has published more than 400 papers on the subject, and has been the principal investigator on more than $100 million of studies funded by the National Institutes of Health.
Co-authors of the Archives study include Nancy Cook (first author), Julie Buring and Dr. Kathryn Rexrode of Brigham and Women's Hospital; Eva Obarzanek and Dr. Jeffrey Cutler of the National Heart, Lung and Blood Institute; Dr. Lawrence Appel of Johns Hopkins University and Shiriki Kumanyika of the University of Pennsylvania.
###
Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 25 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 570-licensed bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children?s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 250-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.
http://loyolamedicine.org/News/News_Releases/news_release_detail.cfm?var_news_release_id=973440913
Thursday, March 26, 2009
Urine Test May ID Unhealthy Diets
Low potassium level indicates poor nutrition, study finds
Posted March 26, 2009
By Kathleen Doheny
HealthDay Reporter
THURSDAY, March 26 (HealthDay News) -- Someday, a doctor's office assessment of the overall quality of your diet may come from a simple $8 urine test, researchers report.
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Yale Lab Discovers New Gene-Based Syndrome
Levels of urinary potassium correlate closely with nutrition in general, said study author Dr. Alexander Logan, a professor of medicine at the University of Toronto.
"We can identify people who are eating a poor quality diet by a simple urine test and can recommend an intervention," said Logan, who is also senior scientist at the university's Samuel Lunenfeld Research Institute.
Simply questioning people about their diet isn't as foolproof, he added. "One can get a general idea of [intake of] fruits, vegetables and dairy by asking," he said. But self-reports are notoriously inaccurate. So, Logan's team evaluated 24-hour urine samples from 220 people, aged 18 to 50, all diagnosed with kidney stones.
The participants answered food questionnaires about their food intake and had their weight, height and blood pressure measured.
Logan's team then looked to see if urinary potassium and sodium levels could correlate to diet quality.
They found that the higher the potassium level in urine, the higher the intake of recommended healthy foods such as fruits, vegetables, whole grains and low-fat dairy products.
The lower the potassium, the more likely the food reports were to include more red meat, fast food and sugary, high-calorie drinks.
Those with the highest levels of urinary potassium also tended to have a lower body mass index (BMI), lower diastolic blood pressure and a lower heart rate than did those with lower levels. For instance, people with the highest potassium levels averaged a BMI of 26.5 (under 25 is desirable), while those with the lowest potassium levels had an average BMI of 28.7 (a BMI of 30 is the accepted threshold for obesity).
Sodium levels were not associated with any of those variables, the team found.
The study is published in the April 2009 issue of The Journal of Nutrition.
The Logan research is "an excellent study," said Judith Stern, a distinguished professor of nutrition at the University of California at Davis, who was not involved in the study but reviewed it. Consumers might ask their physician for the test to see if their diet is as healthy as they might think, she said.
"This study supports the [medical] literature that the amount of potassium in urine may objectively measure diet quality," added Jeannie Gazzaniga-Moloo, a dietitian in Roseville, Calif., and a spokeswoman for the American Dietetic Association. "However, the study looked at 24-hour urine collections, which are cumbersome, time-consuming and impractical for some patients," she said.
Moloo called for more research to further validate the findings.
Logan said his team can probably simplify the test to make it a one-time measurement. In the meantime, he advises consumers to pay attention to their fruit and vegetable intake and to follow other healthy dietary guidelines, such as eating three servings of dairy products a day, choosing either low- or no-fat varieties if weight control is a concern.
Logan said his team also plans to study the value of the test in people besides those with kidney disease, including those with irritable bowel syndrome, many of whom eat a poor diet.
More information
To learn more about the dietary guidelines, visit the U.S. Department of Health and Human Services.
Posted March 26, 2009
By Kathleen Doheny
HealthDay Reporter
THURSDAY, March 26 (HealthDay News) -- Someday, a doctor's office assessment of the overall quality of your diet may come from a simple $8 urine test, researchers report.
People Who Read This Also Read
U.S. Asked to Do More for Kids' Mental Health
Good Parents, Bad Results
Few Hospitals Embracing Electronic Health Record Systems
Using Too Much Salt Is Common in U.S., CDC Says
Yale Lab Discovers New Gene-Based Syndrome
Levels of urinary potassium correlate closely with nutrition in general, said study author Dr. Alexander Logan, a professor of medicine at the University of Toronto.
"We can identify people who are eating a poor quality diet by a simple urine test and can recommend an intervention," said Logan, who is also senior scientist at the university's Samuel Lunenfeld Research Institute.
Simply questioning people about their diet isn't as foolproof, he added. "One can get a general idea of [intake of] fruits, vegetables and dairy by asking," he said. But self-reports are notoriously inaccurate. So, Logan's team evaluated 24-hour urine samples from 220 people, aged 18 to 50, all diagnosed with kidney stones.
The participants answered food questionnaires about their food intake and had their weight, height and blood pressure measured.
Logan's team then looked to see if urinary potassium and sodium levels could correlate to diet quality.
They found that the higher the potassium level in urine, the higher the intake of recommended healthy foods such as fruits, vegetables, whole grains and low-fat dairy products.
The lower the potassium, the more likely the food reports were to include more red meat, fast food and sugary, high-calorie drinks.
Those with the highest levels of urinary potassium also tended to have a lower body mass index (BMI), lower diastolic blood pressure and a lower heart rate than did those with lower levels. For instance, people with the highest potassium levels averaged a BMI of 26.5 (under 25 is desirable), while those with the lowest potassium levels had an average BMI of 28.7 (a BMI of 30 is the accepted threshold for obesity).
Sodium levels were not associated with any of those variables, the team found.
The study is published in the April 2009 issue of The Journal of Nutrition.
The Logan research is "an excellent study," said Judith Stern, a distinguished professor of nutrition at the University of California at Davis, who was not involved in the study but reviewed it. Consumers might ask their physician for the test to see if their diet is as healthy as they might think, she said.
"This study supports the [medical] literature that the amount of potassium in urine may objectively measure diet quality," added Jeannie Gazzaniga-Moloo, a dietitian in Roseville, Calif., and a spokeswoman for the American Dietetic Association. "However, the study looked at 24-hour urine collections, which are cumbersome, time-consuming and impractical for some patients," she said.
Moloo called for more research to further validate the findings.
Logan said his team can probably simplify the test to make it a one-time measurement. In the meantime, he advises consumers to pay attention to their fruit and vegetable intake and to follow other healthy dietary guidelines, such as eating three servings of dairy products a day, choosing either low- or no-fat varieties if weight control is a concern.
Logan said his team also plans to study the value of the test in people besides those with kidney disease, including those with irritable bowel syndrome, many of whom eat a poor diet.
More information
To learn more about the dietary guidelines, visit the U.S. Department of Health and Human Services.
Tuesday, March 3, 2009
Harvard Medical School in Ethics Quandary
Harvard Medical School students like Kirsten Austad, left; Lekshmi Santhosh, Kim Sue and David Tian, members of the American Medical Student Association, object to the influence of drug companies in the school’s educational curriculum.
By DUFF WILSON
BOSTON — In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.
Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.
“I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”
Mr. Zerden’s minor stir four years ago has lately grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty, intent on exposing and curtailing the industry influence in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes.
They say they are concerned that the same money that helped build the school’s world-class status may in fact be hurting its reputation and affecting its teaching.
The students argue, for example, that Harvard should be embarrassed by the F grade it recently received from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money.
Harvard Medical School’s peers received much higher grades, ranging from the A for the University of Pennsylvania, to B’s received by Stanford, Columbia and New York University, to the C for Yale.
Harvard has fallen behind, some faculty and administrators say, because its teaching hospitals are not owned by the university, complicating reform; because the dean is fairly new and his predecessor was such an industry booster that he served on a pharmaceutical company board; and because a crackdown, simply put, could cost it money or faculty.
Further, the potential embarrassments — a Senate investigation of several medical professors, the F grade, a new state law effective July 1 requiring Massachusetts doctors to disclose corporate gifts over $50 — are only now adding to pressure for change.
The dean, Dr. Jeffrey S. Flier, who says he wants Harvard to catch up with the best practices at other leading medical schools, recently announced a 19-member committee to re-examine his school’s conflict-of-interest policies. The group, which includes three students, is to meet in private on Thursday.
Advising the group will be Dr. David Korn, a former dean of the Stanford Medical School who started work at Harvard about four months ago as vice provost for research. Last year he helped the Association of American Medical Colleges draft a model conflict-of-interest policy for medical schools.
The Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class — a blanket policy that has been adopted by no other leading medical school. (One Harvard professor’s disclosure in class listed 47 company affiliations.)
“Harvard needs to live up to its name,” said Kirsten Austad, 24, a first-year Harvard Medical student who is one of the movement’s leaders. “We are really being indoctrinated into a field of medicine that is becoming more and more commercialized.”
David Tian, 24, a first-year Harvard Medical student, said: “Before coming here, I had no idea how much influence companies had on medical education. And it’s something that’s purposely meant to be under the table, providing information under the guise of education when that information is also presented for marketing purposes.”
The students say they worry that pharmaceutical industry scandals in recent years — including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims — have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members.
Dr. Flier says that the Harvard Medical faculty may lead the nation in receiving money from industry, as well as government and charities, and he does not want to tighten the spigot. “One entirely appropriate source, if done properly, is industrial funds,” Dr. Flier said in an interview.
And school officials see corporate support for their faculty as all the more crucial, as the university endowment has lost 22 percent of its value since last July and the recession has caused philanthropic contributors to retrench. The school said it was unable to provide annual measures of the money flow to its faculty, beyond the $8.6 million that pharmaceutical companies contributed last year for basic science research and the $3 million for continuing education classes on campus. Most of the money goes to professors at the Harvard-affiliated teaching hospitals, and the dean’s office does not keep track of the total.
But no one disputes that many individual Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees. Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck.
The rules, though, do not require them to report specific amounts received for speaking or consulting, other than broad indications like “more than $30,000.” Some faculty who conduct research have limits of $30,000 in stock and $20,000 a year in fees. But there are no limits on companies’ making outright gifts to faculty — free meals, tickets, trips or the like.
Other blandishments include industry-endowed chairs like the three Harvard created with $8 million from sleep research companies; faculty prizes like the $50,000 award named after Bristol-Myers Squibb, and sponsorships like Pfizer’s $1 million annual subsidy for 20 new M.D.’s in a two-year program to learn clinical investigation and pursue Harvard Master of Medical Science degrees, including classes taught by Pfizer scientists.
Dr. Flier, who became dean 17 months ago, previously received a $500,000 research grant from Bristol-Myers Squibb. He also consulted for three Cambridge biotechnology companies, but says that those relationships have ended and that he has accepted no new industry affiliations.
That is in contrast to his predecessor as dean, Dr. Joseph B. Martin. Harvard’s rules allowed Dr. Martin to sit on the board of the medical products company Baxter International for 5 of the 10 years he led the medical school, supplementing his university salary with up to $197,000 a year from Baxter, according to company filings.
Dr. Martin is still on the medical faculty and is founder and co-chairman of the Harvard NeuroDiscovery Center, which researches degenerative diseases, and actively solicits industry money to do so. Dr. Martin declined any comment.
A smaller rival faction among Harvard’s 750 medical students has circulated a petition signed by about 100 people that calls for “continued interaction between medicine and industry at Harvard Medical School.”
A leader of the group, Vijay Yanamadala, 22, said, “To say that because these industry sources are inherently biased, physicians should never listen to them, is wrong.”
Encouraging them is Dr. Thomas P. Stossel, a Harvard Medical professor who has served on advisory boards for Merck, Biogen Idec and Dyax, and has written widely on academic-industry ties. “I think if you look at it with intellectual honesty, you see industry interaction has produced far more good than harm,” Dr. Stossel said. “Harvard absolutely could get more from industry but I think they’re very skittish. There’s a huge opportunity we ought to mine.”
Brian Fuchs, 26, a second-year student from Queens, credited drug companies with great medical discoveries. “It’s not a problem,” he said, pointing out a classroom window to a 12-story building nearby. “In fact, Merck is right there.”
Merck built a corporate research center in 2004 across the street from Harvard’s own big new medical research and class building. And Merck underwrites plenty of work on the Harvard campus, including the immunology lab run by Dr. Laurie H. Glimcher — a professor who also sits on the board of the drug maker Bristol-Myers Squibb, which paid her nearly $270,000 in 2007.
Dr. Glimcher says industry money is not only appropriate but necessary. “Without the support of the private sector, we would not have been able to develop what I call our ‘bone team’ in our lab,” she said at a recent student and faculty forum to discuss industry relationships. Merck is counting on her team to help come up with a successor to Fosamax, the formerly $3 billion-a-year bone drug that went generic last year. But Dr. Marcia Angell, a faculty member and former editor in chief of The New England Journal of Medicine, is among the professors who argue that industry profit motives do not correspond to the scientific aims of academic medicine and that much of the financing needs to be not only disclosed, but banned. Too many medical schools, she says, have struck a “Faustian bargain” with pharmaceutical companies.
“If a school like Harvard can’t behave itself,” Dr. Angell said, “who can?”
Monday, March 2, 2009
Good or Useless, Medical Scans Cost the Same
By GINA KOLATA
When Gail Kislevitz had an M.R.I. scan of her knee, it came back blurry, “uninterpretable,” her orthopedist told her.
A poor-quality scan of a ligament, left, and one of high quality. Many scans are done by machines that are a decade old.
Her insurer refused to pay for another scan, but the doctor said he was sure she had torn cartilage that stabilizes the knee and suggested an operation to fix it. After the surgery, Ms. Kislevitz, 57, of Ridgewood, N.J., received a surprise: the cartilage had not been torn after all.
She had a long rehabilitation. And her insurer paid for the operation. But her knee is no better.
More than 95 million high-tech scans are done each year, and medical imaging, including CT, M.R.I. and PET scans, has ballooned into a $100-billion-a-year industry in the United States, with Medicare paying for $14 billion of that. But recent studies show that as many as 20 percent to 50 percent of the procedures should never have been done because their results did not help diagnose ailments or treat patients.
“The system is just totally, totally broken,” said Dr. Vijay Rao, the chairwoman of the radiology department at Thomas Jefferson University Hospital, in Philadelphia.
Radiologists say a decent M.R.I. scan should have clearly shown whether the cartilage in Ms. Kislevitz, a meniscus, was torn. But bad scans, medical experts say, are part of a growing problem with medical imaging.
Many factors contribute. Insurers pay the same for a scan done on a 10-year-old machine as one on the latest model, though the differences in the images can be significant.
Insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors. Aside from mammography, whose standards were established by a law that went into effect more than a decade ago, the field is largely unregulated. And increasingly, doctors refer patients to scanning centers they own and profit from.
Ten years ago, the age of a scanner might not have mattered so much. Now, said Dr. Gary Glazer, the chairman of radiology at Stanford, technology has advanced so much that the older scanner “is not the same machine.”
“I can tell you from my experience that between those extremes the gap is huge,” Dr. Glazer said.
Yet, he added, many scanning machines used today are a decade old.
Imaging centers can, if they choose, become accredited by the American College of Radiology. That requires, among other things, scanning a phantom, a device that simulates a body part. Technologists must also be certified, and there are standards for supervising physicians. And the scanners must be regularly assessed to ensure they are properly functioning.
But many centers are not accredited, although the percentage is not known because there is no national registry of imaging centers.
Accrediting will be partly addressed by a little noticed aspect of a wide-ranging Medicare law passed last year. After it goes into effect in 2012, Medicare will pay only for scans done at accredited centers. But imaging experts say the law fixes only part of the problem. High-tech scanning is complicated, and there is no consensus on objective measures to ensure quality. Even with the new law, there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.
Radiologists are struck by the wide variation in the quality of scans, and they say there is little patients can do other than to ask why the scan is necessary and, if it is, to ask about accreditation, the credentials of the person reading the scan and the age of the scanner.
“The studies I see coming from the outside vary from marginal quality to very good quality,” said Dr. Chris Beaulieu, a Stanford radiology professor. “Some of it is related to equipment, and some is related to people with very good equipment who don’t know how to use it right. And on the interpretation side, there is also a very wide range of quality or accuracy, in my opinion.”
Interpretation can be crucial, Dr. Beaulieu added. “A good radiologist can sometimes accurately read scans off of a lower-quality scanner,” he said. “I see that all the time. A good radiologist and a lower-quality scan could be better than a bad radiologist and a good scan.”
But logical as it might seem to pay more for a better scan, there are problems. Health insurers have no way of knowing whether scans are good, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. Doctors, not insurers, receive the images and reports, and all insurers can do is notice if there are frequent requests to redo scans from a particular center.
“We see a lot of poor-quality scans,” said Dr. Freddie Fu, the chairman of the orthopedic surgery department at the University of Pittsburgh Medical Center. “I joke with the patients: The insurance pays the same amount of money for the scan. You get a hamburger somewhere else and a prime rib here for the same price.”
Another concern is the growing number of doctors who refer patients for imaging done by scanners they own and profit from. Studies have found that up to 3.2 times as many scans are ordered in such cases
In a recent report, the Government Accountability Office said nearly two-thirds of the money Medicare paid for imaging was for scans in doctors’ offices. And, the report added, doctors were receiving an ever larger part of their income from providing scanning services. Not only were patients more likely to have scans if a doctor did this, but the quality of some of the scans was questioned.
“No comprehensive national standards exist for services delivered in physician offices other than a requirement that imaging services are to be provided under at least general physician supervision,” the G.A.O. wrote.
Private health insurers were concerned, too. “These are alarming patterns that have also been observed in the private sector,” America’s Health Insurance Plans wrote in a response to the G.A.O.
It is clear why self-referral can be tempting, said Dr. Bruce Hillman, a radiology professor at the University of Virginia.
“It’s all profits,” Dr. Hillman said, adding that a group of doctors can make an extra $500,000 to $1 million a year simply by acquiring a scanner.
For now, radiologists said, patients and insurers are often in a bind.
“If you are going to buy a car,” said Dr. Beaulieu, the Stanford professor, “and you have a certain amount of money to spend, you know what you are getting. You know what you will get if you buy a Yugo or if you buy a BMW.”
But with imaging, Dr. Beaulieu said, “you don’t know: you might get a Yugo and you might get a BMW.”
When Gail Kislevitz had an M.R.I. scan of her knee, it came back blurry, “uninterpretable,” her orthopedist told her.
A poor-quality scan of a ligament, left, and one of high quality. Many scans are done by machines that are a decade old.
Her insurer refused to pay for another scan, but the doctor said he was sure she had torn cartilage that stabilizes the knee and suggested an operation to fix it. After the surgery, Ms. Kislevitz, 57, of Ridgewood, N.J., received a surprise: the cartilage had not been torn after all.
She had a long rehabilitation. And her insurer paid for the operation. But her knee is no better.
More than 95 million high-tech scans are done each year, and medical imaging, including CT, M.R.I. and PET scans, has ballooned into a $100-billion-a-year industry in the United States, with Medicare paying for $14 billion of that. But recent studies show that as many as 20 percent to 50 percent of the procedures should never have been done because their results did not help diagnose ailments or treat patients.
“The system is just totally, totally broken,” said Dr. Vijay Rao, the chairwoman of the radiology department at Thomas Jefferson University Hospital, in Philadelphia.
Radiologists say a decent M.R.I. scan should have clearly shown whether the cartilage in Ms. Kislevitz, a meniscus, was torn. But bad scans, medical experts say, are part of a growing problem with medical imaging.
Many factors contribute. Insurers pay the same for a scan done on a 10-year-old machine as one on the latest model, though the differences in the images can be significant.
Insurers do not distinguish between scans that are done poorly or done well or read by less- or more-qualified doctors. Aside from mammography, whose standards were established by a law that went into effect more than a decade ago, the field is largely unregulated. And increasingly, doctors refer patients to scanning centers they own and profit from.
Ten years ago, the age of a scanner might not have mattered so much. Now, said Dr. Gary Glazer, the chairman of radiology at Stanford, technology has advanced so much that the older scanner “is not the same machine.”
“I can tell you from my experience that between those extremes the gap is huge,” Dr. Glazer said.
Yet, he added, many scanning machines used today are a decade old.
Imaging centers can, if they choose, become accredited by the American College of Radiology. That requires, among other things, scanning a phantom, a device that simulates a body part. Technologists must also be certified, and there are standards for supervising physicians. And the scanners must be regularly assessed to ensure they are properly functioning.
But many centers are not accredited, although the percentage is not known because there is no national registry of imaging centers.
Accrediting will be partly addressed by a little noticed aspect of a wide-ranging Medicare law passed last year. After it goes into effect in 2012, Medicare will pay only for scans done at accredited centers. But imaging experts say the law fixes only part of the problem. High-tech scanning is complicated, and there is no consensus on objective measures to ensure quality. Even with the new law, there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.
Radiologists are struck by the wide variation in the quality of scans, and they say there is little patients can do other than to ask why the scan is necessary and, if it is, to ask about accreditation, the credentials of the person reading the scan and the age of the scanner.
“The studies I see coming from the outside vary from marginal quality to very good quality,” said Dr. Chris Beaulieu, a Stanford radiology professor. “Some of it is related to equipment, and some is related to people with very good equipment who don’t know how to use it right. And on the interpretation side, there is also a very wide range of quality or accuracy, in my opinion.”
Interpretation can be crucial, Dr. Beaulieu added. “A good radiologist can sometimes accurately read scans off of a lower-quality scanner,” he said. “I see that all the time. A good radiologist and a lower-quality scan could be better than a bad radiologist and a good scan.”
But logical as it might seem to pay more for a better scan, there are problems. Health insurers have no way of knowing whether scans are good, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group. Doctors, not insurers, receive the images and reports, and all insurers can do is notice if there are frequent requests to redo scans from a particular center.
“We see a lot of poor-quality scans,” said Dr. Freddie Fu, the chairman of the orthopedic surgery department at the University of Pittsburgh Medical Center. “I joke with the patients: The insurance pays the same amount of money for the scan. You get a hamburger somewhere else and a prime rib here for the same price.”
Another concern is the growing number of doctors who refer patients for imaging done by scanners they own and profit from. Studies have found that up to 3.2 times as many scans are ordered in such cases
In a recent report, the Government Accountability Office said nearly two-thirds of the money Medicare paid for imaging was for scans in doctors’ offices. And, the report added, doctors were receiving an ever larger part of their income from providing scanning services. Not only were patients more likely to have scans if a doctor did this, but the quality of some of the scans was questioned.
“No comprehensive national standards exist for services delivered in physician offices other than a requirement that imaging services are to be provided under at least general physician supervision,” the G.A.O. wrote.
Private health insurers were concerned, too. “These are alarming patterns that have also been observed in the private sector,” America’s Health Insurance Plans wrote in a response to the G.A.O.
It is clear why self-referral can be tempting, said Dr. Bruce Hillman, a radiology professor at the University of Virginia.
“It’s all profits,” Dr. Hillman said, adding that a group of doctors can make an extra $500,000 to $1 million a year simply by acquiring a scanner.
For now, radiologists said, patients and insurers are often in a bind.
“If you are going to buy a car,” said Dr. Beaulieu, the Stanford professor, “and you have a certain amount of money to spend, you know what you are getting. You know what you will get if you buy a Yugo or if you buy a BMW.”
But with imaging, Dr. Beaulieu said, “you don’t know: you might get a Yugo and you might get a BMW.”
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