Is genetic testing in your future?

Nature magazine asked more than 90 genomics centres and labs to estimate the number of human genome sequences they have in the works. Although far from comprehensive, the tally indicates that at least 2,700 human genomes will have been completed by the end of this month, and that the total will rise to more than 30,000 by the end of 2011.

What does this mean for you and me?

FuturePundit writes: This is an example of why I keep saying that the floodgates on genetic data are opening, that the rate of discovery of what genetic mutations mean is rapidly accelerating, and that we will soon learn enormous amounts about what many thousands of our genetic variants mean. The utility of getting yourself genetically tested is going to rise sharply.

He points to this article:

A handful of physicians have quietly begun using whole-genome sequencing in attempts to diagnose patients whose conditions defy other available tools.

"If one hospital is doing it, you can be sure others will start, because patients will vote with their feet," Elizabeth Worthey, a genomics specialist at the Human and Molecular Genetics Center (HMGC) of the Medical College of Wisconsin in Milwaukee.

Some in the field say we need better regulation of genetic testing. More here. So be wary, but expect this new field to grow.

Experimenting with your health

Congressional Budget Office Director Douglas Elmendorf throws some doubt on the many provisions of the new health care law.

Calling the bill health care "reform" is misleading. For example, it was sold as a way to reduce costs.

Elmendorf, who is Congress’ chief accountant, said the Democrats’ health care bill will reduce unnecessary spending on health care by insured people -- but only to a "very limited extent" over the next decade. One of the main complaints about the health care law, even as it was being written, is that it doesn’t do enough to control costs.

And if you thought it would make the whole process more predictable:

Elmendorf revealed that some of ObamaCare's so-called reforms may not be reforms at all. Analyzing the many provisions that are supposed to make health care more efficient and less expensive, Elmendorf said that there was little evidence any of them would actually work -- leading CBO to view their potential with skepticism.

“The legislation set up a number of experiments in delivery and payment systems to induce providers to offer higher-quality and lower-cost care,” he said. “However, for a number of reasons, it is unclear how successful the experiments will be.

A grand experiment with our health.

Can we reverse hearing loss?

As we age our hearing tends to decline, and this can set in motion other problems. Not being able to pick up all of a conversation causes us to isolate and miss out. 

Researchers at the W.M. Keck Center for Integrative Neuroscience at the University of California, San Francisco, have been studying the hearing ability of aging rats and think it may lead to new therapies for older people.

In a recent study, UCSF researchers found that trained lab rats were able to recover more than 20 auditory cortex alterations. In most cases, they saw a partial or complete reversal of auditory damage. This study provides compelling evidence that the effects of aging — at least in the auditory cortex of elderly lab rats — are both reversible and preventable.

The study carries hefty implication for the use of audio in neurorehabilitation therapy for humans, especially in cases of age-related dementia, Alzheimer’s and sensory degradation.


In some cases of dementia, music is already being used to ameliorate symptoms of agitation, anxiety and depression. In instances of age-related decline or injury therapy, music and rhythmic cues are being used for cognitive rehabilitation, spatial awareness and muscle recovery. Findings from UCSF may help therapists hone training strategies and tailor their use of audio to not only treat symptoms of age-related decline, but improve the degradation of its causes.

 Say again?

News roundup: aspirin, fish oil, statin, naps

News from the world of medicine:

Aspirin, already linked in some studies to a lower risk of developing colon cancer, may also cut the risk of dying of prostate cancer by more than half, a large study suggests.

Researchers from Harvard found that dietary intake of polyunsaturated fatty acids (PUFAs) like fish oil, known to have anti-inflammatory properties, shows promise for the effective treatment and prevention of periodontitis.

Following a healthy lifestyle, which means exercising, eating healthfully, keeping the waistline trim, limiting alcohol intake, and avoiding smoking, could reduce the risk of colorectal cancer by 23%, according to a study from Denmark.

A systematic review of the medical literature supports the hypothesis that statins, cholesterol‐lowering drugs used to prevent cardiac problems, are associated with reduced risk of colon and rectal cancers.

Drinking about a half cup or more of coffee or tea per day is associated with a 34% reduction in the risk for glioma, a type of brain tumor, researchers report.

Men with heart disease die sooner if their testosterone levels are low, a U.K. study shows.

New research shows that an occasional nap can make older people more able to lead a fully active life by giving them enough energy to take part in recreational and social activities.

The right sleep position can ease heartburn

It matters whether you sleep on your left or right side. Several studies have found that sleeping on the right side aggravates heartburn; sleeping on the left tends to calm it, The New York Times reports.

The reason is not entirely clear. One hypothesis holds that right-side sleeping relaxes the lower esophageal sphincter, between the stomach and the esophagus. Another holds that left-side sleeping keeps the junction between stomach and esophagus above the level of gastric acid.  

Sometimes it's the little things.

Should you store your medical record online?

hIt's now possible to store all of you health information online, making it easily accessible anywhere, but only about four percent of people do. Many are afraid of the privacy implications, although these sites use the same technology as banks do to protect your information.

The Wall Street Journal has reviewed three of the most popular sites.

Google Health doesn't have many tools of its own to allow users to evaluate their health. Instead, it focuses on sharing your data with online applications that do such tasks, like the My Diabetes Health Assessment website, which evaluates users' risk of diabetes based on data from their health records.

Microsoft HealthVault, too, has a limited number of self-evaluation tools but connects to a wide variety of helpful services that can extract data from or import data to your profile.

You can accesss WebMD's Health Manager in two main ways: through its public site, WebMD.com, or through the sites of insurance companies and employers that are WebMD customers.

The Journal's assessment:

In the end, we found that each PHR offers a remarkable value for a free application, but none of the three emerged as a clear winner.

Microsoft HealthVault gets high marks for portability, but it has no features for printing. WebMD Health Manager has all of its health evaluation features built in, so you don't have to connect to external applications, but it lacks the ability to export information in some key industry formats. So does Google Health (it says it may add this later), but it does export data to online health applications.

One way to choose among the PHRs is by the applications that link to them. If you want to import data from LifeScan Inc.'s OneTouch glucose monitor into your PHR, for example, currently only HealthVault does that (Google may add this).

On the other hand, if your insurance company (yours or your employer's) is a WebMD customer, you may want to use Health Manager for its easy importing of all the health data your insurance company already has on you.

Also posted on my technology blog, My Skunkworks

Another reason to eat whole grains

People who consume several servings of whole grains per day while limiting daily intake of refined grains appear to have less of a type of fat tissue thought to play a key role in triggering cardiovascular disease and type 2 diabetes, a new study suggests.

This was true even after accounting for other lifestyle factors such as smoking, alcohol intake, fruit and vegetable intake, percentage of calories from fat and physical activity.

The Tufts University researchers observed that participants who consumed, on average, three daily servings of whole grains but continued to eat many refined grains did not demonstrate improvement. 

“Whole grain consumption did not appear to help if refined grain intake exceeded four or more servings per day,” said one author of the study.  “This result implies that it is important to make substitutions in the diet, rather than simply adding whole grain foods. For example, choosing to cook with brown rice instead of white or making a sandwich with whole grain bread instead of white bread.”

The endless stream of nutritional studies

I like to read medical news, and in fact I recently started a health blog, Tell Your Doctor, which I invite you to visit. I particularly love articles announcing new research that says, for example, that if you drink pomegranate juice you'll live forever. I figure that if pomegranate juice doesn't kill you, then why not give it try?

I know to check the source -- if the research was paid for by The National Got Pomegranate? Council you might want to sip it or maybe just drink water. And if the discovery was based on a study of seven people in India who ate nothing but cranberries for a year you might postpone your trip to Maine and your long-anticipated deep dive in a cranberry bog.

Along comes an important article in The Atlantic about all this. It's based on the work of Dr. John Ioannidis in Greece, who studies medical studies and finds just about all of them wanting.

Take nutrition research.

Consider, he says, the endless stream of results from nutritional studies in which researchers follow thousands of people for some number of years, tracking what they eat and what supplements they take, and how their health changes over the course of the study. “Then the researchers start asking, ‘What did vitamin E do? What did vitamin C or D or A do? What changed with calorie intake, or protein or fat intake? What happened to cholesterol levels? Who got what type of cancer?’” he says. “They run everything through the mill, one at a time, and they start finding associations, and eventually conclude that vitamin X lowers the risk of cancer Y, or this food helps with the risk of that disease.” In a single week this fall, Google’s news page offered these headlines: “More Omega-3 Fats Didn’t Aid Heart Patients”; “Fruits, Vegetables Cut Cancer Risk for Smokers”; “Soy May Ease Sleep Problems in Older Women”; and dozens of similar stories. 

When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you’d think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.

For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you.

Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death. Instead, they track easily measurable health “markers” such as cholesterol levels, blood pressure, and blood-sugar levels, and meta-experts have shown that changes in these markers often don’t correlate as well with long-term health as we have been led to believe.

This guy has credentials.

He was a physician-researcher in the early 1990s at Harvard. He worked with prominent researchers at Tufts University and then taking positions at Johns Hopkins University and the National Institutes of Health. He was unusually well armed: he had been a math prodigy of near-celebrity status in high school in Greece, and had followed his parents, who were both physician-researchers, into medicine.

I encourage you to pour a big cup of coffee, pour in lots of sugar, grab some chips and read the whole thing.

A new theory about depression

What causes depression? Two researchers at the University of California, San Diego School of Medicine think it may be a response similar to what the body experiences when it suffers a physical injury.

According to the new theory, Science Daily reports, severe stress and adverse life events, such as losing a job or family member, prompt neurobiological processes that physically alter the brain. Neurons change shape and connections. Some die, but others sprout as the brain rewires itself. This neural remodeling employs basic wound-healing mechanisms, which means it can be painful and occasionally incapacitating, even when it's going well.

"It's necessary and normal so that an individual can adapt, change behavior and deal with altered circumstances," says Athina Markou, PhD, professor of psychiatry. Real problems occur only "when these restructuring processes go into overdrive, beyond what is necessary and adaptive, and for longer periods of time than needed. Then depression becomes pathological."

The theory extends findings made by other researchers that the neurobiological substrates of physical and emotional pain overlap. Just as the body's repair mechanisms for physical injury can sometimes result in chronic pain and inflammation, so too can the response to psychological trauma, resulting in chronic depression.

If the theory proves out -- and more research is needed -- the findings may have clinical ramifications. If psychological and physical pain responses share similar biological mechanisms, then analgesic agents could be useful in treating at least some symptoms of depression. Similarly, if chronic depression is proven to be a neuroinflammatory condition, then anti-inflammatory treatments should also have some antidepressant effects. Several small trials with depressed patients have already been published that support this possibility,

A plant compound reduces memory problems

A diet rich in the plant compound luteolin  -- found in many plants, including carrots, peppers, celery, olive oil, peppermint, rosemary and chamomile -- reduces age-related inflammation in the brain and related memory deficits, researchers report.

The researchers focused on microglial cells, specialized immune cells that reside in the brain and spinal cord. Infections stimulate microglia to produce signaling molecules, called cytokines, which spur a cascade of chemical changes in the brain. Some of these signaling molecules, the inflammatory cytokines, induce "sickness behavior": the sleepiness, loss of appetite, memory deficits and depressive behaviors that often accompany illness.

Inflammation in the brain also appears to be a key contributor to age-related memory problems, said University of Illinois animal sciences professor Rodney Johnson, who led the new study. Johnson directs the Division of Nutritional Sciences at Illinois.

"These data suggest that consuming a healthy diet has the potential to reduce age-associated inflammation in the brain, which can result in better cognitive health," Johnson said.

New advice on giving CPR

A person suffering a heart attack whose heart has stopped beating and who receives cardiopulmonary resuscitation (CPR) fares better if resuscitators skip the rescue breaths and do only chest compression, according to a study  at Washington University School of Medicine in St. Louis.

"When we combined three studies, there was a significant increase in survival when witnesses were told by 911 dispatchers to provide chest compression only," said principal investigator Peter Nagele, MD.

The three studies covered survival rates in more than 3,700 cardiac arrest patients who received either standard CPR or chest compression only.

"When a person goes into cardiac arrest because of a problem with the heart, that individual normally has plenty of oxygen in the body," said Nagele,assistant professor of anesthesiology and chief of trauma anesthesiology at Barnes-Jewish Hospital in St. Louis. "So rescue breaths aren't as vital to survival as trying to keep blood flowing as regularly as possible. However, if cardiac arrest is secondary to trauma, drowning or a problem not directly related to heart function, then it is advisable to do standard CPR that includes rescue breaths. In those cases, getting oxygen into the system is crucial."

But it's different with children.

"It is very uncommon for kids to go into cardiac arrest due to a primary heart problem," Nagele says. "If cardiac arrest does occur, it's likely to be secondary to a severe asthma attack, an allergic reaction or something else unrelated to the heart. Under those circumstances, the body needs oxygen. I strongly recommend chest compression and rescue breaths in kids."

The study found that the benefit occurred only when 911 dispatchers coached bystanders to use chest compression-only CPR. In several uncontrolled studies that simply asked bystanders whether they did only chest compressions or standard CPR, the investigators found no survival benefit with the chest compression-only technique.

Nagele says his findings suggest that if someone nearby has a heart attack, it's important to first call 911, and then begin chest compressions. He says if it takes several minutes for help to arrive, it also may become necessary to begin rescue breaths, but for the first five to 10 minutes, chest compressions are more important.

PIck a number, any number

Ever notice that many pill prescriptions last seven days? Why?

Daniel Gilbert, a professor of psychology at Harvard, writes that certain numbers have magical properties.

The magic numbers are the familiar ones that have something to do with the way we keep track of time (7, say, and 24) or something to do with the way we count (namely, on 10 fingers). The “time numbers” and the “10 numbers” hold remarkable sway over our lives. We think in these numbers (if you ask people to produce a random number between one and a hundred, their guesses will cluster around the handful that end in zero or five) and we talk in these numbers (we say we will be there in five or 10 minutes, not six or 11).

Important decisions are made on the basis of magic numbers.

A recent study of antibiotic treatment published in a leading medical journal began by noting that “the usual treatment recommendation of 7 to 10 days for uncomplicated pneumonia is not based on scientific evidence” and went on to show that an abbreviated course of three days was every bit as effective as the usual course of eight. My doctor had recommended seven. Where in the world had seven come from?

Italy! Seven is a magic number because only it can make a week, and it was given this particular power in 321 A.D. by the Roman emperor Constantine, who officially reduced the week from eight days to seven. The problem isn’t that Constantine’s week was arbitrary — units of time are often arbitrary, which is why the Soviets adopted the five-day week before they adopted the six-day week, and the French adopted the 10-day week before they adopted the 60-day vacation.

So if you're told to take three pills a day for seven days, that's 21. But what if your body really only needs 20?

If even one of those pills is unnecessary — that is, if people who take 20 pills get just as healthy just as fast as people who take 21 — then millions of people are taking at least 5 percent more medication than they actually need. This overdose contributes not only to the punishing costs of health care, but also to the evolution of the antibiotic-resistant strains of “superbugs” that may someday decimate our species. All of which seems like a rather high price to pay for fealty to ancient Rome. 

Might be fun to annoy your doctor with this information next time you're in to get some pills.

Eating to prevent diabetes

The Mediterranean diet -- high in vegetables, fibre-rich grains, legumes, fish and plant-based sources of unsaturated fat -- particularly olive oil and nuts -- while being low in red meat and high-fat dairy -- may help prevent diabetes.

Spanish researchers studying more than 400 adults found that those following the traditional diet were less likely to develop diabetes over four years -- even without counting calories or shedding weight.

The participants were randomly assigned to one of three diets: a Mediterranean diet with emphasis on more consumption of olive oil, the same diet with a focus on getting unsaturated fats from nuts, and a diet cutting all types of fat. After four years, 10 to 11 percent of those in the two Mediterranean groups had developed diabetes, compared to 18 percent of those in the low-fat diet group.

But don't rule out exercise and calories: when the researchers accounted for a number of other factors, such as the participants' weight, smoking history and reported exercise levels, the Mediterranean diet itself was linked to 52 percent reduction in diabetes risk compared to the low-fat diet.

Now it's personal

Obamacare strikes close to home. We have health insurance with Anthem Blue Cross/Blue Shield in Connecticut, and I woke up this morning to this news.

The state has given Anthem Blue Cross and Blue Shield the go ahead to raise premiums by as much as 47 percent for some members, and says health care reform is the reason why.

"The rates that were filed and approved reflect the current cost to deliver care and the impact of more comprehensive benefit designs required under the federal healthcare reform law," Insurance Commissioner Thomas Sullivan said, responding to the attorney general. "If the attorney general wants to complain to someone, he should complain to Congress."

And we're learning that long-term care insurance is going up as well.

People with long-term-care insurance polices are getting hit with a new round of steep premium increases. Last month, industry behemoth John Hancock Financial said it would ask state regulators for an average 40% increase for about 850,000 of its 1.1 million policyholders. 

In recent months, companies including American International Group Inc., MetLife Inc. and Lincoln National Corp. have applied for or received approval in one or more states for rate rises ranging from 10% to 40%.

All of this makes U.S. Sen. Tom Coburn's words about these rate hikes sound less like campaign alarmism and more like fact.

"There will be no insurance industry left in three years. That is by design. You’re going to make insurance unaffordable for everyone -- which is what they want. Because if there’s no private insurance left, what’s left? Government-centered, government-run, single-payer health care.”

Ouch.

News roundup: watermelon, CPR, walking

News from the world of medicine:

For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can -- and should -- get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.

Evidence from a pilot study led by food scientists at The Florida State University suggests that watermelon can be an effective natural weapon against prehypertension, a precursor to cardiovascular disease.

Women with fibromyalgia can reduce symptoms of the disease and improve their function by practicing the mind-body techniques of yoga, a new study says.

Heart attack patients whose hearts have stopped beating and who receive cardiopulmonary resuscitation (CPR) from bystanders fare better if their resuscitators skip the rescue breaths and do only chest compression, according to a study led by researchers at Washington University School of Medicine in St. Louis.

Walking 6 miles or so every week is not only good for the heart, but for the brain, preventing shrinkage and possibly dementia down the road, new research indicates.

Higher levels of vitamin D in newborns are linked with better insulin sensitivity at age 3, perhaps reducing their obesity risk, according to a new study.

Scientists have demonstrated that a biomarker called TCF21 may be used to develop a potential screening test for early-stage lung cancer.

Will electronic health records ever arrive?

My family doctor provides excellent care, but he still works on sheets of paper in a manilla folder. An alternative, putting all this into a computer, is slowly creeping into medical practices.

I've seen an eye surgeon who uses such a system -- in fact, was learning the system with his staff when I was there. It can take longer to input data using the system, because it's pretty rigid about what goes where.

Ideally, such a system should bring in all kinds of information for the doctor's use, such as an updated recommendation from the Centers for Disease control on vaccinations.

Kenny Lin, a family doctor, writes in U.S. News that electronic systems have advantages.

An electronic medical record system can do that and can also allow test results to be emailed or transferred automatically into a patient's chart; paper charts rely on office administrators to input them by hand, which can lead to mistakes. I, myself, have occasionally forgotten to record that a vaccine was administered during the chaos of a busy work day. Nor did I have any systematic way of knowing how many of my patients were actually receiving the preventive and chronic care they needed.

However to truly be effective these systems need certain features, he writes.

The latest research suggests that electronic health records don't necessarily improve care unless they include interactive features: They should make it easier for doctors to implement proven guidelines for good care, providing the necessary shots and screenings, follow-up exams and treatments to help patients live longer with chronic diseases or to prevent these diseases altogether. Ideally, these records should include a software tool that periodically culls through patients' records looking for gaps in care such as who is overdue for a cholesterol screening or flu vaccine. The system would then send out reminders to patients to come in for a test or appointment.

One big outfit has such a system.

Kaiser Permanente added such a tool to their electronic medical record system several years ago and found that it works to improve care. A study published last month in the American Journal of Managed Care found that the support tool brought more diabetes and heart disease patients in for health screenings, vaccinations and medication adjustments. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 68 percent to 73 percent; for heart disease patients, the percentage rose from 64 percent to 71 percent. Another study found that tool helped more healthy patients get the recommended screening and exams for preventive care. Bottom line: This support tool lowers the rate of skipped appointments and gaps in care.

Change comes slowly. It's costly for doctors to implement a new system, and there are privacy concerns galore. However, I believe that anything that can be digitized eventually will be.

Planning your health insurance next year

Smart Money looks at the coming changes and makes suggestions:

Plan for price hikes
The rising cost of medical care and new requirements of the reform bill are expected to increase employers’ health costs by about 9 percent next year. To compensate, experts say, firms will raise co-pays and deductibles, the amount paid out of pocket before coverage kicks in. According to the consultancy Mercer Health & Benefits, about 20 percent of companies are also considering making employees with more dependents pay a larger share. For people who could be covered under a spouse’s plan, Barry Schilmeister, a partner with Mercer, suggests doing a fresh comparison to find out whether switching might mean more savings.

Is your doctor in?
Many doctors and hospitals are being “very aggressive” in their negotiations with insurers this year, says Dean Hatfield, national health practice leader for Sibson Consulting, so employees shouldn’t assume their current MD and hospital are still in their insurance network. Those who lose a favorite practitioner may want to opt for a plan with good out-of-network coverage. Another change to look out for: In 2011 the pretax flexible-spending accounts used to cover extra health expenses can no longer be used for over-the-counter drugs unless a doctor writes a special prescription.

Check for new benefits
Not all changes will hurt. Hatfield estimates as many as one in five employers will offer plans with incentives designed to keep employees healthy—like waived co-pays for the inhalers that help asthmatics keep their disease in check. Many employer health plans will be required by law to make other consumer-friendly changes as well, including reimbursing patients equally for emergency room care received at both in-network and out-of-network hospitals.

A second look at antioxidants

One of the current fads in nutrition today is antioxidants -- vitamins like C and E that go after free radicals, molecules created by the breakdown of oxygen during metabolism.

"Each of us constantly creates free radicals simply by living and breathing, Tara Parker-Hope writes in The New York Times. "But these molecules are highly reactive and capricious, sometimes attacking other cells and damaging tissue. Wilding free radicals have been linked with a number of diseases and with aging."

Exercise, she writes, creates even more free radicals, and so athletes were encouraged to to lots of antioxidants. A few years ago, however, some researchers started fooling around with rats. One group got lots of antioxidants before exercise, the other got none. The antioxidant bunch showed no free radicals in their blood.

The leg muscles of the other exercised rats, though, teemed with free radicals. But at the same time, they buzzed with other, unexpected biochemical reactions. In their legs, genes were being expressed that activated growth factors that, in turn, increased levels of ‘‘important enzymes associated with cell defense’’ and ‘‘adaptation to exercise,’’ the researchers wrote. There was hardly any similar activity in the rats with low free-radical levels. Somehow, the researchers speculated, the free radicals had jump-started a process that over time would allow the rats’ muscles to adapt to exercise. Suppressing the production of free radicals had, they concluded, prevented the ‘‘activation of important signaling pathways’’ and altered the muscles’ ability to adapt to exercise. As a result, they wrote, ‘‘the practice of taking antioxidants’’ to ward off the presumed free-radical damage caused by exercise ‘‘may have to be re-evaluated.’’

Then another study last year, this time with humans.

A group of young men were enrolled in a month-long exercise program. Some swallowed moderately high doses of the antioxidant vitamins C and E. Others did not. At the end of the month, the men not taking the vitamins showed higher-than-average activity in their bodies’ innate antioxidant defense system. The men downing the vitamins did not, which makes sense; the antioxidant vitamins were mopping up the free radicals for them. But at the same time, the men not taking vitamins significantly increased their insulin sensitivity, a key measure of the health benefits of exercise, while those taking the antioxidants did not. Apparently, when the body’s natural antioxidant defense system went into high gear, so did its ability to handle insulin. Removing the necessity for the body to deal, on its own, with the free radicals also prevented other adaptations that make exercise healthy.

What does all of this mean?

‘‘The evidence suggests that antioxidants are not needed’’ by most athletes, even those training strenuously, said Li Li Ji, a professor of exercise physiology and nutritional science at the University of Wisconsin and one of the authors of the rat study. ‘‘The body adapts,’’ he said, a process that can, it seems, be altered by antioxidant supplements.


Another lesson: ‘‘Eat well,’’ he said. Although this is not yet proved, it seems likely, he continued, that antioxidants from foods, like blueberries, green tea and carrots, may work in tandem with the body’s natural antioxidant defenses better than those from supplements.

But the overriding lesson of the newest science about exercise and antioxidants may be as simple as: let the body be. ‘‘It is quite a smart machine,’’ Dr. Ji said. ‘‘It knows how to respond’’ to stresses like a hard run, without the need for antioxidant pills.

It's not clear how this affects people not consider "athletes," and that will be something to discover. But, in the Duh Department, it seems that if exercise is good for us, and we know it is, the body is wise in its own ways.

Emailing your doctor

My family physician doesn't use email with patients, at least not with me. I've got a doctor in New York City who prefers it. I can understand why doctors don't want to get into endless conversations with patients, especially if the meter isn't running.

Doctors who use email are rare.

According to the Center for Studying Health System Change, only 6.7% of the 4,200-plus office-based physicians who responded to a 2008 national survey “routinely” emailed patients about clinical matters. Most just didn’t have the technology available, but even among the doctors who had email access, only 19.5% regularly emailed with patients.

The reasons, according to the center: “lack of reimbursement, the potential for increased workload, maintaining data privacy and security, avoiding increased medical liability and the uncertain impact on care quality.”

Doctors working in practices the have already converted to electronic medical records were more likely to communicate with patients via email. So were physicians in HMOs or academic centers, compared to those in solo or two-doctor practices.

Given the reimbursement issue, it’s not surprising that physicians on a fixed salary were more likely to communicate with patients than those with other compensation arrangements. (Aetna and Cigna are among the insurers reimbursing providers for communicating with patients via secure messaging.) Other options for compensation include a set per-patient fee paid to physicians for agreeing to coordinate care using email and other means or an annual fee paid directly by patients for email access privileges, the center says.

Perhaps we can jump start this with some texting acronyms specifically for talking to doctors. IHWIL -- it hurts when I laugh. HMTDIH -- how much time do I have?  GITMS -- give it to me straight.

LOL.

Get in touch with your inner squirrel

I try to eat some walnuts everyday, typically throwing a few into some cold cereal. Smart guy, I am: a new study found that regularly eating a handful of walnuts can affect the blood pressure response to stress.

The people tested were given one of three diets: no walnuts, 1.3 ounces of walnuts (about 18 walnut halves) and a tablespoon of walnut oil substituted for some of the fat and protein in the average American diet, and walnuts, walnut oil, and 1.5 tablespoons of flaxseed oil.

The subjects were put under stress -- giving a speech -- and tested. The result: Including walnuts and walnut oil in the diet lowered both resting blood pressure and blood pressure responses to stress by two to three points.

The best result came with adding flaxseed oil.

Some of the participants also underwent a vascular ultrasound examination to measure artery dilation.  The results showed that adding flaxseed oil to the walnut diet significantly improved this test of vascular health.  The researchers have previously shown that adding flax to walnuts also lowered C-reactive protein levels, indicating an anti-inflammatory effect that could reduce the risk of cardiovascular disease.

Primary funding for the study came from a walnut trade group, but the beauty of this is that eating some walnuts everyday -- in place of some other source of fat, can't harm you. Otherwise, there would be dead squirrels everywhere.

On the horizon: seeing is believing

The breakthroughs in medicine come daily.

For many people past the age of 40, focusing on close objects restaurant menus, — for instance — just gets harder and harder. Most people with this condition, called presbyopia, eventually give in and get reading glasses, bifocals or glasses with progressive lenses. But what if there were another alternative that didn't require people to carry an extra set of glasses or have only part of their field of vision in focus at any one time? Zoom Focus Eyewear has just such an option: eyeglasses, called TruFocals, that the wearer can manually adjust to give clear, undistorted vision whether reading a book, working on a computer or looking into the distance.

Three scientists have won the Nobel Prize in chemistry for developing a process that, among other things, helps synthesize medicines. One example involves a marine sponge called Discodermia dissoluta. As a defensive mechanism, the sponges produce large and complex chemical molecules that are poisonous and that prevent other organisms from exploiting them. And the substance produced by this particular sponge, discodermolide, seemed to have anti-cancer properties. The process that the Nobel winners helped develop made it possible to artificially produce the substance in large enough quantities to make research practical.

Researchers at the University of Massachusetts Amherst say they can deliver a dormant toxin into a specific site such as a tumor for anti-cancer therapy, then chemically trigger the toxin to "de-cloak" and attack the tumor from within.

Researchers are developing an artificial retina that transforms a camera feed into electric pulses that stimulate the optic nerve, providing rudimentary vision for millions of people with degenerative retinal diseases. The research, involving six national labs, four universities and a commercial partner is developing technologies that will enable third- and fourth-generation models using as many as 1024 electrodes—which could provide enough detail to read 24-point font and recognize faces. 

Errors in the copying of genes during cell division can cause numerous diseases, including cancer. Yale School of Medicine scientists, however, have unraveled the secrets of a much more rare phenomenon with potential therapeutic implications – disease-causing genes that show a high frequency of self-repair. The researchers say that knowing that these particular mutations can revert with high frequency gives them hope that they might find a way to mimic this process to develop treatments for other genetic diseases.

Here come electronic prescriptions

Think about how we still get prescription medicines. A doctor writes in Latin on a little piece of paper. We carry that piece of paper to a pharmacist. This gives us an opportunity to lose the little piece of paper.

If we don't, the pharmacist tries to read it, gives up and calls the doctor to clarify. The pharmacist then checks to see if our insurance policy will pay for it. Then the pharmacist puts the pills in an orange, plastic bottle and puts stickers on it to warn us not to drink a bottle of whiskey and then go out and play on the tractor until we know how the pills will affect us.

The new way to do it is electronically. I'm sure we'll figure out how to screw that up, too. But it's catching on.

Some 200,000 doctors use e-prescribing, or roughly one in three office-based doctors. That compares with 156,000 at the end of last year, and 74,000 at the end of 2008, according to new data released by Surescripts, which operates the largest U.S. electronic prescribing network.

All this is driven by money, of course. And fear.

In 2009, Congress authorized $27 billion to promote electronic health records as part of the economic stimulus package. Incentives will be paid out over five years, and by 2015 providers will face penalties if they don't adopt the new technology.

More evidence for mammograms

Researchers reported Wednesday that mammograms can cut the breast cancer death rate by 26 percent for women in their 40s. But their results were greeted with skepticism by some experts who say they may have overestimated the benefit. 

Last year the United States Preventive Services Task Force, an independent group that issues guidelines on cancer screening, questioning the benefit of screening women younger than 50. 

The new study took advantage of circumstances in Sweden, where since 1986 some counties have offered mammograms to women in their 40s and others have not, according to the lead author, Hakan Jonsson, professor of cancer epidemiology at Umea University in Sweden. 

The researchers compared breast cancer deaths in women who had a breast cancer diagnosis in counties that had screening with deaths in counties that did not. The rate was 26 percent lower in counties with screening. 

Other experts were not convinced. 

One problem, said Dr. Peter C. Gotzsche of the Nordic Cochrane Center in Copenhagen, a nonprofit group that reviews health care research, is that the investigators counted the number of women who received a diagnosis of breast cancer and also died of it. They did not compare the broader breast cancer death rates in the counties. 

It is an important distinction, Dr. Gotzsche said, because screening finds many cancers that do not need to be treated or found early. With more harmless cancers being found in the screened group, it will look like the chance of surviving breast cancer is greater in that group. “The analysis is flawed,” he said.

The new study is here. This sounds like the controversy surrounding PSA screening for prostate cancer: screening finds a lot more cancers, but they may not all be lethal. You have to read up and talk to your doctor about your particular case.