Category: Health

Mice Genome Reprogrammed to Rejuvenate Organs and Extend Life

(p. A22) At the Salk Institute in La Jolla, Calif., scientists are trying to get time to run backward.
Biological time, that is. In the first attempt to reverse aging by reprogramming the genome, they have rejuvenated the organs of mice and lengthened their life spans by 30 percent. The technique, which requires genetic engineering, cannot be applied directly to people, but the achievement points toward better understanding of human aging and the possibility of rejuvenating human tissues by other means.
The Salk team’s discovery, reported in the Thursday issue of the journal Cell, is “novel and exciting,” said Jan Vijg, an expert on aging at the Albert Einstein College of Medicine in New York.
Leonard Guarente, who studies the biology of aging at M.I.T., said, “This is huge,” citing the novelty of the finding and the opportunity it creates to slow down, if not reverse, aging. “It’s a pretty remarkable finding, and if it holds up it could be quite important in the history of aging research,” Dr. Guarente said.
. . .
Ten years ago, the Japanese biologist Shinya Yamanaka amazed researchers by identifying four critical genes that reset the clock of the fertilized egg. The four genes are so powerful that they will reprogram even the genome of skin or intestinal cells back to the embryonic state.
. . .
Dr. Izpisua Belmonte believes these beneficial effects have been obtained by resetting the clock of the aging process. The clock is created by the epigenome, the system of proteins that clads the cell’s DNA and controls which genes are active and which are suppressed.
. . .
Dr. Izpisua Belmonte sees the epigenome as being like a manuscript that is continually edited. “At the end of life there are many marks and it is difficult for the cell to read them,” he said.
What the Yamanaka genes are doing in his mice, he believes, is eliminating the extra marks, thus reverting the cell to a more youthful state.
The Salk biologists “do indeed provide what I believe to be the first evidence that partial reprogramming of the genome ameliorated symptoms of tissue degeneration and improved regenerative capacity,” Dr. Vijg said.

For the full story, see:
NICHOLAS WADE. “Scientists Learn About Human Aging by Lengthening the Life Span of Mice.” The New York Times (Fri., DEC. 16, 2016): A22.
(Note: ellipses added.)
(Note: the online version of the story has the date DEC. 15, 2016, and has the title “Scientists Say the Clock of Aging May Be Reversible.”)

To Save Administrative Costs, Health-Care Providers Give Discounts for Paying Out-of-Pocket

(p. R6) As consumers get savvier about shopping for health care, some are finding a curious trend: More hospitals, imaging centers, outpatient surgery centers and pharmacy chains will give them deep discounts if they pay cash instead of using insurance.
When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.
When she needed an MRI to investigate further, she was offered a similar choice–she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.
Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?” says Ms. Surdoval, who divides her time between Boulder and Tucson. “I thought insurance companies negotiated good deals for us. Now things are totally upside down.”
Deep discounts
Not long ago, hospitals routinely charged uninsured patients their highest rates, far more than insured patients paid for the same services. Now, in the Alice-in-Wonderland world of health-care prices, the opposite is often true: Patients who pay up front in cash often get better deals than their insurance plans have negotiated for them.
That is partly due to new state and federal rules aimed at protecting uninsured patients from price gouging. (Under the Affordable Care Act, for example, tax-exempt hospitals can’t charge financially strapped patients much more than Medicare pays.) Many hospitals also offer discounts if patients pay in cash on the day of service, because it saves administrative work and collection hassles. Cash prices are officially aimed at the uninsured, but people with coverage aren’t legally required to use it.
Hospitals, meanwhile, have sought ever-higher rates from commercial insurers to make up for losses on other patients. Insurers pass those negotiated rates on to plan members, and given the growth in high-deductible plans, more Americans are paying those rates in full, out of pocket, than ever before.

For the full story, see:
Beck, Melinda. “Here’s a Way to Cut Your Health-Care Bill: Pay Cash.” The Wall Street Journal (Tues., Feb. 16, 2016): R6.
(Note: bold heading in original.)
(Note: the online version of the story has the date Feb. 15, 2016, and has the title “How to Cut Your Health-Care Bill: Pay Cash.”)

Doctors Lack Incentives to Use Best Ovarian Cancer Treatment

(p. 22) In 2006, the National Cancer Institute took the rare step of issuing a “clinical announcement,” a special alert it holds in reserve for advances so important that they should change medical practice.
In this case, the subject was ovarian cancer. A major study had just proved that pumping chemotherapy directly into the abdomen, along with the usual intravenous method, could add 16 months or more to women’s lives. Cancer experts agreed that medical practice should change — immediately.
Nearly a decade later, doctors report that fewer than half of ovarian cancer patients at American hospitals are receiving the abdominal treatment.
“It’s very unfortunate, but it’s the real world,” said Dr. Maurie Markman, the president of medicine and science at Cancer Treatment Centers of America. He added, “The word ‘tragic’ would be fair.”
Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.

For the full story, see:
DENISE GRADY. “Ovarian Cancer Treatment Is Found Underused.” The New York Times (Tues., AUG. 4, 2015): A1 & A13.
(Note: the online version of the story has the date AUG. 3, 2015, and has the title “Effective Ovarian Cancer Treatment Is Underused, Study Finds.”)

Jewish Medical Inventor Invested in Human Capital Because That “Could Never Be Taken from Me”

Louis Sokoloff’s son Kenneth authored, or co-authored, important papers on how patents aided invention in the 1800s.

(p. A21) Dr. Louis Sokoloff, who pioneered the PET scan technique for measuring human brain function and diagnosing disorders, died on July 30 [2015] in Washington.
. . .
. . . he leapt at the opportunity when he won a scholarship to the University of Pennsylvania, guided by his grandfather’s advice.
“He advised me to choose a profession, any one,” he wrote, “in which all my significant possessions would reside in my mind because, being Jewish, sooner or later I would be persecuted and I would lose all my material possessions; what was contained in my mind, however, could never be taken from me and would accompany me everywhere to be used again.”
. . .
Dr. Sokoloff’s wife, the former Betty Kaiser, died in 2003, and his son, Kenneth, an economic historian, died in 2007.

For the full obituary, see:
SAM ROBERTS. “Louis Sokoloff, Pioneer of PET Scan, Dies at 93.” The New York Times (Thurs., AUG. 6, 2015): A21.
(Note: ellipses added.)
(Note: the online version of the obituary has the date AUG. 5, 2015.)

The Good Old Days Were Grim

(p. A15) In “Progress,” the Swedish author Johan Norberg deploys reams of data to show just how much life has improved–especially over the past few decades but over the past couple of centuries as well. Each chapter is devoted to documenting progress in a single category, including food, sanitation, life expectancy, poverty, violence, the environment, literacy and equality.
In response to people who look fondly on the “good old days,” Mr. Norberg underscores just how grim they could be. Rampant disease, famine and violence routinely killed off millions. In the 14th century, the so-called Black Death wiped out a third of Europe’s population. Five hundred years later, cholera outbreaks throughout the world led to hundreds of thousands of deaths and even killed a U.S. president, James Polk.

For the full review, see:

MATTHEW REES. “BOOKSHELF; Bending the Arc of History.” The Wall Street Journal (Tues., December 13, 2016): A15.
(Note: the online version of the review has the date Dec. 12, 2016,)

The book under review, is:
Norberg, Johan. Progress: Ten Reasons to Look Forward to the Future. London, UK: Oneworld Publications, 2016.

Double-Blind Trials Are Not the Only Source of Sound Knowledge

(p. 1) . . . while all doctors agree about the importance of gauging the quality of evidence, many feel that a hierarchy of methods is simplistic. As the doctor Mark Tonelli has argued, distinct forms of knowledge can’t be judged by the same standards: what a patient prefers on the basis of personal experience; what a doctor thinks on the basis of clinical experience; and what clinical research has discovered — each of these is valuable in its own way. While scientists concur that randomized trials are ideal for evaluating the average effects of treatments, such precision isn’t necessary when the benefits are obvious or clear from other data.
Clinical expertise and rigorous evaluation also differ in their utility at different stages of scientific inquiry. For discovery and explanation, as the clinical epidemiologist Jan Vandenbroucke has argued, practitioners’ instincts, observations and case studies are most useful, whereas randomized controlled trials are least useful. Expertise and systematic evaluation are partners, not rivals.
Distrusting expertise makes it easy to confuse an absence of randomized evaluations with an absence of knowledge. And this leads to the false belief that knowledge of what works in social policy, education or fighting terrorism can come only from randomized evaluations. But by that logic (as a spoof scientific article claimed), we don’t know if parachutes really work because we have no randomized controlled trials of them.

For the full commentary, see:
PAGAN KENNEDY. “The Thin Gene.” The New York Times, SundayReview Section (Sun., NOV. 27, 2016): 1 & 6.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date NOV. 25, 2016.)

The academic article calling for double-blind randomized trials to establish the efficacy of parachutes, is:
Smith, Gordon C. S., and Jill P. Pell. “Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of Randomised Controlled Trials.” BMJ 327, no. 7429 (Dec. 18, 2003): 1459-61.

Science Can Learn Much from Outliers “Who Are Naturally Different”

(p. 1) Abby Solomon suffers from a one-in-a-billion genetic syndrome: After just about an hour without food, she begins to starve. She sleeps in snatches. In her dreams she gorges on French fries. But as soon as she wakes up and nibbles a few bites, she feels full, so she ends up consuming very few calories. At 5 feet 10 inches tall, she weighs 99 pounds.
Now 21 years old, she is one of the few people in the world to survive into adulthood with neonatal progeroid syndrome, a condition that results from damage to the FBN1 gene.
. . .
(p. 6) Dr. Chopra told me that, as far as medical science is concerned, Abby Solomon is worth thousands of the rest of us.
. . .
“Nothing comes close to starting with people who are naturally different,” he said. This is why he searches out patients at the extreme ends of the spectrum — those who are wired to weigh 80 pounds or 380 pounds. He said, “We have the opportunity to help a bigger swath of humanity when we learn from these outliers.”
In 2013, after hearing about Ms. Solomon’s unusual condition from another patient, he asked her to visit his clinic. Ms. Solomon warned him that she would be able to carry on a conversation for only 15 minutes before she needed to snack on chips or a cookie. That remark inspired a revelation. Dr. Chopra realized that “she had to eat small, sugary meals all day to stay alive, because her body was constantly running out of glucose,” he said.
The clue led Dr. Chopra and his colleagues to their discovery of the blood-sugar-regulating hormone, which they named asprosin. Ms. Solomon’s natural asprosin deficiency keeps her on the brink of starvation, but Dr. Chopra’s hope is that an artificial compound that blocks asprosin could be used as a treatment for obesity. He and his team have already tested such a compound on mice, and found that it can reverse insulin resistance and weight gain.

For the full commentary, see:
PAGAN KENNEDY. “The Thin Gene.” The New York Times, SundayReview Section (Sun., NOV. 27, 2016): 1 & 6.
(Note: ellipses added.)
(Note: the online version of the commentary has the date NOV. 25, 2016.)

“Patients Should Be the Owners of Their Own Medical Data”

(p. A21) THERE’S quite a paradox when it comes to our health data. Most of us still cannot readily look at it, but there’s been an epidemic of cybercriminals and thieves hacking and stealing this most personal information.
. . .
. . . , giving consumers control of their own medical data would revolutionize who owns medical data and how it is used. Concerns about researchers losing access to this amassed data are overstated. Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data).
. . .
We need to move on from the days of health systems storing and owning all our health data. Patients should be the owners of their own medical data. It’s an entitlement and civil right that should be recognized.

For the full commentary, see:
KATHRYN HAUN and ERIC J. TOPOL. “The Health Data Conundrum.” The New York Times (Tues., January 3, 2017): A21.
(Note: ellipses added.)
(Note: the online version of the commentary has the date January 2, 2017.)

British Government Ignored Scurvy Cure

(p. C14) Scurvy, we know today, has a single and simple cause: lack of vitamin C. But between the years 1500 and 1800, when an estimated two million sailors died from the disease, it seemed to defy all logic.
. . .
The conventional medical narrative holds that the mystery was solved by James Lind’s announcement, in his “Treatise of the Scurvy” (1753), that it could be cured by drinking lemon juice. But in “Scurvy: The Disease of Discovery,” Jonathan Lamb, a professor at Vanderbilt University, shows that the story is nowhere near so simple and that scurvy was a much stranger condition than we imagine, with effects on the mind that neuroscience is only now beginning to elucidate. The result is a book that renders a familiar subject as exotic and uncanny as the tropical shores that confronted sailors in the grip of scurvy’s delirium.
James Lind was not the first person to recommend the lemon-juice cure. Contemporaries of Francis Drake had discovered it 150 years before, but the secret was lost and found again many times over the centuries. Some citrus juices were much more effective than others, and their efficacy was reduced considerably when they were preserved by boiling. The British admiralty ignored Lind’s researches, . . .

For the full review, see:
MIKE JAY. “The Disease of the Enlightenment.” The Wall Street Journal (Sat., December 10, 2016): C14.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 9, 2016, and has the title “Scurvy: The Disease of the Enlightenment.”)

The book under review, is:
Lamb, Jonathan. Scurvy: The Disease of Discovery. Princeton, NJ: Princeton University Press, 2017.

Superagers Engage in “Strenuous Mental Effort”

(p. 10) Why do some older people remain mentally nimble while others decline? “Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds.
. . .
Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.
The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

For the full commentary, see:
LISA FELDMAN BARRETT. “Gray Matter; How to Become a ‘Superager’.” The New York Times, SundayReview Section (Sun., January 1, 2017): 10.
(Note: ellipsis added.)
(Note: the online version of the commentary has the date DEC. 31, 2016.)

The passages quoted above are related to Barrett’s academic paper:
Sun, Felicia W., Michael R. Stepanovic, Joseph Andreano, Lisa Feldman Barrett, Alexandra Touroutoglou, and Bradford C. Dickerson. “Youthful Brains in Older Adults: Preserved Neuroanatomy in the Default Mode and Salience Networks Contributes to Youthful Memory in Superaging.” The Journal of Neuroscience 36, no. 37 (Sept. 14, 2016): 9659-9668.