Fifty Shades of Gray---in Medicine
Posted by on February 25, 2015 - 11:37am

Someone once reminded me that our healthcare system is really the "practice of medicine", implying that as technology improves and ongoing studies are completed, our knowledge base continues to grow.  In other words,  what we knew yesterday may change tomorrow.   Like many aspects of life,  there are many shades of gray in medicine.

This week, the 2015 Dietary Guidelines Advisory Committee  recommended several changes  to the U.S. government's Dietary Guidelines for Americans  that is updated every five years by the Dept. of Health and Human Services and the Dept. of Agriculture.   These guidelines are used to set national policies related to diet.  The new recommendations take aim at current cholesterol intake guidelines, suggesting that current available evidence shows no appreciable relationship between consumption of dietary cholesterol and the serum cholesterol circulating in one's blood.    Does this mean eggs are back on the menu?  After all, they are high in protein and low in saturated fats!   There will be more debate on this issue before a final recommendation is entered into the official guidelines and we may end up agreeing that everyone metabolizes cholesterol differently resulting in different levels of risk.

Another well-known "shady"  example is hormonal therapy for menopause symptoms.  Forty years ago hormone therapy was  the panacea for all menopause symptoms and many women believed it to be the 'fountain  of youth'.   Then the bombshell from  the  Women's Health Initiative--one of the largest studies done in women-- was released in 2002 and told us hormone therapy (HT)  could cause great harm.    The pendulum swung, and many women suddenly stopped HT and many women found their symptoms return.    Today, we now know that there are many variables in hormone therapy, including dosage, delivery method, timing, etc  and for some women, HT is a viable treatment and could benefit their health.   In other cases, we better understand who is at greatest risk for complications due to hormone use.    New data leads to new knowledge.....and better options!   There are now many formulations of hormone therapy and new non-hormonal options that have changed the way we practice medicine.   To learn more about menopause, visit menopausenu.org

The lesson:   the practice of medicine is constantly changing and the risks and benefits we know today may be altered tomorrow.

What do we do to be sure we get the best treatment available?

  • Find a provider who stays current and is willing to accept new options.
  • Seek second opinions for complex health issues.
  • Recognize that every medicine has risks and benefits   (What would happen if you did not take that drug?   Will side effects be worse than the cure?")
  • Review your treatment plan at least once a  year to determine if newer therapies may be more effective.
  • Report unpleasant side effects (it advances knowledge!)
  • Consider lifestyle changes that can compliment your treatments.

 

 

 

 

Use of Mind & Body Practices Increasing in US
Posted by on February 18, 2015 - 12:28pm

A nationwide survey reported that more Americans are using mind and body approaches to improve health and well-being. Interest in yoga is particularly on the rise.   The 2012 survey, developed by the NIH National Center for Complementary and Integrative Health (NCCIH) and the CDC, compared results with versions from 2002 and 2007.  Survey highlights:

Approximately 21 millions adults (nearly double the number from 2002) and 1.7 million children practice yoga.
Nearly 20 million adultw and 1.9 million children had chiropractic care.
Nearly 18 million adults and 927,000 children practiced meditation.
Children whose parents use a complementary health approach are more likely to use one as well.

The high rates of yoga are particularly interesting and may have been influenced by the growing number of yogo studios in the U.S.

To view more on this report, click HERE.

Sex differences in eye disease featured
Posted by on February 17, 2015 - 10:46am

When we think about sex differences in health, we do not normally think about our eyes.   While some clinical conditions are well known to affect the visual systems of men and women differentially, the sex-dependent effects on the visual system of other clinical conditions may be more subtle or more sporadic and hence less documented. Researchers are now discovering that sex differences exist in a wide range of eye disorders.  In some cases, the differences can be related to the hormone milieu.  In others, they are intertwined with other bodily systems such as neurotransmitter activity and blood flow. 

The visual system is especially amenable to assessment and examination because it has an organ-- the eye , that provides a "window" for interior inspection and study.     All these sex-dependent effects need to be better understood – from the front surface of the eye, to its interior, and to those parts of the visual system behind the eye.

A special issue of Current Eye Research includes a series of 12 review articles, solicited from experts in their respective fields, with most articles focused on different opthalmology subspecialtes. These articles collectively serve as a resource for eye care professionals as well as health care providers in other fields, especially those fields pertaining to women’s health.  In addition to helping improve care, the information in this special issue will provide timely foundations for future research projects reflecting the new NIH mandates that concern the inclusion of sex variables into preclinical studies.While this special issue centers on ophthalmic disorders, it aims to bridge existing specialties and it takes the view that women’s health concerns more than obstetrics and gynecology.

To learn more, visit:  Sex, Eyes, and Vision:   Male/female Distinctions in Opthalmic Disorders
 

 

Beware Miracle "Weight Loss" Programs
Posted by on February 13, 2015 - 3:44pm

If you find yourself making this common New Year’s resolution, know this: many so-called “miracle” weight loss supplements and foods (including teas and coffees) don’t live up to their claims. Worse, they can cause serious harm, say FDA regulators. The agency has found hundreds of products that are marketed as dietary supplements but actually contain hidden active ingredients (components that make a medicine effective against a specific illness) contained in prescription drugs, unsafe ingredients that were in drugs that have been removed from the market, or compounds that have not been adequately studied in humans.

“When the product contains a drug or other ingredient which is not listed as an ingredient we become especially concerned about the safety of the product,” says James P. Smith, M.D., an acting deputy director in FDA’s Office of Drug Evaluation.

To read more about the good, the bad and the ugly about weight loss programs, visit the FDA site.   

HRT preserves joint implant
Posted by on February 12, 2015 - 12:16pm

A new study found that women who were taking hormone replacement therapy (HRT) at least for 6 month after total knee or hip arthroplasty demonstrated a reduced rate of implant failure.   The most common reason for implant failure is aseptic loosening of the implant due to osteolysis (degeneration) of the bone surrounding the implant..   HRT is approved to prevent bone loss though many women reject HRT due to other concerns about side effects.  To learn more about the benefits and risks of HRT, visit  menopauseNU.org

 

HRT and Joint Replacement
Posted by on February 12, 2015 - 12:03pm
A New Noninvasive Method May Detect Alzheimer's Early
Posted by on February 11, 2015 - 4:06pm

No methods currently exist for the early detection of Alzheimer’s disease, which affects one out of nine people over the age of 65. Now, an interdisciplinary team of Northwestern University scientists and engineers has developed a noninvasive MRI approach that can detect the disease in a living animal. And it can do so at the earliest stages of the disease, well before typical Alzheimer’s symptoms appear.

Led by neuroscientist William L. Klein and materials scientist Vinayak P. Dravid, the research team developed an MRI (magnetic resonance imaging) probe that pairs a magnetic nanostructure (MNS) with an antibody that seeks out the amyloid beta brain toxins responsible for onset of the disease. The accumulated toxins, because of the associated magnetic nanostructures, show up as dark areas in MRI scans of the brain.

This ability to detect the molecular toxins may one day enable scientists to both spot trouble early and better design drugs or therapies to combat and monitor the disease. And, while not the focus of the study, early evidence suggests the MRI probe improves memory, too, by binding to the toxins to render them “handcuffed” to do further damage.

“Using MRI, we can see the toxins attached to neurons in the brain,” Klein said. “We expect to use this tool to detect this disease early and to help identify drugs that can effectively eliminate the toxin and improve health.”

With the successful demonstration of the MRI probe, Northwestern researchers now have established the molecular basis for the cause, detection by non-invasive MR imaging and treatment of Alzheimer’s disease. Dravid introduced this magnetic nanostructure MRI contrast enhancement approach for Alzheimer’s following his earlier work utilizing MNS as smart nanotechnology carriers for targeted cancer diagnostics and therapy. (A MNS is typically 10 to 15 nanometers in diameter; one nanometer is one billionth of a meter.)

Details of the new Alzheimer’s disease diagnostic were published December 22 by the journal Nature Nanotechnology. Klein and Dravid are co-corresponding authors.

The emotional and economic impacts of Alzheimer’s disease are devastating. This year, the direct cost of the disease in the United States is more than $200 billion, according to the Alzheimer’s Association’s “2014 Alzheimer’s Disease Facts and Figures.” By the year 2050, that cost is expected to be $1.1 trillion as baby boomers age. And these figures do not account for the lost time of caregivers.

This new MRI probe technology is detecting something different from conventional technology: toxic amyloid beta oligomers instead of plaques, which occur at a stage of Alzheimer’s when therapeutic intervention would be very late. Amyloid beta oligomers now are widely believed to be the culprit in the onset of Alzheimer’s disease and subsequent memory loss.

Read more

High School Programs to Introduce Students to Northwestern Medicine
Posted by on January 15, 2015 - 12:30pm

Northwestern University has a long history of opening its doors to young high school scholars interested in programs towards careers in science and medicine. Recently, more than 30 young men from Westinghouse College Prep spent time on Northwestern's medical campus during their Northwestern Medicine Scholars Program, which introduces young men to all types of medical careers. The Women's Health Research Institute at Northwestern University offers a comparable program for young women in Chicago Public Schools. This program, The Women's Health Science Program (WHSP) offers specialized week-long academies during the summer where students are mentored by current graduate and medical students, clinicians, and researchers. These young women learn clinical skills (such as suturing, vitals, and phlebotomy ) as well as basic science, laboratory skills revolving around oncofertility. While the target populations of these two programs differ, their goals of investing in future science and medical leaders remains the same.

Women Receiving Longer Radiation Therapy than Necessary
Posted by on January 5, 2015 - 2:27pm

A recent study published in the Journal of the American Medical Association (JAMA) has concluded that about two-thirds of women who undergo a lumpectomy to treat breast cancer receive radiation therapy for longer than necessary. Radiation is used after a lumpectomy to reduce the likelihood of cancer returning and to increase survival rates. Traditional radiation treatment following lumpectomies typically lasts five to seven weeks. However, the JAMA study, along with various other tests and studies indicate that a shorter, more intense three to four week treatment of radiation is just as effective. Studies have also found that women prefer to receive shorter courses of radiation treatment, and that shorter treatment is less expensive. Considering that about 60% to 75% of women with breast cancer receive lumpectomies, there is significant potential for increased patient satisfaction and reduced costs by offering shorter radiation therapy. Unfortunately, years of ingrained practice and hesitancy to change a course of treatment used for years may slow the rate in which shorter radiation therapy is used on lumpectomy patients. However, due to this study and others like it, this course of treatment will likely become more common over time. Source: Kolata, Gina. “Long Radiation Treatments Called Unnecessary in Many Breast Cancer Cases.”  The New York Times. 10 December 2014.

Science literacy helps answer life's questions
Posted by on January 4, 2015 - 11:53am

Understanding science isn't just important to scientists and health care professionals, a basic understanding of science is critical for all people to participate fully in the national and international conversation.   A recent issue of The Conversation, discusses the importance of science literacy in today's world whether we are trying to learn the facts about Ebola or wanting to learn what stem cell research is.   Many of our public policies and regulations need to be based on facts and not politics and biased headline reporting.

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