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Health, Fitness and Style
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More about Health, Fitness, Science & Style

Article

Dermatologist Cynthia Bailey, Summer sun protection is much more than just picking the right sunscreen: As a California dermatologist, I spend most of my time treating people with skin cancer. I teach my patients to enjoy being outdoors and keep their skin safe. Today, sun protection information is complicated by vitamin D information such that even doctors are confused

Study

Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage

The Commonwealth Fund supported this study published in the Annals of Internal Medicine. Here are a few paragraphs from the article:

"In time–trend analyses of nationally representative data, blood pressure, glycemic, and cholesterol level control improved significantly from 1999 to 2006 for adults with cardiovascular disease or diabetes. Overall trends were not explained by changes in population characteristics, suggesting that management of cardiovascular disease and diabetes has improved considerably over this period. These improvements probably have prevented adverse outcomes, increased life expectancy, and provided considerable value to society. However, improvements in disease control have not been associated with discernable reductions in racial, ethnic, or socioeconomic differences in blood pressure or glycemic control, and gaps in glycemic control between white and Hispanic adults with diabetes have widened. Therefore, to redress inequities in these health outcomes, quality improvement efforts focusing on disadvantaged groups and their health care providers or broader reforms to address social determinants of poor health are still needed. In particular, because black, Hispanic, and less educated adults are much more likely to be uninsured or underinsured, expanding insurance coverage may be especially beneficial for these groups. With near-universal Medicare coverage after age 65 years, differences in systolic blood pressure, hemoglobin A1c levels, or total cholesterol levels reduced substantially. These reductions may substantially decrease racial and socioeconomic differences in mortality as well. For example, 1 study estimated that eliminating racial differences in mean systolic blood pressure might reduce deaths from heart disease or stroke by more than 7500 annually among black adults."

"Our findings are consistent with previous studies that used experimental or quasi-experimental designs to assess effects of insurance coverage on health outcomes for adults with cardiovascular disease or diabetes. Thus, differences in insurance coverage before age 65 years may contribute substantially to sociodemographic differences in health. Sociodemographic comparisons of self-reported insurance coverage at the time of surveys suggested that diminished sociodemographic differences in disease control after age 65 years were due to narrowed gaps in coverage between groups. However, near-universal Medicare coverage after age 65 years probably improved disease control for greater numbers of elderly black, Hispanic, and less educated adults than these comparisons suggested because insurance status was only assessed at the time of surveys."

 

Article

John Malone, Sailing, Part One: It wasn’t until we began sailing in weekend races at the Pymatuning Yacht Club and won the handicap trophy that Papa stopped trying to be in control and let me handle the boat my way. We were notorious for having loud arguments out on the lake, so loud and prolonged that other boat owners used to joke, “Here come the Malone’s, sailing on hot air again!”

Ethics: A GAO Report on Human Subjects Research

Undercover Tests Show the Institutional Review Board System Is Vulnerable to Unethical Manipulation

Millions of Americans enroll in clinical studies of experimental drugs and medical devices each year. Many of these studies are meant to demonstrate that products are safe and effective. The Department of Health and Human Services’ (HHS) Office for Human Research Protections (OHRP) and the Food and Drug Administration (FDA) are responsible for overseeing aspects of a system of independent institutional review boards (IRB). IRBs review and monitor human subjects research, with the intended purpose of protecting the rights and welfare of the research subjects.

GAO investigated three key aspects of the IRB system: (1) the process for establishing an IRB, (2) the process through which researchers wishing to apply for federal funding assure HHS their human subjects research activities follow ethical principles and federal regulations, and (3) the process that medical research companies follow to get approval for conducting research on human subjects.

GAO investigated these three aspects of the IRB system by creating two fictitious companies (one IRB and one medical device company), phony company officials, counterfeit documents, and a fictitious medical device.

The IRB system is vulnerable to unethical manipulation, which elevates the risk that experimental products are approved for human subject tests without full and appropriate review. GAO investigators created fictitious companies, used counterfeit documents, and invented a fictitious medical device to investigate three key aspects of the IRB system. These are the results:

Establishing an IRB. GAO created a Web site for a bogus IRB and advertised the bogus IRB’s services in newspapers and online. A real medical research company contacted the bogus IRB to get approval to join ongoing human trials involving invasive surgery — even though GAO’s investigators had no medical expertise whatsoever. Since the transaction involved privately funded human subjects research and did not involve any FDA-regulated drugs or devices, GAO’s bogus IRB could have authorized this testing to begin without needing to register with any federal agency.
Obtaining an HHS-approved assurance. GAO also registered its bogus IRB with HHS, and used this registration to apply for an HHS-approved assurance for GAO’s fictitious medical device company. An assurance is a statement by researchers to HHS that their human subjects research will follow ethical principles and federal regulations, which is required before researchers can receive federal funding for the research. On its assurance application, GAO designated its bogus IRB as the IRB that would review the research covered by the assurance. Even though the entire process was done online or by fax — without any human interaction — HHS approved the assurance for GAO’s fictitious device company. With an HHS-approved assurance, GAO’s device company could have applied for federal funding for human subjects research.

Obtaining IRB approval for human testing. GAO succeeded in getting approval from an actual IRB to test a fictitious medical device on human subjects. GAO’s fictitious device had fake specifications and matched several examples of “significant risk” devices from FDA guidance. The IRB did not verify the information submitted by GAO, which included false information that FDA had already cleared GAO’s device for marketing. Although records from this IRB indicated that it believed GAO’s bogus device was “probably very safe,” two other IRBs that rejected GAO’s protocol cited safety concerns with GAO’s device. No human interaction with these IRBs was necessary as the entire process was done through e-mail or fax. GAO’s bogus IRB mentioned above also could have approved the fictitious protocol, which shows the potential for unethical manipulation in the IRB system.

GAO briefed HHS officials on the results of its investigation. The director of OHRP stated that, when reviewing assurance applications, HHS does not consider whether IRBs listed on the applications are adequate — even though HHS is required to do so by law. In addition, HHS officials stated that the department does not review assurance applications to determine whether the information submitted by applicants is factual.

Meet Me at MoMa: An Art Program for Those With Alzheimer's

Aside from The New York Times article* about this program, the New York Chapter of the Alzheimer's Association has posted this explanation of this resource:

"The MoMA Alzheimer’s Project: Making Art Accessible to People with Dementia is a nationwide initiative that builds on the success of MoMA's long history of serving people with disabilities and special needs. As the Museum is committed to enabling all visitors to experience its unparalleled collection of modern and contemporary art, MoMA offers a variety of Access Programs that annually serve over 10,000 individuals with physical, developmental, emotional or learning disabilities, and those who are blind, partially sighted, deaf or hard of hearing, as well as senior citizens. From 2003-2006, MoMA, along with staff from Artists for Alzheimer's, a project sponsored by the Hearthstone Alzheimer's Family Foundation, began focused interviews with people with Alzheimer's, and pilot programs with groups from Hearthstone.

"After this initial phase, MoMA independently expanded and deepened its research and program development. This included workshops for lecturers focusing on gallery teaching strategies and best practice, artwork selection, and audience appropriate activities. Educators also receive bi-annual training from professionals from the New York City Alzheimer's Association and Mount Sinai School of Medicine. In January 2006, MoMA launched Meet Me at MoMA programs for individuals with Alzheimer's and their family members or care partners as well as groups from support networks and assisted living facilities.

"MoMA educators have learned that the act of looking at art can be a rich and satisfying experience for people without full access to their memory, thus providing relaxation and pleasure for those who live with Alzheimer's and their caregivers. Studies show that Alzheimer's disease has a major impact on those who help care for an affected individual."

*Keeping Those With Alzheimer's Engaged

Balad, Iraq Trauma Bay Exhibit

The National Museum of Health and Medicine in Washington, DC has established an exhibit of an Air Force Hospital emergency facility in Balad, Iraq:

"In August 2007, a Congressional delegation visiting the US Air Force base in Balad, Iraq, was touring the installation’s tent hospital when they learned that it was to be demolished since a more permanent facility had recently opened."

"The delegation was moved by stories of the lives saved and heroic measures taken at the hospital’s emergency room, and upon their return, efforts were begun to coordinate with Museum staff and USAF leadership in Iraq to collect and preserve many of the objects on display in this exhibit."

" 'As we stood near Bay II, we realized that perhaps more lives have been saved, and lost, on this spot than perhaps any other during Operation Iraqi Freedom,” said a letter dated Aug. 7 authored by four congressmen, addressed to Army Maj. Gen. Galen Jackman, the Office of the Secretary of the Army legislative liaison chief. “The scuff marks and antiseptic stains on the floor tell a story of heroic efforts to give our wounded the best emergency medical care in the history of warfare. The lives saved, and lost, likely make the slab of concrete the most hallowed of ground in the entire country of Iraq.' — Major Jody Ocker, USAF-NC."

"Since the beginning of Operation IRAQI FREEDOM, this expeditionary hospital saw 700 to 800 patients every month. Thousands of American soldiers, marines, sailors and airmen; contractors and coalition forces; as well as Iraqi Army, Police and civilians were assured the best trauma care available anywhere in the world."

" 'Every American Warfighter knew he could count on us. We lived up to our motto, Bustin Ours to Save Yours! The 98% survival rate of wounded Americans was unprecedented in the history of conflict and we did it in tents!" — Major Jody Ocker, USAF-NC.' "

Congressional Budget Office and Health Reform

There's a website for the CBO that presents health policy (and the need for its reform) and the projected financial impact on the US population.

Rising health care costs and their consequences for Medicare and Medicaid constitute the nation's central fiscal challenge. Without changes in federal law, the government’s spending on those two programs is on a path that cannot be sustained.

Over the past 30 years, total national spending on health care has more than doubled as a share of gross domestic product (GDP). According to CBO’s latest projections in its Long-Term Outlook for Health Care Spending, that share will double again by 2035, claiming more than 30 percent of GDP. Thereafter, health care costs continue to account for a steadily growing share of GDP, reaching more than 40 percent by 2060 and almost 50 percent by 2082. Federal spending on Medicare and Medicaid, which accounts for 4 percent of GDP today, is projected to rise to 9 percent by 2035 and 19 percent by 2082 under current law.

Although the aging of the population is frequently cited as the major factor contributing to the large projected increase in federal spending on Medicare and Medicaid, it accounts for only a modest fraction of the growth that CBO projects. The main factor is excess cost growth-or the extent to which the increase in health care spending exceeds the growth of the economy. The gains from higher spending are not clear, however: Substantial evidence exists that more expensive care does not always mean higher-quality care. Consequently, embedded in the country’s fiscal challenge are opportunities to reduce costs without impairing health outcomes overall.

Policymakers and the public need more analysis of the options for capturing those opportunities. CBO is therefore substantially augmenting its capabilities and work on health care issues--and this Web page collects many of the agency's activities in the area.

The New England Journal of Medicine presents an editorial on Health Care 2009: Budgeting for Change Obama's Down Payment on Health Care Reform:

Obama's new nominee for secretary of health and human services Kansas Governor Kathleen Sebelius brings impressive credentials to the job, but in order to influence the administration's health policies she will have to contend with a phalanx of economists and analysts who are already entrenched in the White House. Seemingly to a person, they share Orszag's belief that, given the competitive environment created by globalization and the lack of evidence that spending more on health care necessarily results in higher-quality care, we must put a stop to the pattern of health care expenditures' growing far more rapidly than wages and the overall economy. A recent study by the McKinsey Global Institute4 estimated that the United States spends $643 billion more every year on health care than its peer industrialized countries, after adjustment for wealth (see graph and table). These findings have had a profound influence on the thinking of Orszag and his colleagues.

MedPage's blog, Musings of a Distractible Mind

Dr. Rob, Patient Rules, Rule 2:  Be Honest

"Nobody likes to look silly.  I think the main reason most people are untruthful is that they are embarrassed about the truth.  But sometimes symptoms are strange, like the man having a heart attack who described it as 'a cold feeling when I take a deep breath.'  Sometimes symptoms are embarrassing, like a testicular lump.  Sometimes you just don't want to feel like a wimp, so you downplay your pain.

"While I can sympathize with this feeling, I don't see any good reason to be anything but truthful with your doctor.  Yes, your symptom might sound strange.  Yes, you may have flubbed up and not followed instructions properly.  Yes, you may be afraid of what some of your symptoms may mean.  But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility.

"We physicians hear it all.  There are very few things a person can say to me in the exam room that will surprise me.  My job is to help people, not judge them as 'weird,', 'crazy,' 'wimpy,', or 'panicky.'  Don't worry about making a good impression on your doctor.  Just give the facts.  That will give the best chance to get the desired outcome."

Read all six of this doctor's rules at MedPage

Articles

Dermatologist Cynthia Bailey begins a quarterly column with Hydrate Skin to Soothe Winter Itch: If you give the skin a little extra attention in the winter and employ some simple tips, it will be as soft and hydrated as it is during the warmer and more humid weather of summer

Adrienne Cannon, Last in Line: I look around during rehearsals and classes and don’t see many of my age who are as persistent or energetic in trying to perfect their skill. I feel successful in many of the things I do, in spite of not being the best performer

Julia Sneden, Shrink Shrank Shrunken: My spine has begun to collapse, and most cruelly of all, this is happening as my granddaughter is starting her adolescent growth spurt. Soon she will be kissing me on the top of the head and, worse yet, noticing that my part isn’t straight as she does so

Multivitamin Use and Risk of Cancer and Cardiovascular Disease in the Women's Health Initiative Cohorts

"Neuhouser et al investigated multivitamin use and disease risk in the Women's Health Initiative (WHI), a large study of 161 808 postmenopausal women participating in either a set of clinical trials or an observational study. Of the WHI participants, 41.5% used multivitamins, but after a median of 8.0 years of follow-up in the clinical trials and a median 7.9 years in the observational study, there was no evidence that multivitamins confer meaningful benefit or harm in relation to cancer or cardiovascular disease. The risk for invasive cancers of the breast, colon/rectum, endometrium, lung, bladder, and ovary was no different among women who used multivitamin compared with those who did not use multivitamins. Similarly, risk of myocardial infarction, stroke, venous thrombosis, and death from any cause was no different for multivitamin users than for nonusers. Multivitamins do not appear to be effective for the prevention of cancer or cardiovascular disease.

Effects of Intentionally Enhanced Chocolate on Mood

by Dean Radin, PhD,1# Gail Hayssen,1 and James Walsh

Objective: A double-blind, randomized, placebo-controlled experiment investigated whether chocolate exposed to “good intentions” would enhance mood more than unexposed chocolate.

Design: Individuals were assigned to one of four groups and asked to record their mood each day for a week by using the Profile of Mood States. For days three, four and five, each person consumed a half ounce of dark chocolate twice a day at prescribed times. Three groups blindly received chocolate that had been intentionally treated by three different techniques. The intention in each case was that people who ate the chocolate would experience an enhanced sense of energy, vigor, and wellbeing. The fourth group blindly received untreated chocolate as a placebo control. The hypothesis was that mood reported during the three days of eating chocolate would improve more in the intentional groups than in the control group.

Subjects: Stratified random sampling was used to distribute 62 participants among the four groups, matched for age, gender, and amount of chocolate consumed on average per week. Most participants lived in the same geographic region to reduce mood variations due to changes in weather, and the experiment was conducted during one week to reduce effects of current events on mood fluctuations.

Results: On the third day of eating chocolate, mood had improved significantly more in the intention conditions than in the control condition. Analysis of a planned subset of individuals who habitually consumed less than the grand mean of 3.2 ounces of chocolate per week showed a stronger improvement in mood. Primary contributors to the mood changes were the factors of declining fatigue and increasing vigor. All three intentional techniques contributed to the observed results.

FDA's Consumer Alerts: Plavix

We continue to encourage our audience to subscribe to the FDA's MedWatch Alerts, a Safety Information and Adverse Event Reporting Program. This, for instance, is one example:

FDA notified healthcare professionals that the makers of Plavix have agreed to work with FDA to conduct studies to obtain additional information that will allow a better understanding and characterization of the effects of genetic factors and other drugs (especially the proton pump inhibitors (PPIs) on the effectiveness of clopidogrel. FDA is aware of published reports that clopidogrel is less effective in some patients than it is in others. Differences in effectiveness may be due to genetic differences in the way the body metabolizes clopidogrel or that using certain other drugs with clopidogrel can interfere with how the body metabolizes clopidogrel. These studies should lead to a better understanding about how to optimize the use of clopidogrel. The FDA recognizes the importance of obtaining these data promptly. The drug manufacturers have agreed to a timeline for completing the studies and FDA will review the new information expeditiously and will communicate its conclusions and any recommendations to the public at that time. It could take several months to complete the studies and analyze the results. Until further information is available FDA recommends the following:

  • Healthcare providers should continue to prescribe and patients should continue to take clopidogrel as directed, because clopidogrel has demonstrated benefits in preventing blood clots that could lead to a heart attack or stroke. Healthcare providers should re-evaluate the need for starting or continuing treatment with a PPI, including Prilosec OTC, in patients taking clopidogrel. 
  • Patients taking clopidogrel should consult with their healthcare provider if they are currently taking or considering taking a PPI, including Prilosec OTC.
  • Read the complete MedWatch 2009 Safety summary, including a link to the Early Communication, at:

    http://www.fda.gov/medwatch/safety/2009/safety09.htm#plavix

    Surgeon-General Interview

    Before we discover who will be nominated for Surgeon-General, MedPage Today interviewed the outgoing holder of that post, Dr. Richard Carmona, 17th Surgeon General of the United States:

    Dr. Val: What sort of experience is appropriate for a candidate of the office of Surgeon General?

    Dr. Carmona:  A successful candidate for the office of Surgeon General should have deep and broad public health experience, especially as a public health or uniformed military officer.  The Surgeon General is given the rank of Admiral, and as such he or she will interface with other Admirals and Generals, and Army and Navy Surgeon Generals, most of whom are career officers with decades of experience in military matters. The Surgeon General must have the wisdom and experience to take on the position of an Admiral and represent our country internationally.

    Dr. Val: What does the Surgeon General do on a daily basis?

    Dr. Carmona:  The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.

    Read the rest of the article at MedPage

    Increasing Connectiveness for Women With Limitations; A Request for Participants

    The Baylor College of Medicine hosts the Center for Research on Women with Disabilities (CROWD) has received a grant to to test an online self-help, interactive health promotion program  designed to increase knowledge about exercise, nutrition, stress management, and the use of health care services; to improve health behaviors; and to reduce isolation and increase connectedness for women with functional impairments. The Principle Investigators are BCM researchers, Doctors Margaret A. Nosek and Susan Robinson-Whelen.

    Eligibility consists of:

    1. Being a woman at least 45 years of age, in the Houston area within one hour drive.

    2. Having access to a computer with a high-speed Internet connection about 2-4 hours per week and who like learning using computers

    3. Having a physical limitation, disability, chronic illness or health condition that limits activities (for at least one year).

    Participants will be randomly assigned to two groups — an online intervention group for 8 weeks or a control group (that will have access to the online program about 6 months later).

    All participants will be asked to complete some surveys and receive payment for participation in either group. They will come to the office once, the rest of the study is online. Participants in this study will help contribute valuable information about how providers can improve the health and well-being of women with physical disabilities.

    Please contact Cathy Courtney, Sr. Project Coordinator
    Center for Research on Women With Disabilities
    Office phone and fax 713-523-0466
    Email: Cathyc@bcm.edu

    Article

    Adrienne Cannon, One Beat Behind: 9:30 AM. Saturday morning. Jazzercise class. The beat revves up as does the complexity of the moves.  Uh-oh ... that old feeling has come back. Was it really three years ago that I began to lament my position of “last in line?. 

    Women Cardiologists

    The Journal of the American College of Cardiology has published an article reflecting the results of a survey conducted by the ACC Women in Cardiology Council. The survey cover a decade of change in cardiologists' professional life.

    "Fewer women than men in cardiology are married or have children, representing a common trend across a broad spectrum of professional women . One possible reason for this trend is our concerning finding that the majority of women in cardiology continue to experience discrimination, largely because of gender in general, and particularly because of parenting responsibilities. In further defining the issues, we can better outline a plan and goals for reaching gender parity, embracing all members of the community, and meeting our workforce needs."

    "At the same time, fewer women interrupted their training or their practice for pregnancy. Whether this reflects more liberal recommendations for continuing to work during pregnancy or, as other investigators have suggested, a greater degree of guilt or overt or subtle pressure not to burden one's colleagues is unknown. The trend for more men and women to choose to work less than full-time may have significant implications across the profession, including workforce supply, volunteerism, continuing medical education, and membership in professional societies, and requires further investigation and planning."

    Global Library of Women's Medicine: A New Link

    Special features of this site now in Beta testing are:The primary feature of the Global Library of Women's Medicine consists of 442 specialist chapters on women’s medicine, plus 53 supplementary chapters, authored by over 650 expert contributors citing more than 40,000 references (read more).

    Short Michigan Alcoholism Screening Test, Geriatric Version

    The Michigan Test has been used by professionals and can be self-administered as a way to determine if there could be an alcohol abuse problem.

    An abstract from a recent publication, Alcohol Consumption by Aging Adults in the United States: Health Benefits and Detriments by Maria Pontes Ferreira and M. K. Suzy Weems, appearing in the past October issue of the Journal of the American Dietetic Association:

    Abstract

    The most rapidly growing segment of the US population is that of older adults (65 years). Trends of aging adults (those aged 50 years) show that fewer women than men consume alcohol, women consume less alcohol than men, and total alcohol intake decreases after retirement. A U- or J-shaped relationship between alcohol intake and mortality exists among middle-aged (age 45 to 65 years) and older adults. Thus, alcohol can be considered either a tonic or a toxin in dose-dependent fashion. Active areas of research regarding the possible benefits of moderate alcohol consumption among aging individuals include oxidative stress, dementia, psychosocial functioning, dietary contributions, and disease prevention. Yet, due to the rising absolute number of older adults, there may be a silent epidemic of alcohol abuse in this group. Dietary effects of moderate and excessive alcohol consumption are reviewed along with mechanisms by which alcohol or phytochemicals modify physiology, mortality, and disease burden. Alcohol pharmacokinetics is considered alongside age-related sensitivities to alcohol, drug interactions, and disease-related physiological changes. International guidelines for alcohol consumption are reviewed and reveal that many nations lack guidelines specific to older adults. A review of national guidelines for alcohol consumption specific to older adults (eg, those offered by the National Institute on Alcohol Abuse) suggests that they may be too restrictive, given the current literature. There is need for greater quantification and qualification of per capita consumption, consumption patterns (quantity, frequency, and stratified combinations), and types of alcohol consumed by older adults in the United States.

    Distraction and the Senior Moment

    We came across a WSJ article about neuroscientist Adam Gazzaley regarding his work with the aging brain. We tried to bring some of that article or bits from other research that has been published by Dr. Gazzaley. Nothing was quite in layman-enough language to allow it to be excerpted. However we did come across an article from the New York Academy of Sciences that seemed to be both interesting and non-technical enough to be understood:

    Top-down Modulation and Normal Aging

    Speaker: Adam Gazzaley, MD, PhD
    University of California, San Francisco

    • To make sense of the world, the brain filters sensory input according to goals.
    • Older patients seem to have trouble ignoring irrelevant information.
    • Perturbing activity in the prefrontal cortex mimics the effect of aging on memory performance.

    "In young, normal patients, the activity of the scene-selective region spikes when patients are told to remember scenes and forget faces, and dips when they are told to forget scenes and remember faces. The converse is true in the face-selective region. Using these data, the researchers formulated enhancement and suppression indices, which quantify the degree to which a region is boosted above or squelched below its baseline activity.

    "Comparing young brains and old brains, Gazzaley and his colleagues found that the baseline activities and enhancement indices are comparable, but older patients have lower suppression indices. The older patients seem to have a deficit not in remembering relevant information, but in ignoring irrelevant information. "Their ability to enhance information for relevant stimuli is preserved across aging, they perform like 20-year-olds in this case, but the suppression is severely compromised as a population."

    Older patients have trouble ignoring irrelevant information.

    "The suppression indices correlate with actual performance in the memory task. While the older patients' memory skills were on average worse than those of their younger counterparts, the average actually concealed a broad range of scores. When the researchers separated the data into high-performing and low-performing groups, only the older patients with poor memories showed deficits in their suppression indices.

    "Interestingly, the poor-performing older patients actually had better memories in one respect: they were significantly better than their peers at recalling information they'd been told to ignore. Taken together, the data provide strong support for the longstanding but controversial "inhibitory deficit" hypothesis. In this theory, a defect in filtering information, not in storing it, underlies the memory declines that often occur during aging. Earlier behavioral studies were unable to distinguish the two processes clearly, but Gazzaley and his colleagues seem to have overcome that hurdle."

    Read the entire article at the New York Academy of Sciences site

    Medicare Advantage Plans At A Crossroads — Yet Again

    The experience with private-plan contracting shows that assuring stable plan choices and extra benefits requires extra money by Robert A. Berenson and Bryan E. Dowd

    ABSTRACT from the Health Affairs Journal:

    Since risk-taking, private health insurance plans were introduced into Medicare twenty-five years ago, policymakers have disagreed on these plans' fundamental purposes. Articulated objectives, which include improving quality, reducing government spending, providing additional benefits (without expanding the entitlement), increasing choices for beneficiaries, and providing benchmark competition for traditional Medicare, are plausible but sometimes conflicting. The program's history demonstrates continuous shifts in emphasis on these objectives. We enumerate the differing advantages of public and private plans in Medicare and argue that policymakers should focus their efforts on leveling the public-private playing field, thereby dealing forthrightly with the reality of growing fiscal problems.

    Read the entire article at the Health Affairs; The Policy Journal of the Health Sphere

    Placebos

    Results of national survey of US internists and rheumatologists

    From the British Medical Journal

    Objective To describe the attitudes and behaviours regarding placebo treatments, defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

    Participants 1200 practising internists and rheumatologists in the United States.

    Main outcome measures Investigators measured physicians’ self reported behaviours and attitudes concerning the use of placebo treatments, including measures of whether they would use or had recommended a "placebo treatment," their ethical judgments about the practice, what they recommended as placebo treatments, and how they typically communicate with patients about the practice.

    Results 679 physicians (57%) responded to the survey. About half of the surveyed internists and rheumatologists reported prescribing placebo treatments on a regular basis (46-58%, depending on how the question was phrased). Most physicians (399, 62%) believed the practice to be ethically permissible. Few reported using saline (18, 3%) or sugar pills (12, 2%) as placebo treatments, while large proportions reported using over the counter analgesics (267, 41%) and vitamins (243, 38%) as placebo treatments within the past year. A small but notable proportion of physicians reported using antibiotics (86, 13%) and sedatives (86, 13%) as placebo treatments during the same period. Furthermore, physicians who use placebo treatments most commonly describe them to patients as a potentially beneficial medicine or treatment not typically used for their condition (241, 68%); only rarely do they explicitly describe them as placebos (18, 5%).

    Conclusions Prescribing placebo treatments seems to be common and is viewed as ethically permissible among the surveyed US internists and rheumatologists. Vitamins and over the counter analgesics are the most commonly used treatments. Physicians might not be fully transparent with their patients about the use of placebos and might have mixed motivations for recommending such treatments.

    Read the entire study in the BMJ

    Discoveries

    The National Science Foundation has introduced a website that displays the objects of its funding: Discoveries. A more logical name could not be desired.

    "With an annual budget of about $6.06 billion, we are the funding source for approximately 20 percent of all federally supported basic research conducted by America's colleges and universities. In many fields such as mathematics, computer science and the social sciences, NSF is the major source of federal backing."

    A sampling of some of the most recent investments:

    Using Your Computer to Grow More Nutritious Rice for a Hungry World: Computational biologists use a powerful distributed computing network to research rice genome for increased yields of more nourishing rice varieties Released October 14, 2008

    Teaching Is in This Scientist's Genes: Doctoral student Susannah Gordon-Messer talks about her research and her science outreach using bouncy, sticky, slimy chemistry to educate and inspire young minds Released October 10, 2008

    Klein Bottle is a Real Natural in the Zoo of Geometric Shapes: Discovery could advance understanding of human vision and lead to powerful data compression techniques Released October 7, 2008

    The Bizarre Creatures of Madagascar: Paleontologist David Krause describes his search for the ancestors of mammals that live in Madagascar today Released September 24, 2008

    Finding the Switches to Our Cells' 'Computer': Thousands of memory switches inside our cells help them remember and function. Released September 24, 2008

    Glacier Movement Limits How Fast Sea Level Can Rise: Study finds 3 to 6 feet by 2100 possible. Released September 18, 2008

    Get Discoveries Updates by Email 

    Consumer Reports Health
    Dangerous drugs for older people

    "People age 65 and older are more than twice as likely as younger ones to be treated in emergency rooms because of adverse drug reactions. One reason: Kidney function declines with age, making it harder for the body to eliminate drugs. Moreover, nearly half of them take at least five different medications, multiplying risks."

    Read the article, cited drugs and possible alternatives at the Consumer Reports Health site.

    NEJM & Candidates' on Health Care

    From The New England Journal of Medicine:

    Election 2008: Health Care in the Next Administration

    http://click2.nejm.org/cts/click?q=137;67038880;unpfQTHXtBpWRBJCFazO5jzqqOOOLBSJhNQXEPGbBqQ=
    Senior health policy advisors to the presidential candidates — David Cutler for Democrat Barack Obama and Gail Wilensky for Republican John McCain — discuss the candidates' positions on health care reform, in a symposium moderated by Arnold Epstein and cosponsored by the Journal and the Harvard School of Public Health.

    View video of the symposium

     

    Election 2008: Campaign Contributions, Lobbying, and the U.S. Health Sector — An Update
    R. Steinbrook
    Free Full Text

    Free Full Text

     

    Undertriage of Elderly Trauma Patients to State-Designated Trauma Centers

    Archives of Surgery 2008;143(8):776-781.

    Objective  To determine whether age bias is a factor in triage errors.

    Design  Retrospective analysis of 10 years (1995-2004) of prospectively collected data in the statewide Maryland Ambulance Information System followed by surveys of emergency medical services (EMS) and trauma center personnel at regional EMS conferences and level I trauma centers, respectively.

    Patients  Trauma patients were defined as those who met American College of Surgeons physiology, injury, and/or mechanism criteria and were subjectively declared priority I status by EMS personnel.

    Main Outcome Measure  Undertriage, defined as when trauma patients were not transported to a state-designated trauma center.

    Results  The registry analysis identified 26 565 trauma patients. The undertriage rate was significantly higher in patients aged 65 years or older than in younger patients (49.9% vs 17.8%, P < .001). On multivariate analysis, this decrease in trauma center transports was found to start at age 50 years (odds ratio, 0.67; 95% confidence interval, 0.57-0.77), with another decrease at age 70 years (odds ratio, 0.45; 95% confidence interval, 0.39-0.53) compared with patients younger than 50 years. A total of 166 respondents participated in the follow-up surveys and ranked the top 3 causal factors for this undertriage as inadequate training, unfamiliarity with protocol, and possible age bias.

    Conclusions  Even when trauma is recognized and acknowledged by EMS, providers are consistently less likely to consider transporting elderly patients to a trauma center. Unconscious age bias, in both EMS in the field and receiving trauma center personnel, was identified as a possible cause.

    The preceding is an abstract for an article in the Archives of Surgery.

     

    The 8th Evacuation Hospital

    The University of Virginia in World War II collection from the Claude Moore Health Sciences Library includes the story of the 8th Evac unit itself, personal recollections of their members and letters after the War.

    What follows are excerpts from the collections:

    Pietramala in Winter and the 1945 Spring Offensive

    The 8th Evacuation Hospital was very busy in October and early November due to the Army’s attempt to advance in the mountains. During the winter months with less fighting the Hospital was only moderately busy, and the less hectic days permitted time for unit members to go to rest camps in Florence, Rome, or Montecatini.

    The coming of spring meant another offensive attack by the Allies. In preparation the wards were cleared of those patients who could tolerate being moved further from the front. On April 15th the fighting started the area near the 8th Evacuation Hospital, and within hours the unit was deluged with casualties. At one point the Hospital had a backlog of eighty operative cases when it received another eighty-five wounded. The spring offensive was quickly successful. Within 19 days the Germans had been driven out of the mountains and across the Po Valley with all of their escape routes to the Alps blocked. More than a million Axis troops surrendered, and the war for Italy was finished.

    Recollections of [Nurse] Alice M. Huffman:

    A German submarine had sunk the ship carrying our equipment so we slept in pup tents for a week or more while waiting to be re-equipped. One day a friend and I decided to climb a small hill that had a church at the top. While we were resting, we found that one outfit was storing some of their belongings in the church. When they finished unloading, a general came out and asked if we would like a lift down the hill. We accepted his offer, and he introduced himself as General Sullivan, head of the quartermaster corps of the Fifth Army. He asked what outfit we were in, and we told him our story and that we were sleeping in pup tents. He asked what we needed most, and we told him we needed tents for the nurses. He sent them over that afternoon. He became a good friend and danced with me when we happened to be at the same party. He waltzed beautifully.

    Correspondence with Nurse Ruth Beery with Next-of-Kin

    Dear Capt. *Ruth Beery,
        It gave me great pleasure to receive your letter, and added satisfaction knowing every thing possible was done for the
    comfort of my son [     ], who made the supreme sacrifice.
        It was very kind of you to write, and I appreciate it. Now that the war is over I am anxiously looking forward to the discharge of my two sons, one who has served Uncle Sam in the Marine
    Corp since July 1940.
        Thanking you for your kindness

    *"Beery then trained at the University of Virginia Hospital where she remained as an instructor in science at the School of Nursing.  While later a graduate student at the University of Minnesota, she was asked to be the principal chief nurse of the World War II hospital sponsored by the University of Virginia. Before she could accept the offer, the Army had to grant her an age waiver as she was 41, one year older than the Army age limit for entering service. Commissioned a 1st lieutenant in the Army Nurse Corps, she was instrumental in recruiting nurses to serve and dedicated herself whole-heartedly to the task, appealing for help by personal interviews, letters, speeches, and radio. According to Byrd Leavell’s book on the 8th Evacuation Hospital, Beery was a “capable nurse and competent administrator” who “was unselfish; her concern was for the comfort of the sick and wounded, the duties and welfare of the nurses, and the reputation of the 8th Evacuation Hospital.” She served as chief of nurses for the duration of the war, obtained the rank of captain, and was awarded the Legion of Merit."

    Coming Clean Campaign

    We tend to use Dr. Bronner's products for just about everything in our house as the older we get, the less we want toxic chemicals in our lives. We found the Organic Consumers Association in a Dr. Bronner's activism newsletter.

    Their background:

    "The Organic Consumers Association was formed in 1998 in the wake of the mass backlash by organic consumers against the US Department of Agriculture's controversial proposed national regulations for organic food. Through the OCA's SOS (Safeguard Organic Standards) Campaign, as well as the work of our allies in other organizations, the organic community over the last eight years has been able to mobilize hundreds of thousands of consumers to pressure the USDA and organic companies to preserve strict organic standards. In its public education, network building, and mobilization activities such as its Breaking the Chains campaign, OCA works with a broad range of public interest organizations to challenge industrial agriculture, corporate globalization, and the Wal-Martization of the economy, and inspire consumers to 'Buy Local, Organic, and Fair Made.' "

    The Coming Clean Campaign is Campaigning for Organic Integrity in Bodycare Products:

    "The word 'organic' is not properly regulated on personal care products (example: toothpaste, shampoo, lotion, etc.) as it is on food products, unless the product is certified by the USDA National Organic Program.

    "Due to this lax regulation, many personal care products have the word 'organic' in their brand name or otherwise on their product label, but unless they are USDA certified, the main cleansing ingredients in particular are usually made with conventional not agricultural material, combined with petrochemical compounds."

    Read more about the campaign at the Organic Consumers Association site.

     

    Excerpt

    From Hyping Health Risks; Environmental Hazards in Daily Life and the Science of Epidemiology

    by Geoffrey C. Kabat, Columbia University Press:

    Toward a Sociology of Health Hazards in Daily Life

    We are all familiar with what has been referred to as the “hazard du jour” phenomenon. Typically, it starts with media reports of the findings of a new scientific study indicating that some lifestyle behavior, consumer product, or environmental factor is linked to some dire disease. Coffee drinking is linked to pancreatic cancer. Eating chocolate is claimed to dispose to benign breast disease in women. Environmental pollution, we are told, may cause breast cancer. Studies appear to show a connection between exposure to electromagnetic fields from power lines and electric appliances and a host of diseases, starting with childhood leukemia. Use of cellular telephones may lead to brain tumors. Exposure to secondhand tobacco smoke, or passive smoking, is linked first to lung cancer, then to heart disease, and most recently to breast cancer. Silicone breast implants are associated with connective tissue disorders. The list could be extended at great length. Following the initial report, a second report may appear soon after yielding further suggestive evidence of a hazard or, just as often, showing no effect. In this way, over time, a scientific literature develops on each topic marked by weak and inconsistent results, and the perception of a hazard takes on a reality.

    Some scares, such as those surrounding coffee and cell phones, may subside fairly quickly, as better studies are published or as the hazard is put in perspective and deflated. In other cases, the hazard can take on a life of its own and persist over years or decades, becoming the focus of scientific research, regulatory action, lawsuits, and advocacy campaigns. In the case of electromagnetic fields from power lines, tens of billions of dollars have been spent to remediate a problem whose very existence is uncertain. But what characterizes all of these scares is that the public’s perception of a hazard was greatly exaggerated and was not counterbalanced by an awareness of the tenuousness of the scientific evidence or of the relatively modest magnitude of the potential risk. Thus, to a large extent, when one examines the public’s response to a high-profile health scare, one is dealing with the dissemination of poor information and appeals to fear. (It sometimes seems that the intensity of the fear is inversely proportional to the actual magnitude of the threat.)

    Read the rest of the excerpt at the Columbia University Press site.

    Articles

    Doris O' Brien, The Girth of a Nation: Prohibition's failure proved that drinking didn't stop simply because the law, in effect, hid the bottle.  The same can be said of any attempt to ban fast foods or the selective use of trans-fat. We learn good nutrition by example, not by condemnation

    John Malone, Broca's Aphasia: Why was Rosie the dog scratching at the closed bedroom door? Or, rather, why was the white, furry thing with the licking tongue and anxious, pawing feet trying to get into our dark bedroom? Because I did not really think of the word “dog.”

    Senate Approves Health Care Safety Net Act

    From Womens' Policy, Inc.

    On July 21, the Senate approved, by voice vote, the Health Care Safety Net Act (S. 901). Originally known as the Health Care Centers Renewal Act, the bill would reauthorize funding for community health care centers and programs for uninsured patients, including the Community Health Centers program, the National Health Service Corps, and the Rural Health Care programs. The Senate Health, Education, Labor, and Pensions Committee passed S. 901 on November 14 ; the House approved a similar version of the measure (H.R. 1343) on June 4.

    The bill would authorize $2.065 billion for FY2008, $2.313 billion for FY2009, $2.602 billion for FY2010, $2.940 billion for FY2011, and $3.337 billion FY2012 for the Community Health Centers Program within the Public Health Service and would reauthorize Rural Health Care Programs at $45 million annually from FY2008-2012.

    Among other provisions, the bill would require the United States comptroller general to study the cost effectiveness and impact of establishing school-based health centers. S. 901 also would require the secretary of Health and Human Services to study health care quality in community health centers and identify strategies, technical assistance, and partnerships with federal agencies, private organizations, or networks that may help to improve health care quality in such centers.

    Swedish Study

    The British Medical Journal (BMJ) has highlighted a Swedish study that reported increased sexual activity among 70 year-olds:

    Discussion

     Abstract
     Introduction
     Methods
     Results
     Discussion
     References
    Self reported sexual activity among married and unmarried 70 year olds in Gothenburg, Sweden increased from 1971 to 2001. At the same time among elderly people attitudes to sexuality became more positive, and the proportion reporting a very happy relationship increased. Furthermore, the proportion reporting high satisfaction with sexual activity and that sexuality was an important factor in life increased, whereas those with sexual dysfunctions (erectile dysfunction among men, orgasmic dysfunction in women) decreased. Consistent with population studies of younger samples of later born cohorts the median age of sexual debut decreased and the proportion that had their sexual debut before age 20 increased. The one year prevalence of intercourse in the two earliest birth cohorts was similar to that among septuagenarians reported from studies in the 1950s and 1980s. The prevalence in the two younger birth cohorts is similar to a European study in 2001-2 and a US study in 2005-6.

    The main reason for men to cease intercourse was self reported as personal reasons, mirroring reports by women that the reason for cessation of intercourse was due to their partner. Whether elderly couples continue to be sexually active seems to a large extent to be determined by men. This pattern, which did not change over time, was also reported in studies in the 1950s and in 2005-6.

    In agreement with previous reports self reported sexual activity was more common in men, regardless of marital status. Differences between the sexes in self reported sexual behaviour, however, decreased from 1971 to 2001 among the 70 year olds in our study. Overall, men reported an earlier age of sexual debut and a higher proportion of premarital sex than women in the 1970s, but this sex difference diminished among those in later born samples. Recent studies on adolescents report that women experience first sexual intercourse at a younger age than men. Finally, whereas 70 year old men in the 1970s more often reported positive attitudes to sexuality than women, there were no sex differences in attitudes in 2000-1. Thus attitudes to sexuality cannot entirely explain observed differences between the sexes in sexual activity. Women were less likely to be married or in other intimate relationships than men, as reported by others. As in other studies, the proportion of elderly people reporting sexual activity was higher among married participants than among unmarried participants, especially in women. Sexual activity was reportedly rare among unmarried women in the 1970s.

    Read the entire article at the BMJ site

    Article

    Ferida Wolff, Getting Goopy: I know this emotional irritability is part of the menopausal profile but it doesn’t make it pleasant. It requires too much energy. And yet …

    Contagion

    From Harvard University's Library Open Collection Program Contagion: Historical Views of Diseases and Epidemics is a digital library collection that brings a unique set of resources from Harvard’s libraries to Internet users everywhere. Offering valuable insights to students of the history of medicine and to researchers seeking an historical context for current epidemiology, the collection contributes to the understanding of the global, social – history, and public – policy implications of disease. Contagion is also a unique social-history resource for students of many ages and disciplines. These materials include digitized copies of books, serials, pamphlets, incunabula, and manuscripts — a total of more than 500,000 pages — many of which contain visual materials, such as plates, engravings, maps, charts, broadsides, and other illustrations. The collection also includes two unique sets of visual materials from the Center for the History of Medicine at Harvard’s Francis A. Countway Library of Medicine. Library materials and archival materials are supplemented by explanatory pages that introduce concepts related to diseases and epidemics, historical approaches to medicine, and notable men and women.Some of the epidemics covered are: Tuberculosis in Europe and North America, 1800–1922; Tropical Diseases and the Construction of the Panama Canal, 1904–1914; Spanish Influenza in North America, 1918–1919; The Boston Smallpox Epidemic, 1721 and “Pestilence” and the Printed Books of the Late 15th Century

    NEJM Editorial

    Planning for the Future — Long-Term Care and the 2008 Election

    Long-term care has all the makings of a great campaign issue. It affects a large portion of the population, it is expensive (it currently accounts for about 10% of all health care costs), and it requires a unique partnership between government and citizens. Moreover, a range of constituencies perceive the current long-term care system as seriously broken. It exposes people who need services to considerable financial risk, and it too often relies on an institutional model of care that is at odds with consumer preferences.

    Nonetheless, the candidates in the 2008 presidential race have been virtually silent about long-term care policy. Health care received substantial attention during the 35 Democratic and Republican debates (garnering more than 1000 mentions), but almost nothing has been said about long-term care. Not a single major debate question has focused specifically on the topic, and it has been mentioned by candidates in response to other questions only 11 times. Nor has long-term care received much attention on the campaign trail. Only one candidate, Senator Hillary Clinton, has delivered a speech on the topic and proposed a detailed agenda for the future. Candidates have backed broadly appealing goals such as improving the quality of care in nursing homes, reducing hassles with companies that offer insurance for long-term care, and more frequently providing long-term care at home or in the community. There has not, however, been a serious discussion about a reformed vision for long-term care in this country — in particular, how it will be financed.

    Read the rest of the free editorial, Planning for the Future — Long-Term Care and the 2008 Election, at the New England Journal of Medicine site.

     

    The Bathtub Collection

    The National Library of Medicine introduces us to a little-known aspect of its history:

    "The Bathtub Collection consists of fragments found in the old and rare bindings of the NLM rare book collection when items were rebound and conserved in the 1940s and 1950s. It is called the Bathtub Collection because then-curator Dorothy Schullian took the leftovers of conservation work home and soaked them in her bathtub to retrieve the often interesting bits and pieces of medieval manuscripts and early printed ephemera she found.

    "The story of the 'Bathtub Collection' begins in the middle of the last century. In the 1940's, The Army Medical Library, as the National Library of Medicine was then known, began a serious conservation program for its rare book collection. The AML hired Dorothy Schullian as curator of rare books and Jean Eschman, a master bookbinder from Switzerland. "Eschman repaired many of the old bindings and, when he considered them beyond repair, replaced them with new leather covers. Some of the old bindings were kept but many of them were discarded as worthless. Conservation practices have changed since then, and conservators are now much more cautious about replacing original bindings and never discard them.

    "Dorothy M. Schullian was a Classics scholar with a doctorate in Latin from University of Chicago. She taught at Western Reserve and Albion College in Michigan before joining the National Library of Medicine staff in 1944 as curator of the rare book collection. She was a learned and meticulous scholar, with knowledge of a wide range of subjects as well as medical history. Her chief legacies are A Catalogue of Incunabula and Manuscripts in the Army Medical Library, published in 1950 - and the Bathtub Collection. "Though she did not consider many of the intact bindings worth preserving, she was aware of the interest and value of the materials from which they were made. When the books were rebound in the bindery, instead of discarding the old covers, Dr. Schullian, took them home, soaked them in her bathtub to loosen the paste and separate the layers of paper or parchment, hung them up to dry, and placed them in envelopes, labeled with information about the volume from which they were removed. The History of Medicine Division staff came to refer to them as the 'Bathtub Collection', both a tribute to Dr. Schullian's labors and a mark of affection for this eccentric assemblage."

    Browse the Little Treasures from the Bathtub as well as Other Treasures.

    Sick Around the World

    Frontline, PBS' investigative unit, is presenting a program hosted by reporter T.R. Reid, Sick Around the World. The following is posted with a few changes, from the site:The program reveals remarkable differences in how these countries handle health care — from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.Reid's first stop is the UK turns up remarkable differences in how these countries handle health care — from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.In the UK, the National Health Service is funded through taxes. According to Whittington Hospital CEO David Sloman, "Every single person who's born in the UK will use the NHS ... and none of them will be presented a bill at any point during that time." Reid is surprised to find the system often dismissed as "socialized medicine." The UK is now trying free-market tactics like "pay-for-performance," where some doctors are paid more if they get good results controlling chronic diseases like diabetes, and patient choice, in which hospitals compete head to head. While such initiatives have helped reduce waiting times for elective surgeries, the London Times' medical correspondent Nigel Hawkes tells Reid the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."Reid reports next from Japan, the world's second largest economy and the country boasting the best health statistics. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRIs, use more drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States. Reid finds out the secrets of the nation's success: By law, everyone must buy health insurance — either through an employer or a community plan — and unlike in the US, insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit. Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, M.D., a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy. It is ... highly accepted by the population." As they do in Japan, medical providers must charge standard prices which are negotiated with the government every year. As a consequence, physicians in Germany earn between half and two-thirds as much as their U.S. counterparts. Taiwan researched many health care systems before settling on one where the government runs the financing, but Reid finds the delivery of health care is left to the market. Taiwanese health care offers medical, dental, mental and Chinese medicine, with no waiting time and for less that half of what we pay in the United States. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But what Reid finds is that the Taiwanese spend too little to sustain their health care system. According to Princeton's Tsung-Mei Cheng, who advised the Taiwanese government, "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers."Reid's final destination is Switzerland, a country whose health care system suffered from some America's problems until, in 1994, the country attempted a major reform. Despite a huge private insurance business, a law called LAMal was passed, which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. Today, Swiss politicians from the political right and left enthusiastically support universal health care. Pascal Couchepin, the president of the Swiss Federation, argues: "Everybody has a right to health care. ... It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."Go to the Frontline site for videos, show dates and a discussion time.

    Health Risks of Long-Term Combination Hormone Therapy Updated

     "The good news is that after women stop taking combination hormone therapy, their risk of heart disease appears to decrease," noted Elizabeth G. Nabel, M.D., NHLBI director. "However, these findings also indicate that women who take estrogen plus progestin continue to be at increased risk of breast cancer, even years after stopping therapy.  Today's report confirms the study's primary conclusion that combination hormone therapy should not be used to prevent disease in healthy, postmenopausal women." The FDA recommends that hormone therapy never be used to prevent heart disease, and, when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible.  The new findings are from a follow-up study of 15,730 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment, who participated in the WHI estrogen-plus-progestin clinical trial. Participants were randomly assigned to receive a combination of estrogen (0.625 milligrams of conjugated equine estrogens per day) plus progestin (2.5 mg of medroxyprogesterone acetate) or placebo (inactive pill). The main estrogen-plus-progestin study was stopped in 2002 after an average of 5.6 years of treatment due to an increase in breast cancer. Women on combination hormone therapy were also at increased risk of stroke, blood clots, and heart disease, while their risk of colorectal cancer and hip fractures was lower, compared to women who did not take hormone therapy.

    Read the rest of the NIH release of the study of 15,730 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment, who participated in the WHI estrogen-plus-progestin clinical trial.

    ScienceTaking it in Stride

    A team of Canadian researchers have come up with almost unique device: "We have developed a biomechanical energy harvester that generates electricity during human walking with little extra effort. Unlike conventional human-powered generators that use positive muscle work, our technology assists muscles in performing negative work, analogous to regenerative braking in hybrid cars, where energy normally dissipated during braking drives a generator instead. The energy harvester mounts at the knee and selectively engages power generation at the end of the swing phase, thus assisting deceleration of the joint. Test subjects walking with one device on each leg produced an average of 5 watts of electricity, which is about 10 times that of shoe-mounted devices. The cost of harvesting-the additional metabolic power required to produce 1 watt of electricity-is less than one-eighth of that for conventional human power generation. Producing substantial electricity with little extra effort makes this method well-suited for charging powered prosthetic limbs and other portable medical devices." The above is a summary of article in the journal Science. Below is a release generated by Simon Fraser University in British Colombia:

    Simon Fraser University researchers have developed a new wearable technology that generates electricity from the natural motion of walking and promises to revolutionize the way we charge portable battery-powered devices.

    The Biomechanical Energy Harvester resembles a lightweight orthopedic knee brace. The device harvests energy from the end of a walker’s step, when the muscles are working to slow the movement of the leg, in much the same way that hybrid-electric cars recycle power from braking.

    Wearing a device on each leg, an individual can generate up to five watts of electricity with little additional physical effort. Walking more quickly generates as much as 13 watts of electricity: at that rate, one minute of walking provides enough electricity to sustain 30 minutes of talk time on a mobile phone.

    “This technology promises to have significant medical, military and consumer applications,” says lead author Max Donelan, an assistant professor of kinesiology and associate member of engineering science at SFU.

    “A fully charged battery pack represents more than just a mere convenience. It allows a soldier to get back home safely. It benefits stroke victims, amputees and others who rely on power-assisted medical devices for mobility. It means a better quality of life for the developing world, where a half-billion children live without easy access to electricity. And of course it is a necessity to anyone in the developed world who has come to rely on portable electronics for work or play.”

    Donelan plans to have a working prototype available within 18 months through his spin-off company, Bionic Power Inc.

    Read the rest of the release at the University site.

    Sport

    Excerpt: Your Brain on Cubs
    Inside the Heads of Players and Fans

    Edited by Dan Gordon

    From Chapter One: "A fan's dedication to a chronically losing baseball team involves a number of social-cognitive processes that allow him to accept his fate. ... In the case of a losing team, a fan has to be prepared to delay gratification for years, decades, and occasionally a century (the latter case involves handing down the delayed gratification to subsequent generation of family fans, entrusting them to appreciate the long road to the ultimate victory).... There is some evidence that being in the majority (everyone loves a winner) reduces reflective thinking, whereas being in the minority (rooting for a loser) increases reflection.  Perhaps that reflection is rewarding in itself and helps motivate fans to root for a losing team (in that sense it is the chase that is important rather than the ultimate victory). ... Sitting with friends at the game, hearing or discussing the game with the fans around you, or listening to it on the radio or watching it on TV allows for bonding with others.  Such bonding activates the septum and the subgenual prefrontal cortex, which then release chemicals such as oxytocin that signal the degree of pleasure of the bonding.... The prefrontal cortex is also an essential brain region for mediating our notion of self.  For example, watching a baseball team play may activate memories of playing baseball in our youth.  Neuroscientists have identified so-called mirror neurons in our brain that are activated whether we engage in playing a sport or watch others play.From Chapter Two:Your child likes to play and is happy with her teammates. But will her talent last more than a season?.... This tension between what kids are born with and what they gain from practice is at the core of understanding what it takes to become an expert.  It is also at the center of understanding how neuroscientists approach the question of defining what the brain of an expert looks like and how it might function differently compared to the merely competent .... expertise is explained in part by higher cortical efficiency.  The expert uses much less brain activity to do the practiced activity.  The implication is that many years of practice may lead to a neural network that is efficient at using the fewest numbers of synapses to get a behavior accomplished... Even though developing expertise requires lots of practice, does extensive practice guarantee that one will become an expert? Not necessarily... The consequences of smart practice compared to exercise alone are beginning to be found in the br ain.... There is emerging evidence that too much thinking during practice can actually interfere with learning motor skills that are better left to unconscious control. From Chapter Three:Here we view the batter-pitcher dual from the point of view of the neural networks involved in making the motor program that enable the batter to swing the bat.  We show that there is more to hitting a baseball than meets the eye... In fact, deciding and planning begin even before the ball leaves the pitcher's hand... What is the nature of the information that the batter uses to make decision about swinging his bat? Recent research emphasizes that athletes in fast-ball sports anticipate where the ball will be based on kinematically relevant source of information.  In baseball, this information is gathered before the ball is thrown: a batter may note the movements the pitcher makes during windup, remember his past experiences with this pitcher, and pick up clues from watching the pitcher face previous batters.  A clear relationship exists between the skill level of the batter and the type of information that is extracted in this pre-swing period.... On order to successfully hit the pitched ball, the hitter's brain must be involved in two tasks: (1) preparing the neuronal program for the movement involved in swinging the bat and (2) interpreting the movement of the pitcher in order to predict where the pitched ball will go.  Although it is quite likely that these two tasks occur simultaneously, we will describe what is know about them separately.  Modern methods of brain imaging, particularly functional magnetic resonance imaging (fMRI), have made it possible to peer inside an athlete's brain while he is preparing to swing a bat.Read all the excerpts from The Dana Foundation site

    FDA's Warning about Bisphosphonates

    FDA informed healthcare professionals and patients of the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates. Although severe musculoskeletal pain is included in the prescribing information for all bisphosphonates, the association between bisphosphonates and severe musculoskeletal pain may be overlooked by healthcare professionals, delaying diagnosis, prolonging pain and/or impairment, and necessitating the use of analgesics. The severe musculoskeletal pain may occur within days, months, or years after starting a bisphosphonates. Some patients have reported complete relief of symptoms after discontinuing the bisphosphonate, whereas others have reported slow or incomplete resolution. The risk factors for and incidence of severe musculoskeletal pain associated with bisphosphonates are unknown. Read the warning at the FDA site Editor's Note: These drugs are marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa

    The View from the Other Side — Patients, Doctors, and the Power of a Camera

    This is part of a Perspective published by the New England Journal of Medicine. The videos are revealing, disturbing and ultimately instructive. By the time Galen Buckwalter's physician knocked on the exam-room door, Buckwalter's video camera had been recording for nearly 40 minutes. He had booked the appointment because his shoulders were hurting, and the camera recorded his view of the examination table, the comments he made while waiting and, eventually, a largely transactional and superficial exchange with his physician. Two weeks later, in his home, the camera would record a strikingly different take on his shoulder pain — a growing problem that, Buckwalter worried aloud, might cost him even more of his cherished independence. As an internist, I was disturbed by the contrast between those two scenes, the second revealing the depth of Buckwalter's concerns and fears, none of which were apparent during the conversation with his doctor. In the later tape, Buckwalter's struggle is palpable. If such stark contrasts are common, how much do I really know about my own patients? Probably far less than I care to admit. Buckwalter's videotaping of his appointment was part of a project I'd begun 9 months earlier (see video at www.nejm.org). The goal was to understand the experience of being in a wheelchair, with the help of a video camera — an approach influenced by my previous career in documentary filmmaking and by research disciplines including participant-action research, narrative medicine, and ethnography. I have spent 10 years giving cameras to participants and have learned much from the projects. The recorded images were often unsteady and out of focus, but the content — representing participants' own views of their experience, not mine — consistently proved interesting. I learned that participants generally need more than a few days or weeks with a video camera to record their experiences adequately; the unfurling of one's life requires time. But the results are rich; film is a medium conducive to exploring the smallest details that make up a life. These details are often overlooked, or missed, in clinical research conducted in more traditional ways. As nuances of a patient's experience are compressed into standardized responses, statistical power is achieved, but depth is lost. What could videotape show about experiences of disability that hadn't already been said eloquently in the medical literature documenting inequities faced by the disabled or in memoirs and films about being disabled? Perhaps a first-person perspective, recorded from the wheelchair, would reveal a world rarely seen by most nondisabled persons. Buckwalter had been the first to volunteer for the project, followed by Vicki Elman and Ernie Wallengren. All lived in the Los Angeles area and had heard about the project through the UCLA medical community. Buckwalter used a wheelchair as a result of a cervical spinal cord injury, Elman because of multiple sclerosis, and Wallengren because of amyotrophic lateral sclerosis.

    Screening Beyond 70

    Medpage covering the San Antonio Breast Cancer Symposium Meeting:Women who are 70 or older remain in the prime of life for screening mammography, researchers reported here. A majority of breast masses and calcifications in patients 70 and older were identified by screening versus diagnostic mammography, Neely Hines, M.D., of Albert Einstein College of Medicine in New York, said at the San Antonio Breast Cancer Symposium. The American Cancer Society recommends that women continue screening mammography as long as they remain in good health. As life expectancy continues to increase, so will the number of women at risk for breast cancer. The CDC estimates that 70-year-old women of any race have 15.9 more years of life expectancy. "We believe that continuation of annual screening mammography beyond the age of 70 years will identify clinically occult and earlier-stage cancers that can be successfully treated and possibly prolong survival," said Dr. Hines. "Our results suggest that screening mammography is beneficial in diagnosing cancers in this population, which represents a growing proportion of the population and has an increased risk of developing breast cancer," said Dr. Hines. "We think older patients and their physicians should request screening mammography." Read the rest of the MedPage article.

    (See the Australian Study below)

    Do Mandrakes Really Scream?
    Magic and Medicine in Harry Potter

    The National Library of Medicine has closely examined some of the myths, potions and herbology cited in Harry Potter and the Philosopher's Stone. "There is more to the Harry Potter series than a child hero or a fantasy adventure — many of the characters, plants, and creatures in Rowling’s stories are based in history, medicine, or magical lore. Death, evil, illness, and injury affect the characters of Harry Potter’s imaginary world. In describing their experiences, Ms. Rowling has drawn on important works of alchemy and herbology. These works and other links to Harry Potter books are examined in this exhibition.""The world of Harry Potter is filled with many magical creatures, including hippogriffs, nifflers, thestrals, phoenixes, dragons, and unicorns. Hogwarts students learn about these creatures in the Care of Magical Creatures class, helped along by their magical biting textbook.""In Harry Potter and the Philosopher's Stone, Nicholas Flamel is featured as the creator of the "Philosopher's Stone." Because this stone allows its owner to live forever, it must be protected from falling into the hands of the evil Lord Voldemort. "Although Harry Potter is fictional, Frenchman Nicolas Flamel lived during the late 14th and early 15th centuries. A scholar and scribe, Flamel devoted his life to understanding the text of a mysterious book filled with encoded alchemical symbols that some believed held the secrets of the Philosopher's Stone."Many myths surround Flamel, including the belief that he successfully created the Stone. His death in 1417 didn’t hurt that myth, and his quest for the Philosopher's Stone lives on in his writings. Although modern scholarship has cast doubt on the authenticity of alchemical texts ascribed to him, he remains an important figure in the alchemical world."

    Physicians, Patients and Consulting

    Biomet is a manufacturer and designer of products for hip, knee, shoulder and elbow replacements, as well as other small joint replacements. The company is one of five that reached a deferred prosecution agreement with the US Attorney in New Jersey. The others include DePuy Orthopaedics, Inc., a Johnson & Johnson company; Smith & Nephew plc; Stryker Corp; and Zimmer, Inc all of whom have posted payments to medical consultants on their websites.

    It pays, so to speak, to ask your physician if he or she has a financial connection to the company that makes the orthopedic device you're considering.

    Cancer and Disclosure

    From the abstract of an free text article entitled Social Constraints on Disclosure and Adjustment to Cancer from Blackwell Synergy: This article introduces the concept of social constraints on disclosure, puts it in a theoretical framework, and examines how it can affect adjustment to major life stressors using the exemplar of cancer. Cancer is a leading cause of death and disability worldwide. It is often life threatening, disfiguring, and unpredictable; hence, it can undermine people's basic and often positive beliefs and expectations about themselves, their future, and social relationships. For many people with cancer, it is important to come to terms psychologically with the illness — to make sense of or somehow accept the reality of it. People often do this by thinking about different aspects of the disease and its implications for their life, but also through socially processing, or talking about, their cancer-related thoughts, feelings, and concerns with others. When people experience social constraints on their disclosure of cancer-related thoughts and feelings, it can adversely affect how they think and talk about their illness, their coping behaviors, and psychological adjustment. In addition to discussing mechanisms and consequences of social constraints on disclosure, we discuss some of its determinants and future research directions.

    You seldom listen to me, and when you do you don't hear, and when you do hear you hear wrong, and even when you hear right you change it so fast that it's never the same.

    — Marjorie Kellogg, 1922–2005. In one study, investigators examined social constraints in communication between recently diagnosed lung cancer patients and their spouse (Badr & Carmack Taylor, 2006). The investigators found that slightly over a third of the sample reported avoiding or having difficulties talking about the cancer in general, and two thirds of the spouses had difficulties or avoided discussing prognosis, death, or funeral arrangements, ostensibly for fear of upsetting the patient. Some patients reported that their partner's denial and avoidance was distressing, made them change how they interacted with the partner, and strained the marital relationship. The investigators also found evidence that social constraints can change over time, perhaps as the ‘reality’ of cancer sets in and denial abates. For example, one female patient reported: ‘[My husband] told me the other day he just didn't realize about what's going on with me, how hard that is, because initially, he just kind of really shut down and didn't do very much at all ... he was sorry he wasn't there for me at the beginning. And I understood’ (p. 677).The entire article, Social Constraints on Disclosure and Adjustment to Cancer, is available.

    A Reminder: FDA's MedWatch

    The FDA has a program that contains safety information and an email adverse event reporting program that can be subscribed to. For instance, we received this notice:FDA informed healthcare professionals and consumers of the seizure of 12,682 applicator tubes of Age Intervention Eyelash, sold and distributed by Jan Marini Skin Research, Inc. of San Jose, California. The product was seized because it may lead to decreased vision in some users. The eyelash product is an unapproved and misbranded drug because it is promoted to increase eyelash growth. Before a new drug product may legally be marketed, it must be shown to be safe and effective, and approved by FDA. FDA considers the product to be an adulterated cosmetic because it contains bimatoprost, an active ingredient in an FDA-approved drug to treat elevated intraocular pressure (elevated pressure inside the eye). Use of the prescription drug in addition to the eyelash product containing the drug, may increase the risk of optic nerve damage because the extra dose of bimatoprost may decrease the prescription drug's effectiveness. Damage to the optic nerve may lead to deceased vision and possibly blindness. Other possible adverse events may include macular edema (swelling of the retina) and uveitis (inflammation in the eye) which may lead to decreased vision.

    Dermatologists, estheticians, and consumers who may still have Age Intervention Eyelash should discontinue use and discard any remaining product. Consumers should also consult their healthcare professional if they have experienced any adverse events that they suspect are related to use of the product.

    Read the complete 2007 MedWatch safety summary including a link to the FDA News Release regarding this issue at: 

    http://www.fda.gov/medwatch/safety/2007/safety07.htm#Eyelash

    Describing Dizziness

    A Mayo Clinic Proceeding covers an always involving subject:

    Dizziness: How Do Patients Describe Dizziness and How Do Emergency Physicians Use These Descriptions for Diagnosis?

    “When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean — neither more nor less.” “The question is,” said Alice, “whether you can make words mean so many different things.”

    Lewis Carroll, Through the Looking Glass

    Physicians are taught repeatedly throughout their training that the clinical history is the single most important source of information on which to build a diagnosis. However, few studies systematically analyze the utility of aspects of history taking and of the reliability of patient descriptions. The importance of this issue cannot be overemphasized because symptoms are why patients visit physicians. New or serious symptoms often drive patients to overcrowded emergency departments (EDs).

    Feelings of dizziness, vertigo, and imbalance can be extremely unpleasant and frightening, especially if they occur suddenly. We all derive security from the feeling that terra firma is firmly placed beneath us, and when we think it is not we often panic. Dizziness and vertigo are among the most common symptoms of patients who come to EDs and physicians offices. In this edition of Mayo Clinic Proceedings, 2 systematic studies (1) how well patients describe dizziness in the ED and (2) how physicians use these descriptions to formulate diagnoses.

    Read the free article at the Mayo Clinic Proceedings site

    70-Year-Old Women & Breast Cancer Screening

    MedPage Today has published this article on an Australian study:

    Given Risk-Benefit Data, Women Age 70 Opt for Routine Mammography

    Seventy-year-old women resoundingly endorsed yearly mammography, rejecting the minuses that were pointed out of them, found investigators here.

    The women chose to continue having an annual mammogram after studying a decision booklet citing mammography pros and cons for women their age. Alexandra Barratt, M.B.B.S., Ph.D., of the University of Sydney, and colleagues, reported in the Oct. 22 issue of the Archives of Internal Medicine. Although better informed than a control group and able to make an informed choice, 95% of the women remained positive about continued screening, they found. But just as many women in the control group, who received only standard information, also chose to continue screening, the researchers wrote. Screening is generally recommended for women ages 50 to 69, but for women 70 years or older, in whom harm starts to outweigh benefit, recommendations are less clear. For example, the US Preventive Services Task Force notes that a mortality benefit from screening is still likely for women older than 70, if life expectancy is not compromised by comorbid disease. On the other hand, there are concerns about detecting and treating cancers in older women, which, without screening, would not have affected patients' health or life expectancy.

    Read the rest of the MedPage article written by Judith Groch and reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.

    New Link

    StarDate.org: Every weekend on NPR, we listen to another segment from StarDate, a public education and outreach arm of the University of Texas McDonald Observatory. Radio programs are presented in both English and Spanish. The resources page includes links to all things starry, solar, spacey and universal as well as to astronomers and observatories. Another resource page offers lists of books and software. Sky Almanac and Weekly Tips are for up-to-date stargazing information. We also noted a page containing information on the radio voice of StarDate, Sandy Wood.

    Eyes, Bones, The Brain and Beyond

    From the Nutrition Action Health Letter's The Greens Party:

    As you age, your eyes age. The older lens no longer adjusts as well to see accurately at different distances, and the older pupil no longer dilates as much to let light reach the retina. An 80-year-old retina receives one-sixth the light of a 20-year-old retina in a well-lit room and one-sixteenth as much light in a darker room. Worse yet, the older eye is more vulnerable to cataracts (clouded lens) and macular degeneration (deterioration of the center of the retina, or macula). Macular degeneration is the leading cause of blindness in people over the age of 60.

    On the bright side, two carotenoid pigments in leafy greens — lutein and zeaxanthin — may help protect both the lens and the retina.“Leafy greens are incredibly high in lutein and zeaxanthin, so just one or two servings a week places people in the highest intakes,” says Julie Mares of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. Researchers got interested in the two carotenoids in part because both concentrate in the eye. “The macular pigment is composed of lutein and zeaxanthin,” says Mares. “The concentration in the macula is 100-fold higher than in the blood.”

    What’s more, she adds, “they’re the only carotenoids that accumulate in the lens, though the level in the lens is much lower than in the macula.” How might lutein and zeaxanthin protect the eye? "In both the lens and the retina, we suspect that they act as antioxidants that scavenge marauding oxygen molecules called free radicals,” says Mares.“In the retina, we think that they also act as a filter that absorbs short wavelength — or blue — light, which is toxic to the retina.”

    Read the rest of the article, The Greens Party, by Bonnie Liebman, which also covers Bones and The Brain and Beyond at the Nutrition Action Newsletter site

    The Bees and Colony Collapse Disorder

    Although we've been caught up with global warming for the last decade, we admit that hearing about the disappearance of bee colonies was of more immediate concern. Even though we haven't sighted a melting iceberg in recent memory, we do notice a honey bee in this northern California gentle climate quite frequently and we would notice its decline almost immediately. For more information, consult the Colony Collapse Disorder Working Group But first, consult A Buzz About Bees, 400 Years of Beekeeping at Cornell's Mann Library:

    The Life of the Bee, by Maurice Maeterlinck, 1911, London No other book on bees has enjoyed the popularity of Maeterlinck's The Life of the Bee. Originally published in 1901, it was the work of Maurice Maeterlinck, a distinguished Belgian playwright and poet awarded the Nobel Prize for Literature in 1911. In this philosophical work, Maeterlinck, a beekeeper since his youth, adorned his knowledge of bees to draw analogies between their activities and human behavior. The addition of the vivid illustrations by the famed English book illustrator, Edward J. Detmold, in 1911, undoubtedly contributed to the book's great popularity.

    Articles

    Read Betty Soldz's Outsmarting Forgetfulness — Strategies helpful to keep your memory sharp and Mental Illness, Undiagnosed and Untreated in Many Older AmericansRead the guidelines for nursing homes testing at the Centers for Medicare & Medicaid Services site. Our Resident Observer and caregiver, Julia Sneden has written a series on caregiving:The Slippery Slope, Part One
    The Slippery Slope, Part Two
    The Slippery Slope, Part Three Liz FlahertySmoke Free: Eight Days and Five Minutes But Who's Counting' - Easy, providing the comparison has to do with bamboo under fingernails & breech birth without drugs

    Fitness Articles

    "Men like to have shoulders that are big and thickly layered with muscle, and men have much more shoulder strength than women. For both genders, the shoulders perform some of the work of lifting, but a woman's strength rapidly begins to diminish as soon as her arms are lifting at shoulder height or above. She relies more on her chest for lifting and doing heavy work, and once her arms are out of the ideal position for the chest muscles to do the work, her power drops very sharply. Weightlifting will improve her power, of course, but the shoulders are never a woman's strong point." Shoulders: Strength and Grace"Every hero has a great chest, and when people want to boost their own appearance or behave with confidence, they lift the chin and thrust out the chest, a sign of confidence. We associate the chest with courage, high spiritedness, and even self-sacrifice. The chest, after all, guards the heart. Behind that wall of muscular strength, the repository of our love and tenderness lies quietly beating, protected and hidden." Of Heroes, Grandmothers, and Good Chest MusclesA Suggestion: Print Jeri's articles and pin them up by your exercise area.

    Additional articles: The Mouse and the Martial Artist & Stepping Up With Jeanne

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