TOP 10 MEDICINE PROGRESS

05 jan 2011--The first decade of the 21st Century brought a number of discoveries, mistakes, and medical advances that have influenced medicine from the patient's bedside to the medicine cabinet.

1. Human Genome Discoveries Reach the Bedside

In 2000, scientists in with the International Human Genome Project released a rough draft of the human genome to the public. For the first time the world could read the complete set of human genetic information and begin to discover what our roughly 23,000 genes do.

Mapping the human genome had become a race of time and money in the 1990s, with two competitors at the forefront: the government-funded Human Genome Project, which completed its task in 15 years with more than $3 billion in taxpayer money, and a private company, Celera Genomics, which was financed with $100 million and took less than a decade.

Both groups announced a rough draft at joint press conference on June 26, 2000.

In 2003 a "final" draft was released by researchers, and in 2007 more updates to the genome were published by Craig Venter, PhD, chief scientist behind Celera Genomics.

"It's the precursor for lots of medical advances," said Venter, now chairman and president of the nonprofit J. Craig Venter Institute.

"That was absolutely the hope for it, that it will begin to change things," said Venter, who was awarded the National Medal of Science by President Obama last month for his work on the human genome.

At the moment Venter sees more medical potential than medical achievements in genomic research. But when those advances do come, Venter predicts it will help preventative medicine and cut our rapidly accelerating medical costs from increasingly expensive treatments.

"I think the biggest area of the future will be preventive medicine," said Venter. "By understanding the genetic causes and links to disease we can spend more and more attention on preventing disease."

For example, Venter said doctors have developed a genetic test for a gene associated with prostate cancer, "and there's a drug available that greatly lowers the risk for prostate cancer in the future."

2. Doctors and Patients Harness Information Technology

Patients may not even think of it as they sign in with a pad and pen, then sit in the waiting room while the nurse pulls their file. But doctors say the Internet and information technology has actually changed the way they practice medicine for the better. Even doctors need to look things up from time to time.

"Early in practice, if I had a clinical question to research, I had to go to the library, pull out multiple years of the Index Medicus, look up the topic, write down the references, go to the stacks and pull the volumes of journals, find the article, read the article, go to the copy machine and make a copy& if I were lucky, I would have my answer in about four hours," said John Messmer, MD, associate professor at the Penn State College of Medicine in Hershey.

"Now I can be on rounds and in five minutes have more information on the topic than I need& on my iPod Touch, I can look up a medication, check the formulary to see if it's covered, check for interactions with a patient's other meds and double-check details of the pharmacology of the med plus quickly review the problem I am treating, and I don't even have to go online," said Messmer.

Information technology has also, to some degree, made life safer for the patient. Once admitted to a hospital, they get a bar code which matches their blood samples and their IVs.

"The ways in which computer systems are improving hospital care& are pervasive and radical," explained Margaret Humphreys, MD, PhD, editor of the Journal of the History of Medicine.

But many physicians have been reluctant to go digital because there is a significant upfront investment, which is why several of the healthcare reform measures now before Congress include provisions to underwrite some of this cost.

And with or without reform, the Obama administration has an ambitious program aimed at converting paper records to electronic health records. It has earmarked $20 billion to pay for the switch-over and named medical IT wonk David Blumenthal, MD, to serve as National Coordinator for Health Information Technology.

3. Anti-Smoking laws and Campaigns Reduce Public Smoking

There is no national smoking ban in the U.S., but 27 states and the District of Columbia have enacted smoking bans, including seven states that ban smoking in bars and casinos in recent years.

In a report issued last October, the Institute of Medicine said those public smoking bans have cut exposure to secondhand smoke, which, in turn, has contributed to a reduction in heart attacks and death from heart disease.

Lynn Goldman, MD, of Johns Hopkins Bloomberg School of Public Health, who chaired the committee that wrote the Institute's report, said the debate was over -- "Smoking bans work."

Experts in the history of medicine agreed.

"Anti-smoking campaigns (at least in the U.S.), including banning of smoking in workplaces and public places, [have] enormous impact across socioeconomic classes on many diseases," said Humphreys, who added that smoking increases the risk for strokes and many cancers.

In terms of the greatest good for the greatest number, there can be no doubt that the decline in smoking (through various means) has had the greatest impact," said Humphreys. "Virginia and North Carolina are just getting around to banning cigarettes in all restaurants now, so the public bans do track over the last 10 years."

While public smoking bans protect people from secondhand smoke, doctors say they also motivate people to quit.

"It's probably the most important 'doable' public health measure for decreasing morbidity and mortality," said Richard Kahn, MD, of Tenants Harbor, Maine. "There is good data that as it becomes more difficult for people to smoke, more will quit."

4. Heart Disease Deaths Drop by 40 Percent

Those looking for dramatic improvements in public health need look no further than the world of heart disease.

A mere 25 years ago, when a patient came to a hospital with a heart attack, the best that could be done was to put the patient in a darkened room, give him or her morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats, and hope for the best.

Heart attacks, called infarcts, were "big" and the damage to the heart muscle was often catastrophic, leading eventually to heart failure and death.

By contrast, today treating a heart attack is all about speed: speed the patient to the hospital so that a clot that blocks the life-saving flow of blood can be "busted" with drugs like the genetically engineered tissue plasminogen activator or tPA.

Or, if the problem is a vessel narrowed by buildup of plaque, a tiny flexible tube called a stent can be guided from an artery in the groin or the forearm up into the heart, where it is used to prop open the vessel to allow blood to flow normally.

Still other patients are sent to surgery, where surgeons have learned sophisticated techniques to sew new vessels into the heart to bypass diseased arteries.

Moreover, drugs that didn't exist 25 years ago -- chiefly statins like simvastatin, Lipitor, mevacor, and Crestor -- are now routinely used to slow the progression of atherosclerosis, the medical term that describes the build-up of the hard, waxy substance called plaque that narrows arteries.

Cardiologists say these efforts really began to bear fruit after 2000.

"In 1998/2000 the American Heart Association set a decade-long goal to reduce coronary heart disease and stroke and risk by 25% by 2010. We actually realized this goal by 2008 and have seen continued improvements in the reduction of deaths due to coronary heart disease and stroke," said Clyde Yancy, MD, of Baylor University Medical Center in Dallas, Texas. "As of today, we have seen a near 40 percent reduction in death due to coronary artery disease since 1998/2000.

Yancy said research shows about half of the gains in heart disease came from new treatment interventions, the other half (up to 60 percent) are due to prevention.

"Importantly, what this means is that the community 'gets it.' Better control of blood pressure, preemptive lowering of blood cholesterol levels, better diets, and reduced smoking are resulting in fewer (cardiac) events," he said.

5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances

Probably no area of research has so fired the public imagination and so ignited the fires of public controversy as that of stem cell research. In reality, this area has generated more political action than reproducible clinical advances -- the much-publicized ban on Federal funding of embryonic stem cell research was rescinded this year.

But the clinical advances with embryonic or adult stem cells -- even when they have come from pilot studies -- have been tantalizing.

For example, European researchers genetically manipulated bone marrow cells taken from two 7-year-old boys and then transplanted the altered cells back into the boys and apparently arrested the progress of a fatal brain disease called adrenoleukodystropy or ALD, which was the disease that affected the child in the movie "Lorenzo's Oil."

Cases like those fuel the promise of stem cell research, be it embryonic or adult stem cells. As the population ages, the opportunity for 'replacement parts' becomes more and more inviting, and I'm counting on stem cell research to give me, at least, new cartilage for my knees," joked Humphreys. "This seems likely to be the future of regenerative medicine."

Stem cell researcher George Daley, MD, PhD, of Children's Hospital in Boston, called progress in both adult and embryonic stem cell research this decade "breathtaking."

"Now we can make embryonic-like stem cells directly from skin cells, which makes it possible to model a multitude of human diseases in the petri dish. New drugs based on stem cells are being developed, and the first human clinical trial based on products of human embryonic stem cells is expected in 2010," said Daley. "The science of the past decade has been spectacular, and we're hopeful that in the next decade, we'll start to realize the promise of new stem cell therapies."

6.Targeted Therapies for Cancer Expand With New Drugs

Two blockbuster-targeted therapies burst on the cancer scene in late 1990s, and arguably changed forever the concept of cancer treatment, converting what was often a fatal disease into a chronic illness. The first, Herceptin, is a drug that targets a type of breast cancer that is characterized by a specific cancer gene -- an oncogene -- called HER-2.

Women whose cancers express HER-2, which is estimated to be about 25 percent of women with breast cancer, will respond to Herceptin even when other powerful chemotherapy drugs have failed.

Kimberly Blackwell, MD, of Duke University Medical Center, said doctors received a standing ovation when they presented the results of Herceptin drug trials.

"The introduction/approval of trastuzumab (Herceptin) and lapatinib (TyKerb) in breast cancer will prevent many women's breast cancers from recurring and have significantly improved survival for many women faced with breast cancer. More important, these drugs represent highly effective agents that target the cancer, not the patient," said Blackwell.

"Probably one of the only standing ovations I will witness in my career was when [it was] presented by Edward Romond at the Annual Meeting of the American Society of Clinical Oncology."

The other drug, a cancer pill called Gleevec, targets genetic mutation called bcr-abl (b.c.r. able) that causes cancer cells to grow and multiply in patients with a variety of cancers, including chronic myeloid leukemia or with a stomach cancer called GIST.

These two breakthrough agents opened the door to a number of cancer drugs that target specific molecules that control not only cell growth, but also the blood supply that feeds tumors.

7. Combination Drug Therapy Extends HIV Survival

Since the introduction of highly active antiretroviral therapy, or HAART, as this combination therapy approach is called, HIV/AIDS has evolved into a serious, but chronic disease with survival stretching into decades.

Moreover, this "cocktail" approach to treatment where drugs are combined in different ways or different sequences has become a model for treating other diseases ranging from lung cancer to heart disease.

"In 1996 a 20-year-old person in the U.S. with AIDS expected to live about three to five years and now expects to live to be 69 years. That is amazing," said John Bartlett, MD, past president of the Infectious Diseases Society of America. "Think of it -- in 1996 everyone in our HIV clinic was prepared to die. Now they all live. And most of them look great. They just need to take the meds."

"Next challenge is the cure," said Bartlett.

In more than a decade since the emergence of HAART, researchers have constantly refined the regimens to improve results, with evidence now emerging that some combinations may be more effecting patients with more extensive disease.

Thomas Coates, MD, of the University of California Los Angeles, pointed out that the HIV death rates are still dropping due to continual HIV research.

"The drop in death rates from HIV in the developed world (is) due to improved medications," Coates said. "There was the 10 percent drop in deaths due to HIV in the US between 2006 and 2007."

In Africa, where the HIV/AIDS crisis hits hardest today, Coates said doctors are slowly making progress-and in some cases real gains, which is the case with the use of antiretroviral drugs to block mother-to-infant HIV transmission.

"It has made a big difference in the developed world where vertical transmission rates have plummeted from over 1,000 at the peak to fewer than 100 per year (in the US)," said Coates. "Advances are being made in the developing world, with Botswana leading the way not with a 3% vertical transmission rate. It was the first and still is the most effective prevention strategy we have."

8. Minimally Invasive and Robotic Techniques Revolutionize Surgery

Ten years ago a patient would typically be left with a 10-inch scar when a doctor removed a kidney, but in late 2007 the surgeons at the Cleveland Clinic began removing kidneys through a single incision in the patient's navel.

And earlier this year, a Cleveland Clinic surgeon removed a diseased kidney from a woman using a technique called natural orifice translumenal endoscopic surgery or NOTES. In the case of the woman the kidney was removed through her vagina-an approach originally developed for hysterectomy.

Tiny metal hands carefully manipulating sutures deep inside the heart seems like a scenario pulled from "Star Trek," but the reality is that robotic surgery is occurring daily in a growing number of centers across the country.

The greatest benefit of tiny openings into the body rather than large incisions made by traditional surgery, may -- believers say -- be shorter and less painful recovery time.

Medical historian Sandra Moss, MD, believes this, especially after watching a sibling undergo a minimally-invasive surgery.

"My younger sister and I had the same operation 20 years apart. I was hors de combat (out of commission) for one month and loopy from pain meds for two weeks -- she was back at work in a few days on no pain medications," said Moss.

Doctors have also used robotic surgery to improve the accuracy of procedures, especially in cancer cases.

"Robotic surgery increased the ability of cancer surgeons to get clean margins as well due to the magnification of the structures," said Douglas Bacon, MD, of the Mayo Clinic in Rochester, Minn.

Richard Caselli, MD, of the Mayo Clinic in Scottsdale, Ariz., pointed out that robotic surgery "offers the potential for surgeons to operate on patients remotely."

But critics, and there are many, say the cost of the robotic hardware may outweigh the benefit. Moreover, critics say that the robot revolution is racing ahead of the evidence.

9. Study Finds Heart, Cancer Risk with Hormone Replacement Therapy

Until July 2002 most doctors treating middle-age women believed that giving their patients hormones -- either estrogen alone or estrogen combined with progestin -- would protect their hearts from the ravages of age that seemed to attack women after menopause.

Hormone replace therapy, or HRT, was also thought to be good for the bones, the brain, the skin, the figure, and the libido, and was considered the best treatment to control the annoying and sometimes disabling symptoms of menopause such as hot flashes, depression, and sleep disturbances.

And then the world changed, the National Heart Lung and Blood Institute, which was sponsoring a placebo-controlled trial of hormone replacement therapy in more than 161,000 healthy women, announced that it was shutting down the study because HRT increased the risk of heart attack, stroke, blood clots, and breast cancer.

It was the "oops" heard round the world.

Larry Norton, MD, of the Memorial Sloan-Kettering Cancer Center in New York City, believes the two biggest advances in breast cancer this decade was the targeted-breast cancer treatment with Herceptin and "the finding that postmenopausal hormone replacement is associated with a huge increase in the risk of breast cancer."

But the news from the Women's Health Initiative, as the study was known, wasn't all bad. HRT did reduce the risk of colorectal cancer and fractures and was proven to be an effective treatment for hot flashes and some other menopause symptoms.

10. Scientists Peer Into Mind With Functional MRI

Mind-reading has moved from carnival attraction to the halls of medicine with what is known as a functional MRI.

The medical mind-readers are not trying to identify a card randomly selected from a deck -- they are using sophisticated imaging techniques to map the way the mind works.

The process, often called fMRI, traces the working of neurons -- brain cells -- by tracking changes in the oxygen levels and blood flow to the brain. The more brain activity in one area, the more oxygen will be used and the more blood will flow to that area. The patient lies awake inside an MRI scanner. He or she is asked to perform a simple task, like identifying a color or solving a math problem.

As the patient answers the question, the fMRI tracks the areas of the brain that are activated by tracing the speed at which the cells metabolize the sugar, or glucose.

First developed in the early 1990s, fMRI began to shape research at the beginning of the decade.

"It has certainly taken off in the past 10 years as a means for studying the living human brain in action," said Caselli. "It has given us innumerable insights into cognition, social interactions, reward systems, decision-making, and so on."

Using this technique, researchers are learning valuable information about disease such as depression, brain cancer, autism, memorydisorders, and even conditions such as the skin disorder psoriasis.

Walking speed associated with survival in older adults

In an analysis that included data from 9 studies, having higher measures of walking speed among older adults was associated with increased length of survival, according to a study in the January 5 issue of JAMA.

05 jan 2011--"Remaining years of life vary widely in older adults, and physicians should consider life expectancy when assessing goals of care and treatment plans. However, life expectancy based on age and sex alone provides limited information because survival is also influenced by health and functional abilities," according to background information in the article. There are currently no well-established approaches to predicting life expectancy that incorporate health and function. Gait speed, or walking speed, has been recommended as a potentially useful clinical indicator of well-being among older adults.

Stephanie Studenski, M.D., M.P.H., of the University of Pittsburgh, and colleagues conducted a study to assess the association of gait speed with survival in older adults and to determine the degree to which gait speed explains variability in survival after accounting for age and sex. The study included a pooled analysis of 9 participating studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling adults age 65 years or older with walking speed data available at the beginning of the study, followed up for 6 to 21 years. Participants had an average age of 73.5 years; 59.6 percent were women; and 79.8 percent were white. Gait speed was calculated for each participant using distance in meters and time in seconds. All studies used instructions to walk at usual pace and from a standing start. The walk distance varied from 8 feet to 6 meters. The average gait speed of the participants was 0.92 meters (3 feet) per second.

During the course of the study, there were 17,528 deaths. The overall 5-year survival rate was 84.8 percent; the 10-year survival rate was 59.7 percent. The researchers found that gait speed was associated with differences in the probability of survival at all ages in both sexes, but was especially informative after age 75 years. At this age, predicted 10-year survival across the range of gait speeds ranged from 19 percent to 87 percent in men and from 35 percent to 91 percent in women.

"Predicted years of remaining life for each sex and age increased as gait speed increased, with a gait speed of about 0.8 meters [2.6 feet]/second at the median [midpoint] life expectancy at most ages for both sexes. Gait speeds of 1.0 meter [3.3 feet]/second or higher consistently demonstrated survival that was longer than expected by age and sex alone. In this older adult population the relationship of gait speed with remaining years of life was consistent across age groups, but the absolute number of expected remaining years of life was larger at younger ages," the authors write.

The researchers also found that predicted survival based on age, sex, and gait speed was as accurate as predictions based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.

The authors suggest there are several reasons why gait speed may predict survival. "Walking requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems. Slowing gait may reflect both damaged systems and a high energy cost of walking."

The researchers write that there are a number of ways gait speed might be used clinically, including helping to identify older adults with a high probability of living for 5 or 10 more years, who may be appropriate targets for preventive interventions that require years for benefit. Gait speed might be used to identify older adults with increased risk of early mortality, perhaps those with gait speeds slower than 0.6 meter (2 feet)/second. "In these patients, further examination is targeted at potentially modifiable risks to health and survival." Also, gait speed might be monitored over time, with a decline indicating a new health problem that requires evaluation.

"The data provided herein are intended to aid clinicians, investigators, and health system planners who seek simple indicators of health and survival in older adults. Gait speed has potential to be implemented in practice, using a stop watch and a 4-meter [13 feet] course. From a standing start, individuals are instructed to walk at their usual pace, as if they were walking down the street, and given no further encouragement or instructions. The data in this article can be used to help interpret the results. Gait speed may be a simple and accessible indicator of the health of the older person," the authors conclude.

More information: JAMA. 2011;305[1]:50-58.

Provided by JAMA and Archives Journals

Angry at God? If so, you're not alone, says psychologist

The notion of being angry with God goes back to ancient days. Such personal struggles are not new, but Case Western Reserve University psychologist Julie Exline began looking at "anger at God" in a new way.

04 jan 2011--"Many people experience anger toward God," Exline explains. "Even people who deeply love and respect God can become angry. Just as people become upset or angry with others, including loved ones, they can also become angry with God."

Exline, an associate professor in Case Western Reserve's College of Arts and Sciences, has researched anger toward God over the past decade, conducting studies with hundreds of people, including college students, cancer survivors and grief-stricken family members.

She and her colleagues report their results in the article, "Anger toward God: Social-Cognitive Predictors, Prevalence, and Links with Adjustment to Bereavement and Cancer" in the new issue of the Journal of Personality and Social Psychology.

Anger toward God often coincides with deaths, illnesses, accidents or natural disasters. Yet anger is not limited to traumatic situations. It can also surface when people experience personal disappointments, failures, or interpersonal hurts. Some people see God as ultimately responsible for such events, and they become angry when they see God's intentions as cruel or uncaring. They might think that God abandoned, betrayed, or mistreated them, Exline says.

Exline notes that it can be difficult for people to acknowledge their anger toward God. Many people are ashamed and don't want to admit their feelings, she says. In particular, people who are highly religious may believe that they should focus only on the positive side of religious life.

"But religion and spirituality are like other domains of life, such as work and relationships," Exline says. "They bring important benefits, but they can bring difficulties as well. Anger with God is one of those struggles," she adds.

According to Exline's findings, Protestants, African Americans, and older people tend to report less anger at God; people who do not believe in God may still harbor anger; and anger toward God is most distressing when it is frequent, intense, or chronic.

Overcoming anger at God, she says, may require some of the same steps needed to resolve other anger issues.

"People may benefit from reflecting more closely on the situation and how they see God's role in it," Exline suggests. "For example, they may become less angry if they decide that God was not actually responsible for the upsetting event, or if they can see how God has brought some meaning or benefit from a painful situation."

People who feel angry toward God also need to be reassured that they are not alone. Many individuals experience such struggles, she adds. She suggests that people try to be open and honest with God about their anger, rather than pulling away or trying to cover up their negative feelings.

More information: http://psychology. … d/index.html

Provided by Case Western Reserve University

7 Major Advances Predicted for Health & Medicine in 2011

In terms of advancement in the fields of science and medicine, 2010 was a stellar year. German doctors appeared to have cured a man of HIV. Doctors watched a drug called PLX4032 melt away the tumors of melanoma patients who otherwise were out of treatment options. And scientists created the first "synthetic life."

03 jan 2011--What significant advances can we expect in 2011? Here are seven predictions, provided by experts in these fields who gave the low down on what might promote our health next year.

Prediction 1: Results of a promising HIV vaccine will be announced.

An American man made international headlines this month when German doctors announced he had been cured of the virus that causes AIDS. The HIV-positive man had suffered from acute myeloid leukemia - a deadly blood cancer - so in 2007 the doctors performed a bone marrow transplant to treat the leukemia. They were lucky enough to find a bone marrow donor with a rare mutation, called Delta 32, that provides natural resistance to the human immunodeficiency virus.

Three years after the transplant, the man continued to show no signs of HIV.

But for all the media attention to this case, another scientific advance is likely to help more people battle HIV and AIDS in 2011.

In 2009, studies in Thailand showed a vaccine could reduce the risk of contracting HIV by about 30 percent. Dr. Susan Zolla-Pazner, an HIV researcher at the New York University Langone Medical Center in New York City, said it was the first sign of real success for an HIV vaccine, and a guide to future research.

"It was the first and only light in a very dark tunnel that suggested that we were beginning to get off of home plate in terms of making any progress," Zolla-Pazner said.

Reflecting on the case of the German achievement, Zolla-Pazner pointed out that only a tiny fraction of HIV patients would be able to find matching bone marrow from a naturally resistant donor, and even then, those patients would risk dying from the bone marrow transplant procedure.

"It shows that, in theory, with bone marrow transplants, you can cure [HIV], which is interesting. But certainly it is not anything that could be applied even on a small scale, let alone on a vast scale with millions of people," Zolla-Pazner said.

So instead of bone marrow transplants, Zolla-Pazner is setting her hopes on HIV vaccine advancements.

"If there's a clear answer about what that vaccine did to provide protection, it provides a foundation to build another vaccine," she said.

Zolla-Pazner said more results based on the experimental vaccine are expected to be announced in mid-2011.

Prediction 2: Many broken hearts will be fixed by freezing them.

The 2.2 million people in the United States afflicted with atrial fibrillation will see another tool in the fight against their condition in 2011: a device that freezes heart tissue.

A healthy heart contracts under a timed pattern of electrical signals, but people with atrial fibrillation have irregular electrical signals, causing the upper chambers of their heart to quiver instead of beat, according to the American Heart Association. Atrial fibrillation can lead to fatigue, shortness of breath, and even stroke.

This month the Food and Drug Administration approved the Arctic Front cardiac cryoablation catheter system device, which freezes sections of heart tissue instead of burning them with radio-frequency energy. Doctors can use the device to purposefully scar certain sections of the heart, blocking the irregular signals that create atrial fibrillation.

"This treatment model has shown to cure this disease in 70 percent of patients," said Dr. Moussa Mansour, who used the device in clinical trials at Massachusetts General Hospital in Boston.

"The old way [radio-frequency ablation] had a similar range of success, but we believe it is easier to do it in the new way," Mansour said. Now that the cryoablation technique has been approved, he added, more people will receive therapy.

Prediction 3: The lowered bar for lap-band surgery will have an impact on the decisions made by millions of obese Americans.

Surgery is one of the more controversial solutions to the nation's obesity problem, even though research shows stomach surgery for weight loss is sometimes the most effective treatment.

This coming year will open up the option of bariatric weight-loss surgery to millions more Americans. Until recently, only people with a body mass index (BMI) of at least 40, or those with BMIs of 35 and higher with another serious health problem related to their obesity, were candidates for lap-band surgery from Allergan, according to the FDA. In the lap-band procedure, a doctor places an inflatable silicon ring around the upper portion of the stomach and constricts it.

In late 2010, the FDA voted to change the eligibility criteria for the Allergan procedure. Now, most people with a BMI of 35 or higher, and patients with a BMI of 30 or higher who also have another serious medical condition, can undergo the operation.

"Only one in 50 people will keep 50 pounds off for one year using diet and exercise. It's just a profound waste of time for people who are obese," said Dr. George Fielding, an advocate of the surgery who works in the Division of Bariatric Surgery at NYU Langone Medical Center.

"Surgery does work, it's just so well established," he said. "All around the world, no matter what method you use, you can see results."

Fielding noted that if a person with diabetes and a BMI of 30 loses 50 pounds and keeps it off, he has an 80 percent chance of coming off their diabetes medications. "There are millions of people, literally, with the BMI of 30 and 35 who have diabetes," he said.

But physicians who specialize in weight loss warn about the dangers of opening a patient's body when there are other options.

"The issue with surgery, any kind of surgery - banding, bypass, etc. - is they work, by far, better than anything else. The problem is that they are surgery, so they're invasive, " said Dr. Lee Kaplan, director of the Massachusetts General Hospital's Weight Center. "They have risks associated with them. "

Kaplan said only 2 percent of patients who meet the criteria for weight-loss surgery actually undergo the procedure, in part because of the risks. Because of this, he doesn't think dropping the criteria by 5 BMI points will drastically change the odds of an obese person submitting to the procedure.

Kaplan acknowledged that research on people who've had weight-loss surgery has contributed to the understanding of exactly how the body can lose weight - or keep it on.

"We're learning an enormous amount from surgery, even though surgery itself is used infrequently," Kaplan said. Doctors used to think weight-loss surgery worked by making the stomach smaller, but they have found evidence that the surgery actually changes physiological mechanisms in the body that eventually determine whether or not a person gains weight, he said.

Prediction 4: School lunches will get a makeover that will lower obesity in the next generation.

More than about any surgery, obesity experts are excited about the Healthy, Hunger-Free Kids Act, which takes effect in 2011.

The new legislation raises the federal reimbursement rate for school lunches by 6 cents per meal, according to the American Academy of Pediatrics. The bill will allot an additional $4.5 billion toward school lunch programs over 10 years, and it has tasked the U.S. Department of Agriculture with creating nutrition standards for food sold through vending machines in schools.

"If you can tell a kid at age 5 or 6, 'Look, this food is really yummy - it just doesn't come from McDonald's, it's just fresh food,' then you've got a chance," Fielding said. "Once a kid is fat and 10 or 12 years old, it doesn't matter how much you're going to tell them, it's hot air."

"You can make the next generation have a chance by teaching them about healthy food," he said.

Kaplan called the legislation "terrific. "

"When the [school lunch] program was developed 50 years ago, the focus was not on obesity, it was on malnutrition," Kaplan said. "Now ... we see obesity is an even bigger problem than malnutrition."

Prediction 5: Restaurant menus that list calories will help us cut our daily total.

This year the nation will follow New York City in requiring restaurant chains to post calorie counts next to standard menu items. The mandate comes as part of the Patient Protection and Affordable Care Act, and requires chains with 20 or more locations to list calories by spring 2011.

Physicians who specialize in weight loss say the move will help some who don't realize their latte has 300 calories, or that their favorite dish might pack more than 1,000 calories. But the doctors aren't predicting whether it will make a dent in the nation's obesity rate.

"I don't think people care. If they did, they wouldn't be going to these stores, because they all know what they are," Fielding said.

The mandate also requires the listing of calories in vending machines and "similar retail food establishments," according to the FDA.

"I think it might help," Kaplan said. But realistically, the effect "is going to be quite modest."

However, Kaplan added, "I think the risk of doing this is essentially zero, and the benefit is undetermined. But with so little risk, I think we ought to do it."

Prediction 6: Genomics will find medicines that work for you.

Sequencing an entire human genome cost about $3 billion a decade ago. Last year it cost around $10,000, according to Dr. Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif.

Topol said he expects to see the price drop again in 2011, to about $4,000. And with lower financial barriers, he said, more medical advances from genomic research will come in the next year.

"This field is exploding," he said.

For example, Topol said, last year pharmacy benefit managers Medco and CVC/Caremark started examining the genes of patients on the widely used heart drug Plavix. The researchers identified two genes - called PON1 and CYP2C19 - that can determine how a person would respond to Plavix.

"These two genes explain why this drug, which is the second biggest drug in the world, is so inconsistent," Topol said. "Two-thirds of patients on Plavix do well, but the others either don't see the drugs' effects and/or suffer from side effects."

Genotyping has already found mutations that would determine a person's response to malaria drugs, blood thinners, and breast cancer therapy, Topol said.

For the hepatitis C drug interferon, Topol said, researchers have identified genes that could save about half of all hepatitis C patients from side effects.

"Fifty percent of people don't respond [to interferon], and that drug costs $50,000 and it makes you sick," Topol said. "That is a really striking example."

Genetic analysis "saves lots of money; it saves patients from being sick for years with a drug that doesn't help them."

Prediction 7: Genomics will help us understand cancer.

Topol predicted the low cost of genome sequencing will also bring good news in cancer research next year, "because the sequencing is becoming so much cheaper and fast, and because bioinformatics is getting more advanced," he said.

With faster technology, Topol said it's become increasingly feasible for cancer researchers to compare a person's genome - the "germ line" genome the patient was born with - with the mutated genome of his or her cancerous tumors, to find the genes that are driving the cancer. In other words, they'll find the genes that are making cancerous cells act cancerous.

Topol said such research has already benefited melanoma patients taking the powerful drug PLX4032. Genomic research has showed melanoma patients with tumors that have what's known as a BRAF mutation will benefit from the drug, while patients whose tumors don't have that mutation will likely get worse with the drug.

A new approach to bladder-disease treatment

A bladder disease called interstitial cystitis affects at least a half-million people in the United States, mostly women, with perhaps an equal number undiagnosed. At present, there are no good options for such people; the only treatment that reduces the symptoms of painful and very frequent urination, which can be debilitating and make it impossible to work, is an infusion of the drug lidocaine into the bladder through a catheter, but the treatment only provides brief relief and needs to be repeated frequently.

02 jan 2011--Researchers at MIT think they have found a much better solution. They fill a small medical-grade silicone tube with the solid drug, after drilling a tiny hole in the tube using a laser beam. A shape-memory wire made of nitinol is threaded through the tube, which is then straightened out, placed in a catheter, and inserted into the bladder. As soon as it is released there, the nitinol wire causes the device to spring back into a pretzel-like shape, which prevents it from being expelled from the bladder during urination, and thus it can slowly, steadily release the drug over a two-week period — which would typically be long enough to treat an interstitial cystitis flare-up, something that may occur about three times a year.

The device, developed by Heejin Lee SM ’04, PhD ’10 and Michael Cima, the Sumitomo Electric Industries Professor of Engineering, is undergoing phase-1 clinical trials, and is described in detail in a paper in the Journal of Controlled Release (available online now, and scheduled to appear in an upcoming issue in print). Though it is initially being tested specifically for interstitial cystitis, Cima says that the same delivery system, if all goes well in the clinical trials, could also be used to deliver drugs for other bladder diseases, including chemotherapy for bladder cancer — the form of cancer that has the highest recurrence rate of all, in part because it is so difficult to deliver drugs to the bladder in a sustained way.

“The biggest problem with these treatments is the patients don’t get the drug long enough,” Cima says, noting that doctors try to make up for this shortcoming by using very high concentrations of drugs. The new device could potentially lead to smaller dosages, thus reducing side effects and adverse reactions.

If all goes well, Cima says, the device could become an approved medical product by 2014. Already, a new MIT spinoff company called Taris Biomedical has been established to carry out the testing and bring the device into production. Lee, who developed the device as part of his doctoral thesis work, is now working for the company as a product-development scientist.

Compared to the discomfort of having a catheter left in place for an hour under the present standard treatment regime, in this device’s initial phase-1 trial after the quick insertion patients couldn’t even tell that the device had been left in place, Cima says.

Dr. Joseph Grocela, a physician at Massachusetts General Hospital, says he is “very impressed” with this work, which he says was “careful and insightful.” Many patients with interstitial cystitis, he says, “give up hope. This device can give them hope for a better life.” In addition, he says, the technology has potential in treating many other diseases, so this particular condition “I think will be only one of many uses for this device.”

Dr. Joseph Moldwin, a physician at the Arthur Smith Institute for Urology at Long Island Jewish Medical Center, who treats many patients with interstitial cystitis and other bladder diseases, says this is “a very novel device. I’m not aware of anything like it.” And while it is never possible to predict how a given device will fare in clinical testing, he says he thinks “the likelihood is high” that this technology will pan out. He adds that official figures on the incidence of IC may be very low, and there could be as many as 3 million people in the U.S. who have the condition — and possible as many as 30 million with other bladder conditions that might also benefit from this drug-delivery system. One remaining uncertainty is how easy it will be to remove the device at the end of the two-week treatment period, he says, but assuming all goes well in the clinical trials, “I think it will be a wonderful thing” for these patients.

---

This story is republished courtesy of MIT News (http://web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

Provided by Massachusetts Institute of Technology

Team-based approach to care shows success in fight against depression with diabetes, heart disease

Many people in the U.S. have multiple common chronic diseases such as diabetes and heart disease, which complicates health care needs. When depression coexists with diabetes, heart disease, or both, health outcomes are often less favorable.

31 dec 2010--In a randomized controlled trial, testing a primary care intervention called TEAMcare, nurses worked with patients and health teams to manage care for depression and physical disease together, using evidence-based guidelines. The result for patients: less depression, and better control of blood sugar, blood pressure and cholesterol and improved quality of life.

Researchers at the University of Washington (UW) and Group Health Research Institute published their findings in the December 30, 2010 New England Journal of Medicine.

"Depressed patients with multiple uncontrolled chronic diseases are at high risk of heart attack, stroke and other complications," said Dr. Wayne J. Katon, a UW professor of psychiatry and behavioral sciences and an affiliate investigator at Group Health Research Institute. "We are excited about finding a new way to help patients control these chronic diseases, including depression. Then they can get back to enjoying what makes their lives worth living," he said.

Depression is common in patients with diabetes and heart disease, and it has been linked to worse self-management and more complications and deaths. Depression can make people feel helpless and hopeless about managing other chronic diseases. In turn, coping with chronic disease can worsen depression. This tangle of health problems can feel overwhelming—for patients, their families and their health care providers.

To explore possible solutions, the trial focused on 214 Group Health Cooperative patients who were randomly assigned to either standard care or the TEAMcare intervention. In the TEAMcare intervention, a nurse care manager coached each patient, monitored disease control and depression, and worked with the patient's primary care doctors to make changes in medications and lifestyle when treatment goals were not reached. Working together, the nurse and patient set realistic step-by-step goals: reductions in depression and blood sugar, pressure and cholesterol levels. Patients assigned to the standard care arm of the study did not receive the nurses' coaching and monitoring services.

To reach these goals, the nurse regularly monitored the patient's mental and physical health. Based on guidelines that promoted incremental improvements, the care team offered recommendations to the patient's primary care doctor to consider changes to the dose or type of medication used for managing blood pressure, blood sugar, lipids or depression. This process is called "treating to target."

Katon said that the "treating to target" approach helped boost patients' confidence as goals were accomplished. "It reverses what happens when they set overly ambitious goals they don't reach, which discourages them, their families, and health care providers."

At one year—compared with the standard care control group—patients with the TEAMcare intervention were significantly less depressed and also had improved levels of blood glucose, low-density lipoprotein (LDL) cholesterol, and systolic blood pressure. These differences are clinically significant, particularly if achieved in large numbers of patients, Katon said.

"Each of these four disease control measures has been linked to higher risks of complications and deaths from diabetes and heart disease," he added.

The researchers have not yet completed their analysis of possible cost savings from the intervention, but they estimated that the two-year TEAMcare intervention cost $1,224 per patient, on average. This is for patients whose medical care costs health care systems approximately $10,000 per year, said Katon.

TEAMcare intervention patients reported enhanced quality of life and satisfaction with care for depression and either diabetes, heart disease or both. Patients were more likely to have timely adjustment of glucose levels, high blood pressure, cholesterol and antidepressant medications.

"TEAMcare is a truly patient-centered approach that enhances a primary care team to deliver optimal care for both physical and mental health in a seamless manner," said co-author Elizabeth H.B. Lin, MD, MPH, Group Health family physician and an affiliate investigator at Group Health Research Institute. "It recognizes there can be no health without mental health."

This trial is the culmination of more than 25 years of collaboration between the UW and Group Health to improve care for patients with chronic diseases including depression in everyday primary care settings.

Provided by Group Health Research Institute

Alzheimer's changes detectable in healthy elderly

A team of UCL researchers, part-funded by the Alzheimer's Research Trust, has discovered that combining spinal fluid testing with MRI scans could provide an early indication of a person’s risk of developing Alzheimer's.

30 dec 2010--The approach could allow scientists to test treatments or preventions far earlier in the disease, when experts believe they could be more effective.

The findings of the study are published online this week in Annals of Neurology.

The researchers studied 105 cognitively normal individuals from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). They split this group into those with high and low levels of cerebrospinal fluid (CSF) amyloid, a protein which is typically reduced in the CSF of patients with Alzheimer’s disease.

MRI scan measurements over 12 months were used to calculate the brain shrinkage rate. The team also checked other characteristics such as the presence of known Alzheimer’s risk gene APOE4.

The results revealed that the brains of those normal individuals with low CSF levels of amyloid (38% of the group), shrank twice as quickly as the other group. They were also five times more likely to possess the APOE4 risk gene and had higher levels of another culprit Alzheimer’s protein, tau.

Study lead author Dr. Jonathan Schott from the Dementia Research Centre (UCL Institute of Neurology) said: “In this study of healthy people in their 70s and 80s we found that about one in three had a spinal fluid profile consistent with Alzheimer’s disease. Using MRI scanning, we showed that these individuals also had increased brain shrinkage over the following year.

“The significance of these findings will only be clear with longer clinical follow-up, but may suggest that these individuals are at increased risk of developing dementia. If so these results add to a growing body of work suggesting that Alzheimer’s disease starts many years before the onset of symptoms.”

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, the leading UK dementia research charity, said: “We are hamstrung by our inability to accurately detect Alzheimer’s, but these findings could prove to be pivotal. Spotting Alzheimer’s early is essential to the global research effort to beat the disease. We know that treatments for many diseases can be more successful if given early and this is likely to be true for Alzheimer’s. It will be crucial to keep following the study group to see how many develop Alzheimer’s, and to expand the research to test the approach further.

“Findings like these underline the importance of research, but detecting Alzheimer’s is only the first step. If we are to defeat the disease, we must invest in research into preventions and treatments now before our dementia crisis spirals out of control.”

More information: More on the research paper in Annals of Neurology: http://onlinelibra … 315/abstract .

Provided by University College London

Placebos work -- even without deception

20 dec 2010-- -- For most of us, the "placebo effect" is synonymous with the power of positive thinking; it works because you believe you're taking a real drug. But a new study rattles this assumption.

Researchers at Harvard Medical School's Osher Research Center and Beth Israel Deaconess Medical Center (BIDMC) have found that placebos work even when administered without the seemingly requisite deception.

The study is published December 22 in PLoS ONE.

Placebos—or dummy pills—are typically used in clinical trials as controls for potential new medications. Even though they contain no active ingredients, patients often respond to them. In fact, data on placebos is so compelling that many American physicians (one study estimates 50 percent) secretly give placebos to unsuspecting patients.

Because such "deception" is ethically questionable, HMS associate professor of medicine Ted Kaptchuk teamed up with colleagues at BIDMC to explore whether or not the power of placebos can be harnessed honestly and respectfully.

To do this, 80 patients suffering from irritable bowel syndrome (IBS) were divided into two groups: one group, the controls, received no treatment, while the other group received a regimen of placebos—honestly described as "like sugar pills"—which they were instructed to take twice daily.

"Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle," says Kaptchuk. "We told the patients that they didn't have to even believe in the placebo effect. Just take the pills."

For a three-week period, the patients were monitored. By the end of the trial, nearly twice as many patients treated with the placebo reported adequate symptom relief as compared to the control group (59 percent vs. 35 percent). Also, on other outcome measures, patients taking the placebo doubled their rates of improvement to a degree roughly equivalent to the effects of the most powerful IBS medications.

"I didn't think it would work," says senior author Anthony Lembo, HMS associate professor of medicine at BIDMC and an expert on IBS. "I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them."

The authors caution that this study is small and limited in scope and simply opens the door to the notion that placebos are effective even for the fully informed patient—a hypothesis that will need to be confirmed in larger trials.

"Nevertheless," says Kaptchuk, "these findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual. I'm excited about studying this further. Placebo may work even if patients knows it is a placebo."

More information: Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, et al. (2010) Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE 5(12): e15591.doi:10.1371/journal.pone.0015591

Study on effects of resveratrol and quercetin on inflammation and insulin resistance

A study was carried out to examine the extent to which quercetin and trans-resveratrol (RSV) prevented inflammation or insulin resistance in primary cultures of human adipocytes treated with tumor necrosis factor-a (TNF-a)—an inflammatory cytokine elevated in the plasma and adipose tissue of obese, diabetic individuals.

28 dec 2010--Cultures of human adipocytes were pretreated with quercetin and trans-RSV followed by treatment with TNF-a. Subsequently, gene and protein markers of inflammation and insulin resistance were measured. The authors report that quercetin, and to a lesser extent trans-RSV, attenuated the TNF-a–induced expression of inflammatory genes such as interleukin (IL)-6, IL-1b, IL-8, and monocyte chemoattractant protein-1 (MCP-1) and the secretion of IL-6, IL-8, and MCP-1.

Forum members were concerned about certain aspects of the study, especially the extrapolation of in vitro results to in vivo situations. The in vitro conditions the authors describe are minimally representative of an in vivo condition. In vivo, after consumption of quercetin or resveratrol, these compounds undergo extensive metabolism, leading to glucuronidated, sulphated or methylated compounds. In a previous study, quercetin 3-glucoside was transformed to 3,4-dihydroxyphenylacetic acid, acetate and butyrate in cells from human gut; only 3'-methylquercetin has been detected in human plasma, present at a concentration of 0.1 to 0.2 µM after 3 h. The authors of the current paper are using concentrations up to 60 µM, concentrations which have not been found in vivo.

There were also concerns with the work on cell uptake of quercetin and resveratrol. Primary adipocytes were incubated with the polyphenols, but it is not clear whether or not the concentrations used were subtoxic. Our current knowledge is limited about local concentration of the molecules we are studying in subcellular compartments, their interaction with alternative targets, and eventually their transformation into products that could be more or less active on a given specific pathway. The real difficult and important issue is the identification of a reasonable convergence -- if not agreement -- between data originating from extremely distant approaches. In this case, the notion that metabolic diseases are related to a homeostatic imbalance in adipose tissue, linked to a different redox status, linked to activation of specific pathways, and that different redox sensitive polyphenols do have a protective effect, encompasses the evidence produced by extremely distant approaches.

From a clinical point of view, the role of phytochemicals acting as antioxidants and anti-inflammatory agents could be extremely important in inflammation-associated chronic conditions such as cardiovascular disease, diabetes, and cancer. Quercetin and resveratrol may indeed play an important role in this regard, and need to be investigated further to establish the clinical importance of natural dietary compounds in the prevention of chronic degenerative conditions.

Provided by Boston University Medical Center

Eating healthier means living longer

The leading causes of death have shifted from infectious diseases to chronic diseases such as cardiovascular disease and cancer. These illnesses may be affected by diet. In a study published in the January 2011 issue of the Journal of the American Dietetic Association, researchers investigated empirical data regarding the associations of dietary patterns with mortality through analysis of the eating patterns of over 2500 adults between the ages of 70 and 79 over a ten-year period. They found that diets favoring certain foods were associated with reduced mortality.

26 dec 2010--By 2030, an estimated 973 million adults will be aged 65 or older worldwide. The objective of this study was to determine the dietary patterns of a large and diverse group of older adults, and to explore associations of these dietary patterns with survival over a 10-year period. A secondary goal was to evaluate participants' quality of life and nutritional status according to their dietary patterns.

By determining the consumption frequency of 108 different food items, researchers were able to group the participants into six different clusters according to predominant food choices:

"Healthy foods" (374 participants)
"High-fat dairy products" (332)
"Meat, fried foods, and alcohol" (693)
"Breakfast cereal" (386)
"Refined grains" (458)
"Sweets and desserts" (339).

The "Healthy foods" cluster was characterized by relatively higher intake of low-fat dairy products, fruit, whole grains, poultry, fish, and vegetables, and lower consumption of meat, fried foods, sweets, high-calorie drinks, and added fat. The "High fat dairy products" cluster had higher intake of foods such as ice cream, cheese, and 2% and whole milk and yogurt, and lower intake of poultry, low-fat dairy products, rice, and pasta.

The study was unique in that it evaluated participants' quality of life and nutritional status, through detailed biochemical measures, according to their dietary patterns. After controlling for gender, age, race, clinical site, education, physical activity, smoking, and total calorie intake, the "High-fat dairy products" cluster had a 40% higher risk of mortality than the "Healthy foods" cluster. The "Sweets and desserts" cluster had a 37% higher risk. No significant differences in risk of mortality were seen between the "Healthy foods" cluster and the "Breakfast cereal" or "Refined grains" clusters.

According to lead author Amy L. Anderson, Ph.D., Department of Nutrition and Food Science, University of Maryland, the "results of this study suggest that older adults who follow a dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, low-fat dairy products, poultry and fish, may have a lower risk of mortality. Because a substantial percentage of older adults in this study followed the 'Healthy foods' dietary pattern, adherence to such a diet appears a feasible and realistic recommendation for potentially improved survival and quality of life in the growing older adult population."

More information: The article is "Dietary patterns and survival of older adults" by Amy L Anderson, Ph.D.; Tamara B Harris, M.D., M.S.; Frances A Tylavsky, Dr.P.H.; Sara E Perry, M.A., M.P.H.; Denise K Houston, Ph.D., R.D.; Trisha F Hue, M.P.H.; Elsa S Strotmeyer, Ph.D., M.P.H.; and Nadine R Sahyoun, Ph.D., R.D. It appears in the Journal of the American Dietetic Association, Volume 111, Issue 1 (January 2011)

Provided by Elsevier

10 tips for heading off stress during the holidays

Wondering if you'll be able to survive the stress of the holidays — the meals, the presents, reliving old times, and all that togetherness?

25 dec 2010--Hal Barkley, Director of Counseling in SMU's Annette Caldwell Simmons School of Education and Human Development, says not to panic. You can survive this. Here are some of his tips:

1) Create boundaries. Say you had an embarrassing nickname when you were a kid and your pesky brother keeps bringing it up. What to do? Tell him you're looking forward to seeing him, but you'd appreciate it if he wouldn't call you that, at least not in front of anyone else.

2) Lower your exercise expectations. If you usually work out for an hour a day, be comfortable less.

3) Being alone is OK. Getting away for a while is fine. Do not feel guilty about needing some space and time alone.

"You need to get away, to rediscover yourself, to recharge your batteries," Barkley says. Use his trick: When his mother runs out of buttermilk, he says, "Oh! I'll go get that for you!"

4) You can still love them even if they don't stay with you. You might even find yourselves a bit more enamored of each other.

"Some people bring their own RV or mobile home," he says. "That's where they stay. I always think maybe there's a reason for that. It gives them space. So does staying in a hotel rather than someone's home."

5) Focus on merely maintaining your weight. If you don't gain pounds, consider yourself successful. If you crave some candy, go ahead and have a piece.

6) It's your house; you set the rules. If relatives tend to drink too much, talk to them beforehand, Barkley says: "Confrontation doesn't have to be negative; it can be positive. It can be a setting of expectations."

7) You don't have to eat any more than you want to eat. It's a matter of breaking a pattern. Before the meal, for instance, tell your mother or sister or that favorite relative: "One thing I look forward to is coming here and eating your cooking. But I want you to know that this year, I'm going to try everything but will only have one helping. Don't be surprised if you have to say 'No thank you' several times."

8) Create active traditions. If sliding doesn't fit your climate, consider bowling or going out to look at Christmas lights.

9) Make your meals last a long time. No, not by having those seconds you swore off in No. 7. But by eating dessert after a rousing game or charades or Twister.

10) Channel your frustrations altruistically. If you can't stand another minute – or even long before you reach that point – volunteer. Do it alone, or bring the family along.

Provided by Southern Methodist University

'Un-growth hormone' increases longevity

A compound which acts in the opposite way as growth hormone can reverse some of the signs of aging, a research team that includes a Saint Louis University physician has shown. The finding may be counter-intuitive to some older adults who take growth hormone, thinking it will help revitalize them.

Their research was published in the Dec. 6 online edition of the Proceedings of the National Academy of Sciences.

24 dec 2010--The findings are significant, says John E. Morley, M.D., study co-investigator and director of the divisions of geriatric medicine and endocrinology at Saint Louis University School of Medicine, because people sometimes take growth hormone, believing it will be the fountain of youth.

"Many older people have been taking growth hormone to rejuvenate themselves," Morley said. "These results strongly suggest that growth hormone, when given to middle aged and older people, may be hazardous."

The scientists studied the compound MZ-5-156, a "growth hormone-releasing hormone (GHRH) antagonist." They conducted their research in the SAMP8 mouse model, a strain engineered for studies of the aging process. Overall, the researchers found that MZ-5-156 had positive effects on oxidative stress in the brain, improving cognition, telomerase activity (the actions of an enzyme which protects DNA material) and life span, while decreasing tumor activity.

MZ-5-156, like many GHRH antagonists, inhibited several human cancers, including prostate, breast, brain and lung cancers. It also had positive effects on learning, and is linked to improvements in short-term memory. The antioxidant actions led to less oxidative stress, reversing cognitive impairment in the aging mouse.

William A. Banks, M.D., lead study author and professor of internal medicine and geriatrics at the University of Washington School of Medicine in Seattle, said the results lead the team "to determine that antagonists of growth hormone-releasing hormone have beneficial effects on aging."

Provided by Saint Louis University